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HELLO, I'M JENNY BACKUS, ACTING ASSISTANT SECRETARY FOR PUBLIC
AFFAIRS HERE AT HHS, AND WELCOME TO OUR THIRD WEBCHAT ON HEALTH
REFORM. WE HOST THESE WEBCHATS BECAUSE
WE UNDERSTAND THAT SOME OF THE DETAILS OF THE HEALTHCARE REFORM
ACT CAN BE CONFUSIN SO WE'RE HERE TO ANSWER YOUR QUESTIONS.
EARLIER THIS WEEK, WE INVITED YOU ALL TO SUBMIT YOUR QUESTIONS
ABOUT HEALTH REFORM, AND TODAY WE'LL ADDRESS AS MANY QUESTIONS
AS WE CAN. WE'LL KEEP THE DOOR OPEN FOR
QUESTIONS DURING THE WEBCHAT IN CASE SOMEONE NEEDS
CLARIFICATION, YOU CAN EMAIL US AT HEALTHREFORM@HHS.GOV,OR SEND
US A TWEET ON TWITTER; OUR handle is @HHSGOV.
WE WILL BE HOLDING THESE CONVERSATIONS REGULARLY IN THE
MONTHS AHEAD, SO IF WE DON'T GET TO YOUR QUESTION TODAY, WE WILL
MAKE EVERY EFFORT TO COVER IT NEXT TIME. KEEP IN MIND THAT WE
WILL ALSO BE ANSWERING SOME OF THE MOST FREQUENTLY ASKED
QUESTIONS EACH DAY ON OUR WEBSITE:
HEALTHREFORM.GOV, SO CHECK THE SITE REGULARLY FOR
MORE INFORMATION AND UPDATES. JOINING ME TODAY TO TALK ABOUT
DETAILS OF THIS LAW INCLUDING HOW IT HELPS INCREASE YOUR
HEALTH SECURITY, ARE THE TWO WOMEN WHO LED THE FIGHT FROM HHS
AND THE WHITE HOUSE. SECRETARY OF THE U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES,
KATHLEEN SEBELIUS, AND WERE'RE HONORED TO ALSO HAVE
NANCY-ANN DEPARLE, DIRECTOR OF THE WHITE HOUSE OFFICE OF HEALTH
REFORM. NANCY-ANN, YOU'RE LEADING HEALTH
REFORM IMPLEMENTATION ACROSS THE GOVERNMENT FOR THE PRESIDENT.
WHAT'S HE LOOKING FOR WHEN IT COMES TO IMPLEMENTATION?
-- He wants us to work hard to deliver the benefits to the
American people as soon as possible.
That's what we are doing, working together.
SECRETARY, YOU WORKED CLOSELY WITH NANCY- ANN ON THIS BILL.
WHAT'S SOMETHING ABOUT THE BILL THAT ISN'T AS WELL KNOWN?
-- I think one of the great pieces of news is a lot happens
this year. We have been talking about this
law for almost a year. But here we are in 2010 and
there are a lot of benefits that are about to happen.
Seniors are going to get some help, small accident owners,
parents of kids who are about to become college graduates, so we
want to make sure that people understand here in 2010, there
is good news coming their way. -- Anything else?
-- I was looking at the law yesterday and particularly how
it affects seniors and that's one of the places I see the
biggest lack of knowledge, really.
There is new prevention benefits so that tests that seniors need
to help prevent disease will be covered with no copays starting
next year. There is coverage for doctors,
more primary care doctors will get more payments and things
like that that seniors don't know about.
We have a lot of work to do. -- One of the things I have
always heard about and my dada 89, and Medicare beneficiariy,
Medicare never paid for annual Czech ups for seniors.
If you think about keeping people healthy, that is a great
move. So starting next year, an awn
yell checkup will be part of the over all Medicare benefit and
available to everybody who sigh beneficiary right now.
-- You talk about seniors, we'll now go to the questions we are
getting in. Seniors have been getting a lot
of migs information. It's interesting, the questions
range from people repeating something they heard to asking
really great questions. I want to thank you.
These were received over the last three web webcasts, over
1,000 questions. I'm not going to ask 1,000
questions but we'll try to get through as many as possible.
Since today is tax day, I'm going to start off with a
question about small businesses. This is coming from Becky from
Texas.
Can you please explain when employers will have to declare
the value of health benefits on an employee's W2?
Is it January of 2012 for tax year 2011?
-- Yes. We will be doing that for next
tax year but won't have to make the declaration until 2012.
-- Now you're overseeing it for everybody.
You're working with the treasury department too?
They are working on this? -- They are working together
with us on our team and working with the secretary.
-- And I think we also have information on the web site.
That's a good plagues to go. Janet is e-mailing us a
different topic.
Can my under 26-ear-old child who is not in school be covered
under my health insurance policy?
-- In the past, Janet was kind of out of luck as my kids were
when they graduated from college.
We had to go out and shop in the individual market and find plans
because neither of them went into jobs that came with health
benefits. That's going to change this
year. So either in a state where there
is an age limit, you can't be beyond past 21 or 22 or until
you finish full-time school, now we will have a benefit available
to Janet's child and children across America, that they can
stay on a family policy until the age of 26.
And we are defining those rules right now.
We are about to get the information out to people.
It's very good news for families across this country.
-- And young people too. -- Exactly.
They may not know it. -- Their parents will tell them.
-- Donald is following up.
What if my son graduated from college at 21 and he was dropped
from my insurance plan. He is now 23 and out of work; can I
put him back on my Insurance?
-- Yes, and as the secretary said, she and the secretary of
treasury and labor are in the process of working on the
regulation that is will make the guidance clear on this.
So it will be sometime later this year.
It's for plan years starting January 1 of next year.
So it could be later this year. Some companies may come forward
on their own. But the secretary has been
working with them and asked them to go ahead and keep some people
on who might otherwise go off and I actually met with a
company today who said they might reach out and allow people
to come on early. But regulations are going out
and we are confined to next plan year.
-- Great. And just to follow-up on that,
when you're talking about younger people and losing jobs,
Charlie just sent this very fresh question.
My girlfriend and I recently lost our jobs.
And our friends told us that health insurance is is now
mafnedtory with a penalty if you do not have it.
How can we afford health insurance without income and
will we be fined for not having it?
-- First of all, Charlie, I'm sorry about the job and
unfortunately, Charlie is not alone nor is his girlfriend.
A lot of people have lost their jobs in this market and have
lost their health insurance along with it, which is part of
the urgency of getting this law in place starting in 2014, four
years from now, when we have a new health insurance market
available, there will be some individual responsibility.
It always will have a waiver for people who can't afford
coverage. That will always be a part of
opting out. But the good news is that not
only will there be an affordable market but help for the the
lower income workers, subsidies for families and workers who
can't afford the 100% of the payment on their own, they'll be
tax breaks. So the largest tax break for
middle-class Americans is going to be available to help people
have the kind of health security they need.
-- Can I just stress the 2000 14 date too?
Charl seworried he is going to get penalized tomorrow.
I bet he will get a job before 2014.
-- Hopefully he'll have a job with employer coverage because
one of the things we are trying to do is stabilize the employer
marketplace. And if you have coverage by your
employer, if you like the plan, if you like it, nothing changes.
We want to make it easier for small employers to offer
coverage to their employees to stabilize that market.
In 2014, there will be a new market for those who don't have
coverage, don't have employer coverage, don't have affordable
coverage in the marketplace, but some help to help pay for that.
-- Speaking of help, someone from Virginia, they identified
themselves as a viewer from Virginia, we are a small
nonprofit organization that would like to offer our
employees health care insurance. But we haven't been able to
afford it. Will this new legislation help
us? -- It will.
And I'm so glad that it does. The secretary said that we want
small businesses, small employers to be able to provide
health insurance and they are often the ones who have the
hardest time doing it. They don't have the leverage in
the marketplace to get the kinds of choice that is larger
employers get. Starting right now, there is a
small business, small employer tax credit available and it
affects not just the for profit companies, also not for profits.
So there is guidance up on the White House.gov website as well
as the IRS.gov has FAQs that explain how to take advantage of
this tax expretd we hope that will help businesses like their,
to also be able to afford to help subs dice health insurance.
-- And I know we have a lot of questions but I think this point
is so important. So we have got a tax credit that
starts in 2010. And is available building up to
the new markets in 2014 there will be some new, more
affordable options for small-business owners.
The kind of leverage that the big companies have, government
employees have, the kind of choice that is members of
congress have, because they will be pooled with a lot of their
peers. So it's a step-by-step
operation. Tax cret is available right now.
The other thing I hear all the time, and Nancy Anne sure does
also, is a lot of small employers say, am I going -- do
I have to provide coverage for my employees?
Absolutely not. We hope that they'll be some
afford ab choices, that that will encourage people to come
into the market, but if you employ 50 people or less, that
doesn't count. Part-time employees, or seasonal
employees, you do not have any mandatory coverage issues and it
certainly is not for right now. So there is a sense of some
penalty is going to happen if I don't provide coverage to my
employees. I think the penalty often is
that you lose good employees who go down the street or around the
corner because they want health benefits and you can't afford to
provide them. -- I'm struck by what you were
talking about. The perception of the penty but
it sounds like an incentive. -- It's money in their pocket to
help them go out. -- Do what they want to do any
way. -- That's what I think -- we
want to provide it, it's just hard for them to find the
choices and also hard to afford it.
This will help them do that. -- I don't want to hog questions
but one I think I was struck, the secretary mentioned, now
that it's 2014 -- I think there is a lot of people out there
that think everything in this bill is happening to me right
now. Is this designed to build to
where we are getting to in 2014? -- It is.
We were talking about it the other day and I think we both
see it as the things that are happening now are a bridge to
what happens in 2014. The exchanges, new marketplaces
set up and the tax credit that will be available for people to
help them purchase. Those are the things that really
come into full bloom in 2014. But between now and then -- and
some of the insurance market reforms like the ban on all
preexisting exclusions which we all want and wish we could have
in place today, but you really can't do that until you get
everyone covered and so that will happen in 2014.
But between now and then, there are things to help make the
markets work better such as some of the insurance reforms we will
be rolling out this summer. The benefits beginning to close
the donut hole for seniors, which is something they needed
very much for years. So those things will happen T
will buildup to the reform marketplace.
It will be in full bloom in twentdy 14.
-- Interesting you just mentioned markets.
Because tony has a question. Why are premiums going up in
large amounts and when will it slow down?
-- That's a very good question. First of all, the new law was
signed two weeks ago and as we said, will gradually be in
place. I think in large part, we see
these dramatic rate increases on some parts of the market.
So people who are buying individual coverage or folks who
are self-employed or small-business owners who are
shopping for their own plans are seeing double digit rate
increases. So two things will happen.
A new market that will put people in bigger pools and give
them some negotiating power, some rules for the insurance
companies making sure they have to pay the ma nort joritiy of
money in benefits and not in overhead and CEO salaries and
advertising which they can do right now.
That will be in place. But also we are starting to take
some serious steps to reduce the overall increase in health care
costs. Aiming at better quality at
lower costs, which occurs in some parts of the system, fewer
people going back into the hospital after they have been
treated once. Bundling care so hospitals and
doctors work more closely together.
Trying to keep people healthy and not just waiting until they
are sick and paying for that care at the later point.
So there are a bunch of steps that will happen along its way
which will affect everybody whether you have insurance or
not and lower of the cost of the health care system.
-- One of the things you have been talking about is hybrid
schools. This question came in from
Twitter. It looks like it's one49
characters. How do uninsured Americans get
added to the high-risk pool so they can get access to the
affordable insurance? -- That's something again that
the secretary and her team is working on right now.
One of the first things we did the law passed, was sent out a
letter to all the governors saying that the new law does
provide funding to help them and to help us provide a high-risk
pool for people with preexisting conditions and who have been
denied coverage. So some states, maybe 20 states,
I guess, provide such a pool right now.
But a lot don't. And the secretary will be
working with each state to figure out what works best for
them, whether they want to do it themselves or some are already
doing or whether the department will do it on behalf of the
federal government on behalf of those people in those states.
-- And a little bit of difference in the law between
how children are treated who have preexisting conditions and
how adults. The law basically says if you're
a parent and have a sick child, that child needs to be covered
starting this year. So no policies will be written
any longer to exclude your child or the treatments he or she
needs. By 2014, that is going to apply
to everybody but in the meantime, the high risk pool for
adults is available. We are starting with states
saying to states, you set up the pool, we will help you.
But it should be at the state level.
But if the state decides they don't want to do it, they don't
want to have that benefit available to their citizens, we
don't want people to be penalized by the state not
willing to do it, so we will have a backup plan that
individuals can take advantage of.
But we hope that the goch list engage.
We hope that states will indeed decide that this is a great
benefit for their citizens who are right now often locked out
of the insurance market. -- David, I'm going to go back
to that one I mentioned earlier. He scdz, can you tell me how the
new law will protect me from the donut hole?
-- I can explain really quickly what it is.
-- The donut hole is a gap in coverage of prescription drugs
that seniors have. The law was changed for many,
many years seniors in Medicare didn't have a prescription drug
benefit. And the law was changed in 2003
so they now have a prescription drug benefit but there was a gap
between roughly 2,500 dollars in spending and 4,500
dollars -- almost a 2,000-dollar gap where there was no
assistance for Medicare. The Medicare beneficiaries is on
his or her own to afforditose drugs.
The people who fall into that gape, more than seven mill
million a year. Some get assistance from other
sources like retiree coverage but if they don't, they are the
people who need a drug probably have a chronic illness and need
those drugs and we heard many stories from people who just
don't take their medications or have to make many, many other
sacrifices in order to be able to afford them.
So the good news is that it's being closed by the new
affordable care act. Start this summer, we estimate
that 4 million seniors who fall into that gap will get a rebate
check from the government of $two50 to help defray some of
the costs. And that's just a down payment
on what will happen starting in January.
Which is that we'll eventual close the hole.
Over time so over the next ten years it will no longer be there
and it won't be a donut hole. They will pay the 25% in the
donut hole as they do all the way up to pay their piece of it
but the rest of it won't be there anymore for them.
-- Mary sent in a question and said,y I don't want to see
unappreciative but how is $two$50 going to help me?
A little bit of relief and working towards closing it.
-- Starting in January they will get a 50% discount on the drug
and discount on generics and yes, 2$50 we know is just a down
payment on what they need. But we think it's very good news
that help is on the way. -- I don't think a lot of people
will get a check but some will --
-- Some don't. -- And I think one of the things
that we have heard already from seniors is what do they have to
do to apply? Nothing.
This is monitored by the Medicare services if someone
tries to sell you something related to getting this check,
say no. You will be automatically mailed
a check depending on when you hit the coverage gap.
It could come this summer or come later this fall.
But you don't have to apply to get it.
The President feels strongly this is a group of individuals
who need help paying for their prescription drugs and we want
to make sure they go out the door.
-- We are doing a web chat from someone with the AARP and senior
folks and we will be pushing hard to educate people on that
message. Nicole, I was wondering what the
new health care bill will do for deaf or heard of hearing
citizens? Any specific provisions?
What about Cochlear implants and hearing aid coverage?
I don't know the answer to that. -- a couple of things.
First of all, I think there is good news in preventive care.
One of the things we been children is that too often they
might hit school and nobody has ever even identified the fact
that they have some sort of hearing defect that makes it
harder to read. It makes it harder to learn.
So preventive coverage, expanded, I think is the first
step to even identifying some hearing issues.
In terms of the over all benefit packages that will be available
in the new exchanges, we haven't made those determinations yet.
They won't be available until 2014 for people who don't have
coverage now. So that is coming down the road.
So there are no -- I would say the preventive care, the
expanded health care providers is something that hits right
now. -- Okay.
David, from Washington, does the new health care reform law
include provisions for long-term care?
-- Yes, it does. It includes a new program, a new
voluntary program called the class program, to help people
stay in the community longer so if you decide to participate in
this program and you pay in for five years and you can receive a
cash benefit, if you have needs for activities of daily living
you can't perform anymore, the idea is to try to help people
provide for their own long term care needs later on through
payments they will make now when they are working they can afford
it and then if they need help later, they will get this
benefit. The estimate is around $200 a
day to help them with affording whether they need chore services
or someone coming and providing home health care.
So it would cover things that right now are not covered
through Medicare or Medicaid. -- That's a big deal.
-- Probably no one heard about that.
-- And I think first of all, it's totally voluntary.
No one has to participate. But it's a way that people can
save some of their own salaries right now and to -- into a trust
fund and then get it back to use for arksz voiding in many cases,
nursing home care. A lot of people find themselves
in a situation where they can't fully take care of everything.
They can't give themselves a bath any longer or can't get to
the grocery store or can't make a meal but they really dock a
lot of other things. They don't want to end up in a
residential facility. But they are forced to make that
choice because they are not family members around or there
is not a support system. This actually helps provide some
of those elements which will alo people to live independently a
lot longer, to be on their own a lot longer, to have the kind of
needs that they may find themselves with taking care of.
And it's really their own money they have been able to save and
then drawdown for these kind of services.
-- There is many of my friends are facing aging parents issue
and so it's really interesting to know that.
-- Seniors groups and the groups, disability groups,
really advocate to this and it's something that they sought for
years because they want people to be prepared for that.
-- Okay. A family.
They are saying it is my understanding that all families
and individuals will be required to purchase health insurance or
face a fine. Talk about this a little bit.
It appears that families in rural areas who do not have that
many health care options are in a particularly -- they want to
know how that impacts people in rural areas where they don't
have a lost choices for doctors. -- Well, you asked at the
beginning one of the things in the bill that no one knows
about? One of the things people don't
know I think, is there are policies in the law to help make
sure that there are more providers in rural areas.
There is bonus payments that will be available to primary
care physicians who practice in rural areas because we do know
that there is sometimes -- our secretary is from Kansas and I'm
from Tennessee and we know about areas of the country where there
aren't as many health professionals perhaps are
needed. So there are provisions to make
sure that they have incentives to practices in those areas.
But secondly, the -- let's be clear too that the new policy in
the law that says everyone has a responsibility to have health
insurance if they can afford it, and here is help if you can't
afford it. But those don't go into affect
until 2014. And there will be tax credits
for people, families, family of four with income of less than
88,000 dollars will be eligible for tax credited to help them.
The Medicaid program will expand so people who are eligible for
that will be eligible under the new law for that if that's the
right program for them and there will be an exemption.
If someone can't afford it, there will be a hardship
exemption. So that will be make it much
easier for people to afford it and then the choices they have,
we think will be much broader because the new exchanges will
be set up so the insurance plans will be available and accessible
to people who -- right now they aren't.
That's why there aren't many choices in some areas of the
country. -- We also know a lot of docs
right now who are young students in medical school, may not
choose pede eight at Rick or jare at Rick care.
Because they are not paid as well as a specialist in a big
city hospital. So one of the things that is
being done is to make sure that doctors who provide primary care
or wellness care get paid more adequately, more appropriately,
and encourage more of the younger students to look at that
specialty area. Knowing we need a lot more
people if we are going to keep people healthy in the first
place. We want that pipeline of medical
providers. We need more nurse practitioners
and again, there is scholarships being paid off and recruitment
efforts. So by the time we hit 2014, we
are going to have more health care providers focused in this
very important area. -- We have about five minutes
left. So I'm just going to try to ***
through some questions here. We don't have to speed around
but -- [Laughter]
But tony wants to know, you were talking about families earlier.
How is coverage of ma maternity care affected by health reform?
-- It's strengthened because there are many areas of the
country where insurance policies don't cover maternity care and
they will be covered under the new law.
And it will be part of the essential benefits in the new
plans that will be provide. -- The other thing is right now,
women, who are the last time I checked, the only people who can
get pregnant, are often charged far more for their health
insurance than are their male coworkers or their brothers.
And I think that also will change.
In the new marketplace, you won't be able to charge women
two and three times you what can charge their male counterparts
because they might get pregnant sometimes.
-- It's not a preexisting condition.
-- That's right. -- Deborah.
I'm a single mom of two kids. I would like to know where a
person like myself stands in this new bill.
I have no health care for myself or my son.
I have implied she lifts in New Jersey with New Jersey care but
was denied. How does a low-income person
like myself get health care? -- Well, I can't answer
specifically why she was denied. But let's just say that the bill
has provisions again starting in 2014 where there will be a
marketplace that will be available to all Americans.
A hardship waiver if you can't afford coverage.
Help for people who want it and it will be some choices and
option that is people don't have right now.
So, right now, Deborah, your kids may be eligible for
Medicaid or chip and you should check that out immediately.
If you have a job that provides coverage for you, you would be
available but by 2014, there will be a system that we can
pretty well guarantee you will get some help with health
insurance and have some choices you don't have right now.
-- And for folks who are interested in Medicaid and chip
enrollment we have a special website called, ensure -- insure
kids now. I'm going ask for two seconds of
closing thoughts and then wrap this up.
-- my closing thoughts are these are great questions and this is
a great forum and opportunity to get some of the basic
information out about this new law and a hope Deborah goes to
the website for her child. We know help is on the way and
that makes me feel good. -- And we will certainly keep
doing these web chats and hopefully in the not too distant
future, have some numbers that people can call.
We know there are a lost questions out there.
And we want people to particularly know what is coming
this year. What can benefit their families,
their parents, their kids this year and that information will
be coming in a variety of forms. But we hope people check the
website and stay tuned. -- Great.
And that sets me up for next week.
We will have a website, specifically targeted towards
seniors. We will have a rep from the AARP
and the some of our top senior experts here at HHS.
We will hopefully get Nancy Anne back very soon.
We want to thank you. I know there are so many
questions. We are working with the website
and we are friends at the White House to do FAQs every day so we
are trying to get to your general area of questions.
Keep them coming. I hope you watch this on demand
if you didn't see all of it and I'll see you next time.
Thank you.