Understanding Federal Health Reform

The Federal Health Reform law is more than 2,400 pages long and includes many changes for the health care industry. Here are some of the major highlights:

• Coverage will expand to 32 million individuals by 2019 through public program expansions, an individual mandate, an employer mandate and other private sector health insurance reforms.
• Health Insurance Exchanges will be formed in each state by 2014 where individuals and small businesses can purchase health coverage.
• Cost savings will be achieved through reduced reimbursement rates and payment reforms to help pay for the coverage expansions.
• Insurance industry regulation includes a requirement for plans to offer an essential benefits package, provide dependent coverage for children up to age 26, prohibit lifetime limits and prohibit pre-existing condition exclusions.

Allina Hospitals & Clinics serves many Medicare beneficiaries and remains committed to providing exceptional care to these loyal patients, as well as new Medicare patients. Some of the changes Medicare beneficiaries will see within the first two years are highlighted below

• Beginning in 2010, any Medicare beneficiary who crosses into the "Doughnut Hole" coverage gap under Medicare Part D will receive a $250 rebate check to help pay for their medications. Starting in January 2011, patients in the coverage gap will receive a 50 percent discount on all brand name drugs and a seven percent discount on generic medications. These discounts will grow each year until 2020 when the discounts and subsides will add up to 75 percent of both brand name and generic drugs.
• Starting January 1, 2011, Medicare will cover proven preventive services at no charge to the patients, meaning no co-pays or premiums. This will cover preventive services such as mammograms and screenings for colon and prostate cancer. Medicare beneficiaries will also qualify for a new annual wellness visit at no charge and will receive incentives to complete behavior modification programs.
• Starting in 2011, spending will be reduced for Medicare Advantage, the private plan part of Medicare. This will bring these private plans more in line with the costs in the original Medicare program. Basic, guaranteed Medicare benefits will not change. Some of the extras under Medicare Advantage likely will be pared down.

Patients who have health coverage through their employers are unlikely to see any major changes to their premiums or coverage. They also will not see any change in the care they receive from Allina.

Allina does not anticipate any changes to our current practice of accepting most forms of commercial insurance.

Additional benefits taking effect in 2010 for patients with private insurance include:

• Insurers cannot drop individuals if they become sick.
• Children ages 18 and younger can no longer be denied coverage due to pre-existing medical conditions.
• Young adults up to age 26 can remain as a dependent on their parents' private insurance plan.
• Insurers can no longer impose lifetime financial limits on benefits.

Most Americans without health insurance will be required to have coverage by 2014 through:

• expansions to the state Medicaid program, Medical Assistance
• or by purchasing a health plan through one of the newly created Health Insurance Exchanges.

Government subsidies will be available to help individuals and families with incomes below a certain level purchase health coverage and those without coverage will pay a penalty starting in 2014.

Individuals without health coverage due to a pre-existing condition will be able to purchase coverage through high-risk insurance pools starting this year. In 2014, all insurers will be banned from denying health coverage to individuals based on their health status.

Allina's policies around financial assistance and billing and collections will not change due to federal health reform.

Learn about Allina's financial assistance services.

In recent debates, Allina has supported bold changes in health policy that aim to reduce the number of uninsured, create new payment incentives that support the promotion of health, as well as advance public health and primary prevention. The recently signed Federal Health Reform does much good, but it also leaves critical work undone.

This is an exciting time in health care. Our challenge and opportunity have never been greater to create a new and sustainable model for delivering on our mission in collaboration with one another, our patients and communities.

Allina Hospitals & Clinics has been a strong supporter of changes to the health care system that aim to improve the health of the population, enhance the patient care experience and reduce the cost of care. Allina is committed to continuing to provide exceptional care to all of our patients – and health reform will not change this.