Healthcare Reform Affects Medicare Patients and the Under 65 Set Differently on Orlando Medical News

Healthcare Reform Affects Medicare Patients and the Under 65 Set Differently

By: SHARON H. FITZGERALD

Posted: Monday, July 12, 2010 2:10 pm

Healthcare Reform Affects Medicare Patients and the Under 65 Set Differently | Healthcare reform, J. James Rohack, American Medical Association, Jordan McNerney, AARP

How to Answer Questions from Your Patients

Editor’s Note: This story is the second in a three-part Medical News series examining some impacts of sweeping federal health-reform legislation signed into law in March by President Obama. The series looks at three groups of stakeholders – providers, patients and third-party payers. This month: patients.

If you’re a physician, chances are you have already fielded a bevy of questions from patients about healthcare reform. Rest assured, the questions will keep coming. Experts say that doctors need to be up to speed, and fast, about how reform will affect their patients’ healthcare and their insurance options in the future.

“For those under age 65 especially, the physician becomes not only the confidant of what’s happening in patients’ lives with their health, but also the one who is being asked about insurance problems,” said J. James Rohack, MD, president of the American Medical Association. That’s a role some physicians don’t relish, he acknowledged, but the ability of a doctor to talk to patients knowledgeably about reform is an avenue to improve doctor-patient rapport. “There are good things in this legislation that will be helpful to patients,” added Rohack, a Texas cardiologist and professor at Texas A&M Health Science Center College of Medicine.

Effects on Medicare Patients

How reform affects patients depends in large measure on their age – 65 and older or 64 and younger. For patients on Medicare, Rohack said the main question is, “Doc, will I still be able to see you?” And that’s one of the toughest questions to answer because the reform legislation failed to address the Medicare physician-payment formula. “The conversations across the country are very honest, and some physicians are answering, ‘I’m not sure I can see you,’ ” Rohack said. “If I get a bill from the utility company and I pay them 20 percent less than the bill is, they’re going to turn off the lights. But the expectation of Congress is that our ethics as physicians will always save the day. We will do what we can, but at some point, doing what’s right still doesn’t pay the bills, and one has to make some pretty difficult decisions.” Congress recessed for the Memorial Day holiday without delaying a 21 percent Medicare physician payment cut.

Otherwise, Jordan McNerney, AARP’s media relations manager for health issues, said the new law makes no cuts to guaranteed Medicare benefits that patients already have. “In fact, there are improvements to those benefits with better preventive services, in that patients won’t have to pay a co-pay when they go to the doctor for preventive care,” he explained, suggesting the physicians should be well-versed in the new preventive care benefits.

Patients on Medicare Advantage plans could see some shifts. “You won’t see any of the plans drop below what everyone gets in Medicare benefits, but you may see some changes,” McNerney said. Reform means that the federal government will bring payments to Advantage plans back in line with traditional Medicare costs, and plans may therefore adjust premiums and benefits offered. Yet, Medicare will be paying bonuses to plans that meet certain quality measures, so Advantage plans have opportunities to make up potentially decreased payments.

Another important benefit, McNerney noted, is the eventual closing of the “doughnut hole” in the Medicare drug benefit. Starting this year, Medicare begins closing that gap between when initial coverage ceases and when a senior spends enough out of pocket to qualify for catastrophic coverage. “Anybody who falls into it (the doughnut hole) this year gets a $250 rebate check just as a little bit of a down payment,” he said. In fact, those checks were already appearing in Medicare patients’ mailboxes before the June 15 deadline.

McNerney said another benefit of reform legislation – and one that hasn’t garnered much media attention – is the first-ever national long-term care insurance plan, called Community Living Assistance Services and Supports. Financed through payroll deductions, the voluntary long-term care plan would be managed by the U.S. Department of Health and Human Services. Once someone has paid into the system for five years, he or she is vested in the program and can collect benefits when needed. “This will pay a cash benefit for a caregiver, a nursing home or assisted-living care,” McNerney explained. Enrollment should start early next year, he added.

Patients under 65

For patients not yet eligible for Medicare, Rohack said the advice he’s giving is “hang on.” Rohack discussed one of his patients, a man in his 50s who Rohack had been treating for a decade. Self-employed, the patient bought his own insurance – and the premium recently jumped up nearly 50 percent. “I told him to hang on ’til 2014, because that’s when state-based health insurance exchanges will be up and coming,” he said. These exchanges will create insurance pools that will allow people to choose among affordable coverage options. All insurance companies in the exchange must provide a minimum benefit package and additional coverage options beyond a basic plan. Here’s other good news regarding coverage:

Beginning this year, an insurer can no longer drop a patient if the patient gets sick.
Beginning this year, children 18 and younger can’t be denied private insurance coverage if they have a pre-existing condition.
Beginning this year, young adults up to age 26 can remain as a dependent on their parents’ private plan. Several insurance companies already are offering this service.
Beginning this year, health insurance benefits can’t run out anymore because of a long or expensive illness.
Medicaid coverage will be expanded in 2014 to all eligible children, pregnant women, parents and childless adults under age 65 who have incomes at or below 133 percent of the federal poverty level.
In 2014, U.S. citizens and legal residents can’t be denied private health-insurance coverage for any reason.
Federal subsidies through tax credits or vouchers will be provided in 2014 to people who can’t afford the full cost of coverage.

Yes, patients will be required to have some sort of health insurance coverage in 2014 , and Rohack said that’s a top concern in many patients’ minds. When they ask, he first assures patients that there’s federal aid available and then he explains, “The bottom-line message is, for you whose employer has decided not to provide health-insurance coverage, you now have the ability to get it through a pooling of everyone like yourself into a massive pool that never existed before.”

This year, a high-risk insurance pool kicks in for uninsurable individuals who can’t obtain insurance on the open market because of a pre-existing condition. To help subsidize the premiums and set up the pools for the participating states, the reform law allocates $5 billion. “Some states aren’t going to do it, and others are saying thank goodness for the help,” Rohack said. “If your state isn’t participating, I think that’s an important question to ask the elected leaders.”

In closing, Rohack recommended leaving patients with this one assurance: “The law does not create a mechanism where a federal bureaucrat will interfere with what a physician believes the patient needs to get.”