Vol. 19 April 15, 2010 Patient Protection and Affordable Care Act passed as Public Law 111-148 on March 21, 2010

“Incremental, It Is” – Yoda

“May the Faults be with You” – Obi Wan

Largest provider of health care insurance in the U.S:  Medicare

Health care spending per year by Medicare in U.S: $414 Billion

Per cent of total annual health care spent by Medicare: 19% (1)

Number of people gaining new access to health insurance through this law: 31-36 million

Estimated number of people still lacking health insurance once law is fully implemented in 10 years: 18 – 23 million

Year that those eligible for an insurance policy who haven’t purchased a “minimum essential coverage” policy will be fined (“taxed”) : 2014 (2)

Amount of the fine (tax) in 2014: $750/yearly

Year that a “Cadillac” insurance coverage policy (a family plan that exceeds $27,500/yr. premiums) will be taxed at 40% of any amount OVER that cap:  2018

  • This tax is levied against the insurance company writing the policy.This  may reduce its profits or the company may pass additional cost on to the insured person.
  • Number of people in Massachusetts that would be vulnerable in 2010 to that tax on their health insurance company: 8,600 (mostly town and city employees) (2)
  • This means that union members with these “Cadillac policies” have nearly 8 years to renegotiate their salary/benefits packages.

Minimum number of employees before any company has to offer a health insurance plan: 50

Per cent of newly insured that went into employee-based or private health insurance plans when a similar health care bill was passed in Massachusetts: 50% (2)

REDUCTION of federal deficit by this law estimated by Congressional Budget Office (CBO) by 2018: 143 Billion (3)

Number of new major actions that will help fund this law: 5

  • 40% tax on health insurance companies and medical device companies by year 2020
  • 3.8% tax on financial investments
  • Increase of current Medicare payroll tax of 1.4% to 2.35% ONLY for those with income over $250,000
  • phase out Medicare Advantage Plans by 2012. These “Medicare Managed  Care Plans” are 14% more expensive and have shown no outcome or utilization improvements.(4)
  • reduce Medicare “waste, fraud, and abuse”

Year that children up to age 26 years can remain covered by a family policy: 2010

Year that “doughnut hole” in Medicare coverage of drugs (Part D) will be closed completely: 2020

Year that health insurance companies can no longer reject coverage of children (under age 19 y) with a preexisting condition: 2010

  • An attempt by insurance companies to interpret this regulation as one delayed to 2014 was quickly squashed by new wording that “clarified” the regulation.

Year that health insurance companies can no longer reject adults who have a preexisting condition and can not impose  a “maximum cap lifetime benefit” that ends further coverage: 2014

Major employers must provide private places for mothers to breast feed their babies.

  • Per cent of mothers who breast feed their babies for at least 6 months: 43%
  • Per cent of mothers who feed their babies ONLY breast milk for 6 months: 12% (5)

References:
1. NEJM 362;1  1/7/2010 Peter Lee, et al
2. Boston Globe, pg. 1,  April 1, 2010, Sean Murphy
3. AARP Magazine, March/April 2010
4. AARP website accessed April 13, 2010
5. Am Acad of Pediatrics. Ruth Lawrence, MD

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