What health reform changes to expect in 2012 — assuming the Supreme Court doesn't strike down the entire law

The U.S. Supreme Court is set to hear arguments later this month about the federal health care-reform law, and is expected to decide the law's future this summer. While the court mulls the constitutionality of an individual mandate to buy health insurance, "implementation marches on, and a number of notable changes will take effect for consumers this year," writes Michelle Andrews for Kaiser Health News.

If the high court strikes down the Patient Protection and Affordable Care Act, "all bets are off," Andrews writes. Popular provisions, such as allowing children to stay on their parents' insurance until age 26 and the 50 percent discount on brand-name drugs for seniors under the prescription drug doughnut hole, could be eliminated — and provisions set to take effect this year could be cancelled. But, if the Supreme Court does not invalidate the entire law, here's a list of new provisions consumers can expect this year:

Free contraception coverage: "Women in a new health plan or in an existing one that has changed its benefits enough to not be considered grandfathered under the law will be able to receive contraceptives without an out-of-pocket charge," Andrews writes. Insurance plans will also have to provide basic health services for women, including screening for gestational diabetes; HPV testing; STD counseling; screening and testing for HIV; and screening and counseling for interpersonal and domestic violence. Religious employers such as churches are exempt from the new regulation, but colleges, hospitals and other employers that are religiously affiliated are not — though they do have a one-year grace period to implement it. Employees of those institutions will receive their free benefit from their employer's insurance.

Consumer rebates: Under the law, insurance companies have to spend at least 80 to 85 of their premium revenues on medical claims and quality improvement. If they don't, they have to pay the difference to policyholders, which, in most plans, means the employer. If the provision had been in place in 2010, an analysis by the National Association of Insurance Commissioners estimated that would have meant $2 billion going to consumers. In December, the Obama administration said that about 9 million Americans could receive rebates that added up to $1.4 billion.

Clearer descriptions: Starting in September, all health plans will have to give consumers benefits information that is easy to understand. "Every plan will be required to give people a short summary of coverage and a uniform glossary of terms," Andrews reports. "It will also have to provide examples of how much the plan would cover if someone had a baby or was managing Type 2 diabetes — two common situations that should make it easier for people to compare plans."

Smaller doughnut hole: "This is the break in Medicare prescription drug benefits that, in a standard plan, begins after total drug spending by the beneficiary and the health plan exceeds $2,930 and continues until the beneficiary has hit the $4,700 out-of-pocket limit," Andrews reports. Last year, people on Medicare with high drug costs got a 50 percent discount on brand-name drugs once they reached the doughnut hole. This year, they'll also get a 14 percent discount on generic drugs. (Read more)

Health reform means millions more will be covered and more illness will be prevented, federal health official says at UK

By Tara Kaprowy
Kentucky Health News

What will the healthvcare system look like in 2020? Assistant Secretary of Health Dr. Howard Koh told a packed house in Lexington Monday that millions more people will have insurance, the patient will be at the center of a coordinated system, and there will be a great emphasis on prevention and public health "so the patient doesn't become the patient in the first place."

Koh talked about federal health-care reform during a panel discussion at the University of Kentucky's Albert B. Chandler Hospital. It also included Dr. Steve Hester, senior vice president of Norton Healthcare; Dr. Richard Lofgren, vice president of health care operations and chief clinical officer at UK HealthCare; and Stephen Wyatt, dean of UK's College of Public Health.

Koh said the current health-care system "is fragmented, it's episodic, it's not as coordinated as we would like, and there is still not enough attention to quality outcomes." But he said implementation of key parts of the health-care law would address those issues.

He said insurance is already more accessible, since companies can no longer refuse children with pre-existing conditions. By 2014, the same will be the case for adults. State insurance exchanges, which he called "a one-stop shop where buyers can compare plans," will inject "transparency in the whole market" and will ensure basic levels of coverage.

Insurance will also become more affordable, he said. The Medicare prescription "donut hole" is being covered; young adults can stay on their parents' plan until the age of 26; insurance companies must assure that 80 percent of their expenses go toward medical care and not overhead; and there will be a rate-review process, in which insurance companies wanting to increase their rates by 10 percent or more must formally defend their request.

Patient-centered medical homes will put the patient at the center of care and accountable care organizations, and "voluntary networks who have agreed to care for a defined Medicare population and also share in savings," will make coverage more coordinated, Koh said.

The law also puts systems in place for prevention and public health. On the individual level, new plans must cover "high-value preventive services and screenings," Koh said. Businesses are being encouraged to focus on wellness. The Centers for Disease Control and Prevention are offering community transformation grants so communities "can designs ways to make the healthy choice the easy choice," he said. And a national prevention counsel has been formed dedicated to public health.

The law also provides millions for health-care technology, which Hester said will revolutionize the health-care landscape and "the way we respond to patients." Koh agreed, saying a paper-based system "was another example of fragmentation. . . . prevSometimes you could find the chart, sometimes you couldn't. The electronic-based system will coordinate."

Hester said patients have recently become more equipped to accept the technology of electronic health records because they've become used to devices like smart phones. Logren said that, traditionally, patient records have been "proprietary." Electronic records will get information moving from place to place and will no longer be "owned."

Koh acknowledged one of the greatest challenges of the health-reform law is sustainability, but by 2020, he said "We will see stable funding and stable results" in public health and prevention. While the law has created divisiveness in the political arena, Koh said strong opinions about health care are a good thing because they generate discussion and passion. "We can debate many parts of the health reform law," he said, "but in the meantime, we are making progress."

Health insurance exchange benefits will be decided at the state level; Kentucky can now proceed to set up its exchange

For months, Kentucky officials have said the state cannot move forward with setting up a health-insurance exchange under the new federal health law because there weren't enough details about which benefits they had to offer. On Friday, the Obama administration answered that question when it "let states, rather than the federal government, define which medical benefits insurance companies will have to offer consumers starting in 2014," reports Noam L. Levey of the Los Angeles Times. "This is significantly more state-flexible and friendly than many would have expected," Alan Weil, head of the National Academy for State Health Policy, told Levey.

The law says that by 2014, each state must offer an insurance exchange, an online insurance marketplace in which people can choose from a variety of plans from companies like Anthem or Bluecross/Blueshield and then, for the most part, be given federal subsidies to help pay their premiums. About 30 million individuals and employees of small businesses are expected to use the exchanges. The plans in an exchange must cover a basic set of benefits, including hospitalizations, emergency care, newborn and maternity care and pediatric services, but until now the federal government could have decided how generous the benefits had to be.

"Under the guidance issued Friday, state leaders can define their own set of benefits by using an existing major health plan in their state as a benchmark," Levey reports. "That means that some states may require insurers to cover services such as chiropractic therapy and in vitro fertilization, while others may not."

It's this variability between states that worries some. "In passing a good deal of the decision-making to states, the administration has guaranteed that Americans will continue to face a patchwork of state regulations that make coverage uneven and inefficient," report Gardiner Harris, Reed Abelson and Robert Pear in a news analysis for The New York Times.

Some consumer advocates also worry the move will allow states to make benefits too meager. Timothy Jost, a law professor at Washington and Lee University, said the policies "could restrict, for example, the number of covered visits a pregnant woman could make to her obstetrician or which prescription drugs to pay for."

However, by passing the responsibility on to the states, "President Obama will most likely make his plan for health care reform more politically palatable," the Times reporters write. "States will be allowed to set benefits at levels similar to what they are now, making coverage not much more expensive than it is today."

While some Republican state officials were happy with the decision, saying it makes it easier for states to comply with the law, others opposed to the law were critical. "All they're trying to do is avoid making tough calls before the election," said Ed Haislmaier, a senior research fellow at the Heritage Foundation. (Read more)

Giuliani backs P'Pool, citing attorney general candidate's opposition to health-care reform law

Republican Rudy Giuliani, former mayor of New York City and presidential candidate in 2007-08, has endorsed GOP nominee Todd P'Pool in the race for attorney general, citing the candidate's "eagerness to join the legal fight against President Barack Obama's health care overhaul," reports Bruce Schreiner of The Associated Press.

"You've got to elect Todd as your next attorney general because you want to put Kentucky on the side of those states that say 'enough' with how far left our government has gone ... on health care policy," Giuliani said at a rally.

Twenty-six states are "challenging the law's requirements that people buy health insurance or pay a penalty on their taxes" starting in 2014, Schreiner reports. All of the attorneys general in the case are Republicans, except those in Iowa, Nevada and Wyoming. (In some states, attorneys general are appointed.) The case is headed to the U.S. Supreme Court.

Conway, who is seeking a second term, has defended the basic approach of the law, bringing into coverage most of the uninsured who now use emergency rooms to get care, while saying parts of it need changing. Giuliani said, "Your attorney general has Kentucky in a position, by not opposing it, of supporting Obamacare." (Read more)