Miller & Associates Insurance

About Healthcare Reform

On March 23, 2010, the Patient Protection and Affordable Care Act became federal law, initiating the most significant changes in the U.S. health care system since the establishment of Medicare in 1965. The Insurance Industry believes that this law will affect our organizations and the members we serve in many different ways. This work will progress and evolve over the next several weeks and months, and for some provisions of the law, implementation will occur over several years.

The Passage of Health Care Reform

The new health care reform law has the potential to improve lives in some important ways. Thirty-two million Americans, who today find themselves outside of the system, will finally have access to vital preventive services and care for their chronic conditions. Medicare will reward high-quality health care for the first time in its history. This is a first important step in fixing a health care system that has long rewarded the provision of more care instead of better care. Guaranteeing health care coverage and connecting financial incentives to high-quality care are watershed changes in the U.S. health care system that will substantially improve the lives of Americans.

Reforms in 2010

While many key aspects of the legislation will phase in over the next seven years, there will be significant insurance market changes in the next three to six months. These include the elimination of pre-existing condition exclusions for children, elimination of cost sharing on preventive services, continuation of insurance coverage for dependent children up to age 26, and establishment of a high-risk pool for adults who have had difficulty purchasing individual coverage due to ongoing medical conditions. We will keep you informed of the changes that are coming and provide updates when plans are developed to meet the new law's provisions.

Medicare Advantage

Reductions in Medicare Advantage payments were included in the health reform legislation and are to be phased in over time beginning in 2012, with payment levels frozen in 2011. It is too early to know how such changes will affect Medicare beneficiaries. We won't know the full impact of any payment reductions until the federal government completes the regulatory process. Medicare will reward high-quality health care under the new law. The legislation will also gradually close the Part D drug coverage gap, or "doughnut hole," from 2011 to 2020, and provide a $250 rebate by the federal government to Part D enrollees who reach the coverage gap in 2010.

Universal Coverage

The long-awaited expansion of coverage to most of those currently uninsured will begin in 2014, with about half of new enrollment coming through the Medicaid program and the other half enrolling in private coverage. Many will access coverage through newly formed exchanges. By 2019, it is expected that more than 30 million more Americans will have health care coverage, bringing the percentage of Americans with health care coverage to about 95. Other fundamental changes to the health insurance market will take effect in 2014, including a requirement that health plans offer coverage to all applicants. This is paired with a requirement that all Americans purchase health coverage.

Implementation of the Reform Law

The Insurance Industry is now working to implement these and other key provisions in accordance with the schedule outlined in the law. In some cases, such as the coverage of adult children, the law calls on the benefit to be offered six months after the bill becomes law. In other cases, provisions of the health reform law will take effect in future years. In almost all cases, the government will need to put new regulations in place before these changes can be made. The following is a list of key provisions and their implementation dates under the new law:

The Next Wave of Reform

Insurance reform has been the center of the reform debate for the last several years, largely pushing care delivery reform off the policy agenda. Opportunities to reform how care is provided in our nation are huge. Over 75 percent of all care costs in the United States come from services provided to people with chronic conditions -- with 10 percent of all patients needing 80 percent of our total care resources -- and America is getting care right for patients with chronic conditions barely 50 percent of the time. The lack of coordination prevalent in American health care results in poorer health and higher costs. Bad care for chronic care patients with multiple conditions costs far more money than good care for those same patients.

With health insurance reform now federal law, Miller & Associates Insurance and EZInsureColorado.com believe that it is time for the country to focus on what we can do to improve health. It starts with care that is coordinated by teams, supported by information technology, and built on a culture of health in the United States.