Health Care Reform: What does it Mean for Seniors?

On Thursday, September 13th the Housing Bureau for Seniors held our annual meeting where Dr. Aaron David Cooke gave a presentation on this topic. Here is a synopsis of his presentation.

Dr. Cooke is an Assistant Professor of Internal Medicine at the University of Michigan Health System. His presentation does not necessarily represent the views or opinions of the University of Michigan Health System.

 

What is in the Bill: 

Expanded patient protections

  • Eliminates pre-existing conditions clauses after 2014
  • No lifetime limits on care
  • New appeals process
  • Patient’s Bill of Rights

Cost Controls

  • Limit insurance overhead spending to no more than 15%
  • Insurance plans must justify 10%+ premium increases
  • Reduce Medicaid/Medicare fraud
  • Change payment model – quality, rather than quantity
  • Promote preventive care

Medicaid

  • Eligibility expanded to cover those at or below 133% of poverty (monthly income for 1 individual up from $931 to $1238, for 2 persons from $1261/month to $1677/month)

Medicare

  • Annual health maintenance visit
  • Preventive services covered (and no co-pays, co-insurance or deductibles on these services) including colon cancer screening, mammograms, osteoporosis screening, cholesterol testing, blood pressure screening, more immunizations, dietary counseling for high-risk patients and smoking cessation
  • Closure of the “Donut Hole”
  • o By 2020, once patients have spent over $2830 on medications, they will have a 50% brand-name discount and a 25% co-pay.  Once patients reach the catastrophic range of over $6440, they will have a 5% copay
  • o Over the next 8 years, there will be increasing coverage for generic drugs

What is NOT in the Bill:

  • Death panels
  • Euthanasia
  • Setting maximum, lifetime limits on care
  • Health care rationing (limit health care procedures based on age)
  • Outlawing private insurance
  • Jail time for refusing to buy health insurance
  • Free health care for illegal immigrants

During this political season there’s been a lot of talk about the “Ryan Plan” and how it differs from the Affordable Care Act. Here’s a side-by-side comparison of the major provisions:

Provision

Affordable Care Act (ACA)

“Ryan Plan”

Individual Mandate Implements Eliminates
Insurance Exchanges and Premium Support Implements Eliminates
Medicare Eligibility Age Remains 65 Age begins to rise in 2022 until reaches 67 years old in 2033. In 2022 closes Medicare enrollment for persons turning 65, who will then receive $8,000/yr towards private health insurance
Medicare Prescription Drug Plan Donut Hole Eliminates by 2020 Revert to pre-ACA, individuals pay 100% of annual medication costs between $2830-6440
Services Covered Retains current structure, adding preventive care benefits Minimum coverage standards; otherwise determined by individual insurance plans
Spending Growth Caps Limits spending increases to GDP growth + 5%If spending exceeds cap, payment advisory board recommends cuts, but not in benefits or coverage Limits spending increases to GDP growth + 5%Premium support payments are subject to a hard cap
Cost Control Mechanisms Reduce payments to providers, limit insurance overhead, pay-for-performance, best research practices, independent advisory board Assumes that free market competition will reduce costs
Medicaid Changes States encouraged to increase eligibility to 133% of povertyMaintains current federally-determined payment/benefit structureMaintains asset protection for community-residing spouse Eliminates expansion to 133% of povertyConvert Medicaid to fixed block grants, indexed for inflation but do not keep pace with costs. States set eligibility and benefits.Assets of both spouses considered for Medicaid coverage of nursing home payments; some seniors may lose nursing home care coverage

Want to know more? Check out these Web sites!

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