This morning, President Obama signed the Senate health reform bill (which oddly is now called HR 3590) into law during a ceremony at the White House.

While many of the program’s new provisions will not go into effect until 2014 or later, some aspects do go into immediate effect.

The most important immediate effect, according to Mark D. Smith, MD, MBA, president and CEO of the California HealthCare Foundation, is that more Californians will receive coverage.

"As many as two million low-income Californians would be newly enrolled in Medi-Cal and other public coverage programs and another two to three million would obtain private coverage," said Smith in a statement. "Having health insurance would make it easier for people to get the care they need at a price they can afford."

Caring for these patients, having enough physicians, nurses, and the state apparatus to handle the increased patient load is a major concern that is yet unanswered.

Smith says that under the new legislation, California's government is assigned many implementation tasks. He said that new resources and public-private partnerships will be required. 

Some of the immediate applications of the law that may affect your patients and your practice include:

• Closing of the so-called ‘donut hole’ for Medicare patients’ prescription drugs. About 4 million patients who are on Medicare fall into the so-called ‘donut hole’ for prescription drugs. These patients will receive a $250 rebate on those pharmaceuticals in 2010. After that, patients who receive Medicare will get a pharmaceutical manufacturers’ 50% discount on brand-name drugs, which increases to a 75% discount on brand?name and generic drugs to close the donut hole by 2020.
• Eliminating the lifetime spending cap on coverage. Also, all existing insurance plans will be barred from imposing lifetime caps on coverage, which could benefit patients with chronic illnesses who delay or forego treatment in order to extend the cap. Restrictions will also be placed on annual limits on coverage.
• Insurers must also now report how much they spend on medical care versus administrative costs. This will be followed by closer government review of premium increases.
• Providing new, free annual wellness visits, and eliminating the out-of-pocket copayments for preventive benefits under Medicare, such as cancer and diabetes screenings.
• Reducing the rates Medicare pays for services such as hospital visits. Also reduces the amounts paid out through the Medicare Advantage program.
• Increasing taxes, in 2013. If your income is more than $200,000 a year, you’ll now pay a 0.9% Medicare payroll tax (this will also apply for couples who make more than $250,000 a year) and a 3.8 percent tax on unearned income for the same tax brackets.

How your Representative Voted on HR 3590