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Join us at 11 a.m. CT (12 p.m. ET/9 a.m. PT) on Thursday, Jan. 20, for an hour-long chat about company health care costs.

Millions of Americans this year have new benefits under the health care overhaul law signed last year by President Barack Obama. With co-payments and deductibles disappearing for a host of preventative services, primary care doctors will be on the front lines when patients seek these new benefits and bring with them many questions.

Dr. Glen Stream (left), president-elect of the American Academy of Family Physicians, will offer insurance advice and insight with Chicago Tribune health care reporter Bruce Japsen. The American Academy of Family Physicians represents more than 94,000 doctors and medical students across the country. Dr. Stream has been a family physician serving the Pacific Northwest for more than 25 years, most recently at the Rockwood Clinic in Spokane, Wash. He earned his medical degree from the University of Washington School of Medicine in Seattle and completed his residency at the Swedish Hospital Family Medicine Residency program in Seattle.

If you are unable to make the chat, or would like to send your question in advance, e-mail Bruce Japsen (right) at bjapsen@tribune.com.

Health chat: Health care overhaul

(01/20/2011)

  

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10:58

BruceJapsen:  Welcome to our chat today on new benefits of the health care law. I'm Bruce Japsen, health care reporter for the Chicago Tribune and Tribune Newspapers. Joining me today is Dr. Glen Stream, president-elect of the American Academy of Family Physicians. Dr. Stream is a family physician in Spokane, Washington and part of the Rockwood Clinic, a multi-specialty group in Spokane. So, Dr. Stream, given that so many new benefits under the law this year are related to preventive medical care are there tips primary care physicians should be giving to their patients? Thursday January 20, 2011 10:58 BruceJapsen

11:01

Glen Stream, MD:  This is a learning situation for both patients and their doctors. Many patients aren't used to having coverage for preventive services and now will have this coverage. Thursday January 20, 2011 11:01 Glen Stream, MD

11:03

[Comment From garygary: ]  exactly what will these benefits cover and how will they be reimbursed? Thursday January 20, 2011 11:03 gary

11:05

BruceJapsen:  Gary, for a list of benefits covered, go to www.healthcare.gov and the government has a list. Your insurance company or employer is responsible for paying the benefits. If you have had a copayment or deductible, you will no longer need to pay that under the new benefits that are taking effect with your new benefit year. Thus, if your employer has a Jan. 1 renewal date for benefits, it should start now. Benefits can be medical tests, preventive health screenings or diagnostics like a colonoscopy. Thursday January 20, 2011 11:05 BruceJapsen

11:05

[Comment From GuestGuest: ]  I am 23yr old female, live with my parents, am a freelance-courtreporter, work part-time at a restaurant, and have no benefits. In order to stay on parents health ins. I would need to make only $3600 a yr. How is this fair? Should I not have had ambition and graduated early with my degree,and gotten my career going? Should I have sat around the house not making more than $300 a month and been able to qualify for health care till I am 27? My sibling will also be in this same situation a year from now. I have been looking for private health insurance but as you know it is extremely expensive. Where can I and my sibling look to get affordable insurance? Thank you. Your advise is greatly appreciated. Thursday January 20, 2011 11:05 Guest

11:06

Glen Stream, MD:  @Guest- what you describe is certainly not fair and effects many like yourself. The efforts to reduce cost of private insurance will take effect in 2014 with the insurance exchanges. In the meantime many states have information to help folks identify affordable issurance. Check with your state dept of health. Thursday January 20, 2011 11:06 Glen Stream, MD

11:06

[Comment From robertrobert: ]  is there a site I can go to to get the list of the new preventive measures which are now covered Thursday January 20, 2011 11:06 robert

11:07

BruceJapsen:  Yes, Robert. You can go to www.healthcare.gov and there is a list under preventative health measures. You should also check with your employer or insurance company. Thursday January 20, 2011 11:07 BruceJapsen

11:07

[Comment From JerryJerry: ]  with an individual policy can the insurance company go back and say they dont want to cover something Thursday January 20, 2011 11:07 Jerry

11:09

Glen Stream, MD:  The health care reform law does limit insurance abuse such as you describe and also does not allow insurance companies to drop coverage for patients who have expensive health care needs. Thursday January 20, 2011 11:09 Glen Stream, MD

11:09

[Comment From RoyRoy: ]  Why the FSA restrictions on OTC drugs? You need a script from your doctor for OTC items such as aspirin? Band aids qualify, but aspirin does not? Reading glasses are approved, but not cough, cold flu medications? What is the rationale for this? Thursday January 20, 2011 11:09 Roy

11:11

Glen Stream, MD:  @ Roy - This is an IRS ruling and not part of health care reform. I agree it doesn't necessarily make sense. Thursday January 20, 2011 11:11 Glen Stream, MD

11:11

[Comment From RichardRichard: ]  I just changed my individual insurance last November so that I was in a "new" plan which would cover preventive services, like a colonoscopy. I had a colonoscopy in December; my five year recomended procedure. The insurance company said it was not 100% covered because it was diagnostic not routine. This was because I have had polyps in the past. Is this correct? Thursday January 20, 2011 11:11 Richard

11:13

Glen Stream, MD:  @ Richard - did you have a previous history of colon polyps? Thursday January 20, 2011 11:13 Glen Stream, MD

11:15

[Comment From RichardRichard: ]  Yes. I had some in the past and that was why the doctor recommended coming back every five years. Thursday January 20, 2011 11:15 Richard

11:16

Glen Stream, MD:  @ Richard - then yes, this would have been a diagnostic follow up colonoscopy rather than primary screening. Thursday January 20, 2011 11:16 Glen Stream, MD

11:16

BruceJapsen:  Richard - When a polyp is found, insurance companies then see the visit as going from a preventive diagnostic procedure to a medical procedure so the removal of the polyp would not be 100 percent covered. It would cause your co-pay or deductible to kick in depending on how your benefits work. Thursday January 20, 2011 11:16 BruceJapsen

11:17

[Comment From William LuvisiWilliam Luvisi: ]  Many of our health insurance clients including myself, have opted for an HSA Arrangment with a deductible of $2500 or $5000 to cover the catastrophic, but reduce our premiums greatly. Although recomendations I & II on the USPSTF are covered in network without deductible, why aren't annual routine physicals listed as a recomendation? Thursday January 20, 2011 11:17 William Luvisi

11:17

Glen Stream, MD:  @ William - These guidelines are based on best available scientific evidence and there is no evidence routine of the value of yearly physicals. Thursday January 20, 2011 11:17 Glen Stream, MD

11:18

Glen Stream, MD:  @ Richard (11:15) - the value is in the screening that is done: paps, mammograms, colonoscopy, cholesterol screening, diabetes screening, etc. Thursday January 20, 2011 11:18 Glen Stream, MD

11:18

[Comment From margemarge: ]  how is this going to afect us on medicare? Thursday January 20, 2011 11:18 marge

11:19

Glen Stream, MD:  @ Marge - Medicare will now cover a yearly preventive care and wellness visit. This is a great improvement for Medicare patients and the doctors who care for them. Thursday January 20, 2011 11:19 Glen Stream, MD

11:20

Now that certain health benefits are available under the law, do you like the legislation better than when it was first passed by Congress and signed into law last spring by President Obama? Yes  ( 66% ) No  ( 27% ) Undecided  ( 7% ) Thursday January 20, 2011 11:20

11:20

[Comment From JerryJerry: ]  Dont you have to have a yearly physical if you are any type of medication? Thursday January 20, 2011 11:20 Jerry

11:21

Glen Stream, MD:  @ Jerry - yes, but that visit is for management of the medication and not a true wellness or preventive care visit. Thursday January 20, 2011 11:21 Glen Stream, MD

11:22

[Comment From RichardRichard: ]  So, let me get this straigh. If you have had polyps in the past, which means a colonoscopy is recomended to "prevent" cancer from developing, than it is not covered. However, if you never have polyps and, therefore, have less of a chance of getting cancer, it is covered. Who wrote this law. Thursday January 20, 2011 11:22 Richard

11:23

Glen Stream, MD:  @ Richard - this is simply the difference between the medical process for preventive screening vs. management of an identified problem. Not really related to this new law. Thursday January 20, 2011 11:23 Glen Stream, MD

11:24

[Comment From SusieSusie: ]  How long can a new individual plan do a look back before they are able to deny a claim Thursday January 20, 2011 11:24 Susie

11:24

BruceJapsen:  Susie, are you wondering about pre-existing conditions. Thursday January 20, 2011 11:24 BruceJapsen

11:25

[Comment From SusieSusie: ]  Yes: if I did not know about them Thursday January 20, 2011 11:25 Susie

11:28

Glen Stream, MD:  @ Susie - it doesn't take effect yet, I believe it is in 2014 that insurance plans will not be able to deny coverage due to pre-existing conditions for adults. This is already true for children. Thursday January 20, 2011 11:28 Glen Stream, MD

11:28

BruceJapsen:  Susie - If you have a pre-existing condition, it will not matter how long an insurer will look back come 2014 when the ability to deny care for such a thing goes away. In addition, now health plans cannot rescind you. Here is a story I wrote on that topic a few months ago. http://www.chicagotribune.com/health/ct-health-rescissions-07062010,0,7736747.story Thursday January 20, 2011 11:28 BruceJapsen

11:28

[Comment From margemarge: ]  overall do you feel this new health program will help everyone better? Thursday January 20, 2011 11:28 marge

11:29

Glen Stream, MD:  @ Marge - yes, overall I and the American Academy of Family Physicians believe this new healthcare program will help keep us all healthier. Thursday January 20, 2011 11:29 Glen Stream, MD

11:30

[Comment From sgsg: ]  How will the new law affect careers in healthcare administration and public health? Thursday January 20, 2011 11:30 sg

11:31

BruceJapsen:  SG - There should be job opportunities throughout health care though there will also be some consolidation among hospitals and certain medical care providers that are looking to gain economies of scale. But more broadly, consider this: the expansion of health benefits under the new law is creating 30 million paying customers. The health care industry will grow and there should be many, many more employment opportunities. Thursday January 20, 2011 11:31 BruceJapsen

11:31

[Comment From jackjack: ]  Dr. Stream - I see depression screening is covered under the new laws. Do you think there is a need for broader mental health screenings to be covered too? A lot has been written lately about the poor state of our mental health system (especially in the wake of the Tucson tragedy), just wondering what resources you think might be beneficial in this area... also an article in the Tribune today about the benefit of mental health screenings in the military. Thursday January 20, 2011 11:31 jack

11:32

Glen Stream, MD:  @ Jack - our system continues to see mental health issues separate from "health/medical' issues. This is an artificial separation. Our system needs to do better in caring for folks with mental health issues. Thursday January 20, 2011 11:32 Glen Stream, MD

11:34

Glen Stream, MD:  @ Marge (11:28) - one of the main things that will help keep us all healthier is having more primary care doctors and the health care law helps promote medical students to choose primary care as their specialty. Thursday January 20, 2011 11:34 Glen Stream, MD

11:35

BruceJapsen:  Dr. Stream - I get a lot of questions about costs of outpatient care under the law. Will patients' primary care doctor's appointment cost them more when they come in for a visit? Thursday January 20, 2011 11:35 BruceJapsen

11:37

Glen Stream, MD:  @ Bruce - most private insurance will not change, so no the cost should not go up. For patients on Medicare, their cost will actually go down for preventive care. Thursday January 20, 2011 11:37 Glen Stream, MD

11:38

[Comment From sgsg: ]  Will primary care physicians earn as much as physicians in other specialties? What other incentives will medical students have to go into primary care? Thursday January 20, 2011 11:38 sg

11:40

Glen Stream, MD:  @ SG - provisions in the health care law will improve payment to primary care providers, but not enough and not up to the levels of most sub-specialty physicians. Thursday January 20, 2011 11:40 Glen Stream, MD

11:40

[Comment From TeriTeri: ]  I thought that all young adults would be covered through age 26 under a parents plan as long as they did not qualify for health insurance from their employer if they are working; is there a $3,600 dollar income limit on their earnings in order to qualify? Thursday January 20, 2011 11:40 Teri

11:41

BruceJapsen:  Teri, I am not aware of any income threshold to qualify. College students, for example, work and make more money than the amount you are talking about and can still stay on their parents health plans until they are 26. Thursday January 20, 2011 11:41 BruceJapsen

11:43

[Comment From KWKW: ]  I've read that small businesses are getting tax incentives to offer better healthcare alternatives. Do you know if that's still the case? Thursday January 20, 2011 11:43 KW

11:44

BruceJapsen:  KW - Yes, small businesses can get tax credits. You can go to www.healthcare.gov or here is a story I wrote. If your small business is an S-Corp., the tax credits might not be as beneficial, however. Here is a story I wrote a few months back on tax credits for small businesses under reform. http://www.chicagotribune.com/health/ct-biz-0816-health-reform-tax-credit-20100815,0,1779821.story Thursday January 20, 2011 11:44 BruceJapsen

11:44

[Comment From margemarge: ]  the law reads that all people must have ins. How will they be able to pay for it if they do not have jobs . I understand they will be fined. many ins. co. have been raising their rates. Thursday January 20, 2011 11:44 marge

11:45

Glen Stream, MD:  @ Marge - the individual mandate takes effect in 2014 at the same time as insurance exchanges. The plan is that the competition between health plans in the exchanges will help drive down the cost of the insurance. Thursday January 20, 2011 11:45 Glen Stream, MD

11:45

[Comment From KimKim: ]  What are the major anticipated changes under the Affordable Care Act for 2012. Thursday January 20, 2011 11:45 Kim

11:47

BruceJapsen:  Kim - The changes are being implemented now through 2014 when broader coverage is available. For a list of specific benefits, check out www.healthcare.gov or go to Tribune's www.healthkey.com web site and we regularly write stories about changes and updates in the law. Here, for example, is a gallery of stories on changes being implemented in the law's first year. http://www.chicagotribune.com/health/ct-japsen-health-reform-sg,0,3817444.storygallery Thursday January 20, 2011 11:47 BruceJapsen

11:50

BruceJapsen:  Dr. Stream, I get a lot of questions about the medical home concept that is encouraged with the new health care law. What should consumers and primary care physicians' patients know about the medical home and its role in the health overhaul law? Thursday January 20, 2011 11:50 BruceJapsen

11:50

Glen Stream, MD:  The patient centered medical home is care delivery model designed to deliver the best quality care possible, convenient to the patient, coordinating all the health care needs. Thursday January 20, 2011 11:50 Glen Stream, MD

11:51

Glen Stream, MD:  It uses the latest health information technology to build on the strengths of family medicine and the central nature of the doctor-patient relationship. Thursday January 20, 2011 11:51 Glen Stream, MD

11:53

Glen Stream, MD:  It allows us to use the family physicians we have to lead teams of health care professionals including nurses, pharmacists, health coaches to help patients stay as healthy as possible. Thursday January 20, 2011 11:53 Glen Stream, MD

11:54

[Comment From coco: ]  is my private health insurance at such a high inorder to pay for the welfare I cant understand why I as a young adult have such a high monthly payment with no pre-existing conditions Thursday January 20, 2011 11:54 co

11:57

BruceJapsen:  Co - Insurance rates rise for a variety of reasons but one of the key reasons is that tens of millions of Americans have no coverage so they don't seek medical care until they are sick. A key idea behind health reform is to expand the pool of people with coverage which is called a risk pool. If the pool of people who are paying claims or having their claims paid for is larger, many observers believe the costs will not rise as fast. Thursday January 20, 2011 11:57 BruceJapsen

11:59

BruceJapsen:  Thanks for participating in our health chat today and I would also like to thank Dr. Glen Stream of the American Academy of Family Physicians for being our guest as well. Thursday January 20, 2011 11:59 BruceJapsen

12:00

Glen Stream, MD:  Thank you Bruce. This was great. Thank you for the opportunity to participate today. Thursday January 20, 2011 12:00 Glen Stream, MD

12:01

BruceJapsen:  Our next health chat will be Tuesday, Jan. 25 at noon Central time when Tribune reporter Trine Tsouderos chats about detoxing. Thursday January 20, 2011 12:01 BruceJapsen

12:01