Implementation News You Can Use

Fact of the Week: The Check Is In The Mail

· This week, $250 rebate checks were mailed to Seniors who have fallen into the Medicare Part D prescription drug coverage gap (donut hole). Currently the donut hole is between $2,830 and $6,440 in annual total drug spending.

· A Senior does not need to do anything to receive their rebate check – it will come automatically once the donut hole is reached. By the end of the year, approximately 4 million Seniors should receive a $250 check.

· Next year, Seniors will receive a 50% discount on brand-name drugs and a 7% discount on generic drugs while in the coverage gap. The gap will narrow and then close by 2020.

· Let us know if this benefit is helping your patients. Do you have a patient that received a check this week? Please send your patient’s story to Dr. Adair Parr, Chair, NPA Communications Committee: adair.parr@npalliance.net

Bringing Implementation Home

· Beginning July 1, 2010, temporary (until 2014) high-risk pools will make insurance available to some individuals who have been uninsured for at least 6 months due to a pre-existing condition(s). Eligible individuals must be citizens or legal immigrants. Insurance premiums will be set at an average cost for the area and individuals will be eligible for subsidy to help pay the cost. There will not be enough money available to cover all eligible individuals. Implementation specifics will vary from state to state so check with your state health care office for details.

· The White House has created useful fact sheets for each state and a number of communities. Go here to quickly find out how many Seniors in your state will receive prescription drug rebate checks, how many young adults are likely to benefit from staying on their parent’s health insurance plan, as well as many other useful numbers about the impact of reform in your state: http://tinyurl.com/2dza8gy

· The expansion of Medicaid in 2014 will significantly reduce the number of uninsured people in every state. This Kaiser Family Foundation report is a state-by-state analysis of the impact.

For Patients:
Download NPA’s 2-page version of the bill.

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The costs of health care reform have been in the news this week as the CBO Director Doug Elmendorf released a presentation given to the Institute of Medicine, which indicated that the federal budget is on an unsustainable course despite the passage of the Affordable Care Act.  Peter Orzag responded to this assertion in a blog post on the White House Blog.  The CBO has estimated that the ACA will reduce the deficit by more than $100 billion over the next decade and by more than $1 trillion in the following decade.  Furthermore, incentives to create a more efficient health care system may result in even more cost savings.

An article by Jonathan Gruber, Ph.D., in the June 3rd edition of The New England Journal of Medicine discusses the cost implications of health care reform.  Although health care costs will increase initially due to expanded coverage, this should lead to lower costs down the road.  Further, it is the excessive growth of health care costs that is currently unsustainable and this is what the ACA has begun to address.

The ACA is the first step in a long path toward control of health care costs and implementation of a more effective and efficient health care system.  We need to keep working to educate our patients and colleagues about the benefits of ACA.