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Understanding federal health reform
Health reform updates
Allina Health resources
U.S. Department of Health & Human Services
Minnesota Department of Commerce
U.S. Supreme Court ruling on the Affordable Care Act
On June 28, 2012, the U.S. Supreme Court issued its decision on the constitutionality of the Patient Protection and Affordable Care Act. In a 5-4 ruling, the Court upheld all of the provisions of the law, including the requirement that all Americans purchase health insurance (also known as the individual mandate).
The Court also ruled that the federal government cannot withhold Medicaid funds from states if they choose to not comply with the expanded eligibility requirement.
"I believe health reform is good for our country. In the long run, it will be less expensive than caring for individuals through current charity-care policies," said Ken Paulus, CEO and president, Allina Health.
"We embraced health reform as it rolled out. We decided it was our civic duty to get behind the law and make it work. We will continue to do that."
Federal health reform and Allina Health patients
Many patients and community members have asked questions about what federal health reform will do and how it will affect their care. We've answered some common questions about the law as it relates to care at hospitals, clinics and specialty care services.
The federal health reform law is more than 2,400 pages long and includes many changes for the health care industry. Here are some of the major highlights:
Coverage will expand to 32 million individuals by 2019 through public program expansions, an individual mandate, an employer mandate and other private sector health insurance reforms.
Health Insurance Exchanges will be formed in each state by 2014 where individuals and small businesses can purchase health coverage.
Cost savings will be achieved through reduced reimbursement rates and payment reforms to help pay for the coverage expansions.
Insurance industry regulation includes a requirement for plans to offer an essential benefits package, provide dependent coverage for children up to age 26, prohibit lifetime limits and prohibit pre-existing condition exclusions.
Allina Health serves many Medicare beneficiaries and remains committed to providing exceptional care to these loyal patients, as well as new Medicare patients. Some of the changes Medicare beneficiaries will see within the first two years are highlighted below.
Last year, any Medicare beneficiary who crossed into the "Doughnut Hole" coverage gap under Medicare Part D should have received a $250 rebate check to help pay for their medications. This year, patients in the coverage gap receive a 50 percent discount on brand-name prescription drugs and a seven percent discount on generic prescription drugs. These discounts will grow each year until 2020 when the discounts and subsides will add up to 75 percent of both brand name and generic drugs.
Medicare now covers proven preventive services at no charge to the patients, meaning no co-pays or premiums. This covers preventive services such as mammograms and screenings for colon and prostate cancer. Medicare beneficiaries also qualify for a new annual wellness visit at no charge and will receive incentives to complete behavior modification programs.
Starting this year, spending will be reduced for Medicare Advantage, the private plan part of Medicare. This will bring these private plans more in line with the costs in the original Medicare program. Basic, guaranteed Medicare benefits will not change. Some of the extras under Medicare Advantage likely will be pared down.
Patients who have health coverage through their employers are unlikely to see any major changes to their premiums or coverage. They also will not see any change in the care they receive from Allina Health.
Allina Health does not anticipate any changes to our current practice of accepting most forms of commercial insurance.
Additional changes that have taken effect over the past year for patients with private insurance include:
Most Americans without health insurance will be required to have coverage by 2014 through expansions to the state Medicaid programs or by purchasing a health plan through one of the newly created Health Insurance Exchanges.
Minnesota opted to expand Medical Assistance (MA), the state's Medicaid program, eligibility early and as of March 1, 2011, adults without children who have incomes at or below 75 percent of the federal poverty guidelines are eligible. Additional information on Minnesota's Medical Assistance program can be found on healthreform.gov.
Health Insurance Exchanges will be up and running by 2014, when individuals are required to have health coverage. Government subsidies will be available to help individuals and families with incomes below a certain level purchase health coverage and those without coverage will pay a penalty starting in 2014.
Individuals without health coverage due to a pre-existing condition will be able to purchase coverage through high-risk insurance pools starting this year. In 2014, all insurers will be banned from denying health coverage to individuals based on their health status.
Allina Health policies around financial assistance and billing and collections will be consistent with federal health reform.
Learn about financial assistance services.
In recent debates, Allina Health has supported bold changes in health policy that aim to reduce the number of uninsured, create new payment incentives that support the promotion of health, as well as advance public health and primary prevention. The recently signed federal health reform does much good, but it also leaves critical work undone.
This is an exciting time in health care. Our challenge and opportunity have never been greater to create a new and sustainable model for delivering on our mission in collaboration with one another, our patients and communities.Allina Health has been a strong supporter of changes to the health care system that aim to improve the health of the population, enhance the patient care experience and reduce the cost of care. Allina Health is committed to continuing to provide exceptional care to all of our patients – and health reform will not change this.
Source: Allina Health; U.S. Department of Health & Human Services
Reviewed by: Allina Health Health Policy and Government Affairs
First Published: 05/13/2010
Last Reviewed: 06/29/2012