More health reform changes are on the horizon

From medication discounts to postings of calorie counts, several key components of the massive Patient Protection and Affordable Health Care Act, signed into law last March, that take effect in 2011 will have an impact on New Hampshire employers and workers.Nutritional labelingAn update to the Federal Food, Drug and Cosmetic Act, a provision in the Affordable Care Act requires restaurant chains and vending machine operators of 20 or more units to “disclose in a clear and conspicuous manner” the calorie content of the food prior to purchase.While condiments like ketchup packets and daily specials are exempt, nutritional information already printed on items may not satisfy the requirement because it often cannot be reviewed prior to purchase.”Obesity is such an epidemic in this country. Many people simply don’t know how many calories they are consuming,” said Hannah Zaitlin, an attorney with the McLane firm who focuses on health-care matters.The law is a bit vague on the compliance date, however, saying a ruling will be available by March 23, 2011, which doesn’t necessarily mean restaurants and vending machines need to have their calories listed by that date.The Portsmouth-based Margaritas Mexican Restaurant chain, which just opened its 21st restaurant in Framingham, Mass., is taking a “wait-and-see” attitude on the new law, said Jaime Forbes, spokesman for the company.”The NRA, FDA and other regulatory bodies are still figuring out how they will move forward,” he wrote in an e-mail. “Obviously we’ll implement whatever the law requires.”Vending machine operators are concerned about where they will have to put the calorie information, not to mention how to obtain it.”This is daunting,” said Michael Cadieux, owner of Cadieux Vending of Auburn. “I’m not sure how we’re going to do this. Posters would be all over the entire machine. I haven’t heard anything from the (food manufacturers) either.”Cadieux is a sole proprietor and services more than 100 machines across the state.”I’m hoping the chocolate manufacturers and the chip companies get together a booklet we could attach to the side [of the vending machine] or put something up on their website we could download,” said Cadieux.Workplace wellness grantsLunchtime yoga lessons in the office will take one step closer to becoming reality at many businesses in 2011.The federal government has set aside some $200 million beginning through fiscal 2015 for grants to small businesses with fewer than 100 employees to create their own workplace wellness program.One issue with the grants is that there’s very little information on how to obtain the money.Jennessa Bissonnette of Workforce Wellness in Concord, a division of Scott Lawson Companies, said her company is wondering what the process is.”We keep checking, as this is something we’d like to work with our clients on, but there haven’t been any further details released by the federal government,” she said.The Accountable Care Act does, however, list some general guidelines as to what has to be included – programs must be based on evidence-based research and include health risk assessments, for example.Changes to tax-free savings accountsBeginning Jan. 1, 2011, the cost for over-the-counter products like cold medicine and aspirin can no longer be reimbursed through tax-free savings accounts, such as a flexible spending account, health reimbursement account or health savings account, without a prescription.Insulin and certain other supplies, such as blood sugar testing supplies or crutches, will remain available for reimbursement through tax-free savings accounts.However, said John Rich, a director and attorney at McLane, Graf, Raulerson & Middleton in Manchester who specializes in federal legislation, some of the newly barred products may still be eligible as long as they’re directed by a physician. “You can ask your doctor for a prescription for something like Robitussin and it should be accepted,” he said.Health insurance exchangesGrants for developing the framework of “health insurance exchanges” – pools of affordable insurance plans – will become available to states starting March 23, 2011. The plans themselves must be available after Jan. 1, 2014.”Exchanges are intended for individuals or small employers with 100 employees or fewer as a place to go to get information on plans or purchase a plan,” said Jim Scammon, executive vice president of Granite Group Benefits in Manchester.The New Hampshire Insurance Department has already received a $1 million grant to begin the process of creating an exchange.”We are interviewing consultants,” said Leslie Ludtke, health-care policy analyst for the state Insurance Department. “We hope to make a decision by early January.”Ludtke said the federal legislation has some basic guidelines regarding what has to be included in exchange plans, “but one of the big questions is if they are going to be standardized or not.”Like many provisions of the landmark Affordable Care Act, the details have yet to be worked out.The health exchange legislation also says that employers with 51 or more employees must pay a penalty if they don’t offer coverage to their employees – some $2,000 per employee per year, minus the first 30 employees.For some employers, however, this penalty could actually be cheaper than providing coverage, said Scammon.And what about workers who don’t qualify for exchange subsidies and are not receiving employer-sponsored benefits?”Exchange plans aren’t necessarily going to be any cheaper,” said Scammon. “I’m still talking about $500 a month for an individual to $1,400 a month for a family, and now you have to pay the whole cost.”CLASS ActAn act in its own right, the Community Living Assistance Services and Supports, or CLASS, Act creates a national voluntary insurance program to help employees purchase community living assistance services, somewhat in the same way Medicare taxes are deducted from paychecks now.Granite Group Benefits’ Scammon said there is still a plethora of questions to be answered about how this provision will be put into practice.”The legislation suggests that it will be effective Jan. 1, 2011, but there has been almost no work done to create or implement the CLASS program,” said Scammon. “The expectation is that nothing will become available prior to Jan. 1, 2013.”One positive point about the CLASS Act at this juncture, said Scammon, is that “the discussion is now being raised” about the need for long-term care planning.Closing the ‘doughnut hole’Medicare enrollees who reach the end of their Medicare Part D pharmaceutical coverage but who have yet to reach their catastrophic care benefits – a coverage gap known as the “doughnut hole” – will receive a 50 percent discount on covered brand-name prescription drugs and a 7 percent discount on generic prescription medications, beginning Jan. 1.The provision has a goal of eliminating the gap by 2020.According to AARP, Medicare Part D benefits typically cover the first $2,800, then members have to pay expenses out of pocket until reaching a catastrophic limit of often greater than $6,600.”This deductible renews each calendar year, so for some seniors with expensive medications, they can reach the donut hole very quickly,” said Doug McNutt, New Hampshire associate director of advocacy for AARP.Medicare subscribers should find the process relatively easy, said AARP New Hampshire Director Kelly Clark.”There are no special actions they have to take to receive the discount,” said Clark. “It should be automatic.”Malpractice reform grantsReducing frivolous medical malpractice lawsuits has long been looked at as a way to reduce the cost of the health care.Beginning in fiscal 2011, some $50 million was to have been appropriated through the Affordable Care Act for five-year demonstration grants to develop, implement and evaluate alternatives to current medical malpractice tort litigation.In 2005, New Hampshire enacted legislation for screening panels consisting of a judge, a lawyer and a clinician to review medical malpractice suits.”We do have pre-trial screening panels, called 519-B panels after the statute,” said Scott Colby, executive vice president of the New Hampshire Medical Society. “But to my knowledge, there hasn’t been any applications submitted for grants.”Form 1099 expansionOne of the more controversial provisions in the health-care reform act is expansion of a reporting requirement on IRS Form 1099, which requires virtually all businesses to issue the form to contractors and corporations for payments of $600 or more for goods and services made after Dec. 31, 2011.Previously, payments for goods and those made to corporations were exempt.While this affects payments made after Dec. 31, 2011, “businesses need to start keeping track now” because a job or a purchase could be started in 2011 with the money changing hands in 2012.There are some exceptions. For instance, purchases made by credit or debit card are exempt, since the banks issuing the cards will send the 1099.While there is talk on Capitol Hill of repealing this particular provision, policy may trump politics primarily on how to recoup the $19 billion over 10 years this provision is estimated to bring in to help pay for the Affordable Care Act.Cindy Kibbe can be reached