ADVERTISEMENT
Health Reform Signed into Law
Yesterday morning, President Obama signed the long-discussed health reform bill into law. It was a historic moment for the White House and Democrats in Congress--many historians have named this law the most significant change to America's health care system since the creation of Medicare and Medicaid in the mid-1960s.
The bill is long and complex; the provisions phase in over six years, so all of this is going to take time.
A thorough summary of the bill can be found by clicking here. However, here are five basic Q&A-style questions to help give a flavor of the new bill:
(1) What's the most important part of the bill?
In the long-run, the most important part of the bill are the "exchanges." The exchanges are state-regulated insurance marketplaces for individuals and small businesses (and eventually any business) to buy health insurance. All plans in the exchanges have to meet some basic standards, such as providing addiction services. Individuals and small businesses generally pay the most for insurance, since insurance works by spreading risk around. The exchanges, modeled on those in use in Massachusetts, will combine those difficult-to-insure groups together into a single pool, (hopefully) lowering costs while ensuring quality coverage. States are also permitted to create multi-state exchanges, which are even better (because the bigger the pools, the lower the cost).
(2) What's the most important part of the bill for people needing addiction treatment?
Overall, the most important part of the bill for people needing treatment is the same as the most important part for people needing any other medical care: the bill increases coverage by a bit over 30 million. Many of these newly insured will receive tax credits to buy insurance in the exchanges. But millions of people will also be newly eligible for Medicaid. The law raises the Medicaid eligibility threshold to 133% of poverty. Additionally, it requires that adults without dependent children be eligible for Medicaid. That's a huge change for many of the young men addiction professionals serve. The law also says that addiction services must be included in the minimum benefits package for all the new Medicaid enrollees (currently, addiction services are a state-option).
(3) What parts of the law go into effect within the next 12 months?
In the next year, some of the changes to our system will include:
- The elimination of co-pays for preventative care under Medicare and new private plans.
- Prohibiting health plans from discriminating against children with pre-existing conditions (eventually this will be phased in for adults).
- Prohibiting "rescission," or the practice of dropping people's coverage when they get sick.
- People up to their 26th birthday will be able to remain on their parents' plan.
- Outlawing lifetime caps on coverage.
I'm certainly satisfied. Mental health and addiction were included with almost no debate or controversy at any point in the process. This is largely a testimony to the effectiveness of the educational effort around the Wellstone-Domenici Parity Act. But it was gratifying to see nonetheless.
I already mentioned the addiction-related provisions in Medicaid and the exchanges. Additionally:
- SAMHSA is included as an agency to be consulted in a wide range of areas.
- There is a workforce development program for child and adolescent behavioral health workers for which addiction professionals are eligible. They're also included as an area to be studied by a new National Health Workforce Commission.
- Grants for school health centers require screening and referral services for substance use disorders.
- Makes addiction prevention and treatment providers eligible grantees for a new medical homes program.
(5) How will this be paid for?
There are a range of payment provisions in the bill (which the independent Congressional Budget Office estimates will, on balance, save money over the next 20 years). These include new taxes on individuals making over $200,000 ($250,000 for families); some reduced payments for certain Medicare and Medicaid services; cuts to the Medicare Advantage program (which lets Medicare beneficiaries buy insurance through private plans); and penalties on individuals who choose not to buy insurance and companies who choose not to provide it to their employees, as well as on "Cadillac," i.e. particularly expensive, health plans. Some industries, such as the pharmaceutical industry, will be required to contribute a given amount to health reform each year.
Some critics have pointed out that some of these savings--such as cuts in Medicare and Medicaid reimbursements--will be politically difficult to enact when the time comes to do so. As it stands though, that's the plan ...
More payment provisions can be found here.
