Health Care Reform Explained Your Questions Answered By: Susan Jaffe | Source: AARP Bulletin Today | April 1, 2010 *
WHERE WE STAND From AARP CEO A. Barry Rand: “We are thankful for the leadership, courage and hard work Members of Congress and the President demonstrated in ensuring they followed through on their commitment to older Americans.” Read more WANT TO TAKE ACTION? HealthActionNow.org Join the movement! SEE ALSO • Get the Facts on Health Reform BREAKING NEWS • Follow us on Twitter • Fan us on Facebook Need help understanding the new health care reforms? You’re not alone. The legislation is more than 2,000 pages—longer than Tolstoy’s epic novel War and Peace—and it’s crammed with new benefits, rules, penalties and projects, spread out over years. To help you find out just what it all means to you, AARP will be answering your questions about health care reform online. E-mail your questions to HCRquestions@aarp.org.
Then check back here for the answers and information you need to know. Q. I’m over 50 and have been turned away by health insurers who either won’t sell me coverage or charge so much I can’t afford to buy it, all because of my health problems. How long do I have to wait before I can get covered? A. If you have preexisting medical conditions and have been unable to get health insurance for at least six months, you should be eligible to buy coverage through a temporary federally funded program called a “high-risk pool.”
Under the new law, this option—expected to be available by July—will cover about 2 million men and women in your situation. Older members cannot be charged more than four times what younger members pay for this coverage, and out-of-pocket expenses are limited to $5,950 for an individual or $11,900 for a family this year. This isn’t a new idea: Many states already offer high-risk pools for their residents, but some are closed to new enrollees because of high costs.
That will change and every state will be participating, thanks to an influx of $5 billion in federal aid. How much premiums will cost to join the high-risk pool, in which hospitals and doctors will participate, and exactly what will be covered are among the key details yet to be worked out. So it’s no surprise that at this point, there isn’t a telephone number the public can call for more information. This program ends in 2014, when insurance companies will be required to sell policies to anyone, regardless of their preexisting medical conditions. Q. I’m having trouble now finding a primary care doctor. Will it be harder for me to get one when millions more people get health insurance because of this new law? A.
While 32 million people will eventually be added to the rolls of the insured, that won’t happen overnight or in one fell swoop. It will take time, and about half will be insured through state health insurance exchanges, which won’t open until 2014. But you are right—it can be hard to find a primary care doctor who will accept a new patient, especially as the nation’s population grows older and demand increases. During the health reform debate, Republican critics such as Florida Sen. George LeMieux warned that a physician shortage could undermine the entire reform effort: “It’s not health care reform if the doctor is not in,” he said. The new law addresses the shortage of primary care doctors in three basic ways.
• First, primary care doctors who treat Medicare patients will receive an extra 10 percent bonus from 2011 to 2016, and earn another small bonus if they file health care quality reports with Medicare. In addition, the law adjusts Medicare payments to reflect the variations in medical costs by geographical area, which the American Medical Association says will benefit doctors in 42 states.
The measure also raises payments for family physicians who treat patients in Medicaid, the government’s health care program for low-income people. And it reduces paperwork for doctors who treat Medicare and Medicaid patients—another sweetener to entice physicians into the programs. • The second way the law tackles the shortage is by providing incentives for doctors to go into the primary care field.
For example, it expands loan forgiveness programs to defray the cost of medical school and provides money for primary care training programs at teaching hospitals. It also provides grants to medical schools to recruit and train students who will practice medicine in rural communities.
There are similar incentives for training nurses and other medical providers, which should help ease the demand for primary care doctors. • Finally, the law encourages changes in how patients are treated by creating “accountable care organizations”—physician and other medical groups—which will be paid according to how well the patient fares, rather than the number of services provided, explained Jean Silver-Isenstadt, M.D., executive director of the National Physicians Alliance. “This means that issues that can be handled over the phone, will be, and patients won’t be required to come in for an office visit just to ensure the physician gets paid,” she said.
“This will free up valuable time for doctors to see more patients.” No one knows for sure whether bonuses and other changes will build up the supply of primary care doctors fast enough to keep pace with demand. Susan Jaffe has written about health care reform for Health Affairs and covered aging issues for the Cleveland Plain Dealer.