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Latest Round of Health Reform Benefits Kicks In

Latest Round of Health Reform Benefits Kicks In Backlash Also Notches Up, With Some Insurers Deciding to Drop Child-Only Policies WebMD Medical News By Andy Miller Reviewed by Laura J....

Sept. 22, 2010 -- Americans will receive an array of new protections against financial and coverage gaps in health insurance Thursday under health care reform

The changes include allowing children to remain on their parents’ health plans until age 26. The protections will apply to insurance plans that begin or renew after Thursday -- six months after President Obama signed the Patient Protection and Affordable Care Act. For many people with job-based coverage, the insurance changes will arrive Jan. 1, 2011, at the start of the new benefits year.

At the same time, the resistance is notching up. This week, as the consumer protections kick in, media reports have revealed that some major insurers, at least in part, will sidestep one new provision: denying coverage for children under age 19 who have pre-existing medical conditions.

Meanwhile, Republicans are pushing to repeal the law or block funding for key provisions. House Minority Leader John Boehner recently told the Cincinnati Enquirer: “They’ll get not one dime from us. Not a dime. There is no fixing this.’’

Elected officials from 20 states are challenging the law in court, focusing mainly on the reform requirement that individuals must purchase health insurance. Florida Attorney General Bill McCollum, a leader of this litigation, told Fox News recently, “There's nothing in the Constitution that allows the kind of tax they're proposing.’’

Health Reform Highlights

Aside from the two children-related changes, other reform provisions rolling out Thursday include:

  • Removing lifetime dollar limits on essential benefits
  • Giving people a right to appeal to an external party if denied coverage for a treatment
  • Preventing insurers from dropping coverage of people when they get sick
  • Limiting the use of annual spending limits of health plans
  • Allowing consumers to use ob-gyns in their networks without needing a referral
  • Prohibiting extra charges for using emergency care that is out of network
  • Guaranteeing full coverage of many preventive services, such as mammograms and colonoscopies, without a co-pay, co-insurance, or deductible

Nancy-Ann DeParle, the director of the White House Office of Health Reform, said these protections “will improve the health care system for everybody.”

Existing health plans can avoid some of these changes by seeking ‘’grandfathered’’ status. But to achieve that designation, these plans can’t make significant changes to benefits or raise consumers’ costs substantially.

A survey by consulting firm Mercer released this month found that 53% of employers believe they are likely to keep grandfathered status for all their plans. Employers also estimated that health care reform requirements would add 2.3%, on average, to the cost of their health benefits next year.

Already launched under reform are “high-risk” pools in states for people with pre-existing medical conditions who have been denied coverage. Enrollment has been slow, but DeParle said this week that “several thousand” people are now covered in these pools.

Uninsured Americans

The uninsured problem, though, continues to grow as the high unemployment rate persists. A newly released Census Bureau report found the number of Americans without health insurance climbed sharply in 2009 to its highest level -- 50.7 million.

A central goal of health care reform is to cover millions more Americans. And in 2014, when reform is fully implemented, individuals would be required to have coverage or face a penalty. Another key change for 2014: Insurers won’t be able to charge more for people with pre-existing medical conditions.

A related reform provision kicking in this week -- that health plans accept children with pre-existing conditions -- has hit a snag. Some major health insurers have decided to stop offering new child-only health policies, which often are purchased by unemployed parents or those who don’t have dependent coverage in their health plans.   

The Denver Post reported that at least six major insurers -- including Aetna, Anthem, Cigna, and Humana -- have said they would stop writing new policies for individual children, citing health reform mandates.

An industry trade group, America’s Health Insurance Plans, said that insurers would accept children with pre-existing conditions in other plans. But a spokesman, Robert Zirkelbach, also told The Washington Post that including that coverage in child-only plans ‘’provides a very powerful incentive for a parent to wait until their child becomes very sick before purchasing coverage.’’  

DeParle says the insurers’ exodus from child-only plans is disappointing.

The administration has pushed tougher scrutiny of health insurance practices, including big premium increases. DeParle cited a decision by Blue Cross and Blue Cross and Blue Shield of North Carolina to refund $155.8 million to about 215,000 individual policyholders, a move related to reform changes. Insurance commissioners are starting to scrutinize rate increase requests more as a result of reform, she said.

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