So Long, Donut Hole

Now that the U.S. House of Representatives has sent a health reform bill to President Obama, seniors in Connecticut can look for help in paying for prescription drugs — and state coffers could $100 million in help for paying for poor people’s health care.

Those are among the initial takes on how the newly passed health care overhaul will impact the lives of real people in Connecticut.

The U.S. House passed the $938 billion bill, aimed at insuring 32 million more Americans, by a 219=212 vote late Sunday night.

Monday, Connecticut health-watchers were tallying up what the law will mean here.

According to a district-by-district recent Congressional analysis, most Connecticut residents will benefit one way or another.

In the Third U.S. Congressional District (Greater New Haven), the law, once signed by President Obama, will:

• Give tax credits and other assistance to up to 136,000 families and 15,400 small businesses to help them afford coverage.
• Improve Medicare for 114,000 beneficiaries, including closing the so-called donut hole.
• Extend coverage to 19,500 uninsured residents.
• Guarantee that 7,700 residents with pre-existing conditions can obtain coverage.
• Protect 1,000 families from bankruptcy due to unaffordable health care costs.
• Allow 58,000 young adults to obtain coverage on their parents’ insurance plans.
• Provide millions of dollars in new funding for community health centers.
• Reduce the cost of uncompensated care for hospitals and other health care providers by $90 million annually. 

The law will also will save the state money. Connecticut will be eligible for $100 million a year under the law to pay for health insurance for single adults earning $14,404 or less a year, under the SAGA (State-Administered General Assistance) program.

The feds will also spend $5 billion nationally support the creation of state programs to cover early retirees, people between 55 and 64. Last year 3,800 state employees took early retirement.

Connecticut women are big winners, according to Teresa Younger, executive director of the Permanent Commission the Status of Women. She said under the existing health insurance system, women seeking individual coverage have been discriminated against in two ways. One is gender rating, in which women are charged more than men for the same policies just because they are women, because women might seek reproductive health services. Under the reform, Younger says, insurance companies will no longer be able to do that. ​“They will be restructuring their health care rates, and all women and men will be paying the same prices,” she said, adding, ​“And that is a huge coup.”

Also, under the current system most individual insurance policies considered some pregnancies — especially those ending in Cesarean section births — a pre-existing condition. So if a woman had a subsequent pregnancy, her insurance was often canceled. Younger noted that in Connecticut, where more than a third of all births were by C‑section in 2006, ​“thousands of women could face coverage exclusions or rejections because of this discriminatory practice.” The new law bans this insurance practice by eliminating pre-existing-condition denials.

Due to the expansion of Medicaid eligibility to those with incomes at or below 133 percent of the federal poverty level, Younger said, up to 23,300 uninsured women in Connecticut will be newly eligible for Medicaid coverage. In addition, those families who make too much to qualify for Medicaid but who earn up to 400 percent of the federal poverty level will be eligible for a health insurance subsidy. That includes 83,000 women in the state.

Meanwhile, state Medicare beneficiaries will no longer have to pay as much money for brand-name prescription drugs. That’s because they currently get caught in the ​“donut hole”: When they’ve reached a certain amount of prescription drugs in a year, usually around $2,800, they have to pay 100 percent of subsequent prescriptions until they reach another level, usually around $4,500. Many seniors don’t have the cash, so they do without. The new law eliminates the donut hole.