Major Health Care Reforms Take Effect January 1

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Starting Saturday, two of the new health care law’s most significant reforms take effect — or at least begin to take effect.

The first will dramatically clamp down on insurance industry waste, abuse, and excesses. Starting on New Year’s Day, insurance companies will have to spend at least 80 percent of the revenues they receive from premiums on actual health care. Not on salaries or overhead.Like so many of the law’s early reforms, the impact of a strict “medical loss ratio” will be invisible to most consumers. But don’t mistake that for insignificance. The bill’s most strident critics cite this one provision as the basis for the claim that the government is “taking over” the health care system. That’s a false claim, no matter how you slice it — this is about insurance companies, not, say, hospitals or pharmaceuticals, and those insurers are all still private. They’ll just have to play by stricter rules.

The other is much more visible. Senior citizens — a demographic that’s skeptical of the bill — will see real benefits. In 2011, the law will begin to close the Medicare Part D coverage gap — the infamous “donut hole.” Seniors who reach the donut hole will now receive a 50 percent discount on brand-name drugs, the first step in a 10 year plan to fill the hole completely. Seniors will also now receive free annual checkups, screenings and other preventive care.

Other changes will also kick in. For a comprehensive list, see here. But these are the biggies. Add them to other reforms that have already taken effect — such as a ban on discriminating against children with pre-existing conditions, and the new right parents have of keeping their children on their family insurance plans until they’re 26 years old — and you’re talking about a bunch of stuff that would be very unpopular to repeal.

ABOUT THE AUTHOR

Brian Beutler is TPM’s senior congressional reporter. Since 2009, he’s led coverage of health care reform, Wall Street reform, taxes, the GOP budget, the government shutdown fight and the debt limit fight. He can be reached at brian@talkingpointsmemo.com

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