Wednesday, September 22, 2010

Stepping In The Right Direction

Six months ago, President Barack Obama signed the Affordable Care Act. Many parts of this new law take effect gradually and are scattered throughout the coming years. On Thursday (Sept. 23), several important reforms become law. Most importantly, these points expand health care coverage to millions of children who previously fell through the cracks of our health care system.

Specifically, these now-in-effect provisions are:
  • Extending Coverage for Young Adults: Young adults can stay on a parent's plan until they turn 26. This doesn't apply to young adults who already have health insurance through a job.
  • Free Preventive Care: New plans must offer free preventive services, such as flu shots, mammograms, and even diet counseling for adults at-rsk of chronic disease (read: pre-diabetics, this applies to you!) This means they cannot charge you a deductible, co-pay, or coinsurance. (Note: This only includes new plans, not those "grandfathered" ones already in effect when the healthcare reform law passed.)
  • ER & Doctor Visits:  If you go to an ER outside your plan's network, you won't get charged extra. Patients will also be able to designate some specialists - specifically a pediatrician or ob-gyn - as their primary care doctor, avoiding the hassle of referrals that might otherwise be required. No clear reading on whether Endos fall into this category, but that's something to explore...
  • Insurers Can't Rescind Coverage: When someone with health insurance got sick, insurance companies would sometimes search for an error or other mistake on that person's application to deny coverage. That practice will no longer be legal. (Note: For most people, this will take effect in January 2011, at the beginning of a health plan's new year.)
  • Insurance Appeals: Consumers will have two ways to appeal coverage decisions or claims: through their insurer or through an independent decision-maker. (New plans only.)
  • No Annual or Lifetime Limits: Insurance companies can't set lifetime limits on key benefits, such as hospital stays. The law also restricts insurers' ability to set annual dollar limits less than $750,000 on individual and group plans. Annual limits will be totally wiped out by 2014. (New plans only.) 
  • Health Care Provider Choice: Patients have the option to select and keep a primary care doctor from among the insurance company's participating provider network. In addition to promoting a long-term relationship between patient and doctor, this provision encourages patients to seek preventive care, which lowers hospitalization rates and costs. The rule also prohibits insurers from requiring a referral for obstetric or gynecological care.
  • Emergency Services Access: Insurers are no longer be able to deny coverage or demand that patients pay co-insurance for the use of out-of-network emergency services. This protects patients who become ill on the road or far from a network hospital.
  • Preventive services covered: All new or renewed health insurance plans must cover preventive services such as vaccinations, mammograms, colonoscopies, and nutrition counseling for obese patients. These services must be free to the patient, with no applicable deductible, co-pay or co-insurance.
Everyone should be aware of these important new benefits and their impact. Some subscribers and employers may choose to stay with their current plans, many of which are exempt from these Sept. 23 provisions. But by 2014, all plans will have to conform to these and other standards. Health care reform innovations still ahead include electronic health records, discount prescription drugs for seniors and state-run insurance exchanges to encourage competition.

The Obama Administration says the new benefits will raise premiums by no more than 1 to 2 percent, and benefit consulting companies report the impact will be in the single digits but may vary from plan to plan. Meanwhile, there's the insurance industry that says rates will skyrocket because of these changes. Uh huh. As if rates have NEVER gone up before and my reading of rate increases every year was a mistaken interpretation on my part. That now, the sole cause of the rising rates is "Obama-Care," and the lying scheming insurance company cats want us to think that had we sat and done NOTHING, the status quo would have made life all peachy and rates wouldn't have to go up now. Uh huh. Sure.

These idiots are of the same ilk of those who once believed the sun revolved around the earth, even after seeing a map of the universe.
Of course, then there's another item that shakes things up and proves that the insurance industry just can't be trusted. News in the days before these 9/23 changes is that major insurers Wellpoint-Anthem, Cigna, Aetna, and Humana say will no longer sell child-only policies. The end of a news story reports this: "Part of the problem for the insurers appears to be the concern that extending coverage for pre-existing medical conditions to child-only policies could be a powerful incentive for parents to wait until their child is very ill before seeking insurance cover. And coupled with the fact it will not be until 2014, that all health insurers will be obliged to extend cover to all individuals with pre-existing medical conditions, regardless of age, this leaves a three to four-year gap when what might happen is that insurers with child-only policies will find themselves primarily covering children with large medical bills, driving up costs to the point that plans could go bust or premiums for other policies could rocket."

Hmmm. Not sure what I make of this. Overall, the net result: fewer options exist for covering children's health. But based on my large amount of trivial knowledge on this, I don't believe it's all that big of deal. The logic seems to make sense to me and it seems as though the insurers have a point (WTF Moment...??!?!) Parents can wait until the last minute to insure their child in these child-only plans, rather insure them as part of the family ahead of time. My reading on the topic from both sides tells me that child-only policies currently comprise less than 10% of the individual market, and existing child-only plans won't be canceled. Only the new enrollment is being nixed. As we've noted insurers will still cover children - including those with pre-existing conditions- in policies that aren’t strictly child-only. Not sure what the potential cost breakdowns might look like, but again it appears the insurers are making a solid argument here.

HOWEVER. There's a larger point: Trust. We patients have little of it when it comes to the insurance industry. History justifies that, because in many cases you just can't trust what an insurance company tells you. That dictates the necessity to talk to five people who give five different stories, before you finally get to the person with the authority to send you documentation of what they're saying. That becomes important later on, when the insurance company GOES BACK ON ITS WORD and tries to screw you over, and you are able to throw the letter in their face. State insurance commissioners and regulators are especially fond of that documentation showing Insurance Company Dishonesty. You know.. Sticking to the promises you make is important. I guess the insurance industry didn't learn that lesson and is fine with going back on its word. Personally, I'm not surprised. But I am biased, since I value my health and doctors' guidance rather than an insurer's bottom line.

With all of this and the new 9/23 provisions, this is a step in the right direction to improving health care coverage and access in this country. But even as these provisions go into effect, these new laws are in danger as we approach the November 2 general election which could shift the balance of Congressional power. Many of those running are voicing their intent to revise and repeal many provisions, and that political rhetoric will likely continue and gain more steam as we approach the presidential election in 2012. Already, we have some who've vowed to repeal these reforms - Tea Party candidates, Sarah Palin, and Mike Huckabee, just to name a few. Some of these fall into the same group that's talking about repealing the 14th Amendment, and reworking the Civil Rights Act and American With Disabilities Act in ways that would be very detrimental to our country's progress in the past three decades. This is a danger and would set us back so incredibly far. We must remember that when heading to the polls and casting our ballots!

What do you think about these new laws? Will these healthcare reform changes affect you? What are you concerned about politically from those who vow to revoke or revise what's put into place?

3 comments:

Megan said...

Just going to point out that with the mathematical techniques available in the ancient world, geocentrism was the logical conclusion. Ptolemy, Aristotle, and several ancient Chinese physicists concluded the same thing :)

Michael Hoskins said...

Thanks for the comment, Megan! Worthy point, and I concur completely that it was perceived as the logical conclusion back in the ancient world. But that train of thought as remained, though it's important to realize that this craziness comes mostly from isolated groups and inviduals and isn't mainstream - not as clear cut as the insurance rate issue that is much more controversial. Still, the two are similiar in that the arguments for either don't make sense once you see the data that's out there proving that rates likely would have gone up anyhow, just as they have in most of the many past years.

Richard said...

The requirement to insure all without preconditions is silly; it would be like people not buying home insurance until their house is on fire. It only works if everyone is required to have or is provided insurance. With the limited experience with Medicare vs provate insurance, I would rather have competitive forces at work in the market place than a government beauracrat making my health care decisions Example BCBS covers CGM - Medicare does not.

An alternative that no one mentions is to provide everyone a voucher to buy their own private plan and for those that like medicare let that be one of the competitive options. The vouchers would be funded by a new consumption tax. The domestic employers could lower their prices by not paying health care. Everyone Teacher Nurse Engineer Politician and Burger flipper would get the same benefits! We might buy a lil less crap from China, but would probably employ more americans once the employers are freed of the burden of Health Care.