by Tammy Alexander
The long, often contentious, debate over health care reform legislation is over. Now, the hard work of implementation and education begins. At the MCC Washington Office, we will be working with other faith-based organizations to help patients, providers and small business owners understand their rights and responsibilities under the new law. And we will continue to advocate for administrative and legislative changes to ensure that health care reform benefits the most vulnerable in our society.
In 2007, Mennonite Church USA–in consultation with MCC and several other Anabaptist agencies involved in health care–adopted a set of principles on health care reform which called for, among other things, eliminating financial and health status barriers to health care access, strengthening public health systems, and a greater sharing of risks, costs, and responsibility by all. The bills signed into law in March generally support these goals.
Basic Framework
(1)Health Insurance Reforms:
- Extend dependent coverage to age 26 (6 months after enactment for the following plan year, though some insurers are extending this coverage immediately)
- Prohibit rescissions (retroactively canceling policies)
- Create temporary high-risk pool
- Require 85 percent of premiums be spent on services (80 percent for individual/small group market)
- Prohibit preexisting condition exclusions and annual/lifetime limits (existing plans grandfathered until 2014; children with preexisting conditions covered 6 months after enactment)
(2) Exchanges
- Marketplace for purchasing health insurance plans (for individuals, families, small businesses)
- State-based
- Plans required to offer “essential benefits”
- Age rating limited to 3:1; tobacco use rating limited to 1.5 to 1
(3)Individual Mandate
- U.S. citizens and legal residents will be required to have “qualifying health coverage”
- Tax penalty phased in (2014: $95/1.0 percent of income; 2016+: $695/2.5 percent of income)
- Exemptions for religious objections
(4)Affordability Provisions
- Expansion of Medicaid to 133 percent of FPL (Federal Poverty Level); include single people and adults without children
- Subsidies reduce both premiums and out-of-pocket expenses on a sliding scale (100-400 percent of FPL)
(5)Employer Penalties & Incentives
- Penalty of $2000 per full-time employee receiving subsidy (excludes first 30 employees)
- Exemption for small businesses with 50 or fewer employees (more than 80 percent of firms)
- Incentives: Small business tax credits; assistance for covering retirees age 55-64
Abortion
- Federal law prohibits federal funding of elective abortions
- States can prohibit coverage for elective abortions in Exchanges
- Those who receive subsidies could choose plans that cover elective abortion, but would have to make a separate payment (not covered by subsidies)
Immigrants
- Only legal immigrants can receive subsidies
- Only legal immigrants can purchase insurance on the Exchange–even with their own money
Additional Provisions
- Wellness
- Long-term care
- Comparative effectiveness research
- Reduce waste, fraud, and abuse
- Gradually close Medicare prescription drug “donut hole”
- Workforce development–training new doctors and nurses, with attention to rural areas
- $11 billion for community health centers
- Indian Health Care Improvement Act reauthorized
More information is online at washington.mcc.org/life/health.
