"Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection." --Harry Truman, 1945
Need for reform:
While healthcare in America can be the most advanced in the world, it is not accessible to many because of high cost, discrimination, and lack of effectiveness. Our nation had been facing a healthcare crisis with average cost of insurance ballooning by over 130% since 1999. This burden has been stretching the finances of families, hurting the profitability of employers, and causing our national deficit to balloon.
• In 2009 almost 20% of all federal spending ($676 billion) was on the two major healthcare programs of Medicare and Medicaid.
• In the eight years prior, health insurance premiums had grown four times faster than wages.
• In 2007 62% of bankruptcies were tied to medical debt.
• Nearly 750,000 Missourians do not have health insurance.
The status quo was unsustainable and jeopardized the health of our citizens and the health of our economy. That is why Claire supported the Affordable Care Act (ACA), which put into place reforms that are strengthening the quality of care in the United States and taming the out of control increases in the costs of medical care that have been common over the past decade. While the debate around this law was often controversial and seen as partisan, the President's fiscal commission made up of both Democrats and Republicans endorsed many of the changes made by the ACA and actually encouraged that implementation of some of the provisions be sped up in order to realize savings more quickly.
Passage of the law was supported by the American Medical Association, the American Hospital Association, the American Cancer Society, AARP, the Consumer's Union (Consumer's Report), and the Catholic Health Association.
What is in the Law?
• Pre-existing conditions: The PPACA bans the practice of refusing to issue insurance based on a patient's pre-existing condition. This happens in two phases. The first phase is already in effect, which bans discrimination against children under 18 years of age. The second phase for adults will occur in 2014. In the meantime, every state has set up a pre-existing condition insurance pool where adults with pre-existing conditions who have been without insurance can purchase insurance that is subsidized so that it is no more expensive than the average person pays. Information on the program in Missouri can be found at www.mhip.org.
• Rescissions banned: The practice of rescission, which is when an insurance company drops a person after becoming sick, has been banned.
• Young adults able to stay on parent's plan: Young people can now stay on their parent's health insurance plan until their 26th birthday if they do not have access to their own employer-sponsored coverage. http://www.healthcare.gov/law/provisions/youngadult/index.html
• Small business tax credits: The new law also provides benefits to small businesses who want to provide health insurance to their employees but have not been able to afford it. The law provides tax credits to employers with fewer than 25 employees whose average salary is less than $50,000 per year and who pay at least 50% of their employees' health insurance premiums. From 2010 through 2013 employers can claim a tax credit for up to 35% of their contribution toward employee premiums. This value jumps to 50% in 2014 and 2015. Further information on employer responsibility and small business tax credits can be found by clicking here.
• Access to affordable insurance: In 2014 each state will have access to an insurance exchange where uninsured Americans can shop for affordable insurance and choose from a variety of plans. These exchanges are not a form of government insurance, but rather are comparable to sites like OrbitzTM or TravelocityTM. On the exchanges private insurance companies will be able to offer their insurance and customers will be able to compare policies and prices on an apples-to-apples basis. Not only will individuals be better able to compare prices between private carriers, the exchange will also allow businesses with less than 50 employees (up to 100 at a state's discretion) and individuals to pool their risk and have the same kind of purchasing leverage that previously only large companies had. Missourians are not required to use the exchange. In fact, just as before reform, most Missourians will continue to get their insurance through their employer. The only people required by law to purchase their insurance through the exchange are members of Congress and their staffs.
• Paying for healthcare - not bureaucracy: Insurance companies now have to spend at least 80% of their revenue on medical care rather than marketing, administration and profits. The ratio of medical expenses to premiums received is known as the "Medical Loss Ratio." More info can be found at: http://www.healthcare.gov/news/factsheets/medical_loss_ratio.html
• Appeals Process: Insurance plans now have to implement an appeals process that allows beneficiaries who have had a claim denied to appeal those decisions. States are also given assistance to help create this appeals program
• Bill of rights: A complete list of new patient protections can be found at: http://www.healthcare.gov/law/provisions/billofright/patient_bill_of_rights.html
Medicare Reforms to Better Serve our Nation's Seniors
Medicare has been the foundation of health insurance for our nation's seniors since 1965 and has provided a crucial health care safety net for nearly 45 million elderly Americans. Claire knows how important Medicare is for seniors living on a fixed income, and she is committed to strengthening this vital benefit program. However, federal entitlement programs, such as Medicare, will not be able to survive if the burgeoning health care costs are not addressed. Before reform it was estimated that Medicare would run out of money by 2017, and there was growing concern the federal government would not be able to keep pace with the aging baby-boomer demand for medical services. In the new healthcare reform law no guaranteed Medicare benefits have been cut, and in fact many new ones have been added. Several of the major changes in Medicare are listed below.
• The ACA adds several new benefits to seniors on Medicare, including an elimination of cost sharing for preventive visits for services like mammograms and colonoscopies. Additionally Medicare beneficiaries can receive an annual wellness visit with their doctor at no cost.
• The Medicare Part D "Doughnut Hole," is closed. Seniors reaching this coverage gap in 2010 received a $250 rebate check, and in 2011, name brand drugs began being offered to beneficiaries in the gap at a 50% price discount.
• Medicare will move toward rewarding quality of care with bonuses for the best providers and bundling of payments rather than the current system which rewards volume of care. Click here for more info.
• The Medicare Advantage program which was conceived in order to save Medicare money actually costs 14% more than traditional Medicare. Going forward, private plans will have to deliver on their promise to save the government money, as their taxpayer-provided subsidies will slowly be phased out. Regardless, all Medicare beneficiaries will continue to have access to Medicare and all of their guaranteed benefits.
• Click here for more info on how the ACA affects Medicare
The ACA has now been upheld by a Republican Supreme Court Justice and is the law of the land. It is not a perfect law and Claire is committed to continuing to improve the law. First, she successfully removed the burdensome 1099 reporting requirements placed on businesses. While this provision had been proposed by Senators on both sides of the aisle, Claire argued that it placed undue stress on small businesses, especially as our economy continues to recover. Claire is also frustrated by exemptions that health insurance companies have from antitrust laws and had hoped that these this would have been corrected during reform. Competition is healthy for businesses, and Claire feels that insurance is no different.
The implementation of the ACA occurs in steps over the course of the coming years and will involve new guidance from the Department of Health and Human Services (HHS). Claire will carefully monitor HHS's actions in the coming years and weigh in where appropriate to protect Missourians from insurance company abuses. A brief timeline is listed below, but for a full timeline please visit http://www.healthcare.gov/law/timeline/
• Immediate Access to Insurance for Uninsured Individuals with a Pre-Existing Condition.
• Small Business Tax Credit. http://www.smallbusinessmajority.org/tax-credit-calculator/
• Eliminating Pre-Existing Condition Exclusions for Children.
• Prohibiting Rescissions.
• Extending Dependent Coverage to age 26.
• Reducing the Part D "Donut Hole" or Coverage Gap with a $250 rebate for seniors entering the hole.
• Wellness benefits in Medicare
• Insurance companies required to spend 80%-85% of premiums on healthcare or more
• Prevention Benefits in Medicare
• State-based insurance exchanges where consumers can shop among private plans and affordability tax incentives available for lower-income Americans
• Guaranteed issue of insurance-no one can be denied based on pre-existing conditions
• Continued closure of the Medicare Part D "Doughnut Hole"
Find your local office