Policy Watch
Health Care Reform & Free Clinics
It is important to remember that this legislation will not begin its largest implementation until 2014, and even when the full implementation is complete (2019), free clinics will remain necessary for America's uninsured.
Signs indicate that some 23 million Americans will still lack insurance in 2019, after key provisions of the law have been in effect for as long as five or six years, according to a Congressional Budget Office (CBO) estimate.
In the upcoming weeks and months, the National Association of Free Clinics and the Georgia Free Clinic Network are committed to reviewing this legislation to see exactly what the legislation will mean for free clinics right now and in the future. Below is a short breakdown.
1. No public option is included in this bill.
2. Broader implementation (i.e. health insurance requirements for all legal Americans) will start in 2014 and the expectation is that full implementation will take place in 2019.
3. Signs indicate that some 23 million Americans will lack insurance in 2019, after key provisions of the law have been in effect for as long as five or six years, according to a Congressional Budget Office (CBO) estimate.
4. The bill restricts access to health insurance through the Health Insurance Exchange to U.S. citizens and legal immigrants who are not incarcerated.
5. Requires most U.S. citizens and legal residents to have health insurance. The bill creates state-based American Health Benefit Exchanges through which individuals can purchase coverage, with premium and cost-sharing credits available to individuals/families with income between 100- 400% of the federal poverty level (the poverty level is $18,310 for a family of three in 2009) and creates separate Exchanges through which small businesses can purchase coverage for its employees.
6. Requires U.S. citizens and legal residents to have qualifying health coverage. Those who are without coverage or who choose to opt-out of the coverage will pay a tax penalty of the greater of $750 per year up to a maximum of three times that amount ($2,250) per family or 2% of the household income.
7. The penalty will be phased-in according to the following schedule: $95 in 2014, $495 in 2015, and $750 in 2016 for the flat fee or .05% of taxable income in 2014, 1.0% of taxable income in 2015, and 2% of taxable income in 2016.
8. People who feel insurance is unaffordable can get an exemption. This is similar to the "opt out," except that they may not owe a penalty. If insurance coverage would cost more than 8 % of household income, people won't face a penalty for going without it.
9. The bill expands Medicaid to 133% of the federal poverty level.
10. Beginning after 2016, the penalty will be increased annually by the cost-of-living adjustment. Exemptions will be granted for financial hardship, religious objections, American Indians, those without coverage for less than three months, undocumented immigrants, incarcerated individuals, if the lowest cost plan option exceeds 8% of an individual's income, and if the individual has income below 100% of the poverty level.
11. Requires employers to pay penalties for employees who receive tax credits for health insurance through an Exchange, with exceptions for small employers. It imposes new regulations on health plans in the Exchanges and in the individual and small group markets. Click HERE for a timeline of implementation.
Policy Watch
The 2010 Legislative Session ended on Thursday, April 29. Unfortunately, lawmakers did not extend the sales tax exemption for free clinics, which will end on June 30. GFCN will continue its efforts to call attention to the effect the loss of this exemption will have on the clinics and their ability to provide patient care.
SB 344, is related to the "'Health Share' Volunteers in Medicine Act," and provides for sovereign immunity protection for compensated physician assistants in safety net clinics who participate in the program. Governor Perdue signed the bill on May 20. It goes into effect on July 1.
Other health legislation that passed and may be of interest:
The FY 2011 budget was adopted on the last day of the session. Health department grants and efforts targeting maternal and child health, strokes and hypertension sustained deep cuts. The Area Health Education Centers were also affected.
HB 307 imposes a 1.45% bed tax on hospitals, which will generate $300 million for the state. The funds be deposited into the Indigent Care Trust Fund where they will be used to draw down more federal dollars to pay providers treating Medicaid and PeachCare patients.
HB 317 states that Georgians cannot be compelled to "participate in any health care system," and that the purchase or sale of health insurance products and/or direct healthcare services could not be prohibited. But, because federal law predominates, HB 317 is not expected to have much impact. Of note and related to this legislation, Georgia has officially joined a federal lawsuit against the new health reform law. The complaint is based on the 10th Amendment to the US Constitution which provides that powers not granted to the national government and not prohibited to the states are reserved to the states.
Road safety legislation includes: SB 360 and HB 23 and are related to the use of cellular phones while driving. The Senate bill bans texting by all drivers, and the House bill bans drivers under 18 from talking on their cell phones while on the road. SB 458 now requires pickup truck drivers to wear seat belts.
SB 367 authorizes extended family or friends to make medical decisions on behalf of another when there are no immediate family members.
GFCN will continue to keep you informed on the issues affecting charitable clinics. You may also visit www.legis.state.ga.us for information from the Capitol.
