4/13/10 The new health-care reform legislation, signed into law late last month, introduces major changes to the current system that likely will affect many of the 46 million people with some form of arthritis – including 300,000 children with juvenile arthritis – across the country. While many of the provisions won’t take effect for several years, others go into play in 2010, some starting just a few months from now. Below is a brief summary of some of those key items and how they may affect you.
Gradually closing the Medicare Part D doughnut hole
The “doughnut hole” is jargon for the lapse in Medicare prescription, or Part D, coverage when beneficiaries, who have been paying a portion of their medication costs through copays, hit the annual limit ($2,830 in 2010) in medication expenses. After that, recipients are responsible for all drug costs until their out-of-pocket expenses reach $4,550 (the limit in 2010), the catastrophic coverage point at which the program will kick in 95 percent of costs until the end of the year.
Everyone on Medicare, such as disabled people less than 65, is eligible for Medicare Part D and, therefore, potentially subject to a coverage gap.
Effective this year, the Medicare Part D drug program will provide a $250 rebate to Medicare beneficiaries who hit the doughnut hole. Next year there will be a 50 percent discount on brand name drugs for those who reach the doughnut hole. By 2020 beneficiaries will receive discounts of 75 percent on brand name and generic drugs.
The gap in coverage has been an important advocacy issue for the Arthritis Foundation since so many people with arthritis fall into the doughnut hole. Those on biologic therapies, which can cost anywhere from $20,000 to $50,000 a year, easily reach this threshold, says Amy Melnick, Vice President, Advocacy for the Arthritis Foundation.
“Closing the doughnut hole obviously is a provision that older people with arthritis care about,” she says.
Regarding the provision: “Does it get rid of all the challenges? No,” she says. “It would have been great to have [the doughnut hole closed] sooner, but it will be gradual relief.”
In 2007, the number of people taking biologics grew faster than any other drug class, increasing by 7.3 percent during 2006, according to Drug Trend Report 2008; Predictions Five Insights that will Shape Healthcare, Volume 10. Currently, many people discontinue use of their biologic medications because they cannot absorb the 100-percent cost of the medications when they reach the doughnut hole.
Allowing adult children to stay on their parents’ health insurance policies up to the age of 26
As the economy continues to stagnate, it is harder for college graduates to find full-time jobs. That could mean a sizeable population living without health insurance. This provision, which will take effect in less than six months, will allow adult children to stay on their parents’ plans longer than most plans currently allow. (Some states have passed legislation requiring insurers to offer parents the option of covering children into their 20s.)
This could be particularly beneficial for young adults with the pre-existing condition of juvenile arthritis who must take powerful drugs for their disease, according to rheumatologist Nathan Wei, MD, of the Arthritis and Osteoporosis Center of Maryland in Frederick. Dr. Wei, whose college-age son has juvenile arthritis, is pleased that his child will not have to leave the family plan, which is helping pay for his expensive biologic medications. Currently, Dr. Wei pays a $70 per month co-pay for the drugs, which cost $1,500 a month.
“Once he leaves college it’s highly unlikely that without this new health-care reform bill he would have been able to secure a job with health care that would pay for his pre-existing condition,” Dr. Wei says of his son.
Mary Ruedlinger
I used to work for the local government here, the county. I can tell you of huge tax dollars waste. The county commissioners make over 125,000 a year and there are 3 of them. Why do they make over $100.000 then most of the full-time working poor? There is no good explanation. Instead of pointing to a president you do not like to complain. Why don't you start in your own town, your own state to change the government waste we have on our hands. Only a handful of politicians are actually in the game to help people, the rest are there to help themselves to our tax dollars. Wake up and educate yourself, check your facts before spouting out some more gossip you have heard. Yea President Obama is not a US citizen! Give me a break!! And the moon is made out of cheese! And all Republicans are not gay!
Billie, with the new legislation, your daughter will probably be eligible for insurance. As far as too many drug addicts and drunks getting help, why don't we just line them up at shoot them? I really have a hard time understanding what people would like to do with the people in our society that aren't making it. Most of the help these people get are through churches and Salvation Army or go to the Emergency Room or just don't go for help at all. If you don't want any of your tax money going to help these unfortunates, maybe you can trade with me who didn't want to pay for the war in Iraq.
Thank God for President Obama. I also pray for our country. I pray that God will change the hard hearts of some of the people in this country. I also thank God for those people that have good hearts and did not look at the color of his skin and voted for a smart, caring, and very capable President.
Lets all work together to make things better for everyone.
As I said in my earlier post, the insurance companies already have rationing of healthcare in what they will and will not pay for and what drugs they will not pay for.
biologics are ASTRONOMICAL. If the insurance companies can get away with NOT paying for something, THEY WILL. Since developing RA, I have also developed type 2 diabetes, brought on by the prednisone that I am dependant on.
I do not want to hear that RA is my fault and the diabetes is my fault. Just today, my insurance company refused to cover a different diabetes medication. So don't tell me that the HealthCare Reform will not be better than what I have now!
Reading comments in here is intertesting. Put the blame on someone else or some other country, insurance company or doctor. Its time for people to start watching their health early. If you have medical problems, see the dr or other health care professional. Don't have expensive insurance? There is always help available somewhere, all you have to do is search for it. Health Care reform has been needed for years and we finally acheived part of it. Its not perfect, but its a start. You have to remember that the primary function of government is the health and safety of the citizens of this country, NOT insurance companies. You Dr's, if you don't make enough money in your practice, why did you go into medicine in the first place. It sounds to me like you forgot your Hippocratic Oath.
Cris, you would be an informed citizen if you listened to FOS more!
The best place to start getting pain relief is in the water. Are you near a YMCA or a place with a pool? The YMCA's usually have water classes for people with arthritis and related problems. If you can't afford the membership, they will help based on your income. It's a wonderful place to start. You will hurt a little at first, but keep it up. After a few weeks you will feel better, but try to get in the water at least two (better three) times/week. After you've done that for a while you can add strength training and low impact aerobic exercise. Start slow, but KEEP GOING. This really really helps.
One thing I do agree with Nancy about is, that we all must do what we can to help us live with our conditions. Pool exercise, strength training and tai chi have helped ease my pain. The more we learn about trigger foods, the better off we are too. We still need medical care, but we have to do whatever we can to be as healthy as possible
You are so negative and I believe you would hate to miss your perks. It seems that you lost your compassion and care about the mighty dollars. You are a very scary M.D. and I truly wish you well. :)
Okay, our health care system is in ruins and if the American people do not understand that there is a huge need for change because the old system is failing. The insurance companies and pharmaceutical companies are winning because they have turn the tables slowly and effectively. They have focused the attention away from themselves and thrive on the ignorant people to blame both sides of the political parties. I worked for years in the medical field and wonder how doctors could afford lavish parties for employees and beautiful vacations to exotic places. People should not confuse racism, politics and fear; with the truth. The insurance companies and pharmaceutical companies are in heaven with the baby boomer generation because they will get every last penny because they can. I have seen too many people denied life saving treatment because of manipulation of the public.
We need people to focus on the insurance companies and pharmaceutical not on politics, a person's income level, race and status of citizenship. It is all a game and the American people have bought it. People need to change because, the old way is not working. We need compassion,and clarity when it comes to health-care.
Health-care insurances wave the dollar bills it front of the politicians. If we do not make a change for good or bad we will still complain about the situation. Democrats or Republican who cares what party! American public needs to become more tougher and not trust the big corporations which include pharmaceuticals. They are the riches businesses through this whole economically problem.
Remember it took years to make a mess of the situation and blaming one political figure is asinine.
You care more about the Insurance business than the quality of your fellow Americans life, how sad. You can't work if you don't have a life.....LIFE, liberty and the pursuit of happiness.
This all sounds wonderful, but insurance companies will not be able to make enough profit to stay in business. They are a business and not a charity organization. In 5 years we will all be in gov. run health care and choices will be a thing of the past.
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