Reform sign on a desk with a blurry background

Well, you might be confused by the title. Perhaps you know it better as “ObamaCare” or “Universal Health Care” or “Health Care Reform” or “Insurance Reform”. Yes, it is the Patient Protection and Affordable Care Act or H.R. 3590. However, this is a mouth full when it is so easy just to say “Obama Care” or “Universal Health Care”.  These names, unfortunately, come with a very negative connotation.  For example, Media Research Center’s Business & Media Institute states “Universal health care leads to an increase in big government, and then America would continue on the slippery slope toward socialism”.  This organization went on to say how the “liberal” general media do not tell the truth. They cited examples of how they “don’t compare ‘Medicare-like’ public option to Medicare’s track record”, or how they report that the total number of uninsured is exaggerated, and how they barely discuss the costs.

Granted, media tend to sensationalize, but “do not tell the truth” – come on. This health reform builds on the private insurance industry. Medicare – perhaps one of the great pieces of legislation for seniors in history, while not perfect, is a very successful system (excluding all the unlawful entrepreneurs out to commit crimes of fraud and abuse). The numbers of uninsured are exaggerated? Actually there are over 50 million uninsured and growing daily because of unemployment and the health reform legislation only will cover about 32 million (518,000 Nevadans).

Well, I want to share with you some additional facts, beyond last month’s article, about our new health reform, the Patient Protection and Affordable Care Act, and how it can impact Nevadans. These facts come from and they cite 27 different sources. I highly recommend that you visit this site. The site also has video of the leaders in Washington, such as Secretary Sebelius, Health and Human Services, discussing the legislation. It’s very informative.

Under reform in Nevada, 518,000 residents today, projected to increase by 56% by 2019, who do not currently have insurance will get it through an affordable health insurance exchange – not government! Options will exist for those who cannot get insurance because of pre-existing conditions, such as having diabetes (9% of Nevadans, about 50% of those who have diabetes are 60 and over.) or high blood pressure (27% of Nevadans, the 5th leading health expense).

In Nevada, 328,000 seniors on Medicare will receive free preventive services, because beginning in 2011, the legislation eliminates co-payments and co-insurance for preventive services and exempts preventive services from deductibles under the Medicare program. For example, a colonoscopy (44% have not had colorectal cancer screening) that costs $756, the co-pay is $175, which could be prohibitively expensive. Under the new law, a senior will not pay anything for the preventive service, as well as others like it, and have free wellness visits with their provider.

In addition, 58,200 Medicare seniors will have their brand-name drug costs in the Medicare Part D “doughnut hole” halved. Some seniors have been paying up to $4,080 per year, hence a significant savings.

Early retirees that have coverage from their former employer are estimated at about 39,100 in Nevada. Even though this health insurance coverage has eroded over time, retirees will receive premium relief and have stabilized coverage through a reinsurance program resulting in up to $1,200 savings in premiums per year.

Medicare Advantage plans have 30% of Nevada seniors enrolled in them.  Since Medicare is overpaying these plans, they will reduce the payments to the plans, impacting the senior enrollees. Exactly how, is to be determined, but it has been estimated that the other 70% of Nevada Medicare beneficiaries in the traditional plan will pay an extra $45 per year in subsidized premiums to cover the excessive payments to Advantage Plans if the overpayment is not eliminated. Therefore, the reduction of payment to the Advantage plans will impact all Medicare Nevadans, some positively and some potentially negatively. However, the Center for Medicare and Medicaid Services will create Accountable Care Organizations that will work together to meet quality care and performance standards through better management, care coordination, and establishing health or medical homes utilizing community-based interprofessional teams.

The Patient Protection and Affordable Care Act will provide relief from rising health care costs by ending the “hidden tax”. It is estimated that $335 million is spent on uncompensated care to Nevadans. Providers lose this amount, which get passed on to the rest of us in hidden premiums. Therefore, when more people are covered by insurance through the health reform legislation, the burden of hidden premium costs covered by those of us who have insurance will disappear.

The health reform law will also improve quality and create more accountability and effectiveness with the health delivery system. It will invest in innovations in primary care and provide financial incentives for providers to better coordinate care and decrease readmissions to hospitals, which occur in 20% of all Medicare admissions or 15,400 patients being readmitted within 30 days. This is a tremendous expense to the Medicare patients and the hospital providers that the new Patient Protection and Affordable Care Act will reduce and/or eliminate.

Many other components of the new law also will take effect, too many to discuss in one article. But I will continue conveying what the new law is doing. Issues such as reducing paperwork or and administrative expense, incentivizing primary medical care, and providing supports for long-term home and community based services through the Community Living Assistance Services and Support (CLASS) act are important components and will be addressed in future articles of Adding Life to Years.