You've probably heard that the new health overhaul law this year will provide an option for young adults to stay on their parents' health plans and set up insurance pools for people with pre-existing medical conditions who can't find insurance.
But several lesser-known provisions also take effect in coming months. And they could have a lasting impact on the nation's health care system.
While some of these changes might sport a low profile right now, they could help build support for the law in the run-up to the contentious mid-term elections. Here's a quick look at some of the changes occurring this year:
1. Free Prevention
What: Insurers won't be able to charge co-payments or deductibles for preventive services like breast cancer screenings every one to two years, cholesterol blood tests and some sexually transmitted disease screenings. Insurers will also have to cover recommended immunizations. Some health care analysts have suggested that premiums may rise as a result of this and other new requirements, but administration officials estimate any increase in premiums would be extremely small.
When: “Though the change technically takes effect Sept. 23, most plans don’t have to make the change until their new health plan years starts, usually on Jan. 1.
Status: Regulations are on their way. Paul Bonta, associate executive director for policy and government affairs at the American College of Preventive Medicine, predicts manufacturers of vaccines and diagnostic tests will push for their products to be labeled "preventive services" in a bid to have them covered at no cost to consumers.
2. ComparingTreatments
What: A nonprofit research institute will examine various medical treatments -- by looking at data and conducting its own studies -- to determine which methods work best. This is often called "comparative effectiveness research."
When: The comptroller general of the United States will appoint the 17 members of the institute's board of governors, which will oversee the institute's operations.
Status: Everything about this institute, from its board members to its findings, is likely to generate controversy. The law says the board can't tell doctors how to practice medicine or insurers what to cover. However, in the quest to control health care costs, the data it provides may offer insurers ammo for changes in coverage and treatment patterns.
3. Helping Early Retirees With Health Costs
What: A new program will help employers with the cost of health care for retirees age 55 and older who are not yet eligible for Medicare, the federal program for the elderly. The reimbursements will cover 80 percent of medical claims between $15,000 and $90,000 for retirees, their spouses and dependents.
When: Applications are now being accepted to help cover claims dating back to June 1.
Status: The $5 billion program is intended to help employers cover retirees' health costs until the health insurance exchanges – state-based insurance marketplaces -- are up and running in 2014. A cautionary note: the Employee Benefit Research Institute found that if the subsidy handed out to all eligible retirees and their dependents, the $5 billion would last no more than two years.
4. Tracking Health Insurance Premiums
What: Insurers must justify premium increases to the federal government and state insurance commissioners. If premium hikes are deemed to be unreasonable, states could exclude insurers from offering their coverage on health insurance exchanges beginning in 2014.
When: Federal regulators have yet to define what "unreasonable" means, and have yet to issue regulations, but the provision has technically gone into effect.
Status: The National Association of Insurance Commissioners is developing recommendations for federal regulators about what information insurers should provide to state and federal officials to justify premium increases. A draft proposed by a subcommittee of the NAIC has drawn fire from consumer advocates who say the government should demand much more detailed information. The federal government won't have the power to regulate rates; however, some states do.
5. Expanding Medicaid Coverage
What: In 2014, Medicaid, the state-federal program for the poor, will expand to include everyone who makes less than 133 percent of the poverty line ($14,400 this year for individuals). Currently, most poor people without children aren't covered by the program.
When: States could expand Medicaid now to cover childless adults and receive some federal funding. In 2014 the federal government will pick up the entire cost of expanding Medicaid to childless adults and others who qualify.
Status: So far, both Connecticut and Washington, D.C., have applied and received permission from federal officials to expand their Medicaid programs right away. Connecticut officials say that as many as 45,000 childless adults they cover under a state program will now be covered by Medicaid. That will save the state $53 million over the next year since it already covers some of the poorest single adults.
Ann Kohler, director of health services for the American Public Human Services Association and head of the National Association of State Medicaid Directors, said many states are worried they don't have the money or staff to expand now. Computer systems used by states and the federal government often don't line up, Kohler said, and there may not be enough doctors to care for all the newly covered individuals.
6. Care Coordination For The Poor And Elderly
What: Approximately 8.8 million "dual eligibles" -- individuals who qualify for both Medicare and Medicaid, many of whom are poor elderly -- could benefit from a new federal office designed to coordinate their medical care.
When: Immediately. HHS officials have said they will soon release additional information about the new office designed to coordinate care.
Status: Jim Verdier, a senior fellow with Mathematica Policy Research, a health policy research firm, said about a dozen states, including Arizona, Minnesota and Wisconsin, are already working to integrate care but that the process is complicated. For one thing, rules on how to deal with this population vary from state to state and also differ from the federal government's regulations. If Medicare and Medicaid had uniform rules, care would be easier to coordinate, he said.
7. FDA Approval For Generic Biologic Drugs
What: The health overhaul law gives the Food and Drug Administration the power to approve lower-cost versions of biologic drugs – often called biosimilars or follow-on biologics – once the original products have been on the market for 12 years. These drugs can be used to treat serious diseases such as cancer and multiple sclerosis.
When: Later this year, the FDA is expected to hold the first in a series of meetings to solicit comments from the public and the industry on how the process should work. Players on all sides of the debate expect the agency to move slowly in figuring out how to bring these drugs to the market.
Status: Issues to be decided in the future include how to define what constitutes a "biosimilar" drug and how to resolve patent challenges that may emerge.
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