Healthcare Reform - Impact of PPAC for the Healthcare Industry.pdf
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1、 HEALTH CARE REFORM: WINNERS AND LOSERS Impact of PPAC for the Healthcare Industry APRIL 2010 Health Care Reform Winners and Losers has been prepared by Kalorama Information. We serve business and industrial clients worldwide with a complete line of information services and research publications. Ab
2、out Kalorama Information Publisher of syndicated primary market research reports in diagnostics, pharmaceuticals, biotech, healthcare, and medical devices Supplier of market research statistics to the trade and consumer media (CNN, The Wall Street Journal, NY Times, BBC, The Economist, the Associate
3、d Press, among others) Provider of custom research services (call to request quote) For more information, 800.298.5603 Intl: +1.240.747.3096 Health Care Reform: Winners and Losers On March 23, 2010, President Barack Obama signed a complex package of legislation that will transform how health care is
4、 delivered in the United States. After many changes and much controversy, the law, “Patient Protection and Affordable Care Act“ (H.R. 3590) affects virtually every aspect of health care with provisions that take effect between June 2010 and 2020. However, certain segments of the health care industry
5、 will be affected more significantly than others. The following table shows the net impact on leading industry stakeholders, including: The Public (Insured and Uninsured Consumers) Health Care Product Manufacturers (Device Companies, Biotech Companies, Pharmaceutical Companies) Health Care Providers
6、 (Hospitals, Physicians, Nursing Homes, Hospices, Nurse Practitioners, Insurance Companies) Positive for Stakeholder Negative For Stakeholder Some Positive, Some Negative Kalorama Information: Healthcare Reform: Winners and Losers Effects of Healthcare Reform on Key Stakeholders Group Stakeholder/Ef
7、fect The Public Currently Uninsured Consumers Currently Insured Product Manufacturers Pharmaceutical Companies Biotech Companies Diagnostics Companies Medical Device Manufacturers Durable Medical Equipment (DME) Manufacturers Service Providers Primary Care Physicians Specialist Physicians Nurse Prac
8、ticners/PAs Retail Clinics Hospitals Nursing and Skilled Nursing Facilities Hospices Insurance Companies Copyright 2010 Kalorama Information Kalorama Information: Healthcare Reform: Winners and Losers The Public Health care reform will impact the public in two key ways: by making medical products an
9、d services more or less available to them (changing their health coverage) and by changing their taxes. In general, the uninsured will experience a net benefit while the effects on those who currently have insurance will be mixed. Currently Uninsured Consumers Approximately 46 million American resid
10、ents have no health care insurance as of early 2010. Under the new law, insurance will be extended to more than 32 million of these persons through a variety of methods: - High Risk Pools: On June 21, 2010, adults with pre-existing conditions will be eligible to join a temporary high-risk pool, whic
11、h will be superseded by the health care exchange in 2014; - Dependents: effective September 23, 2010, dependent children will be allowed to remain on their parents insurance plan until their 26th birthday; - Medicaid: by January 2014, Medicaid eligibility will be expanded to individuals under age 65
12、 with income up to 133% of the poverty line ($22,050 for a family of four in 2009) as well as low income singles without children; - Health care Exchanges: by 2014, health insurance exchanges will provide less expensive coverage for small businesses, the self employed and the unemployed and all pers
13、ons will be required to have coverage in place or face fines equal to the greater of $695 per person per year, up to a maximum of three times that amount ($2,085) per family, or 2.5% of income. Copyright 2010 Kalorama Information Because the currently uninsured largely represent the working poor, wi
14、th the exception of penalties for lack of coverage, this group will not be affected by taxes in order to finance the new law. In fact, by 2014, tax credits will be offered to low income Kalorama Information: Healthcare Reform: Winners and Losers families to offset the costs of health care premiums.
15、A tax credit will also become available for some small businesses to help provide coverage for workers. Currently Insured Consumers The impact upon the approximately 260 million consumers who currently have insurance through Medicare, Medicaid or private plans will be mixed. First and foremost, taxe
16、s will increase for consumers deemed “wealthy”. The Congressional Budget Office projects the health care bill to cost $940 billion over 10 years. While much of that cost will be born by the industry, consumers will also face higher taxes. First, the bill modifies the Medicare Hospital Insurance Tax
17、to 2.35% (a 0.9% increase) on adjusted gross income (AGI) in excess of $200,000 for individuals or $250,000 for families. Second, a new 3.8% surtax will be imposed on investment income (rent, dividends, capital gains, interest and gains from property sale) for individual taxpayers with AGI in excess
18、 of $200,000 or $250,000 for families. By 2018, a new 40% excise tax will be imposed on high cost (“Cadillac”) health plans on the cost of coverage over $10,200 for individuals and $27,500 for families. All consumers will face an increased threshold for deducting qualifying medical expenses from the
19、ir personal income tax, when the deduction increases from 7.5% of AGI to 10% in 2014. Consumers can also no longer use a health savings account, flexible spending account or health reimbursement plan with pre-tax dollars to pay for over-the- counter medications, except insulin. While businesses with
20、 50 or more employees will be required to provide health coverage by January 2014 or face a $2,000 per employee penalty, it is possible that some businesses with older and/or otherwise expensive workers will opt to cancel coverage and pay the penalty. It is also likely that many small businesses wit
21、h fewer than 50 employees will drop coverage altogether as employees will be able to obtain coverage from a newly established health exchange. Copyright 2010 Kalorama Information By 2014, young adults who purchase their own insurance are likely to pay higher premiums under the new law. According to
22、a recent analysis from the Associated Press, premiums for those in the 20 to 30 age group are expected to rise by 17% as insurers will be restricted in the amounts they can raise premiums for older participants. While Kalorama Information: Healthcare Reform: Winners and Losers insurers now charge si
23、x to seven times as much to older customers as to younger ones in states with no restrictions, the new law limits the ratio to 3-to-1 and thereby forces companies to increase rates for younger plan members. Seniors will benefit from a phased-out reduction of the Medicare Part D prescription drug cov
24、erage gap: by 2011, 50% of the gap will be eliminated and by 2020, it will be entirely eliminated, with a $250 rebate paid in 2010 for seniors affected by the “donut hole” gap. This will be accomplished via discounts from drug makers on brand- name prescription drugs, and is expected to amount to $8
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