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AFSCME Legislative Green Sheet – Health Care Reform

Posted by Chris Liebenthal on August 12, 2010

AFSCME led the fight to improve our health care system for decades, and this past spring we notched a huge victory on that front.  But, now that health care reform is law, many AFSCME members want to know what it all means for them and their families.  First and foremost, every AFSCME member should know that you will continue to have the employer-sponsored health coverage you won at the bargaining table.  In addition, no plans covering AFSCME members will be taxed before 2018, and even then, the tax only affects certain plans. They are those that cost more than $10,200 for single coverage or $27,500 for family coverage (not including dental and vision).

Below are some details regarding various provisions of the bill.  In addition to the topics covered below, AFSCME will be engaged in decisions made by the next Governor and Legislature about how specific aspects of the plan will be implemented in Wisconsin.  AFSCME will update Wisconsin members on those discussions and our related efforts when the next legislature convenes in the spring.  For now we will focus on some of the key components of the bill, and what they mean for AFSCME members and their families.

Health Care Reform Provides Important New Coverage for You and Your Family

The health care reform act allows your adult children to stay on your plan until age 26 if they don’t have their own coverage on the job. Come 2014, children up to age 26 can stay on your plan regardless of whether they have their own insurance.  In addition, the bill eliminates annual and lifetime limits on essential health benefits, as well as any limits on coverage of pre-existing conditions for children under the age of 19.  And by 2014, pre-existing condition exclusions for everyone will be eliminated.

Requires Additional Benefits in “New” Health Plans

Under the new law all new plans must contain additional benefits.  Among these are requirments that preventative health care services must be covered with no cost-sharing.  Health plans will no longer be able to require prior authorization or “gatekeepers” for visits to an OB/GYN.  Emergency care will no longer be able to have higher deductibles and co-pays out of network, and prior authorization cannot be required.  Finally, treatment in qualified “clinical trials” must be covered. AFSCME is fighting to ensure that the definition of a “new” plan be applied as widely as possible.

Lowers Costs

As AFSCME members see everyday, and with each new contract, rising health care costs have been crippling government budgets and eating up much of the money available at the bargaining table. The reform law addresses these problems in several ways.  First it changes health insurance payment practices to promote quality and begin to end “fee for service” which encourages inefficient, low-quality care.  Second, it places an emphasis on early detection and prevention.  Third, there is a significant reduction in the “cost shifting” that occurs when hospitals and other providers charge paying customers more for care to cover the bills for those who are uninsured and cannot pay.  By addressing rising health care costs overall, which are straining government budgets at every level and leaving less money available for other vital services  the reform bill cuts the federal deficit by $143 billion by 2019 and by another $1.2 trillion in the 10 years after that.

Improves Care for Retirees

The reform bill closes the Medicare Part D prescription “donut hole” with a $250 rebate this year, a 50 percent discount on brand-name drugs in the donut hole starting next year, and closing the coverage gap completely by 2020.  It also provides free Medicare preventive care for seniors starting Jan. 1, 2011.  Additionally, provisions ensure Medicare will be there for you when you retire by reducing excessive payments to insurance companies through Medicare Advantage.

Health Care Reform Timeline

As different provisions of the health care reform bill go into effect on different dates, many AFSCME members have asked questions about when some of the changes become law.  AFSCME International created the attached timeline to serve as a quick reference for the implementation of some of the provisions in the health care reform bill.  In addition, by going to and clicking on the Issues tab on the left hand side of the screen and choosing Health Care, you can view an online tutorial that will cover some of the main provisions of this historic legislation.

The fight for affordable and quality health care is not over, but a monumental step was taken this year.  It was accomplished largely through the tremendous effort of AFSCME members from around the nation, and we should be proud of what we have accomplished.

Health Care Reform Timeline
·         Tax credits for small businesses

·         Drug help for seniors

·         Coverage for pre-existing conditions

·         All kids get covered

·         Can’t get dropped if you get sick

·         No more lifetime limits

·         Children can stay on until 26

·         Premium payment reformed
(80%-85% for medical care)

·         Free Medicare preventative care

·         Total ban on pre-existing condition denials

·         Health exchanges open

·         End to annual limits on benefits


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