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Talk:Healthcare reform in the United States/Archive 4

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Elements of the reform signed in March 2010

Latest comment: 10 years ago5 comments2 people in discussion

In the "Alternatives and research directions" section, I deleted the subtopic of balancing doctor and supply and demand. This is opinion, not an alternative for healthcare cost reduction.~~InterestedInKansas

In the "Insurance cost and availability" section, I deleted last paragraph. Studies are outdated and off topic for the section.~~InterestedInKansas — Preceding unsigned comment added by InterestedInKansas (talk • contribs) 17:07, 29 November 2013 (UTC)

In Patient Protection and Affordable Care Act section, I added an update regarding reversing the ACA as a condition for restarting the government.InterestedInKansas (talk)InterestedInKansas

I added a link in the history section for HIPAA 2013 latest guidelines so that the most up to date information can be viewed. ~~InterestedInKansas

I added updates to Medicaid coverage for low income Americans related to the implementation of the Affordable Care Act in the cost and availability section. InterestedInKansas (talk) 17:51, 28 November 2013 (UTC)InterestedInKansas

I expanded on the #5 reason for waste in Medicare (fraud)listed in the section "Allegations of Waste". Statistics from 2012 study and some efforts being made by Medicare to reduce the fraud and prosecute individuals that are found committing such acts of fraud. InterestedInKansas (talk)InterestedInKansas —Preceding undated comment added 17:06, 28 November 2013 (UTC)

I added updated information regarding Medicare cuts through 2033InterestedInKansas (talk)InterestedInKansas —Preceding undated comment added 17:34, 28 November 2013 (UTC)

(The unsigned contribution below has since been added to the article. -- Beland (talk) 07:33, 3 March 2013 (UTC))

A Reuters article summarized the key reforms that were later passed in March 2010.[1]

Within one year of enactment (2010-2011)

  • Insurance companies barred from dropping people from coverage when they get sick. Lifetime coverage limits eliminated and annual limits restricted.
  • Insurers barred from excluding children for coverage because of pre-existing conditions.
  • Young adults able to stay on their parents' health plans until age 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.
  • Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.
  • A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.
  • Medicare drug beneficiaries who fall into the "doughnut hole" coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.
  • A tax credit becomes available for some small businesses to help provide coverage for workers.
  • A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

During 2011

  • Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.
  • Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.
  • A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care.
  • Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare.
  • Employers are required to disclose the value of health benefits on employees' W-2 tax forms.
  • An annual fee is imposed on pharmaceutical companies according to market share. The fee does not apply to companies with sales of $5 million or less.

During 2012

  • Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form "accountable care organizations" to improve quality and efficiency of care.
  • An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.
  • The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.

During 2013

  • A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.
  • The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016.
  • The Medicare payroll tax is raised to 2.35 percent from 1.45 percent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.
  • A 2.9 percent excise tax in imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.

During 2014

  • All insurers are fully prohibited from discriminating against or charging higher rates for any individuals based on pre-existing medical conditions.[2][3]
  • All insurers are fully prohibited from establishing annual spending caps.[2]
  • Expand Medicaid eligibility; individuals with income up to 133% of the poverty line qualify for coverage
  • Offer tax credits to small businesses who have fewer than 25 employees and provide health care benefits for them.
  • Impose a $2000 per employee tax penalty on employers with over 50 employees who do not offer health insurance to their full-time workers. (In 2008, over 95% of employers with at least 50 employees offered health insurance.[4])[5]
  • Impose an annual $695 fine on individuals who do not obtain health insurance; exemptions to fine in cases of financial hardship or religious beliefs.[5]
  • Creation of a new voluntary long-term care insurance program.
  • Creation of tax credits for individuals who purchase private insurance policies
  • Employed individuals who pay more than 9.5% of their income on health insurance premiums will be permitted to purchase insurance policies from a state-controlled health insurance option.[6]
  • Pay for new spending, in part, through spending and coverage cuts in Medicare Advantage, slowing the growth of Medicare provider payments, reducing Medicare and Medicaid drug reimbursement rate, cutting other Medicare and Medicaid spending.[7][8]
  • Revenue increases from a new $2,500 limit on tax-free contributions to flexible spending accounts (FSAs), which allow for payment of health costs.[9]
  • Chain restaurants and food vendors with 20 or more locations are required to display the caloric content of their foods on menus, drive-through menus, and vending machines. Additional information, such as saturated fat, carbohydrate, and sodium content, must also be made available upon request.[10]
  • Establish health insurance exchanges, and subsidization of insurance premiums for individuals with income up to 400% of the poverty line, as well as single adults.[11] According to Congressional Budget Office estimates, in 2014 the income-based premium caps for a "silver" plan would be the following:[12][13]
Income Amount paid for premiums
133–150% of federal poverty level 4–4.7% of income
150–200% of federal poverty level 4.7–6.5% of income
200–250% of federal poverty level 6.5–8.4% of income
250–300% of federal poverty level 8.4–10.2% of income
300–400% of federal poverty level 10.2% of income
  • Members of Congress and congressional staff will only be offered health care plans through the exchange or plans otherwise established by the bill (instead of the Federal Employees Health Benefits Program that they currently use).[14]
  • Investment income of individuals earning $125,000 annually or couples earning $250,000 annually will be subject to Medicaid Payroll withholding.[5]
  • Medicare Payroll withholding increases from 2.9% to 3.8% on all earned income.[5]
  • A new excise tax goes into effect that is applicable to pharmaceutical companies and is based on the market share of the company; it is expected to create $2.5 billion in annual revenue.[5]
  • Most medical devices become subject to a 2.9% excise tax collected at the time of purchase.[5]
  • Health insurance companies become subject to a new excise tax based on their market share; the rate gradually raises between 2014 and 2018 and thereafter increases at the rate of inflation. The tax is expected to yield up to $14.3 billion in annual revenue.[5]
  • The qualifying medical expenses deduction for Schedule A tax filings increases from 7.5% to 10% of earned income.

During 2015

  • Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services.

During 2018

  • An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions.
  1. ^ Reuters-Factbox-U.S. Healthcare Bill Would Provide Immediate Benefits-March 19, 2010
  2. ^ a b Cite error: The named reference Top 18 was invoked but never defined (see the help page).
  3. ^ ALONSO-ZALDIVAR, Ricardo (March 24, 2010). "Gap in health care law's protection for children". Associated Press. Retrieved 2010-03-24.
  4. ^ Employer Health Benefits: 2008 Summary of Findings, Kaiser Family Foundation.
  5. ^ a b c d e f g Downey , Jamie (March 24,2010). "Tax implications of health care reform legislation". Boston Globe. Retrieved 2010-03-25. {{cite web}}: Check date values in: |date= (help); Italic or bold markup not allowed in: |publisher= (help)
  6. ^ Cite error: The named reference Kypost was invoked but never defined (see the help page).
  7. ^ Cite error: The named reference CRFB was invoked but never defined (see the help page).
  8. ^ "Health-Care Overhaul Proposals". Wall Street Journal. March 18, 2010..
  9. ^ Burkes, Paula (November 8, 2009). "Medical Expense Accounts Could be Limited to $2,500". The Oklahoman..
  10. ^ Spencer, Jean (2010-03-22). "Menu Measure: Health Bill Requires Calorie Disclosure". Washington Wire. Wall Street Journal. Retrieved 2010-03-23. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
  11. ^ Galewitz, Phil (2010-03-22). "Health reform and you: A new guide". Kaiser Health News. MSNBC. Retrieved 2010-03-23. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
  12. ^ "An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act" (PDF).
  13. ^ "Kaiser Family Foundation:Health Reform Subsidy Calculator -- Premium Assistance for Coverage in Exchanges/Gateways".
  14. ^ H.R. 3590 Public Print, section 1312: the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are (I) created under this Act (or an amendment made by this Act); or (II) offered through an Exchange established under this Act (or an amendment made by this Act).

Graduate Medical Education That Meets the Nation's Health Needs (2014)

Latest comment: 10 years ago1 comment1 person in discussion

The National Academy of Medicine wrote this year on GME reform. EllenCT (talk) 04:37, 8 October 2014 (UTC)

Article needs additional sections and discussion

Latest comment: 7 years ago1 comment1 person in discussion

Under the section on "Insurance cost and availability," more information could be added, specifically in regards to health inequities. Additional information should also be added to the overall "Movtivation" section, for instance, adding another section that corresponds and discusses the idea of health as a human right. Clarification and citations should be added to statements such as "there are health losses from insufficient health insurance." Also, some of the citations should be updated, such as the reference to an oudated study (1997) in this section, which provides irrelevant information due to its age.The article provides a good amount of reliable, properly cited sources, but may need some reorganizing of information in order to be presented in a clearer, more relevant way, and more information should be added.

Chandra Couzens Ckcouzens (talk) 03:32, 5 November 2016 (UTC)

The need to remove most of the ACA references because the ACA is not a health care reform topic

Latest comment: 7 years ago4 comments2 people in discussion

The ACA is not about health care reform, it IS part of the US health care system. This article is about health care reform, a hot topic with the election, and yet it has little of relevance to the reader looking for an article on health care reform. Raggz (talk) 22:00, 2 December 2016 (UTC)

@Raggz: I'm going to disagree with you there. It's linked inline to the main article and it's absolutely a topic of healthcare reform. The implementation of the ACA was an act of healthcare reform, whether or not it's currently in the process of being implemented is irrelevant. -Jergling PC Load Letter 22:09, 2 December 2016 (UTC)
Lets merge then with Health care reforms proposed during the Obama administration. The Reader is looking for an article on health care reform in the United States and there isn't a current one. Raggz (talk) 23:36, 3 December 2016 (UTC)

DELETE Motivation

This section lacks relevancy and citation support. Rather than just delete this important topic can anyone revise it and offer some citations? I'm open to solutions to update this section. Raggz (talk) 23:07, 2 December 2016 (UTC)

International comparisons of healthcare have found that the United States spends more per-capita than other similarly developed nations but falls below similar countries in various health metrics, suggesting inefficiency and waste.[citation needed] In addition, the United States has significant underinsurance[citation needed] and significant impending unfunded liabilities from its aging demographic and its social insurance programs Medicare and Medicaid.[citation needed] (Medicaid provides free long-term care to the elderly poor). The fiscal and human impact of these issues have motivated reform proposals.[citation needed]

 
Health spending per capita, in US$ PPP-adjusted, compared amongst various first world nations.

Insurance cost and availability

Further information: Health insurance coverage in the United States

In addition, the number of employers who offer health insurance has declined and costs for employer-paid health insurance are rising. [citation needed]

There are health losses from insufficient health insurance. [citation needed] The cost of insurance has been a primary motivation in the reform of the US healthcare system, and many different explanations have been proposed in the reasons for high insurance costs and how to remedy them. [citation needed] One critique and motivation for healthcare reform has been the development of the medical–industrial complex.[citation needed] This relates to moral arguments for health care reform, framing healthcare as a social good, one that is fundamentally immoral to deny to people based on economic status. [1] Arguments for a market-based approach to health insurance include the Grossman model, which is based on an ideal competitive model, but others have critiqued this, arguing that fundamentally, this means that people in higher socioeconomic levels will receive a better quality of healthcare.

Uninsured rate

Another concern is the rate of uninsured people in the US. [citation needed] However, Hispanics, who have the highest uninsured rate of any racial or ethnic group, are lagging in their progress.[citation needed] Under the new health care reform, Latinos were expected to be major beneficiaries of the new health care law. Gallup found that the biggest drop in the uninsured rate (2.8 percentage points) was among households making less than $36,000 a year.[2][3][4]

Waste and fraud

In December 2011 the outgoing Administrator of the Centers for Medicare & Medicaid Services, Donald Berwick, asserted that 20% to 30% of health care spending is waste. He listed five causes for the waste: (1) overtreatment of patients, (2) the failure to coordinate care, (3) the administrative complexity of the health care system, (4) burdensome rules and (5) fraud.[5]

An estimated 3%–10% of all health-care expenditures in the U.S. are fraudulent. In 2011, Medicare and Medicaid made $65 billion in improper payments (including both error and fraud). Government efforts to reduce fraud include $4.2 billion in fraudulent payments recovered by the Department of Justice and the FBI in 2012, longer jail sentences specified by the Affordable Care Act, and Senior Medicare Patrols—volunteers trained to identify and report fraud.[6]

In 2007, the Department of Justice and Health and Human Services formed the Medicare Fraud Strike Force to combat fraud through data analysis and increased community policing. As of May 2013, the Strike Force has charged more than 1,500 people for false billings of more than $5 billion. Medicare fraud often takes the form of kickbacks and money-laundering. Fraud schemes often take the form of billing for medically unnecessary services or services not rendered.[7]

References

  1. ^ CRAIG, DAVID M., ed. (2014-01-01). Health Care as a Social Good. Religious Values and American Democracy. Georgetown University Press. pp. 85–120. ISBN 9781626160774.
  2. ^ ALONSO-ZALDIVAR, RICARDO (March 10, 2014). "SURVEY: UNINSURED RATE DROPS; HEALTH LAW CITED". The Associated Press. Retrieved March 10, 2014.
  3. ^ Easley, Jason (March 10, 2014). "Republicans Darkest Fears Realized: ACA Causes Number of Uninsured to Drop Across All Ages". Politicus USA. Retrieved March 10, 2014.
  4. ^ Howell, Tom (March 10, 2014). "Rate of uninsured Americans is dropping: Gallup". Washington Times. Retrieved March 10, 2014.
  5. ^ Pear, Robert (December 3, 2011). "Health Official Takes Parting Shot at 'Waste'". New York Times. Retrieved December 20, 2011.
  6. ^ Phipps, Jennie L. (February 21, 2013). "How big is Medicare fraud?". Retirement Blog. Bankrate. Retrieved November 28, 2013.
  7. ^ "Medicare Fraud Strike Force Charges 89 Individuals for Approximately $223 Million in False Billing". U.S. Department of Justice. May 14, 2013. Retrieved November 28, 2013.

Quality of care

Physicians for a National Health Program, a political advocacy group, has claimed that a free market solution to health care provides a lower quality of care, with higher mortality rates, than publicly funded systems.[1] The quality of health maintenance organizations and managed care have also been criticized by this same group.[2]

References

  1. ^ For-Profit Hospitals Cost More and Have Higher Death Rates, Physicians for a National Health Program
  2. ^ For-Profit HMOs Provide Worse Quality Care, Physicians for a National Health Program

politically biased edits

Latest comment: 7 years ago1 comment1 person in discussion

"I deleted content of this page that had obvious political bias toward President-elect Trump. (I am a Trump supporter myself, but such blatant promotion should not be posted on a general article, especially on its fundamental summary."

Please engage here and discuss what you find objectionable. Raggz (talk) 06:26, 5 December 2016 (UTC)

Patient Protection and Affordable Care Act

Latest comment: 7 years ago1 comment1 person in discussion

I propose to delete all material that relates to the ACA and the Patient Protection and Affordable Care Act UNLESS it relates to the Article. When the ACA health care reform became law in 2010 it then moved outside the scope of this article. This is now policy and law and is not a reform. Raggz WP:BOLD (talk) 06:50, 5 December 2016 (UTC)

PROPOSED ARTICLE MERGER

Latest comment: 7 years ago1 comment1 person in discussion

This article has only dated material about Health care reform in the United States. An article that is current and relevant is needed. Is anyone interested in updating this article?

I propose that Health care reform in the United States be merged into Health care reforms proposed during the Obama administration. I think that the content in the Health care reform debate in the United States article can easily be explained in the context of Health care reforms proposed during the Obama administration, and the Health care reform in the United States article is of a reasonable size that the merging of Health care reforms proposed during the Clinton Administration Health care reform in the United States will not cause any problems as far as article size or undue weight is concerned. Raggz (talk)

Given the length of both articles, I don't think a merger is required (as Health care reforms proposed during the Obama administration is longer, it would leave a single article that is weighted in the direction of a specific period, and likely to be split out again). I would definitely agree with incorporating material from Health care reforms proposed during the Obama administration into this article (especially where the original proposals predate the Obama administration) with a hatnote directing to that article. — Sasuke Sarutobi (talk) 11:15, 5 December 2016 (UTC)

News

Latest comment: 7 years ago1 comment1 person in discussion

Article - White House said to be urging researchers to copy Obamacare data amid worries Donald Trump will erase it - • Sbmeirow • Talk • 20:31, 23 December 2016 (UTC)

Latest comment: 6 years ago1 comment1 person in discussion

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