Immediate benefits of reform

[Startraveler]

Nothing is done yet but it looks like the House will pass the Senate's health care bill (the star of Better Know a Health Care Bill, Part II) tonight. Which means we've got some changes in the law coming this week. Since someone in another thread mentioned having trouble getting insurance coverage due to a pre-existing condition, I thought this information might be useful for some people here. It's well-known that some of the big items in this legislation don't take effect until 2014 when the new health insurance exchanges start operating. But let's recall the provisions in the bill that take effect right away (i.e. this year):

Access to Affordable Coverage for the Uninsured with Pre-existing Conditions

• The Patient Protection and Affordable Care Act will provide $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions. This provision is effective 90 days after enactment, and coverage under this program will continue until new Exchanges are operational in 2014.

Access to Quality Care for Vulnerable Populations

• The Patient Protection and Affordable Care Act makes an immediate and substantial investment in Community Health Centers to provide the funding needed to expand access to health care in communities where it is needed most. This $10 billion investment begins in 2010 and extends for five years.

No Pre-existing Coverage Exclusions for Children

• The Patient Protection and Affordable Care Act eliminates pre-existing condition exclusions for all Americans beginning in 2014, when the Exchanges are operational. Recognizing the special vulnerability of children, the Patient Protection and Affordable Care Act prohibits health insurers from excluding coverage of pre-existing conditions for children, effective six months after enactment and applying to all new plans.

Re-insurance for Retiree Health Benefit Plans

• The Patient Protection and Affordable Care Act will create immediate access to re-insurance for employer health plans providing coverage for early retirees, effective 90 days after enactment. This re-insurance will help protect coverage while reducing premiums for employers and retirees.
  Closing the Coverage Gap in the Medicare (Part D) Drug Benefit
  
• The Patient Protection and Affordable Care Act will reduce the size of the “donut hole,” raising the ceiling on the initial coverage period by $500 in 2010.
  
• The Patient Protection and Affordable Care Act will also guarantee 50 percent price discounts on brand-name drugs and biologics purchased by low and middle-income beneficiaries in the coverage gap, beginning July 1, 2010.

Small Business Tax Credits

• The Patient Protection and Affordable Care Act will offer tax credits to small businesses beginning in 2010 to make employee coverage more affordable.
  
• Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage; later, when Exchanges are operational, tax credits will be up to 50 percent of premiums. The full credit will be available to firms with 10 or fewer employees with average annual wages of $25,000, while firms with up to 25 or fewer employees and average annual wages of up to $50,000 will also be eligible for the credit.

Ensuring Value for Premium Payments

• The Patient Protection and Affordable Care Act will establish standards for insurance overhead and require public disclosure to ensure that enrollees get value for their premium dollars, requiring plans in the individual and small group market to spend 80 percent of premium dollars on clinical services and quality activities, and 85 percent for plans in the large group market. Health insurance plans that do not meet these thresholds will provide rebates to their policyholders. This provision takes effect in 2011 and applies to all plans, including grandfathered plans, with the exception of self-insured plans.

Patient Protections

• The Patient Protection and Affordable Care Act protects patients’ choice of doctors by allowing plan members to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care. This provision takes effect six months after enactment and applies to all new plans.

Extension of Dependent Coverage for Young Adults

• The Patient Protection and Affordable Care Act will require insurers to permit children to stay on family policies until age 26. This provision takes effect six months after enactment and applies to all new plans.

Free Prevention Benefits

• The Patient Protection and Affordable Care Act will require coverage of prevention and wellness benefits and exempt these benefits from deductibles and other cost-sharing requirements in public and private insurance coverage. This provision takes effect six months after enactment and applies to all new plans.
  
• Beginning on January 1, 2011, Medicare beneficiaries will receive a free, annual wellness visit and will have all cost-sharing waived for prevention services.

No Lifetime Limits on Coverage

• The Patient Protection and Affordable Care Act will prohibit insurers from imposing lifetime limits on benefits. This provision takes effect six months after enactment and applies to all new plans.

Restricted Annual Limits on Coverage

• The Patient Protection and Affordable Care Act will tightly restrict insurance companies’ use of annual limits to ensure access to needed care, effective six months after enactment for all new health plans. These tight restrictions will be defined by the Secretary of Health and Human Services. When the Exchanges are operational, the use of annual limits will be banned.

Protection from Rescissions of Existing Coverage

• The Patient Protection and Affordable Care Act will stop insurers from rescinding insurance when claims are filed, except in cases of fraud or intentional misrepresentation of material fact. This provision takes effect six months after enactment and applies to all new plans.

Prohibits Discrimination Based on Salary

• The Patient Protection and Affordable Care Act will prohibit group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. This provision takes effect six months after enactment and applies to group health plans.

Public Access to Comparable Information on Insurance Options

• The Patient Protection and Affordable Care Act will enable creation of a new website to provide information on and facilitate informed consumer choice of insurance options.

Health Insurance Consumer Information

• The Patient Protection and Affordable Care Act will provide assistance to States in establishing offices of health insurance consumer assistance or health insurance ombudsman programs to assist individuals with the filing of complaints and appeals, enrollment in a health plan, and, eventually, to assist consumers with resolving problems with tax credit eligibility. This provision is effective beginning with fiscal year 2010.

Appeals Process

• Under the Patient Protection and Affordable Care Act, all new health plans will implement, within six months of enactment, an effective process for appeals of coverage determinations and claims. And, states will provide an external appeals process to ensure an independent review.

If you want a chart of all the new insurance rules (including those that don't kick in until 2014), try this one.

[+DieChecker]

I'm hoping that the Insurance companies don't do like the Credit Card Companies did and scalp everyone before their rates and prices get under control. Probably we will see a lot of greed making prices skyrocket this year. Hopefully in a couple years things will start to lower in price.

I wonder how many new jobs this legislation will create and I pray that those people are competant.

[Amberlight]

It's about time, anything is better than what we have now.

[Startraveler]

I was going to post a new thread, but I decided to just throw this handy timeline I just stumbled over in this one. Goes beyond the first year and shows what happens when:

[preacherman76]

All hail to our insurance company government.

[Cradle of Fish]

All hail to our insurance company government.

You can't argue with the facts so you throw in an off-hand remark. You Libs are so classy.

[preacherman76]

You can't argue with the facts so you throw in an off-hand remark. You Libs are so classy.

Facts? LOL Here is a fact for ya, Americans should NEVER be forced to buy a product from a private for profit company. Or from any company profit or not. You know, the folks who actualy wrote this bill. The remark isnt off hand at all.

[Startraveler]

If that's your issue, I advise you to buy insurance from one of the non-profit insurers established under this law. Or write your Congressman asking that a public option be added to the law.

Edited May 6, 2010 by Startraveler

[Cradle of Fish]

Facts? LOL Here is a fact for ya, Americans should NEVER be forced to buy a product from a private for profit company. Or from any company profit or not. You know, the folks who actualy wrote this bill. The remark isnt off hand at all.

If the democrats put forth a bill making it mandatory to breathe air you people would suffocate in defiance.

[preacherman76]

If the democrats put forth a bill making it mandatory to breathe air you people would suffocate in defiance.

God knows they want to tax me to breath air. BTW Im just as against republicans as democrates. I dont believe we have a democrat problem. We have a government problem.

[preacherman76]

If that's your issue, I advise you to buy insurance from one of the non-profit insurers established under this law. Or write your Congressman asking that a public option be added to the law.

I already have insurance, by choice.

I dont feel any of those options are a solution. A person should have the right to opt out, and to be left alone regarding that decision.

[FurthurBB]

I already have insurance, by choice.

I dont feel any of those options are a solution. A person should have the right to opt out, and to be left alone regarding that decision.

I have insurance too, more than one policy and they continue to lessen benefits and raise prices. If you look at the history of medical insurance you would see that it drives the increases in health care costs and something needs to be done about it. Maybe this is not the best thing, but, at least it is a step in the right direction.

[acidhead]

God knows they want to tax me to breath air. BTW Im just as against republicans as democrates. I dont believe we have a democrat problem. We have a government problem.

Yes.... you live in america - a representative democracy

Only one major problem.....

-the bureaucrats do not represent the voter they represent their campaign donors.

And when they only represent their campaign donors they follow the advice of CEO's who are selfish and seek only the almighty dollar.

And seeking this almighty dollar they hedge against the voter and destroy the system that should be protected - not disabled.

Goldman Sachs is responsible.

They were given the free ticket to gamble away your nation through foreigners who want to destroy america's way of life.

Forget Al Qaeda or the taliban or muslims..... your country is under attack by the casinos who work for the IMF.

They do not wear burkas or plant road side bombs or board airliners with explosives.

-they have gambled away your coffers and than hold the entire nation hostage.

This is the part where people need to realize that they do not care about 'freedom and prosperity' for all.....they only care about control.

They think their god.

This healthcare bill is just that - "Let then eat cake" while they sip Crystal from champayne glasses.

Its a joke.

The illegals are just that ILLEGALS - and they are being used as pawns against the true american people who have everything to lose - not gain.

[preacherman76]

I have insurance too, more than one policy and they continue to lessen benefits and raise prices. If you look at the history of medical insurance you would see that it drives the increases in health care costs and something needs to be done about it. Maybe this is not the best thing, but, at least it is a step in the right direction.

Oh Im not saying there isnt a problem. There most certainly is. This is not only not the best thing, it does nothing to control cost to folks like you and me who have been able to afford it thus far.

[preacherman76]

Yes.... you live in america - a representative democracy

Only one major problem.....

-the bureaucrats do not represent the voter they represent their campaign donors.

And when they only represent their campaign donors they follow the advice of CEO's who are selfish and seek only the almighty dollar.

And seeking this almighty dollar they hedge against the voter and destroy the system that should be protected - not disabled.

Goldman Sachs is responsible.

They were given the free ticket to gamble away your nation through foreigners who want to destroy america's way of life.

Forget Al Qaeda or the taliban or muslims..... your country is under attack by the casinos who work for the IMF.

They do not wear burkas or plant road side bombs or board airliners with explosives.

-they have gambled away your coffers and than hold the entire nation hostage.

This is the part where people need to realize that they do not care about 'freedom and prosperity' for all.....they only care about control.

They think their god.

This healthcare bill is just that - "Let then eat cake" while they sip Crystal from champayne glasses.

Its a joke.

The illegals are just that ILLEGALS - and they are being used as pawns against the true american people who have everything to lose - not gain.

Your preachin to the preacher Acid

[acidhead]

Your preachin to the preacher Acid

-we're all brothers

[IronGhost]

Yes.... you live in america - a representative democracy

Only one major problem.....

-the bureaucrats do not represent the voter they represent their campaign donors.

And when they only represent their campaign donors they follow the advice of CEO's who are selfish and seek only the almighty dollar.

And seeking this almighty dollar they hedge against the voter and destroy the system that should be protected - not disabled.

Goldman Sachs is responsible.

They were given the free ticket to gamble away your nation through foreigners who want to destroy america's way of life.

Forget Al Qaeda or the taliban or muslims..... your country is under attack by the casinos who work for the IMF.

They do not wear burkas or plant road side bombs or board airliners with explosives.

-they have gambled away your coffers and than hold the entire nation hostage.

This is the part where people need to realize that they do not care about 'freedom and prosperity' for all.....they only care about control.

They think their god.

This healthcare bill is just that - "Let then eat cake" while they sip Crystal from champayne glasses.

Its a joke.

The illegals are just that ILLEGALS - and they are being used as pawns against the true american people who have everything to lose - not gain.

Acidhead, have you ever read "Player Piano" by Kurt Vonnegut? Anyway, in that book he describes a society controlled by powerful corporations who rule everyone's lives.

In this case, the GE types and the IBM types et.al., have created a kind of technocratic oppressive society, rather than the brutal financial institutional domination you always talk about ... but in the book some people revolt againts the system -- but once the have kicked over the ant hill, the start going right back to the behaviors that created the oppressive society in the first place.

I agree with you about Goldman Sachs, etc., but the thing is, if it was ever possible to topple or de-fang the global massive elites, the banks, the IMF, the mega-internationals and all the rest, but my questions to you are:

1. What would happen then?

2. Could we have some kind of utopia with the common man in control of every aspect of his own destiny?

3. Or would the system automatically start reverting back to rebuilding the same old ant hill?

Or maybe you think, historically, we have to have a revolution and kick over the ant hills every generation or so?

I mean, where are you coming from, man?

[Startraveler]

Oh Im not saying there isnt a problem. There most certainly is. This is not only not the best thing, it does nothing to control cost to folks like you and me who have been able to afford it thus far.

I rarely hear this sort of comment coupled with any degree of specificity. What cost control that's not in this law do you wish was in this law?

Edited May 6, 2010 by Startraveler

[Cradle of Fish]

God knows they want to tax me to breath air. BTW Im just as against republicans as democrates. I dont believe we have a democrat problem. We have a government problem.

I don't remember you beating the anti-government drum back in 2008. Of course there were like-minded religious crackpots in power back then.