Lesser-known provisions of the new healthcare reform law could help build support in the run-up to the contentious mid-term elections, according to Kaiser Health News. Here are some of the changes you might have missed:
Certain preventive services such as breast cancer screenings every one to two years, cholesterol blood tests and some sexually transmitted disease screenings will be free, meaning insurers won't be able to charge co-payments or deductibles for them. Insurers also will have to cover recommended immunizations in full. According to KHN, administration officials say any increase in premiums would be minimal, although healthcare analysts contend that premiums could rise as a result of the new coverage requirements.
Furthermore, a nonprofit research institute will be created to do comparative effectiveness research. Researchers will examine various medical treatments, by looking at data and conducting studies, to determine which methods lead to the best outcomes. The institute could be the source of much possible controversy, KHN notes. Although the law says the board's findings can't be seen as telling doctors how to practice medicine or what insurers will have to cover, it's possible insurers and others may look to use such data as rationales for changes in coverage and treatment patterns.
Also, a new program will help employers absorb the cost of healthcare for retirees ages 55 and older who are not eligible for Medicare. The reimbursements will cover 80 percent of medical claims between $15,000 and $90,000 for retirees, their spouses and dependents.
In a move that could make waves in the payer world, if insurance premium hikes are deemed unreasonable--which federal regulators have yet to define--states could exclude insurers from offering their coverage on health insurance exchanges beginning in 2014. The National Association of Insurance Commissioners is developing recommendations on what information insurers should provide to state and federal officials to justify premium increases. Federal regulations haven't been issued yet on this, KHN reports, although the provision has gone into effect.
By 2014, Medicaid will expand to include everyone who makes less than 133 percent of the poverty line ($14,400 for individuals). Most poor childless adults are not covered by the program. In the interim, states may get federal aid to expand their Medicaid programs to cover those people.
Ann Kohler, director of health services for the American Public Human Services Association and head of the National Association of State Medicaid Directors, told KHN that 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 aren't aligned Kohler said, and there may not be enough doctors to care for all the newly covered individuals.
To learn more:
- read the Kaiser Health News report
Forecast: Health overhaul will succeed in covering more, fail in reducing costs
Justice department begins state-by-state battle for health reform
High-risk insurance pools could cost more than $5 billion, report says