Title II of the federal Patient Protection and Affordable Care Act is titled Role of Public Programs. Since it does not relate to private insurance or employer-sponsored plans, I won't spend a great deal of time on it. Some of the high points:
- Individuals with incomes under 133 percent of the poverty line are eligible for Medicaid, starting in 2014. The federal government will reimburse the states for 100 percent of the additional cost until 2017, between 30 and 35 percent in 2017 and 2018, and 32.3 percent starting in 2019. States may phase in eligibility for lower-income individuals sooner if they wish, and they may also choose to make individuals with incomes above 133 percent of the poverty line eligible. States recovering from major disasters may be eligible for increased federal assistance with their Medicaid costs. Medicaid must provide at least the minimum essential benefits.
- States will receive increased federal assistance for the Childrens Health Insurance Program (CHIP) from fiscal years 2013 through 2019.
- States must simply enrollment procedures for Medicaid and CHIP and coordinate them with the exchanges.
- Medicaid will provide coverage for freestanding birth center services.
- States will have the option to designate certain needy groups as eligible for family planning services.
- States have the option of providing medical assistance for home and community-based attendant services for certain low-income individuals. Federal funds are available to help states cover the cost of aging and disability resource centers.
- The Medicaid prescription drug rebate percentage is increased and the types of excluded drugs are reduced. Reimbursement rates for pharmacies are increased.
- Payments to hospitals to cover the cost of treating uninsured patients will be reduced once the percentage of uninsured individuals is reduced to a certain threshold.
- Health care quality will be measured and payments adjusted based on the quality of care provided.
- There are a number of "demonstration projects" designed to test reforms as to whether they improve quality and reduce costs.
- American Indians and native Alaskans enrolled in coverages through exchanges have no cost-sharing if their incomes are below three times the poverty line.
- Maternal, infant and early childhood home visiting programs are strengthened, with improved coordination of services and assessments of high-risk populations.
- There is increased support for services, education and research on postpartum depression. States will receive funding for "personal responsibility education."
Yikes! This section of the law is incredibly long and complex. To be candid, I don't think there's any way a mere mortal could understand all of this. When people say the bill was too large and too complex, this is what they mean. I understand why the administration and the majorities in Congress felt it was advantageous to pass one, sweeping comprehensive bill, but a good argument can be made for considering these changes individually.
My head hurts and it's time to go home. Until next time...