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Health Care Reform Q&A

HHS Secretary Kathleen Sebelius Answers Your Questions
  • My employer has obtained ‘grandfathered status’ on our existing health plan and therefore we will continue to have co-payments for preventive care. Would you describe the impact of the grandfathering rules for health plans? -- Jim
  • Answer:

    Well, Jim, that’s a great question. And the president was committed to making sure that people didn’t lose coverage that was good for them and their family. So that we kept in place -- the coverage that a lot of folks have with their work sites that actually is wonderful coverage and doctors that they like and programs that they like. So the grandfathering is meant to keep in place positive coverage.

    One of the things that happens on Sept. 23 for all plans is no one will be rescinded again, so companies will no longer be able to go back into a plan, find a technical error, and actually boot somebody out of a plan who is paying their premiums. Unless it’s fraud, you cannot lose your coverage. That’s very good news.

    All plans will include young adult children on a family plan so that, even in a grandfathered plan, that will come into effect. And that’s really helpful to keep kids up to age 26 on a family plan, particularly in this economy, when lots of young people may be going into the job market but those jobs don’t have health insurance connected with it.

    And there will also be change so that plans will no longer be able to have lifetime limits. What we know is that there are a small number of people who hit those limits, but if you hit the limit, you’re really out of luck. You lose your health coverage when you need it the most, when you’re very ill and need a treatment or need care.

    So those three benefits will apply to all plans. If an employer chooses to change your grandfathered plan to shift more cost onto the employee, to lower the benefits available to employees, he or she will lose the grandfather status. So we want to protect the plans that are in place. You can’t just keep the grandfather status and yet dump a lot of extra cost or reduce benefits for employees and not come into the new world. So, it’s kind of a balance.

  • Should someone cancel their existing policy and start a new one? Is that necessary to reap the new benefits? Also, how are these increased benefits affecting the rates? If I cancel my existing policy and start a new one, am I to expect to pay, say, two or three times as much for coverage? -- William
  • Answer:

    Well, both really good questions. And first of all, I want to make sure that all the listeners know about our new web site, which is healthcare.gov, which gives very specific information about plans available in the marketplace. After the first of October, we’ll have pricing information along with those plans. But for the first time ever, we’ve pulled together all the information by zip code, by age, by health status, of what’s available in both the public market and the private market. And that’s a really good tool to go to over and over again.

    I would say before you cancel anything and try to rebook, you need to know what your company is going to do with your plan. A lot of companies are picking up these additional benefits. You need to price the alternative. But the good news is, our actuaries have told us that the new benefits will likely only cost between 1% and 2% in terms of premium increases. And we’ve really called on insurance commissioners and others to take a careful look at high rates that are being charged by companies to make sure that they relate directly to health benefits that people are getting.

  • I just lost my job and my son has a pre-existing condition. How can I get coverage for him and how long will it be until it takes effect? -- Dan
  • Answer:

    Well, first of all, I’m really sorry about the job loss. We still have way too many people who are in that situation and, hopefully, there’ll be a new job soon. But a couple of steps: Again, I’d visit healthcare.gov right away. With a new income status, with a job loss, your child may well qualify for the Children’s Health Insurance Program in your state, which has coverage available regardless of health status. So, I would check that out and see what the state level is for income and if that’s possible. And healthcare.gov would give you that information about that public plan.

    In addition, plans after Sept. 23, will have to offer coverage to children in open enrollment periods without regard to health condition. So, for the first time ever in history, a lot of parents who have struggled with this issue with their kids, who either had companies refuse to sell coverage at all or not cover the specific treatment that their child might need. I can’t imagine as a mom anything more agonizing than having a sick child and not being to access the care that he or she needs. But the good news is there’s new coverage in the private market. On or after Sept. 23, plans will have to open up coverage for kids with pre-existing conditions, and, there may a public option with the Children’s Health Insurance Plan that may be available for your child. So healthcare.gov will give you information about both.

  • Is our son who is 24, but will be 25 in November, eligible to go back on our family health plan even though he is not currently in school? -- Judith
  • Answer:

    Absolutely, and that’s the great news. I’m a parent of two 20-somethings, both of whom left college on graduation and did not go into jobs that had health insurance. And we were lucky because our kids were healthy. We could find some coverage in the open market, but we didn’t have this great choice available. So every health plan, starting after Sept. 23, will have coverage available to young adults up to age 26 to stay on their family plan. The only exception is if your young adult child has coverage offered in his or her workplace, and then it’s assumed that they will have that coverage available. But absent that, this is an option for families to look at. It’s a very affordable option. Lots of those kids would age out of the plan or once they finish school, would have to leave the plan and that no longer will be the case. And it’s very good news for a lot of parents and certainly a lot of young adults that they can come back onto the family policy.

  • Which preventive care screenings and tests will be free after Sept. 23? Will they need a doctor's referral to be free, or can I just have them done? -- Lisbett
  • Answer:

    Well, you don’t need a doctor’s referral. Hopefully, you’ll go to the doctor to get the screening but you don’t need any special visit in advance of the screenings.  And the preventive care option will cover a wide variety of things. So for parents, children’s immunizations and vaccines will be covered, a whole variety of cancer screenings will be covered, mammograms and colon cancer. The U.S. Preventive Care Task Force, which is a group of medical providers who are in the public health service, actually look at preventive services that are the most effective and update their recommendations on a regular basis and they grade them A through D of what is effective for which age category and what kind of condition. And any screening that gets an A or a B will be automatically included in the kind of preventive care that’s offered without co-pays and without co-insurance. It’s very good news for people. You know, [WebMD's] Annic [Jobin], I was talking to a group the other day, and if you’re a 58-year-old woman with a chronic condition, you would be recommended to get a pap smear yearly even if you’re healthy, a mammogram yearly, you may have a screening or two for diabetes or for other conditions. You will be looking at potentially $300-$400 out of pocket and that, for a lot of people, is a pretty high financial burden, particularly now in this downturn. So, having preventive care available, we’re updating Medicare benefits so Medicare beneficiaries will be able to have preventive care and have an annual wellness test. We’re getting to illness at the outset, making sure that we can stop people from getting sick as opposed to paying for the care once they get sick makes good sense. And I think this is a great benefit that will be coming effective, again, on or after Sept. 23. And it’s really good news for lots of folks

  • Since the new provisions will extend coverage to many more Americans, some people worry that they will have to wait longer to see their primary care physician. According to the American Academy of Family Physicians, there is a current shortage of family doctors. Secretary Sebelius, could that become an issue? -- WebMD’s Annic Jobin
  • Answer:

    Well, I think it’s absolutely an issue, whether or not we had a new health care law pass or not, which is why the president made sure that it’s part of the initial Recovery Act bill. We looked out for the work force of the future, the health care work force, and there was additional money put in so we can double the number of doctors whose medical loans will be paid off if they actually come into family medicine and serve in an under-served area, which is why there will be more scholarship money for nurses and nurse practitioners, for mental health technicians. The Affordable Care Act, the health care reform law that was passed, increases that number. So we are really looking for ways to make sure that there are accessible docs. And back to our earlier question, if we are going to shift from a sickness system to a real health and wellness system, primary care docs will be more in demand, not waiting until you need a specialist in a hospital but, hopefully, getting to the illness in the first place, keeping people healthy.

    So we’re also changing the payment rate for primary care docs. Right now, specialists can make a lot more money and Medicare is updating the amount of money that will be paid to family practice docs, to gerontologists and to others who deal with people to keep them healthy in the first place

  • Increasingly, doctors will not take Medicare because they don't get reimbursed enough. That is putting my health at risk. What will you do about it? -- Kathryn
  • Answer:

    Well, I think it’s a great question from Kathryn and unfortunately, the payment issue with Medicare dates back to the early nineties to a formula that Congress put in place which is supposed to be updated on a yearly basis and Congress has fallen far behind. So they fix it a little step at a time. The president has called on Congress since he came into office to fix it permanently. Let’s make sure that Medicare is a good payer for docs. Let’s make sure docs, on into the future, understand that their services are essential to make sure that Medicare beneficiaries get access to great care. And we will continue to work on that.

    This isn’t an impact of the Affordable Care Act. This actually has been a decade that Congress has really failed to look at the overall payments for doctors with Medicare beneficiaries. But we’ve got 45 million people, including my 89-year-old father who is a Medicare beneficiary and really depends on those incredibly important services. And having physicians who provide that excellent care is a part of the partnership and we’re going to make sure that happens into the future.

    (If we didn’t get to your question today, here are a few more ways to find some answers. You can go to healthcare.gov to read about the latest changes. You can also continue to share your questions right here on WebMD -- on our new blog, Health Insurance Navigator, where insurance experts will answer questions and share some tips.)

WebMD Ask the Specialist Transcript

Reviewed by Kathleen Sebelius on September 17, 2010
The opinions expressed in this section are of the Specialist and the Specialist alone. They do not reflect the opinions of WebMD and they have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance or objectivity. WebMD is not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your doctor or other qualified health provider because of something you have read on WebMD. WebMD does not endorse any specific product, service or treatment. If you think you have a medical emergency, call your doctor or dial 911 immediately.