Ten things you didn’t know about healthcare reform


Dedicated to affordable, quality healthcare and coverage for all Americans.

By Consumers Union on Monday, April 5th, 2010

A handful of key provisions in the new healthcare reform package have grabbed all the headlines, but there are a lot of other interesting things for consumers going on in the law finalized last week. Here’s a rundown of the top 10 things you may not know are in the law – but could certainly change the way the healthcare system starts working for consumers.

Show us the money. Starting this year, health insurance companies have to report how they’re spending our money. We want to know: How much is going to patient care vs. CEO salaries and advertising? Starting next year, they actually have to give us rebates if they’re spending more than 15% of our dollars on non-medical costs. Score one for consumers.

Calorie countdown. Exactly how many calories are in that double bacon cheeseburger, and is that ‘salad’ with fried chicken and ranch dressing any healthier? Right now, it’s anyone’s guess. But starting next year, chain restaurants with more than 20 locations will have to include calorie counts for each item on the menu to help consumers make more educated food choices. Buffets and vending machines, that includes you too.

You are my Sunshine (Act). Your doc makes a living seeing patients. But, like many health providers, there’s a good chance he’s getting payments or gifts from other sources with a vested interest in the treatments and medicines he prescribes. Who’s paying him and how much? Now you’ll be able to find out. The new reform bill includes the language from the Physician Payment Sunshine Act (Grassley, R-Iowa) which shines light on any cash and gifts he receives (including food, entertainment and travel) worth $10 or more. All info will be available in a national database slated for launch in March 2013.

Free colonoscopies! Okay, perhaps not the most enticing selling point. But like mammograms, immunizations and annual check-ups, your insurance company will have to start covering all approved preventive care services with zero out of pocket costs to you. No co-pays, no deductibles – starting in September 2010. You know what they say about an ounce of prevention.

It’s infectious. No one expects the treatment at a hospital or doctor’s office to leave them in worse shape than when they walked in the door, but it happens more often than you think. Millions of people are injured each year by hospital-acquired infections and errors that are preventable. The problem with the system (other than the obvious harm to patients) is that after the injury is caused, the docs then get paid to treat the patient to fix the problem (either by insurance companies or Medicare/aid). Where’s the incentive to give better care in the first place? Starting in 2012, Medicare (i.e. our tax dollars) will start reducing payments to hospitals when they have to readmit patients for preventable conditions, and the errors must be publicly reported. It’s a good first step to getting quality care from the start.

Read your rights. … because as a patient and consumer, you just gained a bunch of new ones. If you’ve never had to buy an individual insurance policy or try to settle a dispute with your insurance company, perhaps you already thought many of these seemingly-inalienable rights already existed…but in many states, they didn’t. You’ve probably already heard about some of the new protections in the bill: no more denials or higher prices for pre-existing conditions. No more being dropped by your insurance company when you get sick. No more annual or lifetime limits on coverage. But there are a few good ones that haven’t gotten the attention they deserve, such as the fact that gender is no longer a factor in how much you pay for insurance. This is a huge victory for women, who are currently paying staggeringly higher prices than men for the same coverage (even if it doesn’t include maternity coverage – which most individual policies don’t). Also, the bill finally recognizes a trip to the ER for what it is: an unplanned emergency. No longer can you get whacked with bills claiming that you didn’t get ‘prior authorization’ for treatment, or that you were cared for by an ‘out of network’ provider (see what happened to Andrea).

Not on auto pilot. With the many moving parts of our healthcare system, it’s not always clear how a proposed change will pan out – but that doesn’t mean we shouldn’t try new ideas and then tinker with them to get the results we want. In fact, the US has a history of trying new strategies and policies, or ‘pilot projects’, on a small scale before implementing them country-wide. And the private insurers and providers usually embrace the new approaches once they have been proven to work. Many of the proposed changes in the reform bill adopt this tactic. For example, next year the states will be awarded grants to try new ways to address malpractice lawsuits. And in 2012, Medicare and Medicaid will establish pilot programs to try some new payment systems, such as increasing reimbursements to doctors and hospitals that provide high-quality care at low costs. Through trial and error we can start making some smart changes to get the most for our healthcare dollars. (See ‘It’s Infectious’– also a pilot program.)

Primary concern. It’s more than tempting for doctors to go into specialty fields which usually pay twice as much (or more) than primary care. As more people get coverage, we need more doctors willing to focus on check ups, preventative care and monitoring chronic illnesses. The healthcare reform bill provides new funding for training programs to increase the number of primary care doctors and nurses through scholarships, grants and loan repayments. And starting next year, Medicare will give a 10% bonus payment to primary care physicians.

How it burns. How healthy is your ‘healthy glow’ if you got it at a tanning salon? Given the high level of UV rays in tanning beds and their association with melanoma and other skin cancers – not very. The new bill adds a 10% tax onto indoor tanning services starting in 2011, a move that the Skin Cancer Foundation hopes will discourage the use of tanning beds and save lives.

$500,000 is the magic number. Salaries are a business expense – and therefore tax deductible. So the more a health insurance company pays top executives (millions, in most cases), the bigger the deduction – and the less they pay in taxes. But the days of us taxpayers subsidizing huge corporate salaries are over… or at least limited. Starting this year, the most a health insurance company can deduct for executive and employee compensation is $500,000. That’s starting to sound like a bargain.

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