Health Care Reform in 2011: What to Watch

BY Lea Winerman  January 5, 2011 at 10:32 AM EDT

Republicans officially take control of the House today, and a vote to repeal the health care reform law is at the top of their agenda. But with President Obama in the White House and a Democratic-controlled Senate, any House repeal vote will likely be symbolic — the repeal effort is unlikely to advance any further, and provisions of the law scheduled to go into effect this year will continue on course.

With that in mind, Hari Sreenivasan talks to Kaiser Health News reporter Mary Agnes Carey about some of the changes you might see in 2011. The reporters at Kaiser Health News wrote this detailed review of the upcoming changes. Highlights include:

Medicare Changes

Many of this year’s provisions affect Medicare recipients — and are designed to get them to see a doctor before small problems become big ones.

“There’s going to be a focus on making preventive health services more attractive to Medicare beneficiaries,” says Carey.

On January 1, Medicare started providing preventive care measures, including vaccinations and cancer screenings, for free, and also for the first time offering free annual “wellness exams.”

Many seniors will also be paying less for their prescription drugs this year, as Medicare continues to narrow the “donut hole” in which seniors pay out-of-pocket for drugs. This year, they’ll get a 50 percent off brand-name drugs.

But some seniors will be paying more for their pharmaceutical insurance. Medicare Part D, which covers prescription drugs, will for the first time link premium payments to income. Seniors who make more than $85,000 for individuals and $170,000 for couples will have to pay extra for their Medicare Part D coverage.

Medicare will also be making some changes to the way it pays its providers. To encourage more primary care doctors to see Medicare patients, the program will increase its reimbursement rates for primary care doctors by 10 percent.

This year also begins the reduction in payments to private Medicare Advantage plans — 2011 pay rates will be frozen at 2010 levels, and lower pay rates will begin phasing in in 2012. But next year, Medicare will also start offering bonuses to high-performing plans.

Calorie Counts

Diners will soon know exactly how many calories are in their burger, fries or salad — at least at chain restaurants. By March 23, 2011 (one year after the health reform law was signed), the Food and Drug Administration will issue its final rule specifying how restaurants have to implement a provision of the law that restaurants to post calorie counts and other nutrition facts.

The draft guidance is already available, and it says that restaurants with 20 or more locations will have to provide calorie counts on their menus. Consumers won’t see the changes show up immediately though — the FDA will let restaurants know how much time they have to begin complying with the new rules.

New Rules for Flexible Spending Accounts

If you have an FSA, there’ll be no more using it to buy Tylenol and other over-the-counter drugs — at least not without a doctor’s prescription. In the past consumers could use money set aside in an FSA to pay for both prescription and non-prescription drugs, as of January 1 the funds can only be used with a doctor’s prescription. Other rules remain the same — you can still use FSA money for co-pays, deductibles, and medical devices.

Insurance Rebates

As of January 1, health insurance providers are now required to spend a minimum amount of the money they collect in premiums on providing health care for their customers. For large-group plans, that minimum is 85 percent, for small group plans it’s 80 percent.
Plans that don’t meet the minimum requirement will have to give their customers rebates of the difference. The government has estimated that up to nine million people could be eligible for rebates.