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Health Care Reform and You
Author: Raine    Date: 09/23/2010 13:03:52

Today, many previsions of the Health Care Reform acted passed 6 months ago go into effect. Kaiser Family foundation has provided an easy to read and navigate website to explain these changes. Here are a few of them:
Adult Dependent Coverage to Age 26: Extends dependent coverage for adult children up to age 26 for all individual and group policies.

Consumer Protections in Insurance Prohibits individual and group health plans from placing lifetime limits on the dollar value of coverage, rescinding coverage except in cases of fraud, and from denying children coverage based on pre-existing medical conditions or from including pre-existing condition exclusions for children. Restricts annual limits on the dollar value of coverage (and eliminates annual limits in 2014)

Insurance Plan Appeals Process Requires new health plans to implement an effective process for allowing consumers to appeal health plan decisions and requires new plans to establish an external review process.

Coverage of Preventive Benefits Requires new health plans to provide at a minimum coverage without cost-sharing for preventive services rated A or B by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children, and adolescents, and additional preventive care and screenings for women.

Coming in the next week:
Health Care Workforce Commission Establishes the National Health Care Workforce Commission to coordinate federal workforce activities and make recommendations on workforce goals and policies and establishes the National Center for Health Workforce Analysis to undertake state and regional workforce data collection and analysis. (9/30/10)

Medicaid Community-Based Services Provides states with new options for offering home and community-based services through a Medicaid state plan amendment to certain individuals and permits states to extend full Medicaid benefits to individuals receiving home and community-based services under a state plan. (10/1/10)
HealthCare.gov also provides comprehensive information regarding all the provision that go into place, as well as all those that have already gone into place.

Yesterday the President was in Falls Church Virginia talking about the 6 month anniversary. The GOP is still pounding it's repeal drumbeat (including within its recently released manifesto), but I for one think free cancer screening and free immunizations are a good thing. Then there are stories like this:
A cancer patient who had been uninsured told Mr. Obama she had joined a high-risk pool and now has coverage for her chemotherapy and radiation. A mother told the president that her son, who had a disorder that required repeated eye operations, could now get insurance because the law bars companies from excluding children with pre-existing conditions. An elderly woman told Mr. Obama that she paid for her heart medication with a $250 government rebate check.
Don't think for a minute the Insurance companies are going to go easily into this new law with it's new rules. TriSec posted a story yesterday about companies dropping "Child Only Policies"
Aetna, Cigna, Wellpoint, Humana and others told the press they will no longer sell child-only policies; however, children with pre-existing conditions will still be able to apply for coverage under their parent's plans, reports the Wall Street Journal.

A spokesman for Aetna told the paper that they made the decision to protect their existing child-only policyholders from increased premiums.
Nancy Pelosi responded to this:
“Health insurance companies, which have long discriminated against millions of people when they need coverage the most, are now violating their promise to write new policies to cover children with pre-existing conditions. Earlier this year, the companies pledged to cover children with pre-existing conditions – in keeping with the spirit of reform that requires they no longer drop coverage for these children. Now, some companies are backtracking on writing new policies, potentially leaving many children without the health insurance they desperately need.

“Under reform, families of these children have new options, but this reversal of their promise reinforces why a whole slate of new patients’ rights must not be rolled back by Congressional Republicans – because time after time, insurance companies will place profits over patients.”
It should be noted that these companies risk being left out of the larger insurance pool that will be going into effect on 2014 -- thus potentially taking away millions of possible insurance policies. It is frustrating, but we knew the insurance companies would fight this reform tooth and nail. Then there is this. Anthem Blue Cross to Customer: "You don't want to swim in a big polluted pool"
[snip] The audio file must be heard to be believed. In it, the representative spends a full ten minutes trying to talk this customer out of switching to another policy that would be regulated under the Affordable Care Act. He begins with this bizarro threat:
What that means to you specifically is if you make a change after March 23rd, you'll be subject to a [?] requirement [unintelligible] and more specifically - you'll be stepping outside of one underwritten pool of people that were upgraded due to pre-existing health conditions -- and you would be stepping outside into a non-regulated, non-grandfather classed plan.

More specifically, what will be in that pool that you'll be in? You may be very healthy but you will be a healthy fish, so to speak or a healthy person -- you'll be put in the pool of other persons that are in there and insurance is just a pool of people that come together to indemnify a particular [unintelligible].

So when you move from one pool to another and in that pool you have 18-year olds, cancer, diabetes, stroke, heart attacks, brain aneurysms, doesn't matter what it is they could not afford the insurance at that point in time. So now, in that pool is I could afford the premium that I couldn't afford before. The 18-year old. But now you're stepping in there and guess who's helping them pay their premiums?
The entire piece is a must read.

Big Changes have come, are coming and more are on the way. What is critical is to be well informed regarding Health Care Reform. The insurance companies would like for you not to know your rights. They want to keep you in the dark about their responsibilities,and legal obligations. That said -- despite the meme from the GOP that this is too big to understand -- it isn't. You have more rights now than you did yesterday.

and
Raine


 

21 comments (Latest Comment: 09/23/2010 21:27:36 by livingonli)
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