All the delays in passing the health care reform bill will also delay positive changes to Part D coverage. Seniors were supposed to get relief this year, but it appears that people who fall into the donut hole in 2010 will only get a $250 rebate.  Changes that were supposed to take effect in 2010 have been moved to 2011.

In 2011, the threshold for going into the donut hole will be raised by $500 and seniors who go into the donut hole will get a 50 percent discount on brand-name drugs. By 2020, the doughnut hole will be closed and 75 percent of drug costs will be covered.

It’s too bad about the delay because seniors who have been told all the terrible things that will happen as a result of the health care bill would have appreciated the savings this year.   The Medicare Advantage company representatives tell us that about 10% of seniors go into the donut hole.

The Democratic Caucus provided a list of provisions in the health care bill that will take effect immediately. The legislation would:

*Prohibit pre-existing condition exclusions for children in all new insurance plans;

*Provide immediate access to insurance for Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool;

*Prohibit dropping people from coverage when they get sick in all individual plans;

*Lower seniors prescription drug prices by beginning to close the donut hole;

*Offer tax credits to small businesses to purchase coverage;

*Eliminate lifetime limits and restrictive annual limits on benefits in all plans;

*Require plans to cover an enrollee’s dependent children until age 26;

*Require new plans to cover preventive services and immunizations without cost-sharing;

*Ensure consumers have access to an effective internal and external appeals process to appeal new insurance plan decisions;

*Require premium rebates to enrollees from insurers with high administrative expenditures and require public disclosure of the percent of premiums applied to overhead costs.

In the list of provisions included in the health care bill that will be passed this evening (March 21), it looks like the most important element is the Independent Payment Advisory Board, which will have the ability to set policy for Medicare.

I was just reading on the Health Beat Blog that the Independent Payment Advisory Board will be able to propose changes in Medicare payments that “will become law unless Congress enacts its own proposal to achieve the same level of cuts.”  A super-majority of votes would be required in Congress to overturn the board’s decisions.

The Payment Advisory Board will be made up of physicians and health care experts. They will be able to enact changes in Medicare payment policy without dealing with the Congressional politics that have stopped  changes to Medicare in the past.  For example, Medicare will be able to convert successful pilot projects nationwide without waiting for Congressional approval. The Health Beat Blog says that, in the past, Medicare has launched many successful demonstration projects that improved quality and cut costs, but Medicare was not  allowed to implement them without going through Congress.

Making changes in the fee-for-service payment system is supposed to be a key to cutting Medicare costs.  This has been tested in many pilot projects, and the Independent Payment Advisory Board will be able to implement changes without lobbyists and special interest groups pressuring them to maintain the status quo. 

This is where the action will be when it comes to Medicare changes.