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
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.