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Healthcare Reform Law and NETWORK Values

Here are some of ways the new healthcare law reflects NETWORK’s healthcare values. Under the new law, healthcare is:

 

Accessible
  • Focuses on primary care, with incentives for more medical students to specialize in primary care, and higher reimbursement rates for primary care doctors
  • Encourages use of technology foster consultation among doctors
  • Expands community clinics
  • Prohibits denial of coverage because of pre-existing condition (effective in 2010 for children, in 2014 for adults)
  • Prohibits lifetime caps (limits) on coverage
  • Prohibits cancelling policies except in cases of fraud
  • Includes state health insurance exchanges, which will offer options for individuals and small businesses to buy coverage, starting in 2014. [This does not affect employees who get health insurance from large employers, or those who receive insurance through government (Medicare, Medicaid, Veterans, Railroad, etc.).]
Affordable
  • Major expansion of Medicaid to cover people with incomes of up to 133% of the poverty level, whether they have minor children or not. The increase is paid for by the federal government.
  • Tax credits for small business (including non-profits) that provide health insurance to their employees
  • Options for individuals and small businesses offered by state health insurance exchanges to buy coverage (starting in 2014). Premium subsidies in the form of tax credits will be available for people within 400% of poverty level. Competition within state exchanges is expected to lower costs.
  • Having more people covered will reduce the cost paid by all of us for their use of emergency room and hospital care.
  • No deductibles or co-pays for a wide range of preventative services
  • Requirement that health plans report their “medical loss ratio” (percentage of premium dollars spent on medical services as opposed to administration and profits) with rebates if this number is less than 80%
  • Improvements in the Medicare Part D prescription drug plans to lower drug costs for seniors
  • Restructuring of Medicare payment plans

Quality
  • Focus on primary care and integration of services
  • Support for comparative effectiveness research
  • Grants for pilot programs to move from fee-for-service to more effective ways of paying for healthcare. These “best practices” can be implemented in national programs through the Department of Health and Human Services.
  • Increased outcome reporting of patient results.
Universal
  • Establishes that healthcare is a right, not a privilege
  • Requires everyone to participate (with some hardship and religious exemptions) or pay a penalty if they don’t get health insurance coverage once the exchanges are set up (Reported in tax returns.)
  • Expands Medicaid for low-income people and provides subsidies for moderate-income people.
Pro-life
  • Maintains existing law on abortion -- no federal funding of abortion and no federal sponsorship of abortion in any form
  • Requires healthcare plans that offer abortion services to segregate funds so that no federal subsidies can be used for abortion. An annual audit will ensure that this is done
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