Though Americans remain divided on the law -- the most sweeping changes to health care in decades -- critics who want to scrap it may risk getting rid of provisions that people actually like, such as preventing insurers from denying coverage based on preexisting conditions, which went into effect last year, along with the controversial requirement which mandates that all citizens have health insurance in 2014. Some of the bill's more popular elements that begin in 2011 affect senior citizens, who remain a powerful voting bloc. In 2011, seniors should get steep discounts on drugs and free wellness and preventive care such as annual physicals.
Here are some of the biggest changes in health care in 2011:
- The "doughnut hole" will begin to close. Participants in Medicare Part D had reached the dubious milestone after they and their insurance companies had purchased $2,800 worth of medications and could not receive reimbursements until after reaching the $4,500 threshold. Those inside the doughnut hole will get a 50% discount on branded prescriptions. Kaiser Health estimates the changes could slash $700 from the prescription drug costs of a typical Medicare beneficiary.
- Some wealthier seniors will pay higher premiums. Prescription drug subsidies will be cut under Medicare Part D for people with annual incomes above $85,000 and for couples earning $170,000. The downside is that some participants in privately-administered Medicaid Advantage programs will lose extra benefits such as vision and dental coverage, according to Kaiser Health News;
- If health insurers fail to spend at least 80% of their premiums on medical care, they may be forced to issue rebates to consumers. Companies can also no longer enact lifetime limits on coverage;
- Medicaid will stop paying for some preventable hospital-acquired infections, something which Medicare and many private insurers already do;
- People will no longer be able to use flexible spending accounts to pay for over-the-counter medications without prescription;
- Medicare payments to primary care physicians will be increased by 10% through 2015. There also will be increased incentives for medical students to enter the field, such as loan forgiveness programs. "The value we bring to the system is both under-recognized and under-compensated," says Dr. Glen Stream, president-elect American Academy of Family Physicians, in an interview. "Is this a step in the right direction? Absolutely."
About the only point most people agree on is that the bill is far from perfect. The nonpartisan Congressional Budget Office pegs the cost at $940 billion over 10 years while reducing the deficit by $138 billion during that same time. For critics of the bill, such as incoming House Speaker John Boehner, the expenses are too great and the benefits too few.
The Ohio Republican told Fox News in November "...we're going to do everything we can to stop this bill from being implemented, to make sure it never happens. And, frankly, if we're successful, this will become the number one issue in the presidential election in 2012."
Whether Boehner and his allies can make good on these threats remains to be seen, though it reportedly is on the top of the Republican agenda for the new Congress.
One thing is for sure: The fight over health care reform has just begun.