Investing in Quality Health Care

On January 1, 2011, many provisions of the new health care law will begin to take effect.  In the new year, health insurance companies will be required to spend 80 to 85 percent of premiums on health care and quality improvements for patients.  Also, seniors approaching the Medicare 'doughnut hole' will finally get some relief thanks to a 50 percent prescription drug discount provided by the law.  Some provisions already have taken effect.  Much of the major investment in access to quality affordable care which Sen. Bernie Sanders fought for began to take effect in October.  Sanders successfully included in the new law funding to double the availability of the community health centers and thus providing primary health care, dental care, mental health counseling and low-cost prescription drugs for about 40 million Americans, twice as many as now receive care.

Community Health Centers offer basic medical services ranging from prenatal care and childhood immunizations to cancer screenings and diabetes testing.  Open to everyone, the centers care for patients covered by Medicaid, Medicare and private insurance as well as those who have no insurance. Patients without insurance pay on a sliding fee scale.

Because treating patients at health centers keeps them out of more expensive hospital emergency rooms, the investment will more than pay for itself. Medicaid alone should save $17 billion over five years, according to a study conducted by George Washington University.  The system of Federally Qualified Health Centers began more than four decades ago under pioneering legislation by the late Sen. Edward M. Kennedy and has been strongly supported by both Presidents Bush and Obama.

Sanders also included in the bill, working with Sen. Ron Wyden (D-Ore.) a provision to allow states that want to go above and beyond the coverage mandated by the federal law to be allowed to do so with a waiver from the secretary of Health and Human Services.  Sanders has introduced legislation, co-sponsored by Sen. Patrick Leahy (D-Vt.), to move the date upon which such waivers would be available to 2014 from 2017.

The following provisions of the Affordable Care Act take effect on January 1st, 2011.

For all health care consumers:

  • Health insurance companies are now required to spend 80 to 85 percent of premiums on health care and quality improvements for patients-not on overhead or CEO salaries. Insurers who have not redirected premiums so that at least 80 percent goes to customer care will be required to provide a rebate to their customers starting in 2012.

For seniors:

  • Seniors who reach the doughnut hole coverage gap for prescription drugs will receive a 50 percent discount when buying brand-name medications. Over the next ten years, seniors will receive additional discounts until the coverage gap is closed.
  • Seniors will receive free preventive services, such as annual checkups and certain preventative screenings.
  • The Community Care Transitions Program will help high-risk Medicare beneficiaries who are hospitalized avoid unnecessary readmissions by coordinating care and connecting patients to services in their communities.
  • The Center for Medicare and Medicaid Innovation will begin testing new ways of delivering care to patients. These new methods are expected to improve the quality of care and reduce the rate of growth in costs for Medicare, Medicaid, and Nevada Check Up.

Already the Affordable Care Act has opened up access to quality health care and helped small companies provide health insurance to their employees. Provisions that took effect in 2010 include:

  • Prohibiting denial of coverage to children who were excluded due to preexisting conditions
  • Extending coverage to young adults up to age 26 so they can stay covered as they start their careers
  • Delivering tax relief for small businesses across Nevada to help them continue to provide health insurance to their workers
  • Creating a system to help early retirees not yet eligible for Medicare keep their savings and stay insured
  • Requiring all new plans to provide free preventative screenings including mammograms and colonoscopies
  • Ending insurance companies' ability to rescind coverage when people get sick or impose lifetime caps on those with chronic illness
  • Investing millions into community health programs and helping states like Nevada provide coverage for low income families through Medicaid

To read a full timeline of the health care bill's implementation, click here.