May 23, 2011
For those of you who couldn't attend our recent townhall on Aurora Health Access and the Colorado Health Insurance Exchange, I wanted to share a few key updates with you.
SB 200 (Boyd - Stephens) was the bill that created the foundation for the Colorado Health Exchange which will be up and running by the end of 2013. A few facts about the exchange:
- If you already have insurance through your employer you would continue with what you have.
- The exchange will essentially be a shopping / market place for health insurance to make it easier to identify apples-to-apples comparisons between price, coverage and quality of plans.
- All insurance carriers who offer the minimum benefits packages can sell in the health insurance exchange.
- Colorado has about 800,000 uninsured people, Aurora has about 75,000 uninsured people.
- There will be a quasi-governmental oversight structure with specialist and citizen appointees including provisions about open records, open meetings, audits and conflict of interest provisions.
- Customer satisfaction data will be tracked and made available.
Children with pre-existing conditions can no longer denied insurance coverage as of 2011. For adults that provisions takes effect in 2014.
There will be small business tax credits to help businesses afford health coverage for its employees and for individuals who cannot afford the individual mandate there will be federal subsidies available to help pay through the mechanism of your annual tax filing.
Under the current system it is estimated 3 - 9% of your insurance premium is cost-shifting paying for the current cost of the uninsured in the system. In 2010 alone one of our local hospitals wrote off more than $275 million in uncompensated care. By most accounts the current non-system is actually the most expensive form of paying for the uninsured.
Special thanks to:
Jeff Thompson with the University of Colorado Hospital
Rich McClean with Aurora Health Access and St. Therese Church
Joan Henneberry, Director of the Colorado Health Insurance Exchange
Dr. Barry Martin, VP for MCPN (Metro Community Provider Network)
Dr. Dennis Waite, CMO, Medical Center of Aurora
September 18, 2010
We were very fortunate to have Adela Flores-Brennan (Center for Law & Policy), Bob Semro (Bell Policy Institute), Lorez Meinhold (Coordinator Implementation) and Nate Wilkes (impacted parent) as our panelists at our recent townhall.
Overall concept: The current system has those who are covered by employer-based insurance coverage, Medicare or Medicaid -- and for everyone else, there weren't really any options. The health of a health insurance exchange is intended to fill that gap with one-stop consumer interaction to help them find coverage they could not otherwise get.
Important Fact: No one has to use the exchange. If you like your current coverage at the current costs, you can keep it.
What has changed and when will it take effect?
Medicaid: Medicaid eligibility will be exanded to 133% of federal poverty in 2014. Medicaid reimbursement rates for medical providers will increase to 100% of Medicare rates in 2013 & 2014.
Medicare: The "doughnut hole - out of pocket drug gap" will be closed by 2020, starting in 2010 with $250 rebate, 50% discount on name brand drugs in 2011. No cost sharing for key preventive services, 10% bonus as incentive for primary care docs.
Employer Coverage: There is still no mandate for employers to provide health insurance, and most people with employer-provided coverage are not eligible to participate in the exchange. Tax credits will be available for small businesses (<25) for providing insurance in 2010.
Exchange: state run and regulated marketplaces for purchase of health insurance and handling of premium credits. Exchange is open to uninsured individuals and to small businesses, premium subsidies available for participants up to 400% poverty in 2014.
Minimum Benefits Package: There will be a minimum benefits package that must be in plans in the exchange, with at least 4 different plans available.
Caps: Lifetime limits on insurance policies go away in 2010 and annual limits on insurance policies start to go away in 2010 and gone by 2014.
Preventive Care: No out of pocket, cost-sharing (co-pays / deductibles) on basic preventive care for new plans beginning in 2010.
Guaranteed Issue - No Denial for Pre-Existing Conditions: Begins for children in 2010 and adults in 2014.
Other Consumer Protections - No gender rating, health status rating by 2014 and improved medical loss ratios to 80% in the individual market and 85% in the large group market. [Medical Loss Ratio equals the amount of your premium health care dollar that is actually spent on health care].
Individual Mandate: The requirement that everyone purchase insurance (via market, Medicaid, Medicare or exchange) will take effect in 2014, with some exemptions.
The State of Colorado will have a very key role in implementing federal health care reform. Here is a sample of some of the decisions we will need to make:
- What does the exchange look like? Public, private, quasi? Who is on the governing board and how do we prevent conflicts of interest?
- Do we consider entering a "multi-state compact" that the federal legislation contemplates?
- How do we define what is "in" or "out" of the medical loss ratio? In other words in determining what is a legit health care expenditure that would count toward the ratio, how do we define it?
- How does Ballot Measure Amendment 63 to the Colorado Constitution impact Colorado compliance?
- How do we ensure rating is on the largest risk pool, thereby keeping costs and premiums down?
SOURCES:
http://colorado.gov/healthreform
http://www.cclponline.org
https://bellpolicy.org/node/66
July 23, 2010
This morning CPC (academic clinical research trials specialists) announced it is joining The Stem Cell Research Center at the CU Anschutz Medical Campus in Aurora. This partnership will help bridge academic research with clinical applications in some key areas of concern to most people:
And it has the potential for saving lives and teaching us more about healthy living.
- heart disease
- cardiovascular illnesses
- Parkinsons
- cancer
- Alzheimers
The research at the Stem Cell center has discovered how to work with adult stem cells, "regress" them to embryonic state, "correct", grow and strategically use them in ways to replace one's own damaged cells with one's own cells that are not damaged.
This is by no means the only type of research that is going on, but this research is showing promise for restoring vision in corneal cell translants to some people who have been blind, stopping and shrinking cancerous growths (even where metastasized) by better differentiating be cancerous and non-cancerous stem cells, helping with neural degradation, blocked arteries -- you name it.
Seems real progress often comes in understanding not only the treatment or management of symptoms but understanding disease mechanisms so we can better prevent or at least cure many of those conditions that can be most disabling.
This is also good news for us regionally on the economic development front in that:
- it attracts research grants
- generates intellectual capital and property
- fosters new bio-business development
- employs more scientists and researchers
And it has the potential for saving lives and teaching us more about healthy living. This is good news for jobs, economic development, intellectual pursuits, health care and quality of life for potentially millions of people. While nothing is a "silver bullet" I think it is important to highlight progress where it is happening.
April 04, 2010
The federal health care bill has been a high profile political football in recent months but for all the discussion, very little has been focused on what is or is not in the bill. I am writing this post to identify some of the key provisions in the bill.
IMMEDIATE BENEFITS & CHANGES
- Small Business Tax Credits: Tax credits up to 35% of premiums to businesses with 10 or fewer employees if they offer health insurance for their employees. When exchanges are in effect later that credit will increase to 50%.
- No Pre-Existing Coverage Exclusions for Children: Prohibits health insurance companies from excluding coverage of pre-existing conditions for children. (This will apply to ALL people in 2014.)
- Fed Support to Uninsured: $5 Billion in federal support to provide affordable coverage to uninsured Americans with pre-existing conditions until exchanges are operational in 2014.
- Closing Gap in Drug Benefit Medicare Part D: Provides $250 rebate check for Medicare beneficiarieswho hit the "donut hole" in 2010. (By 2011 50% discount on brand name drugs, fills donut hole by 2020.)
- Patient protections: Protects choice of providers,removes prior authorization for women to see ob-gyn, guarantees access to emergency care. Applies to all new plans.
- Reinusrance for Retirees: Creates immediate access to re-insurance for employer health plans providing coverage for early retirees, protects coverage while reducing premiums for employers and retirees.
- Coverage for Young Adults: Requires insurers to permit children to stay on family policies until age 26.
- Free Prevention Benefits (with No $ Out of Pocket): Requires coverage of prevention and wellness benefits in all new plans and exempts these benefits from deductibles, co-pays. (6 months post enactment).
- Free Prevention and Wellness Benefits in Medicare: Medicare beneficiaries will receive a free annual wellness visit and will have all cost-sharing waived for preventive services (Jan. 1, 2011).
- Community Health Centers: $11 Billion over 5 years to provide funding to expand health care clinics in areas of highest need.
- No Lifetime Limits on Coverage: Prohibits insurers from imposing lifetime limits in benefits, which impacts severely disabled, terminally ill and leaving families with medical debt driving bankruptcy etc.
- Medical Loss Ratios - % of Your Premium Dollar on Health Care: A loss ratio is the amount of your premium dollar that is actually spent on health care. Small group is set to 80%, large groups is set to 85% starting Jan. 1, 2011.
- Patient Protections from Recissions: Prohibits insurers from rescinding insurance policies when claims are filed (unless fraud or intentional misrepresentation of fact).
- Consumer Choice Website: New website by July 1, 2010 allowing consumers to better research and make informed choices between health plans.
2010
- Immediate Access to Insurance for Uninsured Individuals with a Pre-Existing Condition. Provides eligible individuals access to coverage that does not impose any coverage exclusions for pre-existing health conditions. This provision ends when Exchanges are operational. Effective 90 days after enactment.
- Small Business Tax Credit. Initiates the first phase of the small business tax credit for qualified small employers for contributions to purchase health insurance for employees. The credit is up to 35 percent of the employer?s contribution to provide health insurance for employees. There is also up to a 25 percent credit for small nonprofit organizations. Effective calendar year 2010. (Later, when Exchanges are operational, tax credits will be up to 50 percent of premiums.)
- Eliminating Pre-Existing Condition Exclusions for Children. Bars health insurance companies from imposing pre-existing condition exclusions on children?s coverage. Effective six months after enactment and applying to all employer plans and new plans in the individual market. (This provision will apply to all people in 2014).
- Rebates for the Medicare Part D 'Donut Hole.' Provides a $250 rebate check for all Part D enrollees who enter the "donut hole.? Currently, the coverage gap falls between $2,830 and $6,440 in total drug spending. Effective calendar year 2010. (Beginning in 2011, institutes a 50 percent discount on brand-name drugs and begins generic coverage in the donut hole; fills the donut hole by 2020.)
- Prohibiting Rescissions. Prohibits abusive practices whereby health insurance companies rescind existing health insurance policies when a person gets sick as a way of avoiding covering the costs of enrollees? health care needs. Effective six months after enactment and applying to all new and existing plans.
- Eliminating Lifetime Limits. Prohibits insurers from imposing lifetime limits on benefits. Effective six months after enactment and applying to all plans.
- Regulating Use of Annual Limits. Tightly regulates plans? use of annual limits to ensure access to needed care in all group plans and all new individual plans. These tight restrictions will be defined by the Secretary of Health and Human Services. Effective six month after enactment and applying to new plans in the individual market and all employer plans. (When the Exchanges are operational in 2014, the use of annual limits will be banned for new plans in the individual market and all employer plans.)
- Covering Preventive Health Services. All new group health plans and plans in the individual market must provide first dollar coverage for preventive services. Effective six months after enactment.
- Improving Prevention Health Coverage. Requires State Medicaid programs to cover tobacco cessation services for pregnant women. Effective Fiscal Year 2011.
- Extending Coverage for Young Adults. Requires any group health plan or plan in the individual market that provides dependent coverage for children to continue to make that coverage available until the child turns 26 years of age. Effective six months after enactment.
- Bringing Down the Cost of Health Care Coverage. Health plans, including grandfathered plans, must annually report on the share of premium dollars spent on medical care and provide consumer rebates for excessive medical loss ratios. Effective January 1, 2011
- Reducing the Cost of Covering Early Retirees. Creates a new temporary reinsurance program to help companies that provide early retiree health benefits for those ages 55-64 offset the expensive cost of that coverage. Effective 90 days after enactment.
- Strengthening Community Health Centers. Provides funds to build new and expand existing community health centers. Effective Fiscal Year 2011.
- Strengthening the Primary Care Workforce. Expands funding for scholarships and loan repayments for primary care practitioners working in underserved areas participating in the National Health Service Corps. Effective Fiscal Year 2011.
- Improving Consumer Assistance. Requires that any new group health plan or new plan in the individual market implement an effective appeals process for coverage determinations and claims. Effective six months after enactment.
- Improving Consumer Information through the Web. Requires the Secretary of HHS to establish an Internet website through which residents of any State may identify affordable health insurance coverage options in that State. The website will also include information for small businesses about available coverage options, reinsurance for early retirees, small business tax credits, and other information of interest to small businesses. So-called "mini-med" or limited-benefit plans will be precluded from listing their policies on this website. Effective not later than July 1, 2010.
- Improving Consumer Assistance. Requires the Secretary of Health and Human Services (HHS) to award grants to States to establish health insurance consumer assistance or ombudsman programs to receive and respond to inquiries and complaints concerning health insurance coverage. Effective upon enactment.
- Cracking Down on Health Care Fraud. Requires enhanced screening procedures for health care providers to eliminate fraud and waste in the health care system. Many provisions are effective on the date of enactment.
- Improving Public Health Prevention Efforts. Creates an interagency council to promote healthy policies at the federal level and establishes a prevention and public health investment fund to provide an expanded and sustained national investment in prevention and public health programs. Effective not later than July 1, 2010.
- Strengthening the Quality Infrastructure. Additional resources provided to HHS to develop a national quality strategy and support quality measure development and endorsement for the Medicare, Medicaid and CHIP quality improvement programs. Strategy submitted not later than January 1, 2011.
- Extending Payment Protections for Rural Providers. Extends Medicare payment protections for small rural hospitals, including hospital outpatient services, lab services, and facilities that have a low-volume of Medicare patients, but play a vital role in their communities. Effective calendar year 2010.
- Establishing a Patient-Centered Outcomes Research Institute. Establish a private, non-profit institute to identify national priorities and provide for research to compare the effectiveness of health treatments and strategies. Effective date of enactment.
- Ensuring Medicaid Flexibility for States. A new option allowing States to cover parents and childless adults up to 133 percent of the Federal Poverty Level (FPL) and receive current law Federal Medical Assistance Percentage (FMAP) will take effect. Effective April 1, 2010.
- Non-Profit Hospitals. Establishes new requirements applicable to nonprofit hospitals beginning in 2010, including periodic community needs assessments. Effective on the date of enactment.
- Expanding the Adoption Credit and Adoption Assistance Program. Increases the adoption tax credit and adoption assistance exclusion by $1,000, makes the credit refundable, and extends the credit through 2011. Effective for tax years beginning after December 31, 2009.
- Encouraging Investment in New Therapies. A two-year temporary credit subject to an overall cap of $1 billion to encourage investments in new therapies to prevent, diagnose, and treat acute and chronic diseases. Available for qualifying investments made in 2009 and 2010.
- Tax Relief for Health Professionals with State Loan Repayment. Excludes from gross income payments made under any State loan repayment or loan forgiveness program that is intended to provide for the increased availability of health care services in underserved or health professional shortage areas. Effective for amounts received by an individual in taxable years beginning after December 31, 2008.
- Excluding from Income Health Benefits Provided by Indian Tribal Governments. Excludes from gross income the value of specified Indian tribal health benefits. Effective for benefits and coverage provided after the date of enactment.
- Establishing a National Health Care Workforce Commission. Establishes an independent National Commission to provide comprehensive, nonbiased information and recommendations to
- Congress and the Administration for aligning federal health care workforce resources with national needs. Effective not later than September 30, 2010.
- Strengthening the Health Care Workforce. Expands and improves low-interest student loan programs, scholarships, and loan repayments for health students and professionals to increase and enhance the capacity of the workforce to meet the range of patients? health care needs. Effective calendar year 2010.
- Special Deduction for Blue Cross Blue Shield (BCBS). Requires that non-profit BCBS organizations have a medical loss ratio of 85 percent or higher in order to take advantage of the special tax benefits provided to them under Internal Revenue Code (IRC) Section 833, including the deduction for 25 percent of claims and expenses and the 100 percent deduction for unearned premium reserves. Effective for tax years beginning after December 31, 2009.
- Indoor Tanning Services Tax. Imposes a ten percent tax on amounts paid for indoor tanning services. Indoor tanning services are services that use an electronic product with one or more ultraviolet lamps to induce skin tanning. Effective for services on or after July 1, 2010.
2011
- Discounts in the Part D 'Donut Hole.' Provides a 50 percent discount on all brand-name drugs and biologics in the donut hole and begins phasing in additional discounts on brand-name and generic drugs to completely fill the donut hole by 2020 for all Part D enrollees. Effective January 1, 2011.
- Improving Preventive Health Coverage. Provides a free, annual wellness visit and personalized prevention plan services for Medicare beneficiaries and eliminates cost-sharing for preventive services. Effective January 1, 2011.
- Increasing Reimbursement for Primary Care. Provides a 10 percent Medicare bonus payment for primary care physicians and general surgeons. Effective January 1, 2011.
- Improving Health Care Quality and Efficiency. Establishes a new Center for Medicare & Medicaid Innovation to test innovative payment and service delivery models to reduce health care costs and enhance the quality of care provided to individuals. Effective January 1, 2011.
- Providing New, Voluntary Options for Long-Term Care Insurance. Creates a long-term care insurance programs to be financed by voluntary payroll deductions to provide benefits to adults who become disabled. Effective January 1, 2011.
- Improving Transitional Care for Medicare Beneficiaries. Establishes the Community Care Transitions Program to provide transition services to high-risk Medicare beneficiaries. Effective January 1, 2011
- Transitioning to Reformed Payments in Medicare Advantage. Freezes 2011 Medicare Advantage payment benchmarks at 2010 levels to begin transition. Continues to reduce Medicare Advantage benchmarks in subsequent years relative to current levels. Benchmarks will vary from
- 95 percent of Medicare spending in high-cost areas to 115 percent of Medicare spending in low-cost areas with higher benchmarks for high-quality plans. Changes are phased-in over three, five or seven years, depending on the level of payment reductions. Effective January 1, 2011.
- Increasing Training Support for Primary Care. Establishes a Graduate Medical Education policy allowing unused training slots to be re-distributed for purposes of increasing primary care training at other sites. Effective July 1, 2011.
- Expanding Primary Care, Nursing, and Public Health Workforce. Increases access to primary care by adjusting the Medicare Graduate Medical Education program. Primary care and nurse training programs are also expanded to increase the size of the primary care and nursing workforce. Ensures that public health challenges are adequately addressed. Effective July 2011.
- Increasing Access to Home and Community Based Services. The new Community First Choice Option, which allows States to offer home and community based services to disabled individuals through Medicaid rather than institutional care. Effective October 1, 2011.
- Reporting Health Coverage Costs on Form W-2: Requires employers to disclose the value of the benefit provided by the employer for each employee?s health insurance coverage on the employee?s annual Form W-2. Effective for tax years beginning after December 31, 2010.
- Standardizing the Definition of Qualified Medical Expenses. Conforms the definition of qualified medical expenses for HSAs, FSAs, and HRAs to the definition used for the itemized deduction. An exception to this rule is included so that amounts paid for over-the-counter medicine with a prescription still qualify as medical expenses. Effective for tax years beginning after December 31, 2010.
- Increased Additional Tax for Withdrawals from Health Savings Accounts and Archer Medical Savings Account Funds for Non-Qualified Medical Expenses. Increases the additional tax for HSA withdrawals prior to age 65 that are not used for qualified medical expenses from 10 to 20 percent. The additional tax for Archer MSA withdrawals not used for qualified medical expenses would increase from 15 to 20 percent. Effective for tax years beginning after December 31, 2010.
- Cafeteria Plan Changes. Creates a Simple Cafeteria Plan to provide a vehicle through which small businesses can provide tax-free benefits to their employees. This would ease the small employer?s administrative burden of sponsoring a cafeteria plan. The provision also exempts employers who make contributions for employees under a simple cafeteria plan from pension plan nondiscrimination requirements applicable to highly compensated and key employees. Effective for tax years beginning after December 31, 2010.
- Pharmaceutical Manufacturers Fee. Imposes an annual, non-deductible fee on the pharmaceutical manufacturing industry allocated according to market share and not applying to companies with sales of branded pharmaceuticals of $5 million or less. Effective for tax years beginning after December 31, 2010.
2012
- Encouraging Integrated Health Systems. Implements physician payment reforms that enhance payment for primary care services and encourage physicians to join together to form "accountable care organizations" to gain efficiencies and improve quality.
- Linking Payment to Quality Outcomes. Establishes a hospital value-based purchasing program to incentivize enhanced quality outcomes for acute care hospitals. Also, requires the Secretary to submit a plan to Congress by 2012 on how to move home health and nursing home providers into a value-based purchasing payment system.
- Reducing Avoidable Hospital Readmissions. Directs CMS to track hospital readmission rates for certain high-cost conditions and implements a payment penalty for hospitals with the highest readmission rates.
2013
- Improving Preventive Health Coverage. Creates incentives for State Medicaid programs to cover evidence-based preventive services with no cost-sharing.
- Administrative Simplification. Health plans must adopt and implement uniform standards and business rules for the electronic exchange of health information to reduce paperwork and administrative burdens and costs.
- Encouraging Provider Collaboration. Establishes a national pilot program on payment bundling to encourage hospitals, doctors, and post-acute care providers to work together to achieve savings for Medicare through increased collaboration and improved coordination of patient care.
- Increasing Medicaid Payment for Primary Care. Requires states to pay primary care physicians the same rate Medicare pays, and fully federally funds any additional state costs.
- Limiting Health Flexible Savings Account Contributions. Limits the amount of contributions to health FSAs to $2,500 per year, indexed by CPI for subsequent years.
- Eliminating Deduction for Employer Part D Subsidy. Eliminates the deduction for the subsidy for employers who maintain prescription drug plans for their Medicare Part D eligible retirees.
- Increased Threshold for Claiming Itemized Deduction for Medical Expenses. Increases the income threshold for claiming the itemized deduction for medical expenses from 7.5 to 10 percent. Individuals over 65 would be able to claim the itemized deduction for medical expenses at 7.5 percent of adjusted gross income through 2016.
- Additional Hospital Insurance Tax for High Wage Workers. Increases the hospital insurance tax rate by 0.9 percentage points on wages over $200,000 for an individual ($250,000 for married couples filing jointly). Expands the tax to include a 3.8 percent tax on net investment income in the case of taxpayers earning over $200,000 ($250,000 for joint returns).
- Medical Device Excise Tax. Establishes a 2.3 percent excise tax on the first sale for use of a medical device. Excepted from the tax are eye glasses, contact lenses, hearing aids, and any device of a type that is generally purchased by the public at retail for individual use.
- Limiting Executive Compensation. Limits the deductibility of executive compensation under Section 162(m) for insurance providers if at least 25 percent of the insurance provider?s gross premium income from health business is derived from health insurance plans that meet the minimum creditable coverage requirements. The deduction is limited to $500,000 per taxable year and applies to all officers, employees, directors, and other workers or service providers performing services, for or on behalf of, a covered health insurance provider. This provision is effective beginning in 2013 with respect to services performed after 2009.
- Fee for patient-centered outcomes research. Annual fee becomes effective on insured and self-insured plans to fund the patient centered outcomes research trust fund.
2014
- Reforming Health Insurance Regulations. Implements strong health insurance reforms that prohibit insurance companies from engaging in discriminatory practices that enable them to refuse to sell or renew policies due to an individual?s health status. Insurers can no longer exclude coverage for treatments based on pre-existing health conditions. It also limits the ability of insurance companies to charge higher rates due to heath status, gender, or other factors. Premiums can vary only on age (no more than 3:1), geography, family size, and tobacco use.
- Eliminating Annual Limits. Prohibits insurers from imposing annual limits on the amount of coverage an individual may receive.
- Ensuring Coverage for Individuals Participating in Clinical Trials. Prohibits insurers from dropping coverage because an individual chooses to participate in a clinical trial and from denying coverage for routine care that they would otherwise provide just because an individual is enrolled in a clinical trial. Applies to all clinical trials that treat cancer or other life-threatening diseases.
- Establishing Health Insurance Exchanges. Opens health insurance Exchanges in each State to the individual and small group markets. This new venue will enable people to comparison shop for standardized health packages. It facilitates enrollment and administers tax credits so that people of all incomes can obtain affordable coverage.
- Ensuring Choice through a Multi-State Option. Provides a choice of coverage through a multi-State plan, available nationwide, and offered by private insurance carriers under the supervision of the Office of Personnel Management.
- Providing Health Care Tax Credits. Makes premium tax credits available through the Exchange to ensure people can obtain affordable coverage. Credits are available for people with incomes above Medicaid eligibility and below 400 percent of poverty who are not eligible for or offered other acceptable coverage. They apply to both premiums and cost-sharing to ensure that no family faces bankruptcy due to medical expenses again.
- Ensuring Choice through Free Choice Vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an Exchange plan.
- Individual Mandate. Requires most individuals to obtain acceptable health insurance coverage or pay a penalty of $95 for 2014, $325 for 2015, $695 for 2016 (or, up to 2.5 percent of income in 2016), up to a cap of the national average bronze plan premium. Families will pay half the amount for children, up to a cap of up to a cap of $2,250 per family. After 2016, dollar amounts are indexed. If affordable coverage is not available to an individual, they will not be penalized.
- Promoting Employer Responsibility. Requires employers with 50 or more employees who do not offer coverage to their employees to pay $2,000 annually for each full-time employee over the first 30 as long as one of their employees receives a tax credit. Precludes waiting periods over 90 days. Requires employers who offer coverage but whose employees receive tax credits to pay $3,000 for each worker receiving a tax credit up to an aggregate cap of $2,000 per full-time employee.
- Increasing Access to Medicaid. Medicaid eligibility will increase to 133 percent of poverty for all non-elderly individuals to ensure that people obtain affordable health care in the most efficient and appropriate manner. States will receive 100 percent federal funding for the first three years of this coverage expansion.
- Small Business Tax Credit. Implements the second phase of the small business tax credit for qualified small employers.
- Quality Reporting for Certain Providers. Places certain providers - including ambulatory surgical centers, long-term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, PPS-exempt cancer hospitals and hospice providers - on a path toward value-based purchasing by requiring the Secretary to implement quality measure reporting programs in these areas and also pilot test value-based purchasing for each of these providers in subsequent years.
- Health Insurance Provider Fee. Imposes an annual, non-deductible fee on the health insurance sector allocated across the industry according to market share. The fee does not apply to companies whose net premiums written are $25 million or less.
2015
- Continuing Innovation and Lower Health Costs. Establishes an Independent Payment Advisory Board to develop and submit proposals to Congress and the private sector aimed at extending the solvency of Medicare, lowering health care costs, improving health outcomes for patients, promoting quality and efficiency, and expanding access to evidence-based care.
- Paying Physicians Based on Value Not Volume. Creates a physician value-based payment program to promote increased quality of care for Medicare beneficiaries.
2018
- High-Cost Plan Excise Tax. Imposes an excise tax of 40 percent on insurance companies and plan administrators for any health insurance plan that is above the threshold of $10,200 for self-only coverage and $27,500 for family plans. The tax would apply to the amount of the premium in excess of the threshold. The threshold would be indexed at CPI-U plus one percentage point for 2019 and CPI for years thereafter. An additional threshold amount of $1,650 for singles and $3,450 for families is available for retired individuals over the age of 55 and for plans that cover employees engaged in high risk professions. Employers with higher costs on account of the age or gender demographics of their employees when compared to the age and gender demographics nationally my adjust their thresholds even higher.
March 02, 2010
I am proudly carrying HB 1008 (S. Schafer, McCann - M. Carroll - Schwartz) which passed out of the house with only 2 no votes. At issue is the question of using "gender" as a rating factor in insurance premiums, apart from a persons actual claim history.
The National Women's Law Center originally released a report in 2008 called "Nowhere to Turn" which documented serious up-charging for women in the individual health insurance market, even in policies where there as no maternity coverage of any kind. They issued an updated report in 2009 called "Still Nowhere to Turn: Insurance Companies Treat Women Like a Pre-Existing Condition".
Women are paying on average 40% more for their individual health insurance premiums than men, for the exact same policies, even excluding maternity coverage.
The large group market has been prohibited from gender discrimination in its rates since passage of the Civil Rights Act of 1964. Colorado closed the discrimination loophole for the small group market but has not closed the loophole for the individual health market. It is past time we did so.
The study found huge variation which defies any actuarial basis ranging from within the same age category and even within the same state. When the data supports an actuarial under-pinning one would expect a narrow range of deviation between plans using the same data in the same state but those variations range from 1% - 84. Only Kaiser Permanente in Colorado does not use gender rating in any of its plans.
At age 40, half of the best-selling plans in Colorado still charge women up to 48% more than their male peers who smoke. This is compounded by the fact that women in Colorado with a batchelor's degree still earn only 64% of the amount earned by men with a batchelor's degree, and are disproportionately in lower wage jobs that do not provide health insurance.
This bill would make insurance more affordable for 140,000 women and their dependent children who depend on the individual health insurance market for their access to health care. It would help help some of the 277,000 Colorado women with no coverage by making it more affordable.
This bill would still allow carriers to use prior claims history so that patients who use more medical services would pay more (regardless of gender) and those who use less services would pay less.
| Older Posts >>
