Health Care Reform Implementation
Under Way on Many Fronts

July 9, 2010

1.	Bucks Voices Web Site Reorganized
2.	Patients' Bill of Rights Released
3.	The Implementation Process Going Well So Far
4.	Government Health Care Web Site Went Live on July 1
5.	Temporary Coverage for the Currently Uninsured
6.	Appealing Claims Denied by Insurance Companies

1. Bucks Voices Web Site Reorganized In case you missed the announcement last week, the Bucks Voices web site has been reorganized to provide a lot of helpful information on the implementation of the new reform bill. In addition to downloadable summaries on various topics, like changes to Medicare, temporary state coverage pools for the currently uninsured, and insurance reforms, the site has copies of or links to many articles and studies on the new law's impact on the health care delivery system, funding provisions, requirements for states and for employers, and the health reform implementation process that is now underway.

Check out the site at www.buckshealthcare.org

Implementation of the new health care law is under way on many fronts. Here are brief summaries of and links to some of the more important news about the implementation effort and problems with the current system.

2. Patients' Bill of Rights Released One of the critical elements in reform is forcing insurance companies to phase out their most onerous rules that hurt individuals trying to get, keep or use their insurance benefits. While some major benefits don't occur until 2014, many of these new law's restrictions on carriers apply as of the start of any new policy year on or after September 23 (six months after passage of the bill). The Associated Press indicates the major changes effective this September:

"In addition to guaranteed coverage for children, the safeguards include:

A ban on lifetime coverage limits. More than 100 million people are enrolled in plans that currently impose such limits, the White House said.
Phasing out annual coverage limits. Starting this year, plans can set annual limits no lower than $750,000. Such limits rise to $2 million in 2012, and will be completely prohibited in 2014.
Forbidding insurers from canceling the policies of people who get sick. Unintentional mistakes on application forms cannot be used to revoke a policy.
Guaranteed choice of primary care doctors and pediatricians from a plan's network. No referral needed for women to see an ob-gyn specialist. No prior approval needed to seek emergency care out-of-network."

But these changes do not apply to "grandfathered" plans (plans already in existence prior to March 23, 2010), unless those plans have a defined material change, such as in reduced coverage levels, scope of benefits, or significantly higher employee contributions.

Read more, click here.

An article on the Kaiser Health News web site provides additional information and an estimate of how many people will be helped by the changes and their potential impact on health coverage premiums, which is claimed to be very modest. Read more, click here.

3. The Implementation Process Going Well So Far Such an ambitious project as this one is bound to have some glitches and missed deadlines, but so far, so good. As a recent New York Times article notes:

"President Obama gets high marks, even from some Republicans, for the way he has begun carrying out the new health care law in the 100 days since it was signed. And a new poll suggests a small increase in favorable views of the measure since May. ...

The administration has issued a blizzard of regulations, including a patient's bill of rights, and has persuaded insurance companies to make some changes sooner than required by the law. It has also assembled a team of insurance experts to help carry out the law, under close supervision from the White House. ...

On Thursday, the administration unveiled a web site, HealthCare.gov, where consumers can obtain information about public and private health insurance options in their states. The administration and many states are also setting up high-risk insurance pools for people who have been denied coverage because of pre-existing conditions.

In the last three months, administration officials have issued rules allowing young adults to stay on their parents' policies and forbidding insurers to deny coverage to children with pre-existing conditions. They have notified nearly four million small businesses of a new tax credit to help defray the cost of insurance.

On Tuesday, they began accepting applications for a separate program that will reimburse employers for some of the cost of providing health benefits to early retirees. And the government has begun sending $250 checks to Medicare beneficiaries with high drug costs." ...

Insurers, who fought the legislation, now say they hope it will succeed. "We are working to get new products on the market by Sept. 23," said Alissa Fox, a senior vice president of the Blue Cross and Blue Shield Association. "After that date, we can't sell new policies to individuals or small groups unless they comply with the new standards."

Read more, click here.

5. Temporary Coverage for the Currently Uninsured For some of the uninsured who cannot get coverage because they have pre-existing health conditions, the health reform act sets up a new "Pre-Existing Condition Insurance Plan" using the high risk pools in some states and a federal pool for states declining to set these up. From AP:

"But here's the catch: Premiums will be a stretch for many, even after government subsidies to bring rates close to what healthier groups of people are charged. And $5 billion that Congress allocated to the program through 2013 could run out well before that.

The Pre-Existing Condition Insurance Plan will begin accepting applications in many states on Thursday, with coverage available as early as Aug. 1, an administration official said Tuesday. Consumers can check availability in their states on a new website, healthcare.gov, starting Thursday. The goal is for all states to be enrolling people by the end of the summer. ...

'I would enroll as soon as you can,' said Stephen Finan, policy director for the American Cancer Society Cancer Action Network. ‘These rates are going to be as affordable as consumers can get these days, particularly for a high-risk individual.' ...

To qualify for the temporary program, a person must have a pre-existing medical condition and must have been uninsured for six months or longer. The main beneficiaries are likely to be the self-employed and their families, and those who work for small employers that don't provide coverage. Only U.S. citizens and legal residents qualify."

Read more at MSN, New York Times or at www.healthcare.gov.

6. Appealing Claims Denied by Insurance Companies According to a June 21 New York Times article:

"Starting this fall, patients in all health plans can contest claim denials in an independent state-level review procedure - a recourse that has not generally been available to employees of companies that pay their employees' health claims directly.

Since more than half of all covered workers are in a "self-funded" plan, the change is significant. "This fixes a long-standing problem," said Sara Rosenbaum, head of the department of health policy at the George Washington University School of Public Health and Health Services. The provision does not apply, however, to "grandfathered" plans - those in existence on March 23, when the health law was enacted. ...

Most states offer an independent review of denials; the new law will extend that option to every state, as well as to the self-funded plans.

But even though these external reviewers rule in favor of consumers about half the time, few people take advantage of them."