Congress Adopts Package of Health Reform Amendments
On March 25, using budget reconciliation rules, which limit debate to twenty hours and require only a simple majority for passage, the Senate approved the Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872) by a vote of 56 to 43. The act makes budget related changes to the Patient Protection and Affordable Care Act (H.R. 3590) which President Obama signed into law on March 23. The House again passed the Reconciliation bill Thursday night, March 25 agreeing to two technical changes required by the Senate parliamentarian, sending the final package to President Obama for signature.
The Reconciliation bill changes a number of provisions important to counties. It eliminates special deals for Nebraska and Florida and increases federal Medicaid funding for states to expand their Medicaid programs. For most states, the federal government would pick up 100 percent of state Medicaid costs for newly eligible individuals for the first three years (2014-2016), 95 percent of those costs for 2017, 94 percent for 2018, 93 percent for 2019, and 90 percent thereafter.
The states that have already expanded Medicaid coverage to childless adults would receive a higher federal matching rate than they do currently for the costs of covering this population.
It also raises Medicaid reimbursement rates to the Medicare rate for primary care physicians in 2013 and 2014. This is intended to help ensure access to care for the expanded Medicaid population. The incremental cost of the increase would be fully funded by the federal government.
The bill reduces the cuts to Medicaid disproportionate share hospital (DSH) payments from $18.1 billion to $14.1 billion, but initiates them in 2014. It increases funding for community health centers from $8.5 billion under the health reform law to $11 billion.
It raises the threshold for the excise tax on “Cadillac” health plans to $10,200 for individuals and $27,500 for family coverage and $11,850 and $30,950 for retirees and employees in high risk professions and delays its application to 2018. Vision and dental coverage would be excluded. It permits an adjustment if an employer’s workers’ age and gender demographics are not consistent with a national risk pool.
The health reform law includes a “grandfather” policy that exempts existing employer?provided health plans from some of its provisions. The reconciliation bill applies some regulations to these “grandfathered” plans. It extends the prohibition on lifetime limits, the prohibition on rescissions, and the requirement to provide coverage for nondependent children up to age 26 to all existing health plans starting six months after enactment.
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Paul McIntosh is Executive Director of the California State Association of Counties. He can be reached at pmcintosh.at.counties.org. |
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