• Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.

• Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.

• A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled.

• Payments to insurers offering Medicare Advantage services are frozen. These payments are to be gradually reduced to bring them more in line with traditional Medicare.

• Employers are required to disclose the value of health benefits on employees’ W-2 tax forms.

• An annual fee is imposed on pharmaceutical companies. The fee does not apply to companies with sales of $5 million or less.

WHAT HAPPENS IN 2012

• Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to improve quality and efficiency of care.

• An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.

• The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.

WHAT HAPPENS IN 2013

• A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.

• The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016.

• The Medicare payroll tax is raised to 2.35 percent from 1.45 percent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.

• A 2.9 percent excise tax in imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.

WHAT HAPPENS IN 2014

• State health insurance exchanges for small businesses and individuals open.

• Most people will be required to obtain health insurance coverage or pay a fine if they don’t. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.

• Health plans no longer can exclude people from coverage due to pre-existing conditions.

• Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren’t counted for the fine.

• Health insurance companies begin paying a fee based on their market share.

WHAT HAPPENS IN 2015

• Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services.

WHAT HAPPENS IN 2018

• An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions.

• $940 billion over ten years.

Coverage

• Once reform is fully implemented, over 95% of Americans will have health insurance coverage, including 32 million who are currently uninsured.

Budget deficit

• Reform will cut the federal budget deficit by $138 billion over the next ten years, and a whopping $1.2 trillion in the following ten years.

Health Insurance exchanges

• Health care will be more affordable for families and small businesses thanks to new tax credits, subsidies, and other assistance paid for largely by taxing insurance companies, drug companies, and the very wealthiest Americans.

• The Uninsured and self employed will be able to purchase insurance through state based exchanges with subsidies available to individuals and families with income between 133% and 400% of poverty level.

Subsidies

• Individuals and families who make between 100% – 400% of the Federal Poverty Level (FPL) and want to purchase their own health insurance on an exchange will be eligible for subsidies. They cannot be eligible for Medicare, Medicaid and cannot be covered by an employer.

Paying for plan by Taxes

• The Medicare Payroll Tax will be expanded to include unearned income. That will be a 3.8 % tax on investment income for families making more than $250,000 per year ($200,000 for individuals).

• Beginning in 2018, insurance companies will pay a 40 % excise tax on so-called “Cadillac” high-end insurance plans worth over $27,500 for families ($10,200 for individuals). Dental and vision plans are exempt and will not be counted in the total cost of a family’s plan.

• Tanning Tax will have 10 % excise tax on indoor tanning services.

Medicare

• Seniors on Medicare will pay less for their prescription drugs because the legislation closes the “donut hole” gap in existing coverage.

• Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs. The bill also includes $500 billion in Medicare cuts over the next decade.

Employer Mandate:

• Technically, there is no employer mandate. Employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance.

• By reducing health care costs for employers, reform will create or save more than 2.5 million jobs over the next decade.

Medicaid

• Medicaid will be expanded to offer health insurance coverage to an additional 16 million low-income people.

• Federal Government will pay 100 percent of costs for covering newly eligible individuals through 2016.

• Medicaid will include childless adults starting in 2014.

Insurance reform

• Health insurance companies will no longer be allowed to deny people coverage because of preexisting conditions—or to drop coverage when people become sick.

• Just like members of Congress, individuals and small businesses who can’t afford to purchase insurance on their own will be able to pool together and choose from a variety of competing plans with lower premiums.

• Instead of losing coverage after they leave home or graduate from college, young adults will be able to remain on their families’ insurance plans until age 26.

• Community health centers would receive an additional $11 billion, doubling the number of patients who can be treated regardless of their insurance or ability to pay.

Illegal immigrants

• Illegal immigrants will not be allowed to buy health Insurance in Exchanges, even if they pay completely with their own pockets.

Abortion

• No health care plan would be required to offer abortion coverage. States could pass legislation choosing to opt out of offering abortion coverage through the exchange.

Individual Mandate:

• In 2014, everyone must purchase health insurance or face a $695 annual fine. There are some exceptions for low-income people.

Here is what to expect from the Bill:

WITHIN THE FIRST YEAR OF ENACTMENT

• Insurance companies will be disqualified from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.

• Insurers will be expelled from excluding children for coverage because of pre-existing conditions.

• Young adults will be able to stay on their parents’ health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.

• Uninsured adults with pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.

• A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This expires in 2014.

• Medicare drug beneficiaries who fall into the “doughnut hole” coverage gap will get a $250 rebate. Currently, the coverage gap falls between $2,700 and $6,154 in total drug costs.

• A tax credit becomes available for some small businesses to help provide coverage for workers.  The credit is up to 35 percent of the employer’s contribution to provide health insurance for employees. There is also up to a 25 percent credit for small nonprofit organizations.

• A two‐year temporary credit subject to an overall cap of $1 billion to encourage investments in new therapies to prevent, diagnose, and treat acute and chronic diseases.

• A new option allowing States to cover parents and childless adults up to 133 percent of the Federal Poverty Level (FPL) and receive current law Federal Medical Assistance Percentage (FMAP) will take effect.

• All new group health plans and plans in the individual market must provide first dollar coverage for preventive services.

• A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

• Expand and improve low‐interest student loan programs, scholarships, and loan repayments for health students and professionals to increase and enhance the capacity of the workforce.

• Improving Public Health Prevention Efforts by creating council to promote healthy policies at the federal level and establish a prevention and public health investment fund to provide public health programs.

Here is a summary of his proposals and the Republican ideas he is exploring.

EXCHANGES AND GOVERNMENT-RUN INSURANCE OPTION

The White House plan calls for state-based insurance exchanges similar to the proposal in the Senate bill which does not include the public option Co-op plans. Instead, it proposes for the federal Office of Personnel Management to negotiate with private insurers to provide multi-state health plans on the exchanges.

TAX REVENUES

• Medicare is the government health insurance program for the elderly and disabled. The White House adopted the Senate approach to raise the Medicare tax on high-income earners to 2.9 percent from 2.35 percent and also impose a new 2.9 percent Medicare tax on some investment income for high-income people.

• The White House plan also modifies the proposed Senate tax on high-cost insurance plans. The so-called “Cadillac” tax would kick in on plans costing $10,200 for individuals and $27,500 for family plans. The starting date for the tax is 2018 rather than 2013 as originally called for in the Senate bill. The change is similar to a deal worked out with labor unions, but would apply to all plans.

• The proposal also provides higher tax breaks for firms that have higher costs because they employ mostly women or older workers. It also provides higher breaks for high-risk professions such as firefighters.

• Obama’s plan increases proposed new assessments on brand-name pharmaceuticals to raise $23 billion over 10 years. Those assessments would be delayed by one year until 2011.

AFFORDABILITY

• The White House plan would improve affordability by taking favorable provisions from the House and Senate bills to help both low- and moderate-income families. A family of four earning as much as $88,000 a year would receive federal assistance in paying for healthcare costs.

• The bill would also gradually close the so-called “doughnut” hole in Medicare prescription drug coverage. Medicare now stops paying for drugs after both the plan and beneficiary have spent $2,830. Coverage starts again only after out-of-pocket spending hits $4,550. By 2020, the coverage gap would be closed.

REGULATION

• The White House plan would allow young adults up to the age of 26 to stay on a parent’s health insurance plan.

• Within months of enactment, insurers would be barred from dropping people from their health plans. When exchanges begin operation in 2014, insurers would be barred from excluding people for pre-existing conditions and setting annual and lifetime coverage limits. The Department of Health and Human Services would get new authority to help states review annual premium rate increases.

MANDATES

• The White House keeps the Senate and House requirement that individuals purchase health insurance. It sided with the Senate on not imposing an employer authorization and assessing fees on those uninsured companies where the employees receive subsidized health policies on the exchange.

• Small firms with fewer than 50 employees would be exempt from those requirements. But a tax credit is provided to encourage small companies to offer health coverage to workers.

REPUBLICAN IDEAS BEING EXPLORED

• An idea by Senator Tom Coburn that medical professionals be engaged to conduct undercover investigations of healthcare providers to reduce waste and fraud in Medicare and Medicaid.

• Increase proposed grants to states for demonstration projects to resolve medical malpractice disputes and curb the need for lawsuits. Some $23 million has been approved for these programs and Obama said he is considering authorizing as much as $50 million for the projects.

• Increasing doctor reimbursements for Medicaid patients.

• A proposal to expand health savings accounts used in combination with high-deductible health plans.

Obama has made some significant changes and has promised to make The Healthcare reform a reality very soon but for now let’s wait and watch hopefully a plan will be produced which in agreement with all the stakeholders but ultimately the government has to realize that the maximum beneficiaries are not the lobbyists, senators or interest groups but the people of United States who are eagerly waiting and hoping for the best.

Some Highlights of the Health Care Budget are:

• India’s public health budget has gone up by Rs.1,253 crore from previous year, with special focus on AIDS control and mental health programs and the prevention of diabetes and cardiovascular diseases.

• About Rs. 3,181 crore has been allocated for various schemes to benefit the health of the people – up from Rs.1,928 crore in 2009-10.

• The allocation for providing medical relief to people uprooted by natural disasters saw a decrease of Rs.149 crore. The amount has dipped to Rs.96 crore from about Rs.245 crore in 2009-10.

• India’s AIDS control program saw an increased allotment from Rs.888.15 crore to Rs.1,291 crore, which is Rs.403 crore more from last year.

• With nearly 2% Indians in need of medical attention in the area of mental health, the government has increased the amount for the National Mental Health Program with Rs.103 crore – up from Rs.50 crore – an increase of Rs.53 crore.

• India being called the diabetes capital of the world and younger people are suffering from heart disease, the budget focus is also on the national program for the prevention and control of diabetes, cardiovascular disease and stroke. The program has got Rs.90 crore – an increase of Rs.73 crore from the previous budget.

• The allocation of the Tobacco Control programme was increased from Rs. 24 crore to Rs.39 crore.

• The budget has also hiked the allocation for manufacturing vaccines with the government speeding up efforts to produce a vaccine to combat the contagious swine flu virus, which has killed 1,366 people and affected 29,599 in the country so far. The amount to manufacture vaccines has gone up from Rs.31.65 crore to Rs.35.52 crore.

• The National Rural Health Mission (NRHM) is an essential instrument for achieving goal of Health for all currently operational in 18 states. The amount was for carrying out various schemes under the NRHM and has gone up to Rs. 13,910 crore.

• Rashtriya Swasthya Bima Yojana (RSBY) was operationalized last year. The initial response has been very good. Government proposes to bring all below poverty line (BPL )families under this scheme. An amount of Rs.350 crore, marking 40% increase over the previous allocation, is being provided in Budget Estimates. RSBY entitles the beneficiaries to hospitalization coverage up to Rs 30,000 for most of the diseases that require hospitalization.

• As the country faces a shortfall of trained doctors, nurses and paramedics, the government has set aside Rs.323 crore for creating more trained human resource in the health sector. According to a Planning Commission report, India faces a shortage of about 600,000 doctors, one million nurses, 200,000 dental surgeons and a large number of paramedic staff.

• As per the 2010-11 budget allocation, the AIIMS will get Rs.800 crore in 2010-11 as against Rs.886.5 crore in 2009-10, while the PGI Chandigarh has been allocated Rs.82 crore less in the new budget.

• The minister also proposed the country was set to conduct a national health survey next fiscal year. An Annual Health Survey will compile district health profiles. Contributions to the Central Government Health Scheme have become liable for deduction under the Income-tax Act. The government increased the allocation for the Ministry of Health and Family Welfare by Rs.2,766 crore, a part of which would go towards conducting the survey to prepare the health profile of all districts.

• In his Budget speech the Finance Minister recognized providing health facilities at the household level, both in rural and urban areas amongst issues that require significant resources and government have to find those resources.

In a country where 80% of health care spending comes from out-of-pocket  and more than half the population doesn’t have proper access to basic health services, these are some good proposals. Overall, it appears better than previous years but in the budget there is no mention of categorization of  health care as an infrastructure service or of any concessions to increase private sector participation and investment in healthcare infrastructure in India. There was also no announcement that promotes setting up of new hospitals within rural areas.

I believe that government must continue to increase the allocation of funds to the health sector to reach at least 3% of GDP and introduce bold reforms such as a regulatory mechanism in the public and private sectors to improve access, quality and delivery of care for 1.1 billion Indians.