Repealing the healthcare reform law is at the top of congressional Republicans' to-do list this year. But as long as President Obama is in office, he will do anything he can to keep his administration's marquee achievement on the books. So, as the law lives on, provisions keep rolling out.
With the start of the new year, the Department of Health and Human Services implemented about a dozen more reforms from the Affordable Care Act. Experts say that the 2011 provisions, like some already put in place, could prove popular with consumers—seniors especially—making the path to repeal a bit steeper politically for the GOP. [See photos of healthcare reform protests.]
Medicare beneficiaries stand to gain most from the early 2011 changes. According to professor Kenneth Thorpe, who heads the Department of Health Policy and Management at Emory University, two provisions will be especially tough for Republicans to eliminate. First, while seniors have been required to pay part of the cost of Medicare services like cancer screenings and annual physicals, the law makes such preventive services free for most beneficiaries. In addition, the law made these services free for those enrolling in new private plans starting last September. Another provision starts closing the coverage gap, also known as the "donut hole," for seniors on the Medicare Part D drug plan. Now, beneficiaries with drug costs that surpass $2,840 within a year must pay full price for all drugs until their annual drug costs reach $4,550. The new rule offers a 50 percent discount on brand-name medicines for those who fall in that gap. "If you do repeal the law, you'll have to start charging people for preventive benefits. You'll have to increase what seniors pay for prescription drugs," says Thorpe. "Neither one of those [actions] would be very popular."
Medicare will also undergo a few less noticeable changes that could benefit consumers down the road. Starting this month, for example, in order to ensure that Medicare patients have continued access to primary care and to prevent physician shortages, primary care providers will receive an average pay bonus of 10 percent from the program. And, according to Peter Cunningham, a senior fellow at the Center for Studying Health System Change, a nonpartisan policy research group in Washington, the provision that could have the most important long-term effect is the creation of the Center for Medicare and Medicaid Innovation. The center, launched by the HHS Centers for Medicare and Medicaid Services in November, tests payment and delivery systems for the public health programs and determines their appropriate scale. Reforms could then be implemented without congressional approval. "To the extent that the center starts identifying various types of practices and delivery system reforms that can help to control costs and improve quality and care, [it] could potentially have the most far-reaching impact," Cunningham says.
A rule that could be popular with customers but not so with insurance companies is one that requires insurers to spend at least 80 percent (85 percent for large group plans) of premium dollars on patient care or quality health measures, rather than on the company's administrative costs. If an insurer spends less than the required percentage on quality and care, the consumer will receive a rebate. While this provision is intended as a protection for consumers, says Robert Zirkelbach, spokesman for America's Health Insurance Plans, insurers oppose it in part because it can make paying for administrative programs, such as fraud prevention, more difficult.
The law also sets up a grant program for states to help Medicaid enrollees avoid chronic illness and a voluntary insurance program for community living assistance.
Thorpe says he expects the law will become a better sell as more provisions go into effect. "Ninety-nine percent of the focus has been on this requirement to buy insurance and the federal spending linked to the subsidies, but this law is so much broader than that," he says. Republicans, however, hope to keep the focus where it is and use the fervor to their advantage.