Dear Citizen Activists,

WV Citizen Action would like to send a BIG thank you to all for your support in helping pass the most historic health reform this nation has seen since Medicare & Medicaid passed during the Johnston administration in the mid-sixties! See below for a list of major reforms that this new legislation will enact.

Stay tuned for the next steps because the fight for true Universal Coverage is not over. Watch for the next issue of Capital Eye for more information.

Be sure to take a minute to thank Congressmen Rahall and Mollohan with a letter, e-note or phone call to make sure they know how much we appreciate their support in spite of the barrage of negative TV ads and tons of phone calls (most from out of state) against reform. See our web page for a link to lawmakers contact info: www.wvcag.org

Also on our web page is a membership form you can fill out to become a supporting member of WV Citizen Action, the state's oldest consumer watchdog group. Your financial support, coupled with your citizen activism, is a winning combination for West Virginia!

Important Facts About Critical Health Care Legislation

The health care reform bill that passed the U. S. House of Representatives last night is the most critical legislation to be passed in over 40 years.  Listed below are the key components of the bill and what it will do for Americans:

• SMALL BUSINESS TAX CREDITS-Offers tax credits to small businesses to make employee coverage more affordable.  Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage.  Effective beginning for calendar year 2010. (Beginning in 2014, the small business tax credits will cover 50 percent of premiums.) 

• BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE-Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010.  Effective for calendar year 2010. (Beginning in 2011, institutes a 50% discount on brand-name drugs in the donut hole; also completely closes the donut hole by 2020.) 

• FREE PREVENTIVE CARE UNDER MEDICARE-Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program.  Effective beginning January 1, 2011. 

• HELP FOR EARLY RETIREES-Creates a temporary re-insurance program (until the Exchanges are available) to help offset the costs of expensive premiums for employers and retirees for health benefits for retirees age 55-64.  Effective 90 days after enactment.

• ENDS RESCISSIONS-Bans insurance companies from dropping people from coverage when they get sick.  Effective 6 months after enactment.

• NO DISCRIMINATION AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS-Prohibits new health plans in all markets plus grandfathered group health plans from denying coverage to children with pre-existing conditions.  Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to all persons.)

• BANS LIFETIME LIMITS ON COVERAGE-Prohibits health insurance companies from placing lifetime caps on coverage.  Effective 6 months after enactment.

• BANS RESTRICTIVE ANNUAL LIMITS ON COVERAGE-Tightly restricts the use of annual limits to ensure access to needed care in all new plans and grandfathered group health plans.  These tight restrictions will be defined by HHS.  Effective 6 months after enactment. (Beginning in 2014, the use of any annual limits would be prohibited for all new plans and grandfathered group health plans.)

• FREE PREVENTIVE CARE UNDER NEW PRIVATE PLANS-Requires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles.  Effective 6 months after enactment. 
• NEW, INDEPENDENT APPEALS PROCESS-Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions by their health insurance plan.  Effective 6 months after enactment. 

• ENSURING VALUE FOR PREMIUM PAYMENTS-Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent.  Insurers that do not meet these thresholds must provide rebates to policyholders.  Effective on January 1, 2011. 

• IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL)-Provides immediate access to affordable insurance for Americans who are uninsured because of a pre-existing condition - through a temporary subsidized high-risk pool.  Effective 90 days after enactment. 

• EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS' INSURANCE - Requires new health plans and certain grandfathered plans to allow young people up to their 26th birthday to remain on their parents' insurance policy, at the parents' choice.  Effective 6 months after enactment. 

• COMMUNITY HEALTH CENTERS-Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years.  Effective beginning in fiscal year 2010. 

• INCREASING NUMBER OF PRIMARY CARE DOCTORS-Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals.  Effective beginning in fiscal year 2010. 

• PROHIBITING DISCRIMINATION BASED ON SALARY-Prohibits group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees.  Effective 6 months after enactment. 

• HEALTH INSURANCE CONSUMER INFORMATION-Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals.  Effective beginning in FY 2010.

• CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM-Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide home and community-based services to adults who become functionally disabled.  Effective on January 1, 2011.