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Health Care Reform:

Health Insurance & Affordable Care Act

Supreme Court Upholds Health Reform Law

What about drug discounts for people on Medicare?

The law has gradually phased in discounts on prescription drugs for seniors who reach the Medicare drug benefit gap known as the "doughnut hole." According to the Centers for Medicare & Medicaid Services, more than 5.25 million seniors enrolled in part D drug plans have saved $3.7 billion between March 2010 and December 2011. Discounts on prescription drugs are scheduled to gradually increase until the doughnut hole is completely closed by 2020.

What about Medicare in general? Will it be cut?

The health reform law does reduce Medicare spending by about a projected $428 billion over 10 years, mostly with reimbursement cuts to private insurers and health providers, and overpayments to private Medicare Advantage plans.

This does not affect any benefits in Medicare part A or B plans, says Judith Stein, JD, executive director of the Center for Medicare Advocacy. She says the law means "good news for the Medicare program, as well as for Medicare beneficiaries."

The law means new, no-cost-sharing preventive services, new annual wellness visits with primary-care providers, and expansion of the Medicare trust fund by approximately 10 years. (The Congressional Budget Office says nine years.)

But former Medicare and Medicaid Director Gail Wilensky says whatever the immediate effects of the Affordable Care Act are in terms of controlling medical costs, it's failed to find a solution for Medicare.

"The whole Affordable Care Act punted on Medicare. ... We have not yet resolved how we're going to make Medicare fiscally viable in the long term."

Where did the fear of "death panels" arise?

The argument that end-of-life counseling services might ultimately become "death panels" was an effective scare tactic during the health care reform debate, according to medical ethicist Art Caplan, PhD, director of the Division of Medical Ethics in the Department of Population Health at NYU Langone Medical Center.

"The [counseling] provision was dropped from the bill, but the impact lingered and became a code word for, 'Obama is proposing a rationing of health care,'" says Caplan.

"Death panels may have killed that reimbursement idea, but they never died," he says.

What does this ruling mean for small businesses?

So far, an estimated 4.4 million small businesses that provide employee health insurance are eligible for a 35% tax credit to offset the cost of insurance premiums (as of mid-May 2011, only about 228,000 small business owners claimed the credit).

To qualify, a business must employ fewer than 25 employees and the average company salary must be less than $50,000. Businesses must also pay at least half of workers' health insurance costs.

These tax credits will remain in effect, and will increase to 50% starting in 2014.

Companies with more than 50 employees will be required to provide workers' insurance or pay a fine.

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