Health Care Reform's First Provisions Start
Great news for me and my wife as our kid will be automatically covered on our plan.
Health care reform's first provisions start
By Lisa M. Krieger and Sandy Kleffman
lkrieger@mercurynews.com
As her 22-year-old daughter faces major surgery, Carol Malnick of Los Altos has at least one less thing to worry about: its stratospheric price tag.
Significant provisions of the health care overhaul bill roll out Thursday, reshaping the insurance landscape by significantly broadening access to coverage and care.
Now, young adults may remain on their parents' policies until age 26 and minor children can't be denied coverage because of pre-existing conditions. Insurers are prohibited from canceling coverage for sick patients or those who have reached coverage limits -- when they need it most.
"Thank God. It is financial security," said Malnick, whose daughter Meredith needs jaw reconstruction, at an estimated cost of $120,000, to correct lifelong sleep apnea and insomnia. She'll still pay thousands of dollars toward the cost of care -- but without Meredith's coverage, "I would be looking to sell my house," she said.
The changes are also good news for Martinez native Julie Walters, whose daughter, Violet, was born two years ago with a rare and life-threatening form of epilepsy. The bills for Violet's hospital stays have reached hundreds of thousands of dollars -- and the baby would have reached the lifetime limit on health insurance by the age of 4.
Even more dramatic reforms, such as full expansion of Medicaid, won't take effect until 2014. But six months after passage of the federal Patient Protection and Affordable Care
Advertisement Act, several big changes start now.
For instance, insurers must cover recommended preventive services, such as mammograms and flu shots, with no co-pay. When people need emergency care while traveling, they can seek treatment at the closest place, without having to worry about out-of-network surcharges.
"The provisions going into effect on September 23 can have a profound impact on the health of California families," said Dr. Gerald Kominski, associate director of the UCLA Center for Health Policy Research.
Mountain View insurance broker Chris Acker also welcomed the reforms. "Any legislation that allows people to protect themselves financially is good legislation," he said. "It will most benefit those people who are not healthy," he said.
Many critics of overall reform, including several prominent members of the Republican Party, are especially opposed to a mandate that everyone obtain insurance, which will take effect in 2014. Those who oppose expanding coverage fear it could significantly cost employers more in financial outlay, according to health management consultant Stephen Beckley in Fort Collins, Colo. Some health insurance companies are already raising their rates as much as 10 percent, blaming federal health reform law.
But U.S. Health and Human Services Secretary Kathleen Sebelius warned a health-insurer trade group last week not to use the Affordable Care Act to game the system. The administration estimates that the changes should raise costs no more than 2 percent.
Surveys show that young adults are the largest group of patients to lack health insurance -- and even healthy youngsters can break a leg in a ski accident, for instance, and face catastrophic bills. About half of all colleges offer insurance -- but many are poor quality, excluding important services. Young people with coverage tend to be on their parents' employer-sponsored plans -- the cheapest, best regulated and most comprehensive option, experts say.
Until now, they've lost coverage when they turn 21 or graduate from college. And many entry-level jobs don't offer insurance. Nor do most graduate schools.
Healthy young adults can find individual plans on the open market, averaging $150 a month. But those with even minor pre-existing problems, such as asthma, may face much higher rates.
"It will help those who have to choose between paying for medical insurance, or paying for other important things," Acker said. "Young adults -- they tend to pay their car bill first."
And patients like Meredith Malnick -- an English literature student now on leave from the University of Oregon, who loves to ski, hike and ride horses -- find it tough to get any insurance, due to previous procedures.
There are some caveats. For instance, some employers' plans created before the reform act will be "grandfathered in" and don't have to abide by the new requirements.
The provisions kick in when parents' plans renew. For some, that's Sept. 1; for others, it's Jan. 1.
Health Insurers in Certain States Won’t Issue Child-Only Policies Anymore
Marian Wang
A provision of the health care bill that bars health insurers from refusing to cover sick children with pre-existing conditions will go into effect on Thursday, and several of the nation’s largest health insurers, anticipating the change, have found a way to avoid bearing the law’s full effect.
Many have dropped child-only policies altogether, in states where they’re allowed to. Because the health care overhaul prevents insurers from turning down coverage of kids, insurers are afraid parents will wait until their children are sick to enroll them. In August, the Obama administration issued a clarification, allowing insurers to restrict enrollment of children to particular “open enrollment” periods, if allowed by state law.
Apparently, that wasn’t enough for the insurance companies. WellPoint’s Anthem Blue Cross & Blue Shield, Aetna, Cigna, CoventryOne, Humana, and UnitedHealth Group’s UnitedHealthCare have all said they will stop writing new child-only policies in one or more states, according to reports from Dow Jones Newswires and The Hill. The affected states include Colorado, California, Ohio, and Missouri.
Here’s The Hill, explaining what this decision could mean:
The announcement could lead to higher costs for some parents who are buying separate coverage for themselves and their children at lower cost than the family coverage that's available to them.
The Obama administration has criticized the insurers for turning their backs on “some of our most vulnerable Americans.” (Children covered by existing child-only policies will continue to receive coverage.)
A Department of Health and Human Services spokeswoman told Politico,“Insurance companies have pledged to offer coverage to children with pre-existing conditions, and we expect them to honor that commitment.”
Insurers have said their decision to drop child-only coverage was prompted by uncertainty in the health insurance market. Dow Jones cited WellPoint’s response, for instance:
We have reviewed the rules regarding the provisions of the Patient Protection and Affordability Care Act (PPACA) limiting the application of pre-existing condition exclusions for children under 19," WellPoint said in a statement. "Unfortunately, there remains a great deal of uncertainty as to how the rules will be implemented and what the impacts might be on participating insurers.
"While some carriers may continue to offer child-only policies, other carriers have dealt with this lack of clarity by choosing to discontinue new business sales of their child-only policies. Some have cited the lack of an effective mandate for individuals to obtain coverage, as well as ongoing market uncertainty," WellPoint said.
Cigna’s vice president of public policy, G. William Hoagland, told Politico that the company “would love to stay in the market” for child-only coverage, but “you can’t have guaranteed issue for this population and be the only one out there.”
_______________________________________
Clarity? Uncertainty? Maybe, maybe not.
Corporate America strikes again.