Experts also discussed how health care and health insurance have changed as a result of the enactment of the Patient Protection and Affordable Care Act.
Overview
The law enacted on March 23, 2010 and amended by the Health Care and Education Reconciliation Act of 2010 on March 26, 2010 is also known as the Affordable Care Act. It will take effect from 2010 to 2018.
The law, according to yesterday’s panelists, will “balance the objective of preserving the rights of individuals to maintain their existing coverage with the goals of ensuring access to affordable essential coverage and improving the quality of coverage.”
Congressman Gregorio Kilili Camacho Sablan, who was among yesterday’s speakers, said while many of the provisions in the law will not be implemented yet, others are already taking effect.
He said in 2014, the CNMI can create a health insurance exchange that will foster competition to lower costs, improve quality and enable customers a chance to compare various health plans.
Sablan said some federal funds will be available to help families pay for coverage, and insurers will also be prohibited from discriminating against people with pre-existing conditions.
Early benefits
Starting July 1, 2011, federal Medicaid funding for the CNMI will start to grow. From nearly $9 million in 2011, it will increase to over $21 million in 2019, or about 182 percent.
The CNMI’s share of Medicaid funding will also decrease from 50 percent of the cost to 45 percent to help reduce the financial burden of the local government.
To address the shortage of health care providers, new incentives will be available to encourage more doctors and nurses to work in primary care, and to help more students become doctors, nurses and other health professionals.
The speakers and panelists yesterday were Katherine Dote, SHRM state director for the Pacific Council and director of human resources for the Guam Marriott Resort & Spa; Joseph Kevin Villagomez, secretary of the Department of Public Health; Frank Campillo, health plan administrator for Calvo’s SelectCare Health Plans; Francis E. Santos, associate administrator for StayWell Health Insurance; Gina Ramos, chief of staff for TakeCare Insurance Company; Jerry Crisostomo, plan administrator for Moylan’s NetCare Life & Health Insurance; Sixto Igisomar, acting secretary of the Department of Commerce and the CNMI insurance commissioner; Augustus Loste, acting district manager of the U.S. Social Security and Medicare office in the CNMI; and Helen Sablan, administrator for the CNMI Medicaid Program.
Speakers who presented the perspectives of the private health care providers were Dr. Norma Ada, president of Medical Associates of the Pacific; George Cruz, president of Marianas Health Services; Thelma Cabrera, operations manager for the Marianas Medical Center; and Natalie Codianne, pharmacist with PHI Pharmacy.
What health care reform can do for you
If you’re a business owner
• Many businesses will be eligible for tax credits that will cover up to 35 percent of employer premium contributions, depending on the size of your company.
• Small businesses will be eligible for grants to start employee wellness programs.
• More information will be available to help you decide which plan is best for you and your employees.
• There will be no employer mandate to provide health insurance coverage for employers in the CNMI.
If you have insurance coverage
When your new insurance plan year begins, most probably January 1, you will have new rights and these are:
• Insurers cannot drop your coverage just because you get sick.
• Lifetime limits on coverage will be prohibited.
• You can keep dependent children on your insurance until age 26.
• Insurers must spend at least 80 cents of every dollar that you pay in premiums on medical care.
If you are denied coverage by an insurance company, you will have access to a new, independent appeals process.
If you are a senior citizen
If you get your senior citizen health insurance through Medicare, you will be enjoying a high level of care for years to come:
• Annual wellness visits such as a yearly checkup will be free of charge so you can stop turning this small issue into a big problem.
• Changes to the Medicare part D Prescription Drug Plan will mean that the donut hole — or the gap between regular Medicare coverage and the extra catastrophic care plans — will gradually be eliminated so all medications will be covered, regardless of cost.
• New discounts on brand-name and generic prescription drugs will make medication affordable.
If you don’t have insurance, or if you lose your coverage
• If you are uninsured because of a pre-existing condition, you will be eligible for coverage soon. Companies will not be able to refuse coverage or limit eligibility because of medical history, genetic information or claims history.
• If you are uninsured because you cannot afford insurance, a new influx of Medicaid funds will take some of the burden off the CNMI government and allow it to expand the program. If you are young and uninsured, you will be able to stay on your parents’ plan until age 26 while you finish an education, or find a job.
