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Health Care Reform:

Health Insurance & Affordable Care Act

Latest Round of Health Reform Benefits Kicks In

Backlash Also Notches Up, With Some Insurers Deciding to Drop Child-Only Policies

WebMD Health News

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.

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