As more reform specifics emerge, so do questions, answers and impacts

As details of health reform policies shake out, questions, answers and consequences are emerging.

Kaiser Health News: The new health care law could shift billions in Medicaid drug rebates from states to the federal government by changing how the rebates are treated. "Democrats included a provision in the health law designed to raise $38 billion over 10 years by requiring greater discounts from drugmakers selling to Medicaid, the joint federal-state health insurance program for the poor. Previously, the rebates were divided between the states and the federal government. Under the law, a significant portion of the rebates will go solely to Washington beginning this year." The law will increase minimum rebates to around 23 percent from 15 percent for brand name medications and generic medication rebates would also be increased. Some rebate losses from states could be offset by a provision in the law that would require drugmakers to provide discounts to states for drugs that are sold to Medicaid managed care plans hired by states, but "California, for instance, stands to lose $50 million next year alone because of the changes, according to Toby Douglas, the state's deputy Medicaid director" (Weaver, 4/20).

In the meantime, a question over a possible lapse in coverage for lawmakers because of the new health law has been resolved, The Washington Post reports. "The issue was highlighted in a recent Congressional Research Service report, which said a possible 'drafting error' in the legislation left unclear the date by which lawmakers and certain staff members will be required to drop their existing insurance and sign up for state-run exchanges that the law will create for people who lack coverage through their jobs." The CRS said that it was possible that because exchanges wouldn't start until 2014, that some lawmakers and staff would be kicked from their insurance, the Federal Employees Health Benefits Program and without an alternative. "But the Office of Personnel Management has concluded that the section of the law forcing them into the exchanges doesn't take effect until the exchanges become operational and that no one will lose his or her insurance" (Markon, 4/21).

Los Angeles Times: Three insurers have said that a provision that makes them allow people younger than 26 remain on their parents' health plans will be enacted sooner than legally required. "Three of the nation's largest health insurers announced this week that young adults can remain under their parents' policies until Sept. 23, when a new federal law guarantees them coverage. UnitedHealthcare, WellPoint Inc. and Humana Inc. said they will not wait until President Obama's new healthcare reforms take effect" (Helfand, 4/21).

CNN Money: Doctors, however, have some issues with the new health law. CNN Money explores five of their complaints. Doctors say the law "continues to leave them vulnerable to lawsuits and decreasing Medicare payments." They also say the measure doesn't do enough to help them pay their medical school debt and that insurers can still deny procedures patients need. "Many insurers now require 'prior authorization' from doctors for expensive procedures such as MRIs and CAT scans. This means that your doctor has to call the insurance company in advance to explain why the tests are needed." The law doesn't address prior authorizations (Kavilanz, 4/21).