“Trillion Dollar Fraudsters”: We’re Looking At An Enormous, Destructive Republican Con Job, And You Should Be Very, Very Angry

Reblogged from
mykeystrokes.com:

republican_party_money_1600_clr_9476-227x182By now it’s a Republican Party tradition: Every year the party produces a budget that allegedly slashes deficits, but which turns out to contain a trillion-dollar “magic asterisk” — a line that promises huge spending cuts and/or revenue increases, but without explaining where the money is supposed to come from.

But the just-released budgets from the House and Senate majorities break new ground. Each contains not one but two trillion-dollar magic asterisks: one on the spending side, one on the revenue side. And that’s actually an understatement. If either budget were to become law, it would leave the federal government several trillion dollars deeper in debt than claimed, and that’s just in the first decade.

You might be tempted to shrug this off, since these budgets will not, in fact, become law. Or you might say that this is what all politicians do. But it isn’t. The modern G.O.P.’s raw fiscal dishonesty …

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Are these YOUR priorities?

GOP2015FederalBudgetChart

55.2 (Military) + 5.6 (Vets) = 60.8% of ALL discretionary spending

Thus, only ~39% remains for things like Education, Infrastructure (roads/bridges), Energy, Environment, etc.

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HHS Presser: 9.4M Medicare Enrollees Seeing Savings Under ACA

Since 2010, 9.4 million people with Medicare have saved over $15 billion on prescription drugs

39 million Medicare beneficiaries received preventive services with no cost sharing in 2014

The Department of Health and Human Services released today new information that shows that millions of seniors and people with disabilities with Medicare continued to enjoy prescription drug savings and improved benefits in 2014 as a result of the Affordable Care Act.

medicareSince the enactment of the Affordable Care Act, 9.4 million seniors and people with disabilities have saved over $15 billion on prescription drugs, an average of $1,598 per beneficiary. In 2014 alone, nearly 5.1 million seniors and people with disabilities saved $4.8 billion or an average of $941 per beneficiary. These figures are higher than in 2013, when 4.3 million saved $3.9 billion, for an average of $911 per beneficiary.

Use of preventive services has also expanded among people with Medicare. An estimated 39 million people with Medicare (including those enrolled in Medicare Advantage) took advantage of at least one preventive service with no cost sharing in 2014. In contrast, in 2013, an estimated 37.2 million people with Medicare received one or more preventive benefits with no cost sharing. In 2014, nearly 4.8 million people with traditional Medicare took advantage of the Annual Wellness Exam, which exceeds the comparable figure from 2013, in which over 4 million took advantage of the exam.

“Thanks to the Affordable Care Act, seniors and people with disabilities have saved over $15 billion on prescription drugs, and these savings will only increase over time as we close the Medicare coverage gap known as the donut hole,” said HHS Secretary Sylvia M. Burwell. “By providing access to affordable prescription drugs and preventive services with no cost sharing, the Affordable Care Act is working for seniors to help keep them healthier.”

As part of the Department’s “better care, smarter spending, healthier people” approach to improving health delivery, providing affordable prescription drugs and certain preventive services with no-cost sharing are some of the many initiatives advanced by the Affordable Care Act. To achieve better care, smarter spending and healthier people, HHS is focused on three key areas: (1) linking payment to quality of care, (2) improving and innovating in care delivery, and (3) sharing information more broadly to providers, consumers, and others to support better decisions while maintaining privacy. Today’s news comes on the heels of Secretary Burwell’s recent announcement that HHS is setting measurable goals and a timeline to move Medicare toward paying providers based on the quality, rather than the quantity of care they give patients.

Closing the prescription drug “donut hole”

The Affordable Care Act makes Medicare prescription drug coverage more affordable by gradually closing the gap in coverage where beneficiaries had to pay the full cost of their prescriptions out of pocket, before catastrophic coverage for prescriptions took effect. The gap is known as the donut hole. The donut hole will be closed by 2020, marking 2015 as the halfway point.

Because of the health care law, in 2010, anyone with a Medicare prescription drug plan who reached the prescription drug donut hole received a $250 rebate. In 2011, beneficiaries in the donut hole began receiving discounts on covered brand-name drugs and savings on generic drugs.

People with Medicare Part D who fall into the donut hole in 2015 will receive discounts and savings of 55 percent on the cost of brand name drugs and 35 percent on the cost of generic drugs.

For state-by-state information on discounts in the donut hole, CLICK HERE.

For more information about Medicare prescription drug benefits, CLICK HERE.

Medicare preventive services

The Affordable Care Act eliminated coinsurance and the Part B deductible for recommended preventive services covered by Medicare, including many cancer screenings and other important benefits. By making certain preventive services available with no cost sharing, the Affordable Care Act is helping Americans take charge of their own health. By removing barriers to prevention, Americans and health care professionals can better prevent illness, detect problems early when treatment works best, and monitor health conditions.

For state-by-state information on utilization of preventive services at no cost to Medicare beneficiaries, CLICK HERE.


Note: All HHS press releases, fact sheets and other news materials are available at http://www.hhs.gov/news.

Like HHS on Facebook, follow HHS on Twitter @HHSgov, and sign up for HHS Email Updates.

Last revised: February 24, 2015

#ItsNotUpToThem Week

— Roberta Lange, Nevada State Democratic Party Chair

A few weeks ago, the United States Supreme Court issued a backwards ruling that allows for-profit corporate CEOs to make medical decisions that should be made between a woman and her doctor.  That’s right – in the year 2014, the Supreme Court thinks female employees’ healthcare decisions should be made in a corporate boardroom, not a doctor’s office.

This week, the United States Senate will vote on legislation to address the Supreme Court’s ruling and ensure women who work at for-profit corporations have access to reproductive healthcare.  While Democrats like Senator Reid, Reps. Dina Titus and Steven Horsford, and Erin Bilbray support ensuring women have access to reproductive healthcare, Republicans like Dean Heller and Joe Heck have consistently voted to restrict women’s access to contraception.

In support of the Senate bill, Nevada Democrats are launching #ItsNotUpToThem week.  All week we will be highlighting how dangerous the Republican agenda is for the health of Nevada women.  Because whether it’s Mark Hutchison leading the charge to go back to a time where private insurance companies could treat being a woman as a pre-existing condition, or Joe Heck voting to weaken the Violence Against Women Act, it’s time we send a message to Nevada Republicans that women’s healthcare decisions aren’t up to them or corporate bosses.

Sign your name here to tell Republicans it’s 2014, not 1914.    


Please note that Roberta mentioned Candidate Erin Bilbray who is running agains Rep. Joe Heck, but failed to mention Kristen Spees who is running against Rep. Mark Amodei to represent those of us who are unfortunate enough to live in NV-Congressional District 2!

The GOP’s Unaffordable WeDon’tCare Act

The GOP’s belated solution to the nation’s health insurance challenges just makes working families pay more.

— by Emily Schwartz Greco

Emily Schwartz Greco

Remember when it looked like the Republican Party could do nothing but stamp its feet and shout about the Affordable Care Act’s shortcomings without coming up with any alternatives?

OK, there was former Sen. Jim DeMint’s suggestion last summer that having the uninsured continue to abuse emergency-room services due to a lack of options would work better than President Barack Obama’s health insurance reform. And conservatives enjoy boasting about how many ideas for overhauling the nation’s health insurance system the GOP has lobbed over the years into what it might call the marketplace of ideas.

The Unaffordable Health Care Act, an OtherWords cartoon by Khalil Bendib

The Unaffordable Health Care Act, an OtherWords cartoon by Khalil Bendib

Since none achieved any traction, the Republicans in Congress are trying again.

Maybe this escaped your attention. After all, Obama signed the Affordable Care Act into law in 2010 and it’s now being implemented regardless of those 47 House repeal votes. Perhaps you heard about its rocky roll-out? Warts and all, major government programs are as easy to revoke as it is to get toothpaste back into the tube.

Plus, four years is a long time, especially when news cycles are so short that blinking means missing out on key developments like Justin Bieber’s latest travails.

The GOP is moving ahead anyway with new plans to replace the Affordable Care Act that are sure to go nowhere in our gridlocked Congress. A trio of Senate Republicans is leading the way with a new approach that upholds the party’s unofficial allegiance to the “WeDon’tCare” creed.

That’s the term Jim Hightower has used to describe Rep. Paul Ryan’s dream of converting Medicare into a privatized voucher scheme.

WeDon’tCare also serves as the Republican approach to many other urgent problems dogging the United States. Intractable unemployment? Rising hunger? Pollution? Climate change? The GOP just doesn’t care.

Maybe you do care and wish Republicans would too. But this policy does have plenty to offer. It’s versatile, consistent, and great for time management.

The GOP’s WeDon’tCare policy is very attractive for lawmakers who might have better things to do with their time than get bogged down in petty problems. Rather than grapple with issues that are making the lives of millions of Americans who can’t afford to make campaign contributions miserable, lawmakers free up time for other activities. Like golf. And taking free trips to France.

The new Republican plan probably won’t save any more tax dollars than the Affordable Care Act and might actually save less. It won’t shock you to hear that it’s structurally very similar to the system often called Obamacare except that its subsidies would be financed more by working families and less by taxes on corporations and the very rich.

Under this new plan, outlined in legislation introduced by Republican Senators Orrin Hatch of Utah, Richard Burr of North Carolina, and Tom Coburn of Oklahoma, insurance companies wouldn’t have to cover preventive care any more. Once again, insurers could charge women more than men. Unlike with the Affordable Care Act, the vast majority of Americans insured through their workplace would start paying more for their coverage. And if that isn’t enough, there are also, plans in motion to set some seriously low caps on amounts for which patients who’ve been harmed can sue the one or ones who did the harming.

I bet there’s a good chance that it will matter to you, personally, should this ever manage to get enacted. You might even get angry.

What about House Republicans? Majority Leader Eric Cantor says they’re on it, with Representatives Dave Camp and Fred Upton — both with Michigan seats — and John Kline of Minnesota taking the lead. If you’d like some specifics, you’ll have to wait a bit longer since apparently they need more time.

Why are they even bothering?

“Pointing and laughing at the failures of Obamacare will not be a sufficient governing vision,” conservative Michael Gerson observed in one of his recent columns.

Something more, in other words, is required to win back the White House. Having a presumed front-runner for the Republican nomination who isn’t embroiled in a career-killing scandal would be helpful.

But if the GOP really wants to fare better in the 2016 presidential election than it did in 2008 and 2012, Republicans will need to ditch their WeDon’tCare platform on health insurance and other issues voters care about.


Emily Schwartz Greco is the managing editor of OtherWords, a non-profit national editorial service run by the Institute for Policy Studies. OtherWords.org

How the Health Care Law is Making a Difference for Nevadans

Because of the Affordable Care Act, the 78% of Nevadans who have insurance have more choices and stronger coverage than ever before. And for the 22% of Nevadans who don’t have insurance, or Nevada families and small businesses who buy their coverage but aren’t happy with it, a new day is just around the corner.

Soon, the new online Health Insurance Marketplace will provide families and small businesses who currently don’t have insurance, or are looking for a better deal, a new way to find health coverage that fits their needs and their budgets.

Open enrollment in the Marketplace starts Oct 1, with coverage starting as soon as Jan 1, 2014.  But Nevada families and small business can visit HealthCare.gov right now to find the information they need prepare for open enrollment.

Key Features of the health care law are already providing better options, better value, better health and a stronger Medicare program for the people of Nevada:

Key Features

Coverage

Costs

Care

Better Options

The Health Insurance Marketplace

Beginning Oct 1, the Health Insurance Marketplace will make it easy for Nevadans to compare qualified health plans, get answers to questions, find out if they are eligible for lower costs for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in health coverage.

By the Numbers: Uninsured Nevadans who are eligible for coverage through the Marketplace. 

  • 473,971 (22%) are uninsured and eligible
  • 347,244 (73%) have a full-time worker in the family
  • 174,840 (37%) are 18-35 years old
  • 218,730 (46%) are White
  • 44,217 (9%) are African American
  • 157,518 (33%) are Latino/Hispanic
  • 33,012 (7%) are Asian American or Pacific Islander
  • 258,036 (54%) are male

438,826 (93%) of Nevada’s uninsured and eligible population may qualify for lower costs on coverage in the Marketplace, including through Medicaid.

Nevada has received $74,754,285 in grants for research, planning, information technology development, and implementation of its Health Insurance Marketplace.

New coverage options for young adults

Under the health care law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. Thanks to this provision, over 3 million young people who would otherwise have been uninsured have gained coverage nationwide, including 33,000 young adults in Nevada.

Ending discrimination for pre-existing conditions  

As many as 1,157,045 non-elderly Nevadans have some type of pre-existing health condition, including 162,452 children.  Today, insurers can no longer deny coverage to children because of a pre-existing condition, like asthma or diabetes, under the health care law. And beginning in 2014, health insurers will no longer be able to charge more or deny coverage to anyone because of a pre-existing condition.  The health care law also established a temporary health insurance program for individuals who were denied health insurance coverage because of a pre-existing condition.  1,373 Nevadans with pre-existing conditions have gained coverage through the Pre-Existing Condition Insurance Plan since the program began.

Better Value

Providing better value for your premium dollar through the 80/20 Rule

Health insurance companies now have to spend at least 80 cents of your premium dollar on health care or improvements to care, or provide you a refund.  This means that 88,491 Nevada residents with private insurance coverage will benefit from $3,977,544 in refunds from insurance companies this year, for an average refund of $75 per family covered by a policy.

Scrutinizing unreasonable premium increases 

In every State and for the first time under Federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. Nevada has received $4,959,972 under the new law to help fight unreasonable premium increases.

Removing lifetime limits on health benefits 

The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 937,000 people in Nevada, including 329,000 women and 269,000 children, are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely in 2014.

Better Health

Covering preventive services with no deductible or co-pay

The health care law requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults.

In 2011 and 2012, 71 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 615,000 in Nevada. And for policies renewing on or after August 1, 2012, women can now get coverage without cost-sharing of even more preventive services they need.  Approximately 47 million women, including 391,181 in Nevada will now have guaranteed access to additional preventive services without cost-sharing.

Increasing support for community health centers

The health care law increases the funding available to community health centers nationwide. In Nevada, 2 health centers operate 30 sites, providing preventive and primary health care services to 57,987 people.  Health Center grantees in Nevada have received $8,264,743 under the health care law to support ongoing health center operations and to establish new health center sites, expand services, and/or support major capital improvement projects.

Community Health Centers in all 50 states have also received a total of $150 million in federal grants to help enroll uninsured Americans in the Health Insurance Marketplace, including $451,674 awarded to Nevada health centers.   With these funds, Nevada health centers expect to hire 9 additional workers, who will assist 10,600 Nevadans with enrollment into affordable health insurance coverage.

Investing in the primary care workforce

As a result of historic investments through the health care law and the Recovery Act, the numbers of clinicians in the National Health Service Corps are at all-time highs with nearly 10,000 Corps clinicians providing care to more than 10.4 million people who live in rural, urban, and frontier communities.  The National Health Service Corps repays educational loans and provides scholarships to primary care physicians, dentists, nurse practitioners, physician assistants, behavioral health providers, and other primary care providers who practice in areas of the country that have too few health care professionals to serve the people who live there.  As of September 30, 2012, there were 36 Corps clinicians providing primary care services in Nevada, compared to 12 in 2008.

Preventing illness and promoting health

As of March 2012, Nevada had received $7,500,000 in grants from the Prevention and Public Health Fund created by the health care law. This new fund was created to support effective policies in Nevada, its communities, and nationwide so that all Americans can lead longer, more productive lives.

A Stronger Medicare Program

Making prescription drugs affordable for seniors 

In Nevada, people with Medicare saved nearly $41 million on prescription drugs because of the Affordable Care Act.  In 2012 alone, 22,122 individuals in Nevada saved over $14 million, or an average of $611 per beneficiary.  In 2012, people with Medicare in the “donut hole” received a 50 percent discount on covered brand name drugs and 14 percent discount on generic drugs.  And thanks to the health care law, coverage for both brand name and generic drugs will continue to increase over time until the coverage gap is closed.  Nationally, over 6.6 million people with Medicare have saved over $7 billion on drugs since the law’s enactment.

Covering preventive services with no deductible or co-pay

With no deductibles or co-pays, cost is no longer a barrier for seniors and people with disabilities who want to stay healthy by detecting and treating health problems early. In 2012 alone, an estimated 34.1 million people benefited from Medicare’s coverage of preventive services with no cost-sharing.  In Nevada, 166,815 individuals with traditional Medicare used one or more free preventive service in 2012.

Protecting Medicare’s solvency

The health care law extends the life of the Medicare Trust Fund by ten years.  From 2010 to 2012, Medicare spending per beneficiary grew at 1.7 percent annually, substantially more slowly than the per capita rate of growth in the economy.  And the health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology. Over the last four years, the administration’s fraud enforcement efforts have recovered $14.9 billion from fraudsters.  For every dollar spent on health care-related fraud and abuse activities in the last three years the administration has returned $7.90.

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The Truth about Obamacare

Don Rogers, Jack Rabbit Ranch blog

DonRogersWell, I can see it’s going to be a bad six weeks. I just heard a paid TV advertisement for people to call their Congressman and urge him to oppose funding Obamacare, because the President is exempt. I expect to see a lot more of these misleading ads, and if past is any indication there won’t be much response from Democrats. They are not nearly as loud and insistent as Republicans and I’ve never understood why.

Is the President exempt? I guess so, depending on how you define exempt. Anybody who already has medical insurance is exempt. I’m with Aetna, so I’m exempt. If you are over 65 and are on Medicare, you are exempt. If you are in the military, you are exempt. If you are a veteran with VA coverage, you’re exempt. If you are a member of a Native American tribe, you are exempt.

However, some changes will affect everybody. For example, if your medical insurance had a lifetime limit, it’s gone. If your plan had an exclusion for pre-existing conditions, that’s gone. If you have a child under 26 they can stay on your plan.  If you’re a woman, gone are the days when you could be charged higher premiums merely because of your gender.  Plus, all plans now must include preventive screenings, such as mammograms, and routine medical checkups at least once a year.  But most of all, your insurance company can use no more than 20% of what it collects from the pool you participate in for its administrative expenses and profit.  If they collect more than 20% from folks in your pool, they must return the overage they charged those pool participants.

Obamacare, or the Affordable Care Act, is for people who don’t have or cannot afford medical insurance. Up until now, when an uninsured person got sick, their only option in most areas of the country was to go to the emergency room, where the hospital was required to treat them. That is a very expensive way to provide medical care. Many hospitals and doctors, to keep from going under, then raise the costs for their services to the rest of us who do pay for insurance.  If folks had the opportunity to purchase affordable insurance, those critical conditions they ended up being treated in the ER could have been treated much earlier much cheaper.  But instead of being treated early, hospitals see them much later in the disease process when treatment becomes much more intensive and expensive … and even with help from the taxpayers, many hospitals have found it next to impossible make ends meet without passing on costs to those who can pay.

Healthcare costs in the USA were double the costs in every other country, and some method had to be found to cut the cost of heath care, as well as provide coverage to those who had no insurance coverage. The cost of medical insurance was skyrocketing, and we were reaching the point where almost nobody would have been able to afford coverage.  In essence, those purchasing insurance are paying for insurance for themselves and indirectly subsidizing those who choose to not purchase, or who don’t make enough money to purchase their own insurance.

So the object of a national health care plan was threefold:

  1. To cut the cost of health care by providing more competition between insurance providers.
  2. To cut the cost of health care by encouraging more preventive care, and enabling visits to the doctor rather than the hospital.
  3.  To increase the number of people covered by insurance to include as many as possible, especially young families and children.

Several different options were available to achieve these goals. The first would have been Socialized Medicine. This was never even considered by the administration. Under socialized health care, the government would take over all hospitals and clinics. All doctors and nurses would get a salary from the government. There would be no charge for the patients. No one would be allowed to make a profit from anybody’s pain or injury. I had this coverage in the US Army. All the military and VA hospital coverage was socialized when I was on active duty in the US Army in 1965. As I understand it now any service member on Tri-Care Prime and getting health care at a Military Treatment Facility is still receiving socialized medicine. Anyone who contends that Obamacare is socialism is displaying his ignorance or his duplicity.

Another option would have been a Single Payer plan. The hospitals remain private, for profit  institutions and the doctors are independent, for profit providers. But all insurance would be handled by the government on a non profit basis. Medicare is such a plan. Premium payments come out of payroll taxes, and the patient chooses among doctors and hospitals who accept the insurance coverage. President Obama never even brought it to the table, probably because he saw the insurance company lobbyists loading for bear. Some Liberals and Progressives felt betrayed, because Barack Obama spoke of this as he campaigned for the presidency.

A third plan was called the Public Option. This would involve for profit hospitals, doctors, and insurance companies, but would include a federal government run non profit insurance option competing with the insurance companies to force their premiums lower. Bill Clinton proposed a similar plan in 1993, but due to a concerted effort by insurance companies and conservative organizations, he and Hillary could not get it through Congress.This idea didn’t last very long during the negotiations for the Affordable Care Act, either.

So the Affordable Care Act became a collage of compromises to get all the health care actors on board so they would call off their lobbyists. Insurance companies don’t have to compete with a federal insurance plan, because Obamacare agreed to just subsidize the states to increase their state run Medicaid programs with expanded coverage for poor people.

Insurance companies agreed to provide coverage nationwide instead of statewide as long as the law made coverage mandatory, so they get more customers. Most states will get more companies competing for their business, so prices should come down.

Big Pharmaceutical companies agreed to go along if the law prohibited the government from negotiating for lower drug prices. So we still have to go to Canada or Mexico if we want drugs for 1/10th the cost. But the gap in Medicare Part D coverage for drugs (The Donut Hole) will be reduced each year until it disappears in 2020.

Doctors got changes to their billing practices, including being paid by the patient rather than the procedure. That’s supposed to reduce the number of unnecessary and redundant procedures and save costs. Eventually they are supposed to go to standardized medical records on computer, for easier access, reduction of errors and lower costs.

Since Obamacare is expected to greatly increase the number of people receiving health care, hospitals immediately got money to expand and renovate. If your local hospital has a new wing or even a new hospital in the last two years, it’s probably funded by Obamacare.

By co-opting every group who had opposed universal health care in the past, Democrats were barely able to get the bill passed by one vote. By not having all the changes happen in the first year, they gave themselves time to get it implemented. And as snags have come up they have made revisions and postponed some of the deadlines.

This is a big and complicated bill, to deal with a large and complicated problem. The writers knew it would not be perfect, and so there is flexibility written into it to allow for fixing problems as they arise.

Already some people are noticing the elimination of their lifetime limits and their pre-existing condition clauses going away. Some have been able to keep their kids on the policy longer, which is a lot cheaper than having to buy a second policy. Some people have gotten rebate checks back. because insurance companies are now required to give money back if 80% of the premiums are not spent on health care, but on overhead or salaries.

As more and more people start to experience the benefits of having affordable health care, they may begin to understand and appreciate what they have received. For the first time they do not have to live in fear and dread of a medical condition devastating their lifetime savings.

Republicans know this and some have said as much. They are desperate to find some way–any way–to stop the Affordable Care Act from being fully funded and implemented. They fear that voters will remember who helped them when they needed help, much as people remembered for two generations which party got them Social Security, and which party fought it tooth and nail.

Some states with Republican governors and legislatures have decided to refuse the federal funds intended to set up the insurance exchanges and expand their Medicaid coverage, hoping to somehow stymie Obamacare. It will be interesting to see when they figure out that they are handing control over to the federal government to set up the exchanges and provide low cost federal insurance instead of locally controlled Medicaid programs. They are enabling the public option some of us preferred in the first place.

After decades of people losing their savings and their homes, being forced into bankruptcy when struck by cancer or some other medical disaster, finally we are catching up to the rest of the civilized world!

And today I just heard a TV ad for Obamacare with a number to call for information and application forms! Maybe they are going to start selling this thing after all!

What’s Covered in the Affordable Care Act?

— BY KAREN Y.

The Stew steps through the crap the Right-Wing spews about ObamaCare (The Affordable Care Act) and breaks down what this landmark legislation actually means for average Americans.

AFFORDABLE CARE ACT (ACA) OF 2010

  1. Patient Rights and Protections
  2. Insurance Choices and Costs
  3. 65 and Older
  4. Small Business Tax Credits

The Affordable Care Act puts consumers back in charge of their health care. Under the law, a new “Patient’s Bill of Rights” gives the American people the stability and flexibility they need to make informed choices about their health.

Patient’s Bill of Rights

  • Provides Coverage to Americans with Pre-existing Conditions: You may be eligible for health coverage under the Pre-Existing Condition Insurance Plan.
  • Protects Your Choice of Doctors: Choose the primary care doctor you want from your plan’s network.
  • Keeps Young Adults Covered: If you are under 26, you may be eligible to be covered under your parent’s health plan.
  • Ends Lifetime Limits on Coverage: Lifetime limits on most benefits are banned for all new health insurance plans. Before the health care law, many health plans set an annual limit — a dollar limit on their yearly spending for your covered benefits. Many plans also set a lifetime limit — a dollar limit on what they would spend for your covered benefits during the entire time you were enrolled in that plan. You were required to pay the cost of all care exceeding those limits.
  • Restricts Annual Dollar Limits on Coverage: Annual limits on your health benefits will be phased out by 2014.
  • Ends Pre-Existing Condition Exclusions for Children: Health plans can no longer limit or deny benefits to children under 19 due to a pre-existing condition.
  • Ends Arbitrary Withdrawals of Insurance Coverage: Insurers can no longer cancel your coverage just because you made an honest mistake.
  • Reviews Premium Increases: Insurance companies must now publicly justify any unreasonable rate hikes.
  • Helps You Get the Most from Your Premium Dollars: Your premium dollars must be spent primarily on health care – not administrative costs. Starting July 2012, The percentage of your premium dollars that an insurance company spends on providing you with health care and improving the quality of your care (as opposed to what it spends on administrative, overhead, and marketing costs) is known as “medical loss ratio.”

The new law limits how much of your premium dollar your insurer can spend on things other than providing health care and improving its quality. If your insurance company spends less than 80% of your premium on health care, it must provide a rebate of the difference.

  • Removes Insurance Company Barriers to Emergency Services: You can seek emergency care at a hospital outside of your health plan’s network.

Since the Patient’s Bill of Rights was enacted, the Affordable Care Act has provided additional rights and protections.  The health care law:

  • Covers Preventive Care at No Cost to You: You may be eligible for recommended preventive health services. No co-payment.
  • Guarantees Your Right to Appeal: You now have the right to ask that your plan reconsider its denial of payment.

Flexible Spending Account Changes

An arrangement you set up through your employer to pay for many of your out-of-pocket medical expenses with tax-free dollars. These expenses include insurance copayments and deductibles, and qualified prescription drugs, insulin and medical devices. You decide how much of your pre-tax wages you want taken out of your paycheck and put into an FSA. You don’t have to pay taxes on this money. Your employer’s plan sets a limit on the amount you can put into an FSA each year.

  • There is no carry-over of FSA funds. This means that FSA funds you don’t spend by the end of the plan year can’t be used for expenses in the next year. An exception is if your employer’s FSA plan permits you to use unused FSA funds for expenses incurred during a grace period of up to 2.5 months after the end of the FSA plan year.
  • As of January 1, 2011, the costs of over-the-counter medications will be reimbursed under a Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Account (HRA) only if the medications are purchased with a doctor’s prescription. These restrictions do not apply to the purchase of insulin.

Note: Flexible Spending Accounts are sometimes called Flexible Spending Arrangements. Health Reimbursement Accounts are sometimes called Health Reimbursement Arrangements.

Summary of Benefits and Coverage (SBC)

Starting September 23, 2012 or soon after, health insurance issuers and group health plans will be required to provide you with an easy-to-understand summary about a health plan’s benefits and coverage. The new regulation is designed to help you better understand and evaluate your health insurance choices.

Consumer Assistance Programs

  • Many states offer help to consumers with health insurance problems. The Affordable Care Act improves these services with grants that help states start or strengthen Consumer Assistance Programs (CAPs). The states and territories that applied for these grants have received funds provide residents direct help with problems or questions about health coverage.
  • Whether or not your state has a Consumer Assistance Program, you have rights under the health care law, including the right to appeal decisions made by your health insurance provider.
  • If your state does not have a Consumer Assistance Program, some state and federal government offices may still be able to help you determine your rights and solve problems.

Appealing Health Plan Decisions

The Affordable Care Act ensures your right to appeal health insurance plan decisions – to ask that your plan reconsider its decision to deny payment for a service or treatment. New rules that apply to health plans created after March 23, 2010 spell out how your plan must handle your appeal (usually called an “internal appeal”). If your plan still denies payment after considering your appeal, the law permits you to have an independent review organization decide whether to uphold or overturn the plan’s decision. This final check is often referred to as an “external review.”

Covered Preventive Services

Note: Services marked with an asterisk ( * ) must be covered with no cost-sharing in plan years starting on or after August 1, 2012.

Under the Affordable Care Act, you and your family may be eligible for some important preventive services — which can help you avoid illness and improve your health — at no additional cost to you.

  • Screenings for adults: abdominal aortic aneurysm, alcohol misuse screening and counseling, Aspirin use for men and women of certain ages, Blood Pressure screening for all adults, cholesterol screening for adults of certain ages or at higher risk, colorectal cancer screening for adults over 50, depression screening for adults, Type 2 Diabetes screening for adults with high blood pressure, diet counseling for adults at higher risk for chronic disease, HIV screening for all adults at higher risk, immunization vaccines for adults (doses), Obesity screening and counseling for all adults, sexually transmitted infection (STI) prevention counseling for adults at higher risk, tobacco use screening for all adults and cessation interventions for tobacco users, syphilis screening for all adults at higher risk.
  • Covered Preventive Services for Women, Including Pregnant Women: Anemia screening on a routine basis for pregnant women, bacteriuria urinary tract or other infection screening for pregnant women, BRCA counseling about genetic testing for women at higher risk, breast cancer mammography screenings every 1 to 2 years for women over 40, breast cancer chemoprevention counseling for women at higher risk, breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*, cervical cancer screening for sexually active women, chlamydia infection screening for younger women and other women at higher risk, Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs*, domestic and interpersonal violence screening and counseling for all women*, folic acid supplements for women who may become pregnant, gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*, gonorrhea screening for all women at higher risk, Hepatitis B screening for pregnant women at their first prenatal visit, Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women*, Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older*, osteoporosis screening for women over age 60 depending on risk factors, Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk, tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users, sexually transmitted infections (STI) counseling for sexually active women*, syphilis screening for all pregnant women or other women at increased risk, well-woman visits to obtain recommended preventive services for women under 65*.
  • Covered Preventive Services for Children: Alcohol and Drug Use assessments for adolescents, autism screening for children at 18 and 24 months, behavioral assessments for children of all ages, blood Pressure screening for children, Cervical Dysplasia screening for sexually active females, Congenital Hypothyroidism screening for newborns, Depression screening for adolescents, developmental screening for children under age 3, and surveillance throughout childhood, dyslipidemia screening for children at higher risk of lipid disorders, Fluoride Chemoprevention supplements for children without fluoride in their water source, gonorrhea preventive medication for the eyes of all newborns, hearing screening for all newborns, Height, Weight and Body Mass Index measurements for children, hematocrit or hemoglobin screening for children, hemoglobinopathies or sickle cell screening for newborns, HIV screening for adolescents at higher risk, immunization vaccines for children from birth to age 18 (doses, recommended ages, and recommended populations vary), iron supplements for children ages 6 to 12 months at risk for anemia, lead screening for children at risk of exposure, medical history for all children throughout development, obesity screening and counseling, oral health risk assessment for young children, Phenylketonuria (PKU) screening for this genetic disorder in newborns, sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk, tuberculin testing for children at higher risk of tuberculosis, vision screening for all children.

65 or Older
The Affordable Care Act strengthens Medicare, offers eligible seniors a range of preventive services with no cost-sharing, and provides discounts on drugs when in the coverage gap known as the “donut hole.”

  • Medicare Preventive Services: Under the Affordable Care Act, if you have Original Medicare, you may qualify for a yearly wellness visit and many preventive services for free. Medicare provides preventive benefits to keep you healthy including a yearly wellness visit, tobacco use cessation counseling, and a range of no-cost screenings for cancer, diabetes, and other chronic diseases.
  • Medicare Drug Discounts: The Affordable Care Act includes benefits to make your Medicare prescription drug coverage (Part D) more affordable. It does this by gradually closing the gap in drug coverage known as the “Donut Hole.”
  • Strengthening Medicare: Over $4 billion in Medicare fraud recovered in 2010. Under the Affordable Care Act, the life of the Medicare Trust Fund will be extended to at least 2024 as a result of reducing waste, fraud, and abuse, and slowing cost growth in Medicare. This will provide you with future cost savings on your premiums and co-insurance.

Small Business Employers
Tax credits and new programs are now available to small businesses. Learn how the law helps make care more affordable for employers, employees, and early retirees:

  • Small Employer Tax Credits: Tax credits for small businesses and non-profits help you bring down the cost of providing insurance. If you have fewer than 25 employees and provide health insurance, you may qualify for a tax credit of up to 35% (up to 25% for non-profits) to offset the cost of your insurance. This credit will increase in 2014 to 50% (35% for non-profits). This will make the cost of providing insurance much lower.
  • Early Retiree Reinsurance Program (ERRP): If your company provides health insurance to retirees ages 55 to 64, it may be eligible for financial help through the Early Retiree Reinsurance Program. The Early Retiree Reinsurance Program provides much-needed financial relief for employers so retirees can get quality, affordable insurance.

Compiled by VeracityStew.com

Also by this author:  What’s in Dodd-Frank?

Published with permission.  Originally published on VeracityStew.com [http://veracitystew.com/2012/06/17/whats-covered-in-the-affordable-care-act/]