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.

Related articles

Advertisements

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!

Obamacare: Signed, Sealed, Delivering …

Watch the Obamacare videos & get the facts

Obamacare is making health care work better for all of us, even if you already have insurance. It puts the health of your family first—ensuring access to free preventive care and protecting consumers from insurance company abuses.

71 Million Kids & Adults With Private Insurance Have Received No-Cost Preventive Care.
“HHS estimates that, as a result of the ACA, 71 million children and adults with private insurance, and 34 million Medicare beneficiaries have received no-cost preventive care. Enhanced federal matching funds in Medicaid are available to states providing all USPSTF-recommended preventive benefits without cost-sharing, but, to date, few states have made the changes required to gain the higher match rate.” “Health Reform-The Affordable Care Act Three Years Post-Enactment,” Kaiser Family Foundation, March 2013.
Discrimination By Insurance Companies For Children With Pre-Existing Conditions Was Banned.
“Coverage exclusions for children with pre-existing conditions were prohibited as of September 23, 2010. Insurers are no longer permitted to deny coverage to children due to their health status, or exclude coverage for pre-existing conditions. Protections for adults will take effect in 2014. In addition, lifetime limits on coverage in private insurance have been eliminated and annual limits are being phased out.” “Health Reform-The Affordable Care Act Three Years Post-Enactment,” Kaiser Family Foundation, March 2013.
Consumers Received $1.1 Billion in Rebates From Their Insurance Companies.
“Insurance companies that don’t spend at least 80 percent of its customers’ premium dollars on health care are required to provide rebates to policy holders. In 2012, the first year this rule was implemented, 12.8 million consumers received $1.1 billion in rebates.” “Health Reform in Action,” WhiteHouse.gov, accessed 6/5/13.
3.1 Million More Young Adults Have Health Insurance Through Their Parent’s Plan.
“Under the law, most young adults who can’t get coverage through their jobs can stay on their parents’ plans until age 26.” “Health Reform in Action,” WhiteHouse.gov, accessed 6/5/13.
Seniors Have Saved More Than $6.1 Billion on Their Prescription Drugs Since 2010.
“Seniors who hit the gap in Medicare’s prescription drug coverage, often called the ‘donut hole’ now receive 50 percent discounts on covered brand name drugs. The new health reform law will provide additional savings each year until the coverage gap is closed in 2020.” “Health Reform in Action,” WhiteHouse.gov, accessed 6/5/13.

Consumers Saved $3.9B on Premiums in 2012

Health care law will provide families an average of $100 back in premium rebates

Today, the Department of Health and Human Services (HHS) announces that nationwide, 77.8 million consumers saved $3.4 billion up front on their premiums as insurance companies operated more efficiently.  Additionally, consumers nationwide will save $500 million in rebates, with 8.5 million enrollees due to receive an average rebate of around $100 per family.

Today’s report includes the 2012 health insurer data required under the Affordable Care Act’s Medical Loss Ratio, or “80/20 rule.”  The report shows that, compared to 2011, more insurers are meeting this standard and spending more of their premium dollars directly toward patient care and quality, and not red tape and bonuses.

Created through the Affordable Care Act, the rule requires insurers to spend at least 80 cents of every premium dollar on patient care and quality improvement.  If they spend a higher amount on other expenses like profits and red tape, they owe rebates back to consumers.  For many consumers, the report found that the law motivated their plans to lower prices or improve their coverage to meet the standard.  This new standard and other Affordable Care Act policies contributed to consumers saving approximately $3.9 billion on premiums in 2012, for a total of $5 billion in savings since the program’s inception.

“The health care law is providing consumers value for their premium dollars and ensuring the money they pay every month to insurance companies goes toward patient care,” HHS Secretary Kathleen Sebelius said.  “Thanks to the law, 8.5 million Americans will receive $500 million back in their pockets and purses.”

If an insurer did not spend enough premium dollars on patient care and quality improvement, rebates will be paid in one of the following ways:

  • a rebate check in the mail;
  • a lump-sum reimbursement to the same account that they used to pay the premium if by credit card or debit card;
  • a reduction in their future premiums; or
  • their employer providing one of the above, or applying the rebate in another manner that benefits its employees, such as more generous benefits.

Insurance companies that do not meet the standard will send consumers a notice informing them of this new rule.  The notice will also let consumers know how much the insurer did or did not spend on patient care or quality improvement, and how much of that difference will be returned as a rebate.

The 80/20 rule, along with the required review of proposed double-digit premium increases, works to stabilize and moderate premium rates.  And, with the new market reforms, including the guaranteed availability protections and prohibition of the use of factors such as health status, medical history, gender and industry of employment to set premiums rates, this policy helps ensure every American has access to quality, affordable health insurance.

To access the report released today, visit: http://www.cms.gov/cciio/Resources/Forms-Reports-and-Other-Resources/index.html#Medical Loss Ratio

For more information on MLR, visit: http://www.healthcare.gov/news/factsheets/2010/11/medical-loss-ratio.html

Related articles

It’s National Women’s Health Week, So Naturally, the GOP is Voting Yet Again to Repeal Obamacare!

— by Kathleen Sibelius, Secretary–Dept. of Health & Human Services

This week, starting with Mother’s Day,  we celebrate National Women’s Health Week. As a nation, we honor the women in our lives – our mothers, grandmothers, aunts, sisters, cousins, friends, and colleagues – by encouraging them to make their health a priority and to take steps to live healthier, happier lives.

Women are frequently the health care decision-makers in their families. We take time off from work to drive a parent to the doctor. We hold our children’s hands while they get their vaccinations. We make the appointments for our spouses’ checkups – and then make sure they actually go. We stretch and re-work our family budgets to pay the doctor’s bills. And too often, we put our own health last.

But the truth is unless we take care of ourselves first, we cannot really take care of our families. That means we have to eat right, exercise, and get the care we need to stay healthy. Unfortunately, preventive care has not always been easily accessible or affordable for everyone, including young women.

But the health care law is helping to usher in a new day for women’s health. The Affordable Care Act is making it easier for women to take control of their own health.  For many women, preventive services like mammograms, Pap smears, birth control, and yearly well-woman visits are now available without cost sharing. The health care law improves women’s access to appropriate preventive health screenings, which can help detect diseases early, when treatment is most effective and least costly.

Starting next year, insurance companies will no longer be allowed to refuse us coverage just because we’re battling breast cancer or have another pre-existing condition – and they won’t be allowed to charge us more just because we are women.

If you’re one of the millions of women who are uninsured or who buy insurance on their own, more options are on the way because of the Affordable Care Act. Starting October 1, 2013, you will be able to visit a new Health Insurance Marketplace where you can compare and choose from a range of plans to find one that best fits your needs and budget. All of these plans must cover a package of essential health benefits, including maternity and newborn care.

To get more information about the Marketplace and to sign up for email and text updates to get ready for October, visit HealthCare.gov.

Being healthy starts with each of us taking control. So Monday on National Women’s Checkup Day, and during National Women’s Health Week, I encourage you to sit down with your doctor or health care provider and talk about what you can do to take control of your health.

There’s no better gift you can give yourself – or your loved ones.

ACA01

ACA02