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Mar. 22 2010 - 10:59 am | 1,162 views | 6 recommendations | 29 comments

Healthcare reform – what’s in it for you today?

While we now have a piece of reform legislation for the president to sign, most who have followed the process understand that much of what is to change will come in a few years rather than producing immediate benefits 0r – depending on your point of view – future disaster.

So, what’s in it for us now?

Here are a few of the changes that take hold immediately-

The immediate creation of a temporary high-risk insurance pool for adults who cannot get insurance due to a pre-existing condition. This is huge. While many are pleased that the concept of denying coverage to those who need it most will soon go away, if you are one of these people, ‘soon’ is just not soon enough. While the provision will kick in for insurance companies in a couple of years, this doesn’t help someone who has been denied coverage and gets sick next week or next year. Now, all of these people can sign up for the temporary government high-risk pool that will give them coverage and security until the rule kicks in for all insurers. Anyone who thinks this is not huge simply does not understand the horrible feeling of having a poor medical history and knowing that you are one heart attack, cancer reoccurrence, etc. away from financial ruin – or worse.

No more pre-existing condition exclusions for children in all new plans. We’ve all heard the stories of families who cannot get health coverage for their families because of a child who was born with an illness or, for that matter, something deemed an ‘illness’ by an insurance company that may be of no significance whatsoever, except as an excuse to deny coverage. As soon as the president signs the bill passed last night, that will not happen any longer.

No more rescission of coverage on existing health plans. Once the bill is signed into law by the president, the days of an insurance company dropping you at the very moment you need them most come to an end. I think that requires no further explanation.

No more annual limit on coverage. Immediately, your insurance company will no longer be able to send you that letter in the middle of your chemotherapy treatment that you have maxed out the amount of coverage you have in any given year. Down the road, insurers will no longer be able to include lifetime limits on coverage which should give comfort to every single one of us.

Relief from the Part D donut hole. This is a bit complex as it is a combination of lower costs to seniors as a result of the deal made with Big Pharma and a $250 payment the government to seniors when they hit the donut hole period of pharmaceutical coverage. This is a small beginning with the plan being to fully end the donut hole over a period of time.

You may now keep your kids on your insurance policy until they reach 26.

Insurance plans are now required to cover preventive medical services and immunizations with no cost sharing.  This means that there will be no co-pay when you go to your doctor for a flu shot.

Obviously, there is much in the legislation passed last night that troubles many Americans. Some will tell you it is the largest tax increase in the history of the nation while others tell you that it will help get the economy back on track and make a serious dent in the national deficit.

Set the controversy aside just for the moment. As you look at the list of what will go into effect immediately, and how much many of these provisions will mean to Americans who are terrified that they will be unable to access treatment if they become seriously ill or face financial ruin even if they can get in the door, is there anyone who would step up to say that this is a bad thing?

When you set aside the politics and the political theater, there may be challenges presented by passage of the bill. But why not, just for a moment, feel good for the many people who had the best night sleep they’ve had in a long time last night knowing their family’s lives are, in many ways, more secure that they have ever been.

And as for those politicians sending out letters proclaiming last night as the ‘end of freedom’ in America, can we give it a rest? I understand that many have serious objections to this legislation. But all the foolish drama is about the political futures of these cynical people and not a serious conversation about what is or is not best for the country.

I know. I took a look out my window this morning and couldn’t find so much as one tank patrolling my street.

There will be lots of time to get back into the political bull that passes for debate in this country these days. But for now – and maybe even the next few days – I’m going to enjoy the fact that for better or worse, richer or poorer, there are millions of Americans whose lives took a giant leap towards the better with last night’s congressional proceedings – and that’s not something that happens every day.


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  1. collapse expand

    I don’t know about anyone else, but I’m thinking of calling off Socialist to work today. That really has nothing to do with anything, I just have a paper I need to get through and am procrastinating on. Bleh…

    Thanks for the insight again sir…

  2. collapse expand

    /popcorn

    Watching the crazy right go crazy for the next few days is going to be a guilty pleasure kind of spectator sport for me (as long as it stays non-violent). While I don’t think the bill is perfect, in fact, it seems like it’s just the first step to single player since it doesn’t do anything to fix the broken health insurance business model, I felt a great sense of relief that it passed, and hopefulness for the people that it is going to help immediately.

  3. collapse expand

    If anything, Rick, its a relief that congress can still accomplish anything that provides relief for the public and not banks or industry. Ironically, I don’t think this would have passed if the bank bailout hadn’t made everyone angry on both sides. The dems were forced to play nice or their prospects for this year’s elections would have been zip.

  4. collapse expand

    That was the wildest ride since Watergate.

  5. collapse expand

    I like the idea of quiet today. It seems fitting.

  6. collapse expand

    “No more rescission of coverage on existing health plans … I think that requires no further explanation.”

    It does require further explanation.

    Under this legislation “insurers can still rescind to their hearts’ content.

    Had rescission not been unlawful in many states before this bill? Had insurers still engaged in rescission almost at will? Does this bill not burden state enforcement efforts by giving more money to the insurers to pay attorneys to defend their rescissions?

    If this bill had been serious about ending rescissions, it would have provided some level of federal assistance in enforcement (as the House reform bill did), or established a gov’t panel authorized to approve policy cancellations, placing a preemptive burden of proof on insurers who claim “fraud”.

    The Senate has the opportunity to improve this flaw (among others) when they take up the reconciliation bill.

    • collapse expand

      jassong – you’re welcome to have a bug up your butt over the bill’s shortcomings – and, in many instances, I would agree with you. But its important not to twist facts.

      1. No, most states do not have laws preventing rescission. Would you care to state some examples along with authority so that we may all go and review? In almost every instance rescission has either been permitted or denied based on judicial rulings interpreting the rescission language in the insurance policy at bar.

      2. Sugggesting that legislating to end rescission ends up somehow benefiting lawyers who will defend insurance companies who will seek to avoid the law while placing a greater burden on the state to defend the law is, all due respect, bizarre. I suppose you could say that about virtually any item of law. By having laws against murder, we burden the state by forcing them to hire prosecutors to enforce the law against alleged murderers and, in the process, make money for defense lawyers who defend those who are charged with murder. So, by our logic, let’s just throw out the laws against murder, and by so doing, we can save the money we pay to prosecutors and keep money out of the hands of those greedy little lawyers who defend those so accussd.

      3. What exactly is the ‘federal assistance in enforcement that you have in mind and where was this to be found in the original House bill – and please provide authority for you claims.

      Correct me if I’m wrong – and I may not be remembering it correctly – but, based on your last post on this, I thought you were one of those folks who thought this was an unconscionable expansion of big government – yet here you are taking Congress to taks for not creating a gov’t panel to approve policy cancellations. If I’m confusing you with someone else, apologies. If I’m not, aren’t you kind of all over the place?

      In response to another comment. See in context »
      • collapse expand

        1. I don’t know whether most states have laws specific to insurance company rescission practices. But wouldn’t you agree that general contract law applies where insurers fail to perform their part of their contract with the insured (i.e. fail to pay on claims of policyholders from whom they’ve collected premiums for years and years)? In any case, the burden of enforcement of this legislation’s anti-rescission provision will be placed on state insurance commissioners, state attorneys, and the policyholders whose policies are rescinded. In failing to provide a strong federal enforcement mechanism, there is ample opportunity for insurers to challenge that provision (e.g., “what does ‘fraud’ mean?”) and, yes, provides indirect funding (via the reform bill’s subsidies and mandate) to help them defend individual rescission decisions.

        2. You missed my point – see above. The federal subsidies in this legislation provides the insurers more money to defend rescissions, influence elections and legislation, etc. Millions will continue to be uninsured, to suffer and die, from our shameful pay-or-die system, which this legislation in many ways supports.

        3. One example from HR 3200:

        SEC. 141. HEALTH CHOICES ADMINISTRATION; HEALTH CHOICES COMMISSIONER.

        (a) In General- There is hereby established, as an independent agency in the executive branch of the Government, a Health Choices Administration …
        (b) Promoting Accountability …
        (d) Sanctions Authority …

        And yes, you are confusing me with someone else. Click on my profile to read my comments, both on your posts and elsewhere, and you’ll realize that my position is that this legislation does not go far enough to reform our pay-or-die health care system.

        “REFORM: A thing that mostly satisfies reformers opposed to reformation” (Ambrose Bierce, The Devil’s Dictionary, 1906)

        In response to another comment. See in context »
        • collapse expand

          Jassong-

          1. If you are unaware of any states that have such a law, it’s best not to allege it as you did initially as this does a disservice to the debate.

          2. I just can’t work up a lot of sympathy for your point that the burden of enforcement goes on the state rather than the federal government. Doesn’t this skirt the important issue – ie., that we now have a law that prevents insurance companies from rescinding insurance coverage when it is most needed. If you feel a need to argue over whether the state should take the burden of enforcement or the feds should that is certainly your right but, in my opinion, hugely misses the point.

          3. Citing Sec. 141 is hugely misleading and wrong. Sec. 141 speaks to no particular provision of the House bill at all – it is introductory language – period.

          4. Again – sorry for mistaking you with another commenter. And I thin you would find that there are many, including myself, who would have liked this legislation to go farther. But, as was the point of the original piece, I’m going to feel good about the millions of people who immediately benefit in very real ways. I’m going to see this legislation as a framework for improvement, as was Social Security and Medicare, both of which evolved considerably since initial passage. If you chose to take a more negative point of view, than who am I to tell you not to?

          In response to another comment. See in context »
          • collapse expand

            3. My mistake. The (b) & (d) sections I quoted were from Section 142.

            SEC. 142. DUTIES AND AUTHORITY OF COMMISSIONER. …
            (b) Promoting Accountability …
            (d) Sanctions Authority …

            SEC. 143. CONSULTATION AND COORDINATION.

            SEC. 144. HEALTH INSURANCE OMBUDSMAN.
            (b) Duties- The Qualified Health Benefits Plan Ombudsman shall, in a linguistically appropriate manner–
            (1) receive complaints, grievances, and requests for information submitted by individuals;
            (2) provide assistance with respect to complaints, grievances, and requests referred to in paragraph (1), including–
            (A) helping individuals determine the relevant information needed to seek an appeal of a decision or determination;
            (B) assistance to such individuals with any problems arising from disenrollment from such a plan;

            Again, from that NEJM article I linked to in my first post above:

            As we look back a decade from now, whether we see the vast majority of Americans benefiting from ready access to uniformly fair and affordable health insurance or a national patchwork, with some states ensuring access to affordable health insurance for most residents while other states leave many uncovered, will depend largely on whether the final legislation is closer to the House or the Senate approach.
            In sum, the House bill creates a new federal program implemented and enforced consistently throughout the country by a new federal agency, the Health Choices Administration (HCA), in cooperation with the states. The Senate bill takes a bifurcated approach. …
            The House’s HCA would have primary responsibility for administering the regulatory and subsidy programs established under the bill. The House bill would establish a national insurance exchange, which would be responsible for negotiating and enforcing agreements with insurers. It would also create a national public insurance plan.

            [emphasis added]

            In response to another comment. See in context »
          • collapse expand

            “1. If you are unaware of any states that have such a law, it’s best not to allege it as you did initially as this does a disservice to the debate.”

            I did no such thing. I asked (genuinely) whether many states have an anti-rescission law — actually, I simply asked about whether rescission was “unlawful,” a reference not limited to specific laws about rescission, but could also refer to my speculations about general contract law.

            I am not “unaware of any states that have such a law” – indeed, I am familiar with the law in my state:

            Current Illinois law allows a health insurer to rescind an individual or family policy if a claim filed within two (2) years of the policy issuance would have resulted in either (1) denial of the application, (2) exclusion of a preexisting condition, or (3) charging more to the policyholder.
            • By pure volume, Illinois has more rescissions than any state in the United States and, per capita, is second only to New Mexico.
            • Current Illinois law allows a rescission in the absence of a medical nexus between the claim and the historical event (e.g. claim for heart attack leads to discovery of a knee problem). One teenager’s dependent coverage was rescinded due to failure to disclose that she had a “congenital deformity”: braces.

            In response to another comment. See in context »
  7. collapse expand

    I wonder where True/Slant’s resident conservative cheerleader is today? Is Bill holed up in a Doomsday Healthcare Bunker awaiting the end times, or what?

    For all the times he declared that this was a lost cause, I assumed he’d be man enough to post something today about how wrong he was. I’m sure he’s hard at work on a post about how evil this communist bill is though.

    Another conservative I’m curious about today: Is Rush Limbaugh on a plane to Costa Rica yet?

  8. collapse expand

    Regarding kids staying on their parents’ health insurance, does this apply to kids up until their 26th birthday or also through their 26th year?

  9. collapse expand

    I am a little confused as to the government high risk pool. You say that people will be able to enter it immediately, but what will that mean? I imagine that there must be an infrastructure set up. There will have to be some sort of accounting of the numbers of people that want to get into it, etc and some sort of determination as to premiums, correct? If so, how long will this take.

    • collapse expand

      Very good question – and I don’t have the answer. It should be fairly quick and we should know more on this in the coming days. I’ll come back to you when I know.

      In response to another comment. See in context »
    • collapse expand

      Craig- I think I have a better answer for you. From what I’ve been able to find out, the federal government is going to pump 5 billion into existing high risk programs on the state level. Most states have these programs however they are dramatically overstretched and most have long waiting lists to get in. Arguably, this will make it available to many more people. On the downside, there are some predictions that the money will run out fairly quickly, like sometime next year. It is reasonable to expect that the government will send more money as the purpose of this is to make sure that anyone with pre-existing conditions who has been uninsured for 6 months can get into these pools. They are intended to last until 2014 when the provision barring private insurance companies from excluding applicants with pre-existing conditions kicks in.

      In response to another comment. See in context »
      • collapse expand

        Wow, on so many different levels, wow. First of all, it doesnt seem like $5 billion would go to far, and I am sure more will come. But how about that for the federal government eating up all that power? They are actually sending it down to the states to administer. Obviously it is necessary since the states apparently have the system in place, but it is a stroke of political brilliance I was not expecting to hear.

        Do these state insurance pools typically operate on their own state by state in terms of payouts, or do they generally pay out on par with the Medicare or Medicaid pricing schedules? Do they generally charge premiums? If so, I would assume they are affordable given that you said they have long waiting lists.

        Thanks for all your hard work the last few days.

        In response to another comment. See in context »
        • collapse expand

          Actually, much of the legislation is going to be carried out by the states, most importantly the health care exchanges which will happen on the state level.
          As for the high risk pools, yes people pay premiums. The waiting list is not the result of it being a good deal – its the result of so many people not being able to get insurance any other way. The premiums may actually be expensive but at least it is obtainable insurance for those who can’t get it any other way.

          In response to another comment. See in context »
  10. collapse expand

    One thing I haven’t been able to get a straight answer to – where does this leave the insurance companies’ anti-trust exemption? To my mind, this is one of the biggest problems with the current system. You can’t expect these companies to compete when they can make more by colluding to keep margins high.

    • collapse expand

      No impact on the anti-trust issue. Because revoking the anti-trust exemption would be a pure matter of policy, and not related to budget- it would not qualify as being part of the reconciliation bill. Thus, if the Congress wants to do away with the exemption, it will have to be done in a separate piece of legislation.
      Note that while I am all for doing away with the exemption, the CBO has made it clear that doing so would have no measurable effect on the reform effort. I know this seems counter-intuitive as getting rid of the exemption should create a more competitive situation. The truth is that, despite what the GOP says, there is really not all that much room for competition in health insurance. This is because the pricing structure is driven more by the costs and the growing disparity in the balance within the insurance pools and less by price-fixing. Still, it couldn’t hurt to do away with the exemption.

      In response to another comment. See in context »
  11. collapse expand

    As an advocate for people with severe mental illness (the guy pictured with me in my profile is my twin brother Paul who was committed to a state mental hospital in 1977) this health care reform bill means almost nothing. Since Paul is no longer alive, I am speaking for him and for the hundreds of thousands of former state hospital patients who were forced into a community mental health system that does not work for them.

    My main focus is the repeal of the long standing, discriminatory, Medicaid law called the Institutes for Mental Diseases (IMD) Exclusion. This provision of the Medicaid law states that people in “Institutes for Mental Diseases” are not eligible for Medicaid subsidies and almost single handedly is responsible for the homelessness, incarceration and death that people like my brother Paul face today.

    The Senate version of the health care reform bill only offers a partial repeal of the IMD Exclusion and only for emergency hospitalization and stabilization. Paul never had a problem accessing emergency hospitalization and stabilization. Medicaid even paid for it. Therefore, this health care reform bill would not have helped him. People like my brother, who need long-term care, are still facing federally sanctioned discrimination.

    I have likened this to forcing a person’s grandmother, suffering from Alzheimer’s, to live independently and to manage their own treatment plan. While many people with severe mental illness can manage the community mental health system, people like my brother cannot. He was among many who also have anagnosnia, which is the lack of insight into one’s own illness. This is common among many, but not all, people with schizophrenia and bipolar disorder.

    My brother would vehemently state that he was not sick and at the same time talk about the 200 children that came out of where his teeth once were, or about the camera that was implanted in his head (among hundreds of other delusions that would rotate into his conversations). He was just as delusional, full medicated, the day he was released as the day he was committed, yet we were told by his case worker that Paul had to “learn to take care of himself”. Would you do that to your grandmother with Alzheimer’s? Of course not, but that is what Paul and hundreds of thousands of people like Paul, was forced, and failed, to do.

    Yes, the state hospitals were/are horrible places, but we shouldn’t just kick out the patients and ask them to fend for themselves, which is essentially what we have done.

    Like all illnesses, some people with severe mental illness do not recover. Like all people with a debilitating illness, some people with severe mental illness need long-term care, yet are being denied this care while people with illnesses in other organs of their body are not. This is the very definition of discrimination and the IMD Exclusion is the law through which the federal government allows this discrimination to continue.

    You ask what is in this bill for me today? Well, since I am speaking for my brother today, I say nothing.

    • collapse expand

      Flan-reading what you write here leaves me-and I would hope anyone who reads it – speechless. I have to admit that I am not as familiar with this area as I should be. I promise to become more familiar on the subject and to spend some time writing on it. I will also search to see if there is anything of benefit in the bill – even if down the road – that would benefit people who suffered as your brother did.

      In response to another comment. See in context »
      • collapse expand

        Thank you.

        Treatment Advocacy Center (www.treatmentadvocacycenter.org) is one of the best resources on the IMD Exclusion. I have been working closely with them.

        I have written three opinion pieces on this issue, which I had published on the OpEdNews.com site. If you google the titles, you’ll be able to link to them. They are:

        Would You Do This To Your Grandmother?
        The Earthquake Within Our Own Borders
        Mental Health Parity Law Allows Discrimination To Continue

        I am a relative nobody. Even if what I write moves people, which I am often told it does, I will take all the help I can get to educate people on this issue, so Thanks again!

        In response to another comment. See in context »
  12. collapse expand

    I have written this blog post in response to your article. Is there a way you can post it?

    http://mcclucker.blogspot.com/2010/03/what-is-not-in-health-care-reform-bill.html

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    About Me

    I am an attorney in Southern California, and a frequent writer, speaker and consultant on health care policy and politics. To that end, I am active member of the Association of Health Care Journalists. Based in beautiful Santa Monica, California, I'm very pleased to have the opportunity to be a contributing editor to True/Slant. I've recently finished a book designed to make the health care debate understandable to the average reader, and expect it to be out in the next five months or earlier. In my 'spare time', I continue to write for television and, occasionally, for comic books.

    My checkered past includes stints in creative writing and production for television where I did strange things like founding the long running show "Access Hollywood" and serving, for many years, as the president of the Marvel Character Group where I had the distinct pleasure of being one of Spider-man's bosses.

    See my profile »
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    Location:Santa Monica,CA

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