Health Care Reform 2011

A summary of health reform initiatives which become effective in 2011.

Health Care Reform 2011:  Long-Term Care

• Establish a national, voluntary insurance program for purchasing community living assistance services and supports (CLASS program).

Health Care Reform 2011:  Prevention/Wellness

• Eliminate cost sharing for Medicare covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force and waive the Medicare deductible for colorectal cancer screening tests. Authorize the Secretary to modify or eliminate Medicare coverage of preventive services based on recommendations of the Task Force. 
• Provide Medicare beneficiaries access to a comprehensive health risk assessment and creation of a personalized prevention plan and provide incentives to Medicare and Medicaid beneficiaries to complete behavior modification programs.
• Provide grants for up to five years to small employers that establish wellness programs.
• Require chain restaurants and food sold from vending machines to disclose the nutritional content of each item.

Health Care Reform 2011:  Medicare

• Require pharmaceutical manufacturers to provide a 50 percent discount on brand name prescriptions filled in the Medicare Part D coverage gap beginning in 2011 and begin phasing in federal subsidies for generic prescriptions filled in the Medicare Part D coverage gap.
• Provide a 10 percent Medicare bonus payment to primary care physicians, and to general surgeons practicing in health professional shortage areas. (Effective 2011 through 2015)
• Restructure payments to Medicare Advantage plans by setting payments to different percentages of Medicare fee-for-service rates.
• Prohibit Medicare Advantage plans from imposing higher cost sharing requirements for some
• Medicare covered benefits than is required under the traditional fee-for-service program.
• Freeze the income threshold for income related Medicare Part B premiums for 2011 through 2019 at 2010 levels, and reduce the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/couple.

Health Care Reform 2011:  Medicaid

• Create a new Medicaid state plan option to permit Medicaid enrollees with at least two chronic conditions, one condition and risk of developing another, or at least one serious and persistent mental health condition to designate a provider as a health home.
• Create the State Balancing Incentive Program in Medicaid to provide enhanced federal matching payments to increase non-institutionally based long-term care services.
• Establish the Community First Choice Option in Medicaid to provide community based attendant support services to certain people with disabilities.

Health Care Reform 2011:  Quality Improvement

• Develop a national quality improvement strategy that includes priorities to improve the delivery of health care services, patient health outcomes, and population health.
• Establish the Community-based Collaborative Care Network Program to support consortiums of health care providers to coordinate and integrate health care services, for low income uninsured and underinsured populations.
• Establish a new trauma center program to strengthen emergency department and trauma center capacity.
• Improve access to care by increasing funding by $11 billion for community health centers and by $1.5 billion for the National Health Service Corps over five years; establish new programs to support school based health centers and nurse managed health clinics.

Health Care Reform 2011:  Tax Changes

• Exclude the costs for over the counter drugs not prescribed by a doctor from being reimbursed through a health reimbursement account or health flexible spending account and from being reimbursed on a tax free basis through a health savings account or Archer Medical Savings Account.
• Increase the tax on distributions from a health savings account or an Archer MSA that are not used for qualified medical expenses to 20 percent of the disbursed amount.
• Impose new annual fees on the pharmaceutical manufacturing sector.

For More Information

“Focus on Health Reform: Health Reform Implementation Timeline,” The Henry J. Kaiser Family Foundation.