Healthcare News & Insights

Health reform passes: Winners, losers and what to expect next

piggybank

The health care reform bill finally passed, and while no one may be completely happy with it, it brings some definite good news for the industry.

Just how good the news is depends on the type of work you do. But the bill was generally praised by the American Medical Association, the American Nurses Association and the American Hospital Association.

Although the Patient Protection and Affordable Care Act (PPACA) still leaves plenty of room for improvement of the national health care system, it will help millions of currently uninsured get better access to care. Which should, in turn, allow health care providers to:

  • encourage wellness and preventative medicine, and
  • diagnose conditions earlier when they’re both easier and cheaper to treat.

Some of the provisions of the law don’t kick in for several years, so the full effects won’t be felt right away. But in general, expect to see the following changes at health care organizations.

  • Primary care practices get a 10% Medicare bonus for the next five years. A similar 10% bonus will go to general surgeons working in under-served areas.
  • Mental health services paid via Medicare will be increased 5% in 2010.
  • Doctors (all specialties, but especially family practice) should see more patients coming in as the newly insured seek previously delayed care. (Some practices are already getting ready to hire additional staff.)
  • Some of those new patients will have complicated cases due to lack of prior treatment.
  • Hospitals should see a reduction in uninsured patients using emergency departments for basic care.
  • Hospitals and practices are expected to enjoy a reduction in the amount of “charity care” they provide, as more patients will have insurance. (AMA estimated that in 2008 doctors provided $24 billion in unpaid care — mostly to the uninsured.)
  • Pharmaceutical companies will make a combined $85 billion contribution to the government program via industry fees and lowered prices. They’re expected to quickly recoup that money thanks to innumerable new prescriptions from newly-insured patients.
  • The PPACA also eventually closes the Medicare “doughnut hole,” making it easier for many seniors to fill prescriptions, or allowing them to use name-brand drugs in lieu of generics.
  • Insurance companies face the least clear picture — In the short term, they can expect many more enrollees. In the long term, they’ll need to adapt to new ways of selling insurance and weighing risks.

Do you think PPACA is a overall win for the health care system? What else needs to be done? Share your thoughts in the comments.

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Comments

  1. Obama has just taken us closer to his Socialistic agenda. His arrogance is astouding. The whole things a joke. WE DON”T HAVE THE MONEY TO PAY FOR IT. You can’t spend money you don’t have and it’s not fair to make the rest of the working people pay for it. I’m all for helping the disadvantaged and needy, but not the worthless. Everything the Governmant touches fails. The Democrats in Congress and the Senate are a joke. They don’t respresent the majority. They will all be gone in November. I only hope that we can minimize the damage the next 7 months. Obama, Pelosie, Reid and Holder are the worst thing that ever happened to this United States. The sooner they are voted out the better. They have no regard for our Constitution and what it stands for.

  2. Lee Larkin says:

    Re: B. Smith
    You are already paying for it. The 24 billion in charity care has to be absorbed by the paying patients. Increased insurance premiums and medical costs are a direct result. Currently most uninsured patients put off getting treatment until their condition is bad enough that the required treatment is tens or even hundreds of times what it would be if they had seen a physician early on and prevented the problem from becoming that expensive. Check out the CBO cost analysis, if you are open to facts, maybe you could give some input that would improve the existing plan rather than just rail against it. Also, please look up the definition of Socialist, regardless of what you have heard, it does not mean what you appear to think it means!

  3. Very good answer, Lee. The arrogance is astounding, but it’s not Obama’s.

  4. (To clarify, the arrogance belongs to those who speak in absolute certainty that reform is bad, yet are too ignorant to know what they are even talking about and rely 100% on right wing talking points, rhetoric and the usual fear-based propaganda of talk radio, etc. Strange to me that the right speaks of its Christian values and yet, as a believeing Christian, I cannot imagine Christ describing anyone as “worthless.” Who did He go to? THE SICK and THE POOR.)

  5. It is funny how those who say we can’t pay for providing healthcare to 30+ million Americans who don’t have must be people who have healthcare altready. This is exactly what government is for, addressing problems so big individuals can’t. I don’t call it socialisum when we do interstate highways, provide air traffic control system, keep the food supply safe, nationally track disease control, provide a military, but some people have this funny idea that we could live just fine without government do the things that can’t be done nationally by individuals. And regarding paying for it, how come we can pay for two wars and rebuilding other countries during the first eith years of this centry without paying for it, but when it comes to paying for 30+ million Americans all of the sudden we can’t do it without cash in hand. I fully support the law and hope it is the start of a more reasonable delivery of healthcare not dependant on people’s individual income levels like in 3rd world countries.

  6. Alright, I won’t spread fear and result to overdramatic name calling but a couple points:

    1. No where in this legislation does it state that insurance companies are not free to raise the premiums for all of us. It says they can not raise the premiums for pre-existing conditions, but no where does it regulate the general premiums paid by all. Insurance companies are in the business of making money not providing health care and they will find a way to carry on with their business.

    2. Why is the government going to mandate that employers put the full cost of a employees health care benefit be put on their W2? My guess is so that somewjhre in the near future they can be taxed on that amount since it is part of the employees compensation. I mean 1 trillion dollars isn’t going to fall from the sky to pay for this, in the end those already paying for this will be force to pay more, no simple way around this, either through higher taxes or increased premiums. And if you think the wealthy are going to cover the bill, think again, they have money to hire accounts to solve these little annoyances our government throws at them.

    3. Where are the direct cost control mechanisms? The estimates come from benefits that are not easily measurable. I.E. Health care will cost less because more people will go to see the doctor and overall wellness will improve thereby reducing costs for all of us. We will catch more diseases earlier so they wont be a huge cost to cure them. These things are easy to say but very difficult to prove. Where are the regulatory measures to reign in insurance premiums, get hospitals to reign in builling practices that charge enormous sums to insurance companies for service before the prices are negotiated, mechanisms to detect and eradicate illegally manufactured drugs and medical devices, serious tort reform to lower malpractice insurance? The list goes on and on and this legislation did almost nothing to address these problems.

    All that occurred with this bill in the end is that have-nots are once again being provided for at the cost of the haves and instead of trying to correct problems that DIRECTLY effect the 200 million people in this country that pay for their own insurance either through the company they work for otherwise, the focus is on the 33 million that do not have coverage. To me it makes no sense to add people to a broken system. Fix the system first and then cover people with it.

  7. Kreig Smith says:

    If anyone believes that this health INSURANCE reform will do anything to lower costs and actually increase coverage immediately without further bankrupting this country is being intellectually dishonest. There will be continued cost shifting, unnecessary testing for fear of litigation, increased costs for business, increased taxes for everyone without guaranteeing coverage for everyone or any actual improvement in our system. The arrogane comes from both sides- the facts are that someting needed to be done but this was not the solution- Obama has done what Clinton could not accomplish…He moved us one step closer to the single payer system incrementally with the 85 15 insurance rule. The government now mandates who can make a profit, and has provided unfunded mandates for millions of small businessess (the subsidy will not make up for increased costs and lost profits) and he expects the insurance companies to cover higher cost patients without being able to charge for the higher costs. The high risk pool will ultimately be the trojan horse for Single payer system. Medical Device companies that are not profitable yet as startups will move manufacturing, stop expanding or go belly up at a time when the REAL unemployement rate is 17%. If Atlas has shrugged, can he shake of the vestiges of socialism thrust upon us by a supposed democratically elected government? And if this is so great answer one simple question for me…why is Congress and their STAFF exempt from this mandate? The government is mandating purchase of a service from a private company and has truly changed the Commerce clauses in the Constitution. How in the hell can this be good?

  8. Judy Buckley says:

    Lee, Emily and Dennis: Where have you been all my life? (ha, ha) Thanks for saying what I totally agree with – I think it’s safe to say we’re in the minority here! All these blogs (and other “HR” sites as well) seem to be way predominately right wing. Your views are appreciated.

  9. RE: Bruce S. ~ you are right, the arrogance of our current administration is astounding! The President and V. President do not even show respect for the very office they hold. There comments are unprofessional and flippant. Our constitution isn’t even being considered; the spending is out of control, the coffers are empty yet they continue to add to the debt. Lee, you tell Bruce to give input, I am sure he would like to; fact is the speaker and the president were not open to ANY other input. The health care reform was rushed through with no collaboration between parties, Obama is only making a name for himself, he is not about our people. As with all government run programs health care reform will be abused and misappropriated, hang on people as you watch your loved ones wait for Dr. appointments as there health fails. I won’t even start on Christian values, that would take to long to set Emily straight.

  10. Dennis and Judy 🙂
    Joel, even though I disagree but don’t have the time to get into detail here I appreciate at least you are speaking as a thinking citizen, a debate is no doubt worth having, but the madness and tea party mentality honestly gives me the chills and that’s what unfortunatly so much has been reduced to.
    HR, wow, you have a really short memory, look into practices of the last administration.

  11. I’ve been reviewing and reading everything I can about Obama, the Health Care bill, and the State of our Union in general. I’ve come to the realization that people like Emily are the minority. Those of us with education, knowledge and common sense know that this administration has brought us dangerously close to the end of capitalism and freedom as we know it today. I feel SICK to my stomach everytime Obama opens his mouth to spread lies and tear down the constitution of the greatest country in the world. Having said that, We the People will make haste to the voting booths to remove the socialists from our government at every opportunity. Once we reclaim our country we can perhaps revise or remove the “Health Care Bill” before it destroys the wonderful health care systems we enjoy in our country today. People of ALL nations come to the United States for healthcare….there’s a reason for that. I just hope our wonderful and talented physicians don’t leave to practice elsewhere before we get this fixed.

  12. I am not sure there is anyone who doesn’t agree our health care system needs to be overhauled. Health Care Reform has been on political agendas for years. However, few polititicans were willing to take the political heat for enacting any type of meaningful reform. It appears they were more concerned about their own political careers rather than what was good for the country. Did President Obama and the democrats commit political suicide? Probably. But then so did other politicians throughout our history who but the needs of the people before their own political carreers (IE. ending slavery, women’s right to vote, civil rights act, medicare, social security etc. etc. etc.). As with the aforementioned reforems, future generations will read about the struggles regarding the enactment of this legislation and wonder what the big deal was (as they enjoy better health care as a result).

    As for paying for it. It really isn’t about if we can afford it….of course we can afford it (we can’t afford not to reform our health care)….it’s a matter of prioritizing what the government spends our money on. What better way to utilize tax dollars than to provide health care coverage for all. One of the basic principles of a Government is to provide for its citizens.

  13. I believe your assessment of healthcare reform legislation is out of touch with reality. How many physicians do you think are thrilled about taking on more patients that pay at a Medicaid rate? Especially since most states are in serious financial condition and will likely reduce Medicaid reimbursement. Yes, there will be some relief for hospitals and physicians, but at some point in time, you can only live off of a payer that covers 60 to 65% of your costs with a growing population in that payer group for so long before something has to give. Do not be disullusioned about whatever support of this bill was reported by the AHA. They were bullied and threatened by the Obama administration on this one. And what about the deals the AMA cut with the Obama administration? Further, the AMA only represents 17% of physicians in the U.S. so I hardly think they represent the physicians in this country. Has anyone thought about the 2,500 page bill that will transition to about 150 new government agencies and all of the bureaucracies and cost along with it? Have you thought about the 25,000 to 50,000 pages for new rules and regulations that providers will have to live with, comply with and impose unpleasantries on their employees, physicians and patients? That’s in addition to the current 500,000 plus pages today. What human being or entity can possibly comprehend all of this and be in compliance day in and day out. How will a physician practice keep up with this? How will rural hospitals who are barely surviving deal with all of this? Has anyone thought of this stuff or does anybody care? If our citizenry does not see us going down the road to a European socialist democratic form of government, then you are naive and are not a student of how and why our forefathers formed our government as described in the Constitution. The healthcare issue along with some of the other stuff the Obama administration has done is just the beginning if we do not see a change in power from the liberal left to the center right which is the majority of this country.

    • Carol Katarsky says:

      Steve, I’d love to see some documentation/citations for the 150 new agencies you say the government will be forming.

  14. The FACT is the MAJORITY of people are IN FAVOR of reform. The fact is I AM educated (two Masters degrees, thank you). Check your sources as obviously YOU are MISled. As for common sense, the AMERICAN MEDICAL ASSOCIATION recognizes that reform was needed, as while this was not perfect, it was an AMA approved start. I happen to work with physicians. Obama said this was a “victory for common sense” and he is exactly right. And where on earth would you propose our wonderful American doctors go? In case you do not realize it most of the world has government run healthcare, WHICH THIS IS NOT EVEN ABOUT. And guess what else? There are higher standards of living and healthier people and longer lifespans in some of those government run healthcare countries which are democracies. Hmmm… truth, logic and common sense are beautiful things. Fear is ugly.

  15. Unfortunately, people who want to engage in thoughtful debate are often drowned out by others’ screaming. Members of the Tea Party movement and their ilk will probably never realize that silence should not be mistaken for agreement, just better manners. As a health care administrator, I’ll be happy to talk to patients more about their health and less about about their financial situation when discussing options.

  16. Well said Bruce, Joel, Kreig, HR and Susan. I have never been so dissapointed in a President and his cabinet as I am with the current administration. Some days I wonder why we fear terriost at all. The current adminsitration in the White House puts this entire country at greater risk than any terriost.
    As Nancy parades, with her giant gavel, up the steps of the White House flaunting her “I will do as I please attitude” how can anyone not find this a disturbing picture? What has happened to a government for the people by the people?
    I do not need to repeat the above, however, I will just add the target for health care reform was missed.

  17. Charles Scriven says:

    Okay, the Democrats can’t balance a checkbook.

    But the Republican have no hearts.

    It’s a problem.

    When someone says, “Fix the system first and then cover people with it,” that’s a sure strategy for keeping money in taxpayer’s pockets and keeping heathcare out of reach for the unlucky and the…”worthless.”

    How do we learn to tell the truth about money? How do we succeed in fighting off the culture of selfishness?

  18. Well said.

  19. Re: Emily. Educated and common sense? This legislation is not, at least not yet, supposed to be a government run healthcare system. The truth is our representative government has imposed upon us a system they refuse to subscribe to. It is not even universal in its scope. According to the government itself (http://www.census.gov/hhes/www/hlthins/hlthin08/fig06.pdf) as of 2008 there were 46.3 million people without healthcare in the US. Do you think it’s possible that number is higher today with unemployment at record levels? The healthcare bill is projected to eventually cover 30 – 33 million people. What about the other 12 – 15 million people? Are they just garbage? Is this the logic and common sense that’s so beautiful to you?

  20. I just wanted to say what still needs to be done is reform on the cost of medical care. I work as a medical coder/ biller, I take care of every aspect of billing and collection for patients. I also deal with approving charity for patients. What all coders I have spoken with say, is that there should be standard billing prices for everyone. The whole concept of insurance discounts cost millions of dollars each year. If there were no more insurance discounts and an uninsured person could walk in and pay what and insured person or their insurance company would pay, then things would be fair. Prices could be determined by geographical location. So much time and money is spent on dealing with insurance adjustments that healthcare itself could be more affordable for everyone if we put these caps in place. Standard prices for everyone is the only way to fix the problem.
    Thanks

  21. Charles Scriven says:

    Okay, the Democrats can’t balance a checkbook.

    But the Republican have no hearts.

    It’s a problem.

    When someone says, “Fix the system first and then cover people with it,” that’s a sure strategy for keeping money in taxpayer’s pockets and keeping heathcare out of reach for the unlucky and the…”worthless.”
    How do we learn to tell the truth about money? How do we succeed in fighting off the culture of selfishness?

  22. Paul, I was responding to Susan, who had personally attacked me and said I was uneducated, and if you read what I wrote I said it was imperfect but a start. Personally I support universal healthcare for all, and no one is “worthless” or garbage to me. As I said, this bill is not even government run healthcare as people think it is. Enough of this silliness for me today. Sadly too many people on the right rather scream and shout nonsense and carry utterly ridiculous signs than learn anything new, do their research, keep an open mind, or remember the history as short ago as the last administration, who had no problem spending lots of money, just on quite different things. (Anyone remember we had a surplus when GWB walked in?). Oh well.

  23. one quick clarification – well said was meant for Reese & Melissa.

  24. It’s obvious that people on the right and the left are upset. My point is that this legislation will still leave millions in dispair and without adequate healthcare. I know too many people who are about to lose their homes, cars, and have already lost their jobs. The news is already reporting that companies are being proactive in laying off more employees as a result of the bill being passed. 41 banks have already failed this year and the FDIC is broke and more than 20 billion dollars in the red. I wish I had an answer to all of this. At this point I no longer trust the guys in the Red Ties or the Blue ties.

  25. While I don’t necessarily agree with all the conclusions, I think there have been some intelligently worded and thoughtful concerns raised in this forum about the costs of this bill, how effective it will be in solving the problem of uninsured Americans, and the impact it may have on employer groups and physician reimbursements. I beleive these concerns are sincere. Who I don’t find sincere are those politiciians who suddenly become defircit hawks when it comes to this, but were silent when thousands of lives and billions of dollars were spent fighting a war for non-existent weapons of mass destruction, while givng tax breaks to the wealthy. Questioning the effectiveness of this bill is fair, and asking the questions about the financing is fair, but if you are going to be a deficit hawk, be consistent. Calling this bill socialized medicine or an attack on the constitution is at best a major stretch.

  26. What does the new bill say about pharmacy prices? I bought 25 Lidoderm patches with my employer insurance for a $25.00 co-pay. My 94-year-old Mom who has Medicare D paid $258 for the identical prescription. Her Medicare D did not cover unless the doc called the insurance company and explained why she needed them. A physican should not be required to defend his prescriptions. There were ceiling prices on most everything during the FDR/Truman era. Why not ceiling prices on pharmaceuticals for all and quit all the litigation???

  27. Emily, I did not personally attack you. I stated that you are the minority. I referred to myself as educated, did not say you weren’t. Probably best that you get over yourself, it’s not really about you, it’s what’s best for our country and our healthcare system. I work in healthcare, and having been on both sides of the issue (I am also a cancer survivor), I know what it’s like to fight though insurance companies, paperwork and lost medical records. I will always fight for patients rights and the best care for them. But let’s face it, while healthcare reform is warranted, it’s not to the extent that the government is getting involved. This sets us on the path to socialized medicine, and since you mentioned that most countries in the world have government run healthcare, you failed to mention that their healthcare is inferior to ours. I’ve had conversations with citizens of those countries and they have told me that they hated their healthcare options and envied American’s healthcare. And while we’re on the subject of how other countries run their healthcare, I would have to ask WHY IN THE WORLD would you compare our great country with those that don’t have such a great track record. I don’t chose to compare my country with any other because honestly, I don’t believe there is any country as great as ours. I say to you and those that chose to blindly follow the current administration: “Get over yourselves, it isn’t about YOU”.

  28. Susan ~ Bless you! I also am in health care and you said it! As individuals blindly follow this administration they are unaware that they are circling the drain. I was brought up with the unpopular conception that you work to be able to eat or purchase material items, I am the average middle class tax paying citizen, only wait, I have common sense and am not lead by a nose ring. We have built a larger and larger number of the population to believe that they have an entitlement. America is a great nation, that is why we have such an influx of people wanting to live here and seek out our health care that is over and above all other countries. The government will now mandate your healthcare. Look at the fiasco regarding the TARP monies how can they manage the detail in health care. Companies are already gearing up for the costs (laying off people, going out of business), jobs are at stake and so is your health. The government is now in your very own personal medical records ~ enjoy the ride!

  29. After reading all of the commentary, I doubt very much that any of us are going to be convinced to change our opinions on all of the issues discussed. I cannot think of a time when such issues as healthcare and the overall direction of our country has been so hotly debated and divisive. There is a lot of emotion and passion in the commentary. I am sure that everyone that is responding is intelligent, experienced and well educated so I do not believe there is a need to either brag or denegrate anyone. It is a matter of perspective, our experiences, where and how we were raised, where we received our education, where we live and work today, our mentors, our age, etc. At least we have the freedom to express ourselves and not worry that the internet is going to be just down, the press silenced, the talk show hosts taken off the air, or someone in a dark suit and sunglasses knocking down our door and hauling us away. Hooray for the USA and our freedom.

  30. Susan B 2010 says:

    Let’s get real – it’s not about democrats or republicans … We have bill that was passed that has huge ramifications for every citizen in this country. Does everyone know that there are inherent components in the bill that drive up the cost of healthcare? For example, there is a new tax on durable medical equipment. The people that need this stuff the most, will now have to pay for more for it – that wheelchair will now cost more. Did you know that effective Jan 1, 2011, healthcare FSAs have been cut in 1/2 ! Again the people who have healthcare expenses – that they are are trying to pay for themselves, will be able to defer only $2,500 annually. Don’t even get me started on the “cadillac” excise tax on the COBRA VALUE OF HEALTHCARE! It’s not about the employer contribution or the employee contribution. Someone in congress had the idea to say it’s an excise tax paid by either the self-insured employer or the healthplan to the tune of 40% of the amount in excess of $ for 10,200 for individuals or $27,500 for families. Given that this tax starts in 2018, it’s hard to imagine that most plans in high cost-of-living states won’t be well in excess of this threshold. Either employers or healthplans will offer less rich benefits to stay below this threshold – which may not be possible in states which have “minimum necessary coverage” requirements, like Massachusetts. The only way to cover this incremental expense is to … guess what … increase premiums. I encourage all of you to listen to every webcast you can to learn as much as you can. This legislation is bigger than anything Washington has ever produced. Is anyone worried yet?

  31. Susan B 2010 says:

    In our roles as HR Executives, we all need to get a handle on what exactly is imbedded in the law, what is the impact to our organization/employees as well as what to we do to mitigate negative consequences, while complying with the law. I’ve noticed Buck Consultants (I don’t work for them.) has some great content on their website http://www.buckconsultants.com/buckconsultants/Portals/0/Documents/PUBLICATIONS/Health-Care-Reform-Comparison-in-Brief.pdf as well as an on-demand webcast http://www.buckconsultants.com/buckconsultants under the What’s New section on the bottom left side. Has anyone else found some useful analysis on the regs?

  32. Judy Buckley says:

    Bruce: I find your comments a welcome breath of fresh air – finally, something on which I think everyone can agree.

    Since several people are very worried about the costs of this legislation, are you discounting the Congressional Budget Offices’s statement that this will reduce the deficit significantly over the next ten years? That hasn’t been mentioned here.

  33. Susan B 2010 says:

    Judy – Historically, the CBO has not done an effective job at forecasting anything. AMTRAK has been virtually bankrupt for years … the post office (yes – somewhat privatized) is hemoraging money and now wants to operate only 5 days a week, Medicare – doesn’t cover the expenses of the hospital or the physician – which is why private healthcare costs even more. Moreover, this new healthcare regulation is predicated on taxes. As more people lose jobs, there will be less in tax revenue collected. People will opt to not buy services (like tanning services which will now be taxed at 10% effective July 2010). The revenue collection will never be what is currently projected. Our country is in a major recession and we have now hit it with even more taxes and filtered those taxes to our healthcare expenses (tax on durable medical equipement, excise tax on healthcare premiums above a certain national level and more). Not to mention that we HR Excecutives have a nightmare legislation on our hands. It’s FMLA, EGGTRA, PPA, ARRA, HITECH and more all combined!

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