Where is my health insurance?

Last month, on September 22nd, President Obama marked the six month anniversary of the enactment of the new law, the Affordable Care Act. This comprehensive reform was signed into law on March 23, 2010.  The Affordable Care Act has already put into place health insurance reforms that will hold insurance companies more accountable, lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans. Of particular interest, which was implemented last month, is the Patient’s Bill of Rights. Included in this new law are critical consumer protections that will end the worst insurance company abuses and help put consumers in control of their own care. If you have read other articles of mine, this is a theme that I promote.

Last month the White House unveiled a new web site – http://HealthCare.gov/healthreform. This site includes information and reports on the impact of the law and stories from Americans in all 50 states who are benefiting from the Affordable Care Act. I suggest that you visit this site. We have to differentiate between fact and fiction and sound bites. This site should help.

If you purchase or join a new plan on or after September 23, 2010, insurance companies must:

Cover recommended preventive services without charging out of pocket costs: Services like mammograms, colonoscopies, immunizations, pre-natal and new baby care will be covered, and insurance companies will be prohibited from charging deductibles, co-payments or co-insurance.

Provide an opportunity to appeal coverage decisions: Consumers will be guaranteed the right to appeal insurance company decisions to an independent third party. 

Guarantee enrollees their choice of primary care provider: Consumers will have their choice of provider within the plan’s network of doctors, including OB-GYNs and pediatricians, without a referral, as well as out-of-network emergency care.

According to the White House web site, these three provisions will benefit up to 88 million people by 2013. Therefore, as of last month, many provisions in the Affordable Care Act are being implemented. Other changes will be implemented through 2014 and beyond.  Other provisions of the law that have already been implemented include:

Health insurance companies will no longer be able to drop people’s coverage when they get sick and need health care the most. Young adults — the largest population of uninsured before passage of this law — can now remain on their parents’ health insurance plan until their 26th birthday. Health plans can no longer impose lifetime limits on coverage, and annual limits are to be phased out over three years — a dramatic change for families, because more than 60 percent of people who declared bankruptcy in 2007 cited medical bills as a reason, and medical costs have only increased.

Over time, the Affordable Care Act will prohibit insurance companies from denying anyone coverage based on pre-existing conditions, create insurance exchanges so that Americans have the same health plan choices as members of Congress and implement the biggest tax cut for health care in U.S. history to ensure that middle-class families can afford insurance. The new law puts Americans, not the health insurance companies, in charge of their own health care. 

Six months after its enactment, there are two totally different stories to tell about the Affordable Care Act. The public remains split on the law largely along traditional partisan lines. Confusion and misperception are rampant, with more than a third of seniors still thinking the law contains “death panels” (it does not). Yet beneath the political battle lies a success story of early implementation: The federal government that many regard as sluggish and ineffective has turned major elements of the legislation into reality right on schedule.

Since the bill’s passage, the Department of Health and Human Services has set up a program to help people with preexisting health conditions get coverage through state or federal high-risk pools; established a program to help employers provide health insurance to early retirees; issued rebates to help pay drug costs for Medicare beneficiaries stuck in the “doughnut hole”; provided tax credits to small businesses to provide insurance coverage; and created a consumer-friendly web site.

However, the polls show that the public is split on the law, with 49 percent in favor vs. 40 percent against in September and the rest undecided. Public sentiment about health reform has shifted within a narrow band since the spring, with slightly more in favor in some months and slightly more against in others. For many who oppose it, the law reflects deeper discontent. When people were asked about health reform they said they were angry about the law. Why were they were angry? The vast majority reported that, more than being upset with the law itself, they were angry about the general direction in Washington. Meanwhile, with a few notable exceptions, such as requiring that people have insurance, the law’s major provisions appear to be very popular with the public.

The provisions that will touch the most people — an expansion of Medicaid, new insurance marketplaces in every state, tax subsidies for working people without insurance, guaranteed access to insurance and the hotly debated requirement that almost everybody purchase coverage do not come until 2014. And eventually, real-world experience with these changes will prevail.   

Consider what happened when a Republican-controlled Congress created the Medicare drug benefit in 2004. Three times as many seniors opposed the law as favored it, and many liberals criticized the legislation as a first step toward privatization of Medicare, just as some conservatives call current health reform a government takeover. Within three years, though, supporters of Medicare Part D outnumbered detractors as it became clear the program was working well and helping seniors afford their medicines. The new health-reform law represents a much bigger change than the Medicare drug benefit was and may work out differently, especially if Republicans succeed in their efforts to block full implementation. But if the reform continues on pace, as happened with Part D, the law’s fate will be determined not by the early political debate but by how people believe the law is working for them and their families and friends once its major elements are implemented.

At the six-month mark, the politics of health reform remain as ugly as ever, but implementation of the law’s benefits and changes has been a success story so far. There is a lot more still to come, so hold on to your hats.