Policy-ish

Where Implementation Of Health Overhaul Stands

Partner content from:Kaiser Health News

The complexity, scale and sliding timetable for implementation of the federal health overhaul make it tough to figure out exactly what's happened so far. To help you sort through some key provisions, here's a scorecard.

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Health Law Scorecard

While many of the most significant provisions of the 2010 health law don't take effect until 2014, some key changes have occurred. Kaiser Health News consulted congressional, executive branch and independent sources to determine whether a select group of those changes have met expectations. This is a snapshot in time. Much of the data collected on new provisions is partial.

Provision 2010 projected
cost and impact
What's been done Score
Expanding coverage
Pre-Existing Condition Insurance Program provides health coverage from 2010-2014 for adults who have been uninsured for at least six months and who have a pre-existing medical condition. more » Between 200,000 and 400,000 enrollees.
$5 billion authorized through 2013 more »
48,879 people covered through 2011
Cost: $618 million through 2011 more »
Hasn't reached goals
Insuring young adults provision requires private insurers to extend coverage of children until age 26, effective Sept. 23, 2010, regardless of their tax status or whether they are students, unless he or she has another offer of employer-based coverage. more » 1.2 million young adults

Cost: Average 0.7 percent premium increase in 2011 in the group market more »
Estimated 2.5 million young adults enrolled through June 2011 more »

Cost: Estimated 0.9 percent increase in 2011 premiums for those who buy coverage in the group market more »
Reached goal
Children with pre-existing conditions younger than 19 cannot be denied coverage. The provision applies to all job-related health plans as well as to individual health insurance policies issued on or after March 23, 2010. more » As many as 72,000 children with pre-existing conditions more »

Premium increase of 1 percent or less more »
Number of children affected: not available.

Cost: No significant change in premiums for employer-sponsored policies more »
Too soon to tell
Owners of small businesses may qualify for tax credits up to 35% of their contribution to employees' health insurance. The credits were made available beginning in tax year 2010. more » More than 4 million small businesses would qualify.

Cost: $6 billion by the end of September 2011, and for $37 billion through 2019. more | more »
An estimated 309,000 firms applied for and received $435 million worth of tax credits as of last November. more » Hasn't reached goals
Early Retiree Reinsurance Program encourages employers and unions to continue coverage of early retirees and their families by providing a temporary reimbursement for some of their insurance costs. more » Cost: $3.8 billion through 2011 ($5 billion total through 2013) more » More than 2,800 employers received $4.7 billion toward coverage of 19.1 million people. The program ended Dec. 31, because it used up all its money. more » Reached goal
Sales tax on indoor tanning services, effective July 1, 2010, to help fund coverage expansions. more » 25,000 businesses expected to pay the 10 percent tax, generating $2.7 billion over 10 years, or $270 million a year. more » An average of 10,300 businesses paid the tax for the first three-quarters of fiscal 2011
The businesses paid $54.4 million, or an estimated $72.5 million through September 2011 more »
Hasn't reached goals
Many preventive benefits must be provided without cost-sharing to people with private health insurance, if they are enrolled in plans issued after March 23, 2010. more » At least 41 million beneficiaries in 2011.

Cost: An average 1.5 percent premium increase for those covered in a group plan in 2011. more »
An estimated 54 million people received at least one free preventive health benefit in 2011

Cost: Estimated 0.4 percent increase in 2011 premiums for those covered in a group plan more | more »
Reached goal
Seniors benefits
Rebates for prescription drugs provision in the form of a one-time, tax-free payment of $250, were sent to Medicare beneficiaries for drugs purchased in 2010 when they reached the coverage gap, or "doughnut hole." more » 4 million eligible beneficiaries

Cost: $200 million more »
3.8 million beneficiaries received a $250 rebate check

Cost: $946 million

Source: CMS interviews
Reached goal
Prescription drug discounts are to be provided to Medicare Part D beneficiaries beginning in 2011 on covered brand-name and generic drugs when they reach the coverage gap, or "doughnut hole." more » 4 million beneficiaries

Cost: $1.5 billion more »
In 2011, 3.8 million beneficiaries saved $2.3 billion

Cost: NA more »
Reached goal
Many preventive benefits must be provided without cost-sharing to Medicare beneficiaries, effective Jan. 1, 2011. more » About 36 million projected beneficiaries in traditional Medicare

Cost: $200 million in the year ending September 2011 more »
An estimated 32.5 million seniors received at least one free preventive benefit in 2011.

Cost: Not Available more | more »
Reached goal
Consumer protections
Proposed premium rate increases of 10 percent or higher for individual or small group plans must be justified to state or federal reviewers beginning in September 2011 for plans issued after March 23, 2010. Regulators in 37 states can reject a requested increase. If a state has no review authority, federal regulators can step in. However, federal officials can ask, but not require an insurer to reduce a proposed hike. more » Law provides $250 million to states to strengthen their rate review processes more » 42 states and the District of Columbia have received grants of $157 million to develop or improve premium review [KHN interview]

At least five states have forced insurers to reduce proposed premium increases and federal officials say fewer insurers have proposed double-digit rate increases since the provisions went into effect. more »
Too soon to tell
Insurers must spend at least 80 percent of beneficiaries' premiums on medical care or health quality improvements. "Mini-med" plans that offer limited benefits have a one-year exemption. Self-insured employers, which pay claims directly insetad of through an insurance company, are not covered. more » Approximately 74.8 million privately insured Americans affected. As many as 9 million people who buy individual policies projected to receive rebates worth up to $1.4 billion by August 1. more » Insurers will report data for the first time in June showing whether they've met the new standard, called a medical loss ratio. Those plans that fail to do so must pay rebates to individual policyholders by Aug. 1, unless they operate in the eight states that received temporary exemptions. Plans selling group insurance must deliver rebates to the policyholder -- in most cases, the employer -- and can do so in the form of lower premiums. Too soon to tell
Grants for consumer assistance to help states strengthen consumer assistance programs. more | more » All states, territories and the District of Columbia are eligible

Projected cost: $31 million through FY 2011 more »
38 states, territories and the District of Columbia have received grants

Cost: $23.5 million more »
Reached goal
Insurers can no longer impose lifetime dollar limits on essential health services for plans issued or renewed after September 23, 2010 more » Projected to extend coverage to as many as 20,400 people a year who would be expected to exceed lifetime limits. more »

Cost: No more than 0.75% increase in premiums in the group market
105 million people no longer face such limits more »

Cost: estimated 0.5% increase in 2011 premiums in the group market. more »
Reached goal

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