Rep Pete Stark (D-CA), Chairman of the Ways and Means Health Subcommittee, continues to blast House Republicans’ “Pledge for America.” Unveiled two weeks ago, the Republican pledge would do away with important reforms included in the Affordable Care Act.  In a series of daily releases called “Pledge Against America’s Health,” Chairman Stark illustrates the impact that this GOP agenda would have on millions of Americans and businesses.

How the GOP pledge harms America's health…

*Allow insurers to discriminate against people with pre-existing conditions:http://go.usa.gov/ach

*Eliminate a program to help employers retain coverage for early retirees: http://go.usa.gov/ac2

*Shut down healthcare.gov: http://go.usa.gov/al8

*Gut programs to fight Medicare fraud, waste, and abuse: http://go.usa.gov/xuT

*Increase the uninsured by 29 million: http://go.usa.gov/xMU

*Kick people out of new Pre-Existing Condition Insurance Plans: http://go.usa.gov/x60

*Eliminate the small business tax credit: http://go.usa.gov/xsj

*Re-open the Medicare Part D donut hole: http://go.usa.gov/xGe

*Repeal investment in health IT: http://go.usa.gov/xGF

Healthcare Reform Strengthens Middle Class
by Ways and Means Committee Chairman Sander Levin

A few months ago, on the eve of Congress's vote on healthcare reform, I received a letter that summed up what this is all about: strengthening the basic economic security of the middle class.

The letter's writer, a woman from Warren, is a teacher whose daughter was born with a serious medical condition requiring surgery when she was just eight days old. That necessary surgery left the newborn with what will be a lifelong ailment.

Because of healthcare reform, that little girl, who is now three, will never be denied insurance because of her pre-existing condition. Her mother wrote: "Every parent should have peace of mind to know everything with their child is going to be okay."

That's what healthcare reform is about: the middle class's economic security.

Though much of the new law will be gradually phased in, last week, on September 23, a slate of new consumer protections began to take effect for the next plan year.

Starting Thursday, rescissions -- the practice of dropping coverage from paying customers when they get sick and need it most -- became a thing of the past. No child can be denied coverage due to pre-existing conditions. And adult children are allowed to remain on their parents' insurance plans up until their 26th birthday.

All insurers are prohibited from imposing lifetime caps on coverage -- enabling people to receive the treatment they need without having to worry about reaching a limit or facing financial ruin from medical bills. And every new plan must have an effective and efficient external appeals process, so that if you want to appeal a decision your insurer makes, your concerns aren't lost in corporate bureaucracy.

So many hard-working American families are struggling. Over the last two years, we've been trying to right the ship, and we've made some progress, reforming Wall Street and ending taxpayer bailouts, supporting a "Make It In America" manufacturing strategy, and enacting healthcare reform.

Opponents of health care reform would take away consumer protections -- siding with the insurance industry instead of the middle class. We can't afford that.

These reforms -- the Patients' Bill of Rights chief among them -- are vital for working Americans. Starting next year, insurance companies will be required to put more of your premium dollars into providing health care, instead of spending it on exorbitant CEO pay. In 2014, once the health insurance exchanges (where consumers can comparison shop for coverage) come into operation, no American will be denied coverage, as insurance companies will no longer be able to discriminate against adults with pre-existing conditions. To see how healthcare reform will impact you directly, visit www.healthcare.gov.

We need for America to get back to basics and focus on the middle class's quality of life. Healthcare reform is vital to restoring that standard of living.

Only then -- only by siding with the middle class in action, not just word -- will our country truly be healthy.

Cross-linked from the Huffington Post

Originally appeared in Sunday's Macomb Daily. 

 In case you missed HHS Secretary Sebelius's op-ed in the Wall Street Journal yesterday...

Health Insurers Finally Get Some Oversight

In the past, these companies ran wild with no accountability

By KATHLEEN SEBELIUS

In the last two weeks, my department has been accused of "thuggery" (this editorial page) and "Soviet tyranny" (Newt Gingrich). What prompted these accusations? The fact that we told health-insurance companies that, as required by law, we will review large premium increases and identify those that are unreasonable.

There's a long history of special interests using similar attacks to oppose change. In the mid-1960s, for example, some claimed Medicare would put our country on the path to socialism.

But what is really objectionable about these comments is not who they're attacking, but what they're defending. These critics seem to believe that any oversight of the insurance industry is too much, and that consumers would be better off in a system where they have few rights or protections.

Over the past decade, Americans have seen what happens when insurance companies have free rein. The cost of health insurance has more than doubled, while millions of hard-working Americans lost their coverage or drained their savings to keep up with premiums. Employers—big and small—have struggled mightily to absorb these cost increases and have been losing the fight.

As insurance commissioner and governor of Kansas, I saw firsthand how these rate hikes burdened people. I spoke with families who watched their insurance go up 20%, 30%, even 40% a year without explanation. I met with small business owners who had stopped offering health insurance to their employees because they couldn't afford the annual double-digit premium increases.

A woman who wrote to me recently summed up the frustration that many feel. "As a self-employed, hard-working person," she wrote, "I have no good options for health coverage."

Yet even as our insurance markets have failed Americans time and time again, special interests successfully blocked reform.

That's changing with enactment of the new health insurance law. Under the Affordable Care Act, 46 states have already received grants to beef up their premium-review and oversight capabilities. And additional funding is on the way.

The law also gives clear instructions to the new state-based health insurance marketplaces called exchanges that will be created in 2014. As the exchanges decide what plans to include, they must incorporate recommendations from states about whether particular health insurance issuers should be excluded based on a pattern of excessive or unjustified premium increases.

We are already seeing this new level of accountability pay off. Last week, North Carolina's largest insurer announced a "one-time refund that will return $155.8 million to more than 215,000 individual Blue Cross Blue Shield customers as a result of the Affordable Care Act." This rebate will put an average of $720 back into the pockets of each of those policyholders. In addition, thanks to diligent work by North Carolina's insurance commissioner, they'll see their premiums rise by less than 6% in 2011—the smallest rate increase in four years.

A day after Blue Cross Blue Shield's announcement, seniors with private Medicare plans got some news that most Americans haven't heard in years: Their premiums will actually go down 1% next year, even as many of them enjoy better benefits.

The Affordable Care Act is bringing some basic fairness to our health insurance market. So when I learned that a handful of insurers around the country are blaming their significant rate increases on the new law—even though the facts show that the impact of the law on premiums is small, just 1% to 2% declining over time—I let them know that we'd be closely reviewing their rate hikes.

It's understandable that some insurance companies and their allies don't welcome this change. They've made large profits from the status quo. And it's not surprising—though still disappointing—that House Republicans have recently pledged to repeal the Affordable Care Act and get rid of these new consumer protections.

If critics really want to go back to the days when insurance companies ran wild with no accountability, they should have the courage to say so openly instead of hiding behind distracting attacks. In the meantime, we're going to keep standing up for American families and small business owners who deserve a system that works for them.

 

 

 

FamiliesUSA released a report today examining who will be eligible for help from the premium assistance tax credits.

• Nationally, 28.6 million Americans will be eligible for these new premium tax credits in 2014.
• 95 percent of those eligible for the premium tax credit will be in families with a worker who is employed full- or part-time (27.2 million).
• Of those eligible, 48 percent will have previously been uninsured (13.7 million).
• 65.6 percent of those who will be eligible for the premium tax credit (18.8 million) are from families with annual incomes at or above 200 percent of the federal poverty level ($44,100 for a family of four in 2010).
• Over 50 percent of those who will be eligible for the premium tax credit will work for small businesses with fewer than 100 workers (15.1 million).
  
   

In today’s Washington Post, Centers for Medicare and Medicaid Services Administrator Donald Berwick explains how under the Affordable Care Act, “Medicare is stronger than it has been in years, and seniors will get new benefits.”

The Medicare Board of Trustees estimated last month that the Affordable Care Act produces savings that extend the life of the Medicare Hospital Insurance Trust Fund for 12 years, to 2029. The actuary of the Centers for Medicare and Medicaid Services (CMS), an independent office, reached the same conclusion. And the Congressional Budget Office has estimated that the law will reduce the federal deficit by more than $100 billion over the next 10 years and more than $1 trillion in the following decade. Those are real savings that help today's and tomorrow's Medicare beneficiaries.

Berwick also notes that the Affordable Care Act will improve delivery systems that previously focused rewards on quantity of services, and instead “will help us pay for quality and outcomes, not volume.”

The act encourages some of the most comprehensive payment and delivery system reforms in Medicare's 45-year history. It establishes a Center for Medicare and Medicaid Innovation within CMS to help find ways to modernize our health-care system to make it safe, patient-centered, reliable, sustainable and efficient. These approaches, endorsed by health-care organizations, employers and economists, will help make the health-care system of higher quality and more affordable for America's families and businesses.

Click here for more information on the Affordable Care Act and how it is providing better care and lower costs for America’s seniors.

- by Cameron Brenchley

Earlier today Department of Health and Human Services Secretary Kathleen Sebelius announced that the third round of $250 tax-free “donut hole” rebate checks have been mailed to seniors who fell into the Medicare Part D coverage gap earlier this year.

Secretary Sebelius noted that “These checks are an important first step in helping [Medicare beneficiaries] afford the medications they need – and are evidence of how Americans are already seeing the very real benefits of the Affordable Care Act. From strengthening the long-term future of Medicare as evidenced by the recent Medicare Trustees report, to saving seniors and the disabled money on everything from prescription drug costs to preventive services, the Affordable Care Act is helping to preserve and protect Medicare.”

HHS points out that “more than a quarter of Part D enrollees hit the donut hole and often stop following their drug regimen as a result of the added cost burden.”  Chairman Levin said earlier this summer that the $250 rebate checks help eliminate these tough life and death decisions and “provide peace of mind for many seniors who are struggling financially in this tough economic climate.”

In an earlier post, we noted that the one-time rebate checks, provided under the Affordable Care Act, are the first step in completely closing the prescription drug coverage gap that has affected millions of seniors.  Beginning in 2011, seniors in the “donut hole” will receive a 50% discount on brand-name prescription drugs, and the “donut hole” will be completely phased out by 2020.

Click here for state-by-state fact sheets on the immediate benefits of the Affordable Care Act.

- by Cameron Brenchley

Today’s Los Angeles Times has a good article explaining that the Affordable Care Act is spurring doctors and hospitals across the country to team up in order to improve care and control costs:

“As Congress debated the healthcare bill, many critics lamented it would do little to transform a system in which doctors and hospitals bounce patients around in an uncoordinated, costly, sometimes tragic process.

“But something unexpected has happened since President Obama signed the legislation in March. Spurred in part by the law, many independent providers across the country are racing to mold themselves into the kind of coordinated teams held up as models for improving care.

“In some places, the scramble is so intense that physician groups and hospitals are putting aside rivalries and signing new partnerships almost daily.”

The LA Times notes that the health care debate “may have helped spark doctors, hospitals and others to rethink what they do, raising the prospect of better outcomes for millions of Americans.”

"There are a lot of people who have reached the conclusion that they need to change the way they practice medicine," said Dr. Mark B. McClellan, a former Medicare and Medicaid chief in the George W. Bush administration and a leading advocate of more care coordination.”

- by Cameron Brenchley 

REFORM MOVES AHEAD

 

Less than four months after Congress approved historic health care reform legislation, the Obama administration has been making good progress in bringing some early benefits to fruition and issuing rules to guide the reform process. Despite all of the critics’ hype and scare tactics, some polls suggest that the public perception of reform is slowly improving.

 

That hasn’t stopped the critics. More than a score of Republican attorneys general and governors have filed suit to nullify two important requirements of the new law — that everyone obtain insurance or pay a penalty, and that states expand their Medicaid programs. The White House will have to keep pressing back and keep explaining why reform is in the clear interest of the nation.

 

Most of the major elements of the reform law don’t go into effect until 2014, but some important benefits start this year. Administration officials had two early successes: pressuring insurance companies to immediately end their indefensible practice of rescinding coverage after a policyholder becomes sick and to immediately start covering children with pre-existing conditions. Officials also persuaded insurers and a handful of employers to allow parents to keep their dependent children on family policies until age 26.

 

A few hundred thousand Medicare beneficiaries who have reached the “doughnut hole” in Medicare drug coverage have gotten or will soon get small, $250 checks to help pay their drug costs; millions more will get checks when they reach the gap later this year. The administration has already proposed language for contracts that will be signed with the manufacturers of brand-name drugs to provide 50 percent discounts next year to patients who hit the gap. A small blizzard of regulations, each requiring painstaking drafting, has been issued, including new rules issued Wednesday requiring insurers to eliminate cost-sharing for recommended preventive care, such as screening tests and vaccinations.

 

Not everything has moved smoothly. The new law requires insurers to spend at least 80 percent of premium dollars on medical care. But agreeing on a definition of care (versus administrative and other costs) has proved difficult. A plan to open temporary high-risk pools for people unable to obtain insurance because of pre-existing conditions appears to be running behind schedule.

 

On the employer front, the administration has notified nearly four million small businesses that they might be eligible for a tax credit to help defray the cost of insuring their workers. And it is accepting applications from employers for a separate program to help defray the costs of insuring early retirees.

 

President Obama was right to bypass Senate opponents and appoint Dr. Donald Berwick, a respected expert on health care quality and costs, to head the Centers for Medicare and Medicaid Services. With no chief to sign off on crucial decisions, the agency has been reluctant to create and staff a new innovation center, to provide guidance on a vast expansion of Medicaid, and to issue a slew of regulations to reshape Medicare.

 

State leaders also have a lot to do to get ready for reform and ensure that their citizens get the full benefits. They will need to set up new health insurance exchanges, more closely monitor and regulate insurers, and expand Medicaid. While some politicians have de"cided to keep battling reform, at least 21 states have officially designated a task force or committee to oversee implementation. That is responsible government.

For more information about implementation of this provision, please visit healthcare.gov. 

More good news for seniors who fall within the “donut hole,” HHS Secretary Kathleen Sebelius announced yesterday that 300,000 additional $250 tax-free rebate checks are being sent this week to seniors who fell into the Medicare Part D coverage gap earlier this year. This is the second round of checks to be sent to seniors, with the first round being sent last month.  Secretary Sebelius noted that 70 percent of the first-round of checks were cashed within the first week, providing further evidence that these checks are a welcome relief to many financially-strapped seniors.

The checks, provided under the Affordable Care Act, are the first step in completely closing the prescription drug coverage gap that has affected millions of seniors.  Beginning in 2011, seniors in the “donut hole” will receive a 50% discount on brand-name prescription drugs, and the “donut hole” should be completely phased out by 2020.

- by Cameron Brenchley

Today, the Department of Health and Human Services launched HealthCare.gov, a website designed to empower consumers by putting information and access to health insurance plans right at the their fingertips.

The website features a revolutionary tool that allows consumers to search for insurance options -- compiling all available health insurance plans into one easy-to-use database. You simply answer a few basic questions, which specifically pinpoint the coverage options that may be best for you to consider.  The site protects your personal information, and will not require your name, address, or income.  From there, you can shop for the plan that best suits you. You can determine which plans are being offered in your zip code, which benefits plans offer, and, in October, the website will offer price estimates. Consumers will be able to use this site to better navigate the insurance market, and small businesses may also use it to find a full plan menu instead of being limited to the options they are offered through their broker.

The site also educates the consumer about the ins and outs of the new Affordable Care Act.  “Understanding the New Law” is an easy-to-use section that explains what the health care plan means to you, in language not written for experts, but for consumers. The page includes a timeline that shows the dates that each provision of health care reform will be implemented, and what each change means for you. There are also sections on the site about prevention and comparing care quality.

The team behind HealthCare.gov is dedicated to improving the website to best inform and empower you. Wherever you go on the site, there will be a box asking if the page was helpful to you, and if the page did not meet your needs, you will have the opportunity to offer feedback as to how it could be improved. In addition, there will be a Spanish version of the site by the end of July, and HHS is considering translating the site into additional languages.

This a consumer-oriented website designed to find information tailored specifically to your situation, dedicated to improving based on feedback, and seeking to provide you with all your information and care options on one easy-to-use site.  Whether you are searching for answers or searching for a health care plan, HealthCare.gov provides you with a wealth of information, presented in an efficient, informative, and user-friendly manner.

- by Cameron Brenchley

- by Rep. Pete Stark (D-CA)

Friends;

Earlier this year, Congress passed health care reform legislation that made crucial improvements to our nation’s health care system.  Even in the face of calls for repeal, the changes that were promised to the American people are being enacted and helping people.  Here are some provisions of the health care bill that are already keeping Americans insured and healthy.

• HELP FOR THE SICK: As of last month, almost all major insurance companies have agreed to stop rescinding their customers' health care when they fall ill.  A complete ban on this egregious practice will take effect for plan years starting after September.

• HELP FOR SMALL BUSINESSES: The IRS has started making small businesses aware that they may qualify for tax credits to provide their employees with health insurance.

• HELP FOR SENIORS: Seniors who hit the Medicare “donut hole” ARE receiving a one-time check for $250 to help offset the cost of their prescription drugs. In 2011, seniors will receive a 50 percent discount on brand-name drugs in the donut hole and a small discount on generic medications.  By 2020, we will have phased the “donut hole” out completely.

• HELP FOR YOUNG ADULTS:  Insurance companies have announced that they are allowing young adults to stay on their parents’ health plans until their 26th birthday. For plan years starting after September, this will be mandatory for all new health care plans.

• HELP FOR EARLY RETIREES:  Businesses have started receiving financial assistance to maintain coverage for early retirees.  This will help people who retire before they are Medicare-eligible – and who may face high costs for coverage – so that they can stay on their employer-provided plan until they can get on Medicare.

In addition, Americans will be able to experience further benefits of health reform in coming months, when more provisions of the law will become effective, including:

• HELP FOR THE UNINSURED: The law will create high-risk pools for those who have been uninsured for at least six months and have pre-existing conditions, giving at-risk Americans the opportunity to obtain affordable insurance.  

• HELP FOR CHILDREN: The law will prevent insurance companies from denying coverage to children with pre-existing conditions so that nothing stands in the way of providing our nation’s children the health care that they need.

• REPEAL OF LIFETIME LIMITS: The law will prevent insurance companies from setting any lifetime limits on coverage, so no American will face their insurance plan refusing to pay if medical treatments are too costly.

• RESTRICTIONS ON ANNUAL LIMITS: The law will restrict insurance companies’ annual limits on coverage, allowing Americans to receive the medical care they need without facing high out-of-pocket costs.

Reforming our health care system is a work in progress. Two weeks ago, my Subcommittee on Health held a hearing on reducing fraud, waste, and abuse in Medicare.  Health reform legislation provided new tools to reduce fraud, waste, and abuse in Medicare, and we are looking for even better tools to prevent, detect, investigate and prosecute Medicare misuse.

My colleagues on the Ways and Means Committee and I are dedicated to providing Americans with the best and most comprehensive health care system that we possibly can.  The recently passed health reform legislation is already helping us make great strides in that direction.

Be well,

Pete

You can learn more about the changes that have already taken place here and here.

While Republicans claim that Americans strongly oppose the new Affordable Care Act, a recent Gallup poll shows that the law is becoming more popular among Americans. The poll shows a 7 percent increase in the law’s approval among respondents in the 18-29 and 50-64 age groups, and even a 7 percent uptick in approval among Republicans.

This positive news comes on the heels of an AP-Gfk poll last week that also showed an increase in public approval.  “It does seem we're looking at a trend,” said Washington Post columnist Ezra Klein in his article analyzing the poll results.

It is not surprising that more and more Americans support the Affordable Care Act.  Since President Obama signed the law just over 90 days ago, small businesses have received tax credits so they can provide quality health care for their employees, seniors in the “donut hole” have begun to receive one-time checks of $250 to help pay for prescription drug costs, and many parents have been able to keep their children under 26 years of age on their health plans. 

Click here for more immediate benefits under the Affordable Care Act.  

- by Matthew Beck

Earlier today President Obama announced that several new consumer protections included in the Affordable Care Act are going into effect.  The new regulations will eliminate discriminatory practices that for too long have prevented Americans from receiving the care they deserve.  President Obama explained: 

“…today, I’m announcing that the Departments of Health and Human Services, Labor and Treasury are issuing new regulations under the Affordable Care Act that will put an end to some of the worst practices in the insurance industry, and put in place the strongest consumer protections in our history -- finally, what amounts to a true Patient’s Bill of Rights.

“This long-overdue step has one overriding focus, and that’s looking out for the American consumer.  It’s not punitive.  As I said when I met with the insurance executives, it’s not meant to punish insurance companies.  They provide a critical service.  They employ large numbers of Americans.   And in fact, once this reform is fully implemented a few years from now, America’s private insurance companies have the opportunity to prosper from the opportunity to compete for tens of millions of new customers.  We want them to take advantage of that competition.”

Following President Obama’s remarks, Ways & Means Chairman Sander Levin stated that:

“The regulations announced today and the landmark reforms in the Affordable Care Act usher in a new era where the priority is delivering quality care to patients.  Health reform enacted long overdue consumer protections and gave Federal and State governments tools to hold insurance companies accountable, preventing them from socking patients with unjustified rate increases.”

How These New Rules Will Help You (from HealthReform.gov):

• Stop insurance companies from limiting the care you need. For most plans starting on or after September 23, these rules stop insurance companies from imposing pre-existing condition exclusions on your children; prohibit insurers from rescinding or taking away your coverage based on an unintentional mistake on an application; ban insurers from setting lifetime limits on your coverage; and restrict their use of annual limits on coverage.

• Remove insurance company barriers between you and your doctor. For plans starting on or after September 23, these rules ensure that you can choose the primary care doctor or pediatrician you want from your plan’s provider network, and that you can see an OB-GYN without needing a referral. Insurance companies will not be able to require you to get prior approval before seeking emergency care at a hospital outside your plan’s network. These protections apply to health plans that are not grandfathered.

Click here for a fact sheet from the Administration.

Click here for additional information about the Affordable Care Act.

- by Cameron Brenchley

•  30-49 year-olds: from 35 percent to 49 percent
•  Men: from 36 percent to 46 percent
• Republicans: from 8 percent to 17 percent
  

-by Lauren Bloomberg 

The Affordable Care Act ensures that all Americans have access to quality, affordable health care through landmark reforms to the system and the shared responsibility of businesses, the government and individuals.  The new law will provide coverage to 32 million more Americans while reducing the deficit by $143 billion over the next ten years, with $1.2 trillion in additional deficit reduction in the following 10 years.

 -by Lauren Bloomberg