Health Law and Policy Update
Headlines of the week
Governor Ritter announces Office of Health Reform
This week, Governor Ritter named a director of health reform implementation and created an inter-agency oversight board charged with working on reform in Colorado. The director is Lorez Meinhold, who has been the governor's senior health policy adviser. Before joining the governor's staff, Meinhold was a senior program officer at the Colorado Health Foundation, and before that executive director of the Colorado Consumer Health Initiative. The Interagency Health Reform Implementing Board has 11 members, all cabinet members or senior executive branch staff.
Who's doing what
Congress temporarily extends COBRA benefits
The Senate voted late last week on a temporary extension (until May 1, 2010) of COBRA benefits. With the same vote they temporarily delayed a 21 percent reduction in Medicare rates for providers.
United announces early implementation of dependent coverage
UnitedHealth Group Inc. plans to allow graduating college seniors to stay on their parents' health plans, getting ahead of a provision of the federal health overhaul package that will go into effect in September.
The new UnitedHealth policy will extend coverage to about 150,000 children of members when those children graduate from college this spring. Uninsured dependents who aren't graduating this spring will need to wait until Sept. 23 to qualify for coverage. UnitedHealth's provision is only for fully insured employer-sponsored plans. While not far-reaching, the policy change is a sign the country's largest insurer by revenue is moving quickly to comply with the new law's provisions.
Humana, Kaiser Permanente and WellPoint announced similar changes.
Partners now have hospital visitation rights
President Barack Obama issued a Memorandum on Hospital Visitation last week directing the Department of Health and Human Services to develop rules for Medicare and Medicaid allowing patients to designate hospital visitors, with one reason being to guarantee lesbian, gay, bisexual and transgender people, and unmarried partners the right to visit loved ones in the hospital. The memo states that "designated visitors, including individuals designated by legally valid advance directives (such as durable powers of attorney and health care proxies), should enjoy visitation privileges that are no more restrictive than those that immediate family members enjoy." It also states hospitals may not discriminate against visitors on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity or disability.
The Joint Commission, an accrediting body for health care organizations, adopted a similar requirement late last year in new standards for hospital accreditation. The new standards, to be implemented no earlier than January, require hospitals to allow a family member, friend, or other individual to be present with the patient for emotional support during the course of stay and prohibits discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression.
We'll take a look in this section during the next few weeks at what provisions of national health reform will be implemented this year as well as opportunities for states going forward.
What happens to early retirees and others not offered health insurance through the workplace?
By 2014, almost everyone will be required to have health insurance or pay an income tax penalty. There are, however, no criminal penalties attached to failure to pay. Despite what some are saying, the bill is explicit: No one will go to jail for failing to comply with the requirement to purchase health insurance. Text of the bill:
(A) WAIVER OF CRIMINAL PENALTIES. - In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure.
(B) LIMITATIONS ON LIENS AND LEVIES.-The Secretary shall not -
(i) file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section, or
(ii) levy on any such property with respect to such failure.
In addition, certain people are exempt from the requirement to purchase health insurance including for financial hardship, religious objections, American Indians, those without coverage for less than three months, undocumented immigrants, incarcerated individuals, those for whom the lowest-cost plan option exceeds 8 percent of an individual's income and those with incomes below the tax filing threshold.
People without an income are likely to be eligible for Medicaid. As an example, an individual with an income of less than $14,403 a year, who is a U.S. citizen or has been a lawful permanent resident for at least five years will qualify for Medicaid.
People with incomes, but not yet Medicare eligible, will be able to purchase insurance through the exchange. Older people cannot be charged more than three times what younger people are charged. There are guarantee issue requirements, meaning no one who applies may be denied coverage. People with incomes less than 400 percent of the federal poverty level will be eligible for sliding-scale premium credits to help purchase insurance. For a sense of what your premium will look like see the Kaiser Health Foundation's Subsidy Calculator.
Not offered insurance at work
More small employers (with 25 or fewer employees and average annual wages of less than $50,000) are likely to offer health insurance because of the small employer tax credit of up to 35 percent of the cost of insurance that begins this year. Larger employers (with more than 50 employees) may respond to the penalties imposed if any one of their uninsured employees receives public assistance. Those not offered insurance because their employer prefers to pay a penalty rather than offer insurance will have access to coverage and the subsidies offered through the exchange.
The employer penalties are as follows: Employers with more than 50 employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit will be assessed a fee of $2,000 per full-time employee. The first 30 employees are exempt from the assessment. Employers with 50 or fewer employees are exempt from any penalties.
What you can do
House Bill 10-1160 will be heard this Friday on Third Reading in the Senate. Please call your state senators and tell them to oppose the bill. An issue brief by the Colorado Center on Law and Policy explains how the bill could hurt health insurance consumers. Don't know who your senator is? Find out at Project Vote Smart.
Health Care Director
Health Care Attorney
Released April 21, 2010