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Implementation of Health Reform in 2010 and Beyond

By Jessica DeMartino, PhD, NCCN Policy Fellow

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act.  This comprehensive health reform bill was modified by the subsequent passing of the Health Care and Education Reconciliation Act of 2010.  Implementation of the key provisions is the next step in health reform and will occur over the next few years with some actions and steps taking place during 2010.

To manage compliance to reform measures by the private insurance industry, the U.S. Department of Health and Human Services (HHS) has recently established the Office of Consumer Information and Insurance Oversight.  The Office will designate deputy directors in four program areas: oversight, insurance programs, consumer support, and health insurance exchanges.  The Office is headed by Jay Angoff, a former Missouri insurance commissioner and Director of the Private Health Insurance Group at the Centers for Medicare & Medicaid Services. 

The Office will be responsible for ensuring compliance with new insurance market rules, including prohibitions on rescissions and on pre-existing condition exclusions for children that take effect this year.  In the future, they will oversee new medical loss ratio rules and will assist states in reviewing insurance rates.  They will provide guidance and oversight for the state-based insurance exchanges and will administer the temporary high-risk pool insurance program.

Now that health care reform has passed and been signed into law, consumers and patients are wondering how it will affect them personally.  For consumers, there are many potential positive outcomes from health care reform in 2010:

1. Effective new plan years starting September 23, 2010, all individual and group policies must provide dependent coverage for adult children up to age 26.  The adult child cannot be eligible for other employee-sponsored insurance and does not have to reside with the parent.  The adult child can be married, but the adult child’s spouse or children cannot be covered under the plan.  This expanded coverage will also apply to self-funded employers.
2. Individual and group health plans will be prohibited from placing lifetime limits on the dollar value of coverage.
3. Individual and group health plans will be prohibited from excluding children due to pre-existing conditions.
4. Medicare will provide a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010, and Medicare will gradually eliminate the Medicare Part D coverage gap by 2020.

Of special interest to providers and clinicians, comparative effectiveness research will also be supported by health reform.  The non-profit Patient-Centered Outcomes Research (PCOR) Institute will be established and governed by a multi-stakeholder Board of Governors.  The Government Accountability Office (GAO) has responsibility for appointing members of the Board of Governors, and the Board must include three individuals representing patients and health care consumers and five individuals representing health care professionals or institutions.  Letters of nomination and resumes must be submitted to GAO by June 30, 2010.  The Institute will conduct, support, and synthesize research with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.

Financial support for the Institutes’ activities will be provided by the Patient-Centered Outcomes Research Trust Fund (PCORTF), which will be funded in part through fees (starting in policy year ending after September 30, 2012) imposed on insurers of health plans and employer sponsors of self-insured health plans.

Implementation of health reform will continue to take place through 2014 with many key reform measures taking effect in 2013 and 2014.

Sources:  
“Private Insurance Industry Reforms, Exchanges Entrusted To New HHS Oversight Office”, The Pink Sheet, May 17, 2010
U.S. Department of Health and Human Services, The Office of Consumer Information and Insurance Oversight, http://www.hhs.gov/ociio/, accessed May 24, 2010
Kaiser Family Foundation, Health Reform Implementation Timeline, http://www.kff.org/healthreform/8060.cfm, accessed May 21, 2010