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The five most significant healthcare events of 2011

Robin Wulffson MD's picture
healthcare reform, individual mandate, Medicare, pre-existing condition

WASHINGTON, DC - Healthcare reform was the subject of much debate in 2011. The year included several court cases challenging the constitutionality of the” individual mandate,” which required everyone to purchase healthcare insurance or pay a penalty, an attempted House repeal of the federal healthcare law, and the slew of Republican candidate debates, which among other issues, had candidates proposing a replacement plan for healthcare reform.

On March 23, 2010, President Obama signed the healthcare reform bill into law. The 2,400-page tome has been sliced and diced by numerous analysts. Most Americans lack experience in legalese and the time to digest the material even if they have a legal background; thus, they look to those that have for input. In addition, the multiyear and multistep implementation only adds to the confusion and controversy.

The five most significant healthcare events of 2011:

Expanded healthcare benefits for those 25 and younger: The law allows young adults ages 19 to 25 to remain covered by their parents’ health insurance policies. Health and Human Services Secretary Kathleen Sebelius explained that this allows these young adults to take entry-level jobs in fields they like, such as technology start-up firms, rather than take jobs just for the healthcare benefits. In addition, the law allows young adults with pre-existing conditions, such as diabetes, heart disease, or neurologic problems, to maintain their health insurance until age 25. In 2011, 2.5 million lung adults took advantage of this provision.

Expanded healthcare benefits for seniors: Prescription drug costs have been reduced by 50% via pharmaceutical manufacturers’ discounts. Seniors can receive annual exams and some screening procedures without a co-pay; in addition, they can receive free counseling if they screen positively for obesity. It has been well established that obesity impacts health in regard to conditions such as cardiovascular disease, hypertension, and diabetes. Through the end of October, more than 2.65 million Medicare recipients saved a total of $1.5 billion on their prescriptions: an average of $569 per patient. By the end of November, more than 24 million seniors underwent an annual exam and/or a screening procedure; thus, they were being proactive in regard to their health.

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Insurance coverage for pre-existing conditions: In 2011, individuals who had been denied access to healthcare insurance because of a pre-existing condition could join the government's Pre-existing Condition Insurance Plan (PCIP). The program is available to individuals who have been without insurance for at least six months. Enrollment has been slow. By the end of October, the plan had approximately 41,500 enrollees.

Preventive healthcare services for individuals with private insurance: Last fall, insurance companies sent out notices that their subscribers could obtain annual exams, immunizations, and screening procedures without a co-pay, deductible, or co-insurance. This benefit was provided to anyone who received insurance through his or her employer or who was in a personal plan created after March 2010. This provision allowed an individual to be screened for diabetes, have a cholesterol level drawn, or undergo a mammogram without a co-pay or deductible. In addition, the provision covered smoking-cessation programs, treatment for depression, and weight loss programs.

Healthcare fraud: The Justice Department cracked down on healthcare fraud; an 85% increase in prosecutions compared to 2010. It recovered $2.9 billion in healthcare fraud funds in 2011. In fiscal year 2010, the government prosecuted 731 health fraud cases. In fiscal year 2011, the government prosecuted 1,235 cases.

In addition to the most significant events that took place in 2011, the following provisions of the healthcare reform bill will take effect in 2012:

January 1: Accountable Care Organizations: These are groups of healthcare providers that band together to improve the coordination of patient care, increase quality, and save money.

March 1: Reductions in healthcare disparities: All federal healthcare programs will collect and analyze data on the race, ethnicity, and language of patients.

October 1:
Value-based purchasing in Medicare: Hospitals will receive financial incentives to improve the quality of care and will be required to publicize their data regarding heart attacks, heart failure, pneumonia, surgical care, healthcare-associated infections, and patients’ perception of care.

October 1: Electronic records: Federal health officials will begin the implementation of rules for the secure, confidential, and electronic exchange of health information. Currently, many healthcare providers use paper records, which are difficult to share with hospitals, other physicians, and laboratories.



Is so important for people to eat healthy and do moderate exercise. I know this from my own experience, because my husband was overweight. He had heart problems because of this, and he only wanted to start losing weight when his doctor told him that his life is in danger, but nobody should wait so long. He was lucky enough to find a healthy weight loss program that really worked for him. He lost more than 40 lbs and the most important is that he still maintain this weight. Good Luck to all!
I am pleased to learn of his success. Currently, obesity of epidemic proportion in the U.S. It is very disturbing to note the escalating number of obese children in the nation.