Heath Care Bill
The new legislation to provide health care for all has become a problem for DME/HME dealers. They have asked how to respond to questions from their customers. A number of the phone calls I received the last few weeks indicates there is a great degree of misunderstanding about this legislation. This has happened as a consequence of the large number of misleading comments that have come from both the right and the left.
People are going to their DME/HME provider because they are seeking answers rather than political opinions. Our main concern is that what ever you may say or write regarding this law might be offensive. This is the last thing you need. No provider can afford to lose a customer!
Being aware of this you should consider taking the role of supplying information. Instead of making the mistake of trying to give answers to your customer, explain what you understand. Customer “A” might be far to the left and customer “B” to the right. Explaining legislation is difficult. You cannot answer most questions, since many newspapers and magazines are not able to.
One of the providers we saw at Medtrade said he had been invited to speak to the men’s club at the church he attends. Even though he was hesitant, he went. There he made a lot of friends because as he reviewed segments he showed many misleading "horrors." Yes, what they heard was correct but not with all of the facts. Far too many comments were taken out of context!
Before you start, inform your customer that you and your company find yourselves facing many unfair reductions in reimbursements and even having some being taken away. This will bring you to the same level as them.
Politics is a dirty business, but by showing the actual wording of the legislation your customer will appreciate what you say. Then their understanding can be based on facts. For that you will receive their thanks.
The first point to make is the government has stated that health care benefits will remain the same. That is so, but what we see is that the dollars for each service may be different.
Question: Will my taxes go up?
In 2013, couples earning more than $250,000 or individuals $200,000 annually will see an increase of 0.9%. If you have to take some money out of your health savings account other than payment for medical expenses, that sum will be taxed 20% instead of 10%. Today you can take a tax deduction if your medical expenses exceeded 7.5 % of your income, in 2013 that will increase to 10%.
Question: I belong to a Medicare Health plan, will that be changed?
Traditional Medicare providers have always received payments, which are little less than the plans get. This will be changed and new standards will be set for the plans. Under the new legislation they must spend at least 85% of the money they collect from premiums. However, co-payments will be the same for both.
Question: Can I get the same coverage Congressmen receive?
Starting in 2014 members of congress will have to buy state-run insurance.
Question: We understand that illegal immigrants can get the same coverage I do?
The new law specifically states that they (illegal immigrants) are prohibited from buying health insurance.
Question: Part of my earnings is being in a health plan provided by my employer, will that continue?
You will not be obliged to join a new government or other plan. You will be able to maintain what you have currently. Children under the age of 19 are covered and if your employer has a different family plan, now adult unmarried children will be covered until 26. Ask your employer for more information on this topic.
Question: I have been turned down for a pre-existing condition, will that change?
If you have been unable to obtain insurance for six months or longer you will be allowed to purchase into a so-called high-risk program, which sets limits for out of pocket costs. In 2014, insurance will be available. On the same topic, if you have paid your premiums health plans cannot limit what you spend starting in 2014 for your entire life.
Question: I see that as I age the cost of my insurance goes up, will that continue?
A limit of not more that 3 times the premium charged to a young person can be tacked on as one ages? (Note: this is confusing because we do not know the minimum).
Question: Will I be able to choose the health plan I want or will I be forced into one?
Each state, starting in 2014, will prepare a list of those plans they accept. You will be allowed to choose the one you desire and your annual out-of-pocket expenses will be limited.
Question: I work for a very small company. Will they be able to provide health insurance?
If your employer already has a policy in place there will be no change. A company with less than 25 full time employees will receive a tax benefit of 35% of the premium they pay. In 2014 this will go up to 50%. Starting next year small companies can apply for a grant to be able to provide coverage. Employees with companies that do not provide health coverage, an exchange will be established in 2014 that will allow those employees with moderate or even low incomes to obtain coverage.
We could go one with many more Q & As, but the idea of this is for you, the DME/HME provider, not to find yourself in a discussion with your customers that will hurt your relations with them. This can involve you in politics and that is not the same as giving a neutral opinion. When a tricky question comes up, provide them with the telephone or e-mail address of the HLA (health legislative assistant) in either the Senator or Representatives office. If you do not have this information, contact AAHomecare or your state association and they will provide it to you.
Question: Where will the money come from to pay for all of this?
This is the hardest to answer; the government believes that they can save close to $400 billion while still protecting citizens over the next 10 years. Point out that your customer can change their plan annually. There will be standards for both the plan and the participant. Coverage for prescriptions will see the doughnut hole change and the recipients obtain even larger discounts, Children up to the age of 26 will be covered in the family plan.
What you want to impress is there will be a limit to out-of pocket cost and a great many Americans who currently do not have coverage will now be able to obtain the same.
Istrongly recommend that you contact your state DME association and AAHomecare for more information. Please support them by becoming a member if you are not one now. By working together with these associations they will protect you and your company.
Whatever you do please do not allow yourself to get caught becoming a politician. Your role is to direct your customer elsewhere without losing their goodwill.