Democrats and Republicans are working together to repeal the provision of the Accountable Care Act (health care reform) that prevents consumers from using FSA and HSA funds to purchase over-the-counter drugs without a prescription. Legislation was introduced in both the Senate and the House on July 14th.
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Several reports released this week show different views of how health care reform will affect the number of Americans covered by employer-based insurance.
The number has been decreasing for the last 10 years, from 69% of Americans in 2000 to 61% in 2009.
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Senator Orrin Hatch and Congressman Erik Paulsen have introduced legislation to provide additional benefits for Health Savings Accounts. Some of the proposed provisions include removing the restriction on using HSA funds for over-the-counter drugs, allowing spouses to contribute catch-up funds to the same HSA, allow rollovers from FSA’s to HSA’s, and adding wellness expenses to the list of eligible HSA expenses.
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On Tuesday, the Senate voted 87 to 12 to repeal a provision of the Accountable Care Act requiring businesses to issue 1099 forms to all vendors from whom they purchased more than $600 of goods and services during the year.
The House passed a similar bill last month, and the White House has indicated that President Obama supports the repeal.
Many organizations are polling Americans about health care reform, and each poll shows a slightly different perspective. But one trend is consistent: on the one year anniversary of the passing of the Affordable Care Act (ACA), we are confused. Here are few highlights:
- CBS Poll: 55% of Americans disapprove of defunding health care reform.
- Kaiser Health Tracking Poll: 1 in 5 Americans believe the law has been repealed.
- Fox News Poll: Americans are evenly split on whether they think the repeal efforts are “an important effort” or “a waste of time”.
- CNN Poll: Asked whether they favor or oppose the law, 59% oppose and 37% favor it.
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From The Wall Street Journal
WASHINGTON—A congressional committee is widening its investigation of bare-bones health-insurance policies to encompass potentially hundreds of plans offered by low-wage employers.
What started as a probe into McDonald’s Corp.’s insurance plan for store workers is expanding into broad scrutiny of “mini-med” policies that could ensnare large mini-med carriers including Aetna Inc. and Cigna Corp.
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….the IRS issued Notice 2010-69, which makes the reporting optional for 2011 Forms W-2, and indicated that guidance is coming later this year on what should be reported. Also, the IRS released the draft 2011 Form W-2 that indicates that the health care cost can be reported in existing Box 12, using new code “DD,” and makes it clear that this amount is not taxable income to employees.
This guidance is welcome relief for employers who were struggling with their payroll systems trying to figure out how to accommodate the requirement that the cost of health insurance benefits be included on 2011 statements. Previously, the requirements seemed to indicate that employers would have to make the cost of benefits available on W-2s as soon as February 2011, in order to accommodate workers who left a job mid-year, which would have posed a significant compliance burden.
From the National Association of Health Underwriters http://newsmanager.commpartners.com/nahuw/issues/2010-10-15/2.html
Following are provisions that will take effect in 2011:
Source: The Kaiser Family foundation (www.kff.org)
| Long-term Care |
- Establish a national, voluntary insurance program for purchasing community living assistance services and supports (CLASS program).
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| Medical Malpractice |
- Award five-year demonstration grants to states to develop, implement, and evaluate alternatives to current tort litigations.
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| Prevention/Wellness |
- Eliminate cost-sharing for Medicare covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force and waive the Medicare deductible for colorectal cancer screening tests. Authorize the Secretary to modify or eliminate Medicare coverage of preventive services based on recommendations of the U.S. Preventive Services Task Force.
- Provide Medicare beneficiaries access to a comprehensive health risk assessment and creation of a personalized prevention plan and provide incentives to Medicare and Medicaid beneficiaries to complete behavior modification programs.
- Provide grants for up to five years to small employers that establish wellness programs.
- Establish the National Prevention, Health Promotion and Public Health Council to develop a national strategy to improve the nations health.
- Require chain restaurants and food sold from vending machines to disclose the nutritional content of each item.
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| Medicare |
- Require pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begin phasing-in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap.
- Provide a 10% Medicare bonus payment to primary care physicians, and to general surgeons practicing in health professional shortage areas. (Effective 2011 through 2015)
- Restructure payments to Medicare Advantage plans by setting payments to different percentages of Medicare fee-for-service rates.
- Prohibit Medicare Advantage plans from imposing higher cost-sharing requirements for some Medicare covered benefits than is required under the traditional fee-for-service program.
- Provide Medicare payments to qualifying hospitals in counties with the lowest quartile Medicare spending for 2011 and 2012.
- Freeze the income threshold for income-related Medicare Part B premiums for 2011 through 2019 at 2010 levels, and reduce the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple.
- Create an Innovation Center within the Centers for Medicare and Medicaid Services.
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| Medicaid |
- Prohibit federal payments to states for Medicaid services related to health care acquired conditions.
- Create a new Medicaid state plan option to permit Medicaid enrollees with at least two chronic conditions, one condition and risk of developing another, or at least one serious and persistent mental health condition to designate a provider as a health home. Provide states taking up the option with 90% FMAP for two years for health home related services including care management, care coordination and health promotion.
- Create the State Balancing Incentive Program in Medicaid to provide enhanced federal matching payments to increase non-institutionally based long-term care services.
- Establish the Community First Choice Option in Medicaid to provide community-based attendant support services to certain people with disabilities.
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| Quality Improvement |
- Develop a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health.
- Establish the Community-based Collaborative Care Network Program to support consortiums of health care providers to coordinate and integrate health care services, for low-income uninsured and underinsured populations.
Establish a new trauma center program to strengthen emergency department and trauma center capacity.
- Improve access to care by increasing funding by $11 billion for community health centers and by $1.5 billion for the National Health Service Corps over five years; establish new programs to support school-based health centers and nurse-managed health clinics.
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| Workforce |
- Establish Teaching Health Centers to provide payments for primary care residency programs in community-based ambulatory patient care centers.
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| Tax Changes |
- Exclude the costs for over-the-counter drugs not prescribed by a doctor from being reimbursed through a health reimbursement account or health flexible spending account and from being reimbursed on a tax-free basis through a health savings account or Archer medical savings account.
- Increase the tax on distributions from a health savings account or an Archer MSA that are not used for qualified medical expenses to 20% of the disbursed amount.
- Impose new annual fees on the pharmaceutical manufacturing sector.
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“Millions of individuals and small businesses depend on agents to help them find policies that suit their needs and budget. And with the new health reform law set to make the insurance market even more complicated, consumers will need the expert advice of agents and brokers more than ever.”
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