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Linda Bergthold

Linda Bergthold

Posted: March 13, 2010 02:34 PM

Is Health Reform Exhaustion a Pre-Existing Condition?

What's Your Reaction:

Is health reform exhaustion a pre-existing condition? And if so, will exhaustion be banned after health reform is passed? We can only hope. However, now that it is nearly certain that health care reform will pass, it's time to figure out what it will mean for all of us.

No, not the hype about a government takeover or the road to socialism or this is better than sliced bread. What's really in the legislation for you and when will you get it?

After the passage of the legislation, a few things will happen in the first year:

  1. Insurers can no longer put lifetime limits on your coverage. If you've never been seriously ill, this won't mean much to you, but in the case you get hit by a bus, it's surprising how quickly a million dollar lifetime limit can mount up. Now you would be covered no matter how seriously ill you get.
  2. If you are uninsured, you "may" be able to get help within 90 days from one of the state-based "high risk pools". These pools will get federal assistance to offer insurance to people with serious illnesses who have not previously been able to get insurance - I note "may" because some of these pools have long waiting lists already.
  3. Another provision for the uninsured relates to an expansion of Medicaid to adults at or below 133 percent of poverty, a provision that should kick in this year.

  4. If you have been a dependent on your parents' plan, you can stay on that plan until you turn 26 (rules vary by state but many plans only cover young adults until 23 or 24);
  5. Within six months of passage, your children cannot be denied insurance because of pre-existing conditions, and by 2014, no one can be denied because of pre-existing conditions;
  6. The so-called "donut hole" in Medicare prescription drug coverage will be eliminated - at first, reduced by500 and then ultimately closed. (If you're on Medicare you know all about this complicated provision ...)
  7. Insurers will have to spend a minimum of 80 to 85% of your monthly premium on actual medical services (not advertising, marketing, administrative costs). Why is that important? Because if you have tried to buy insurance as an individual, you may have noticed that, if you can get it, it costs a lot and the deductibles are often huge. Forcing insurers to pay out more for medical services (it's called the "medical loss ratio") is predicted to lower premiums nearly immediately.
  8. Small businesses with fewer than 25 employees would get tax credits to encourage them to purchase insurance for their employees - it might help you if you work in one of those places.
  9. Community health centers will get an immediate infusion of money from the government to help take care of people who need care but cannot afford it. Here's where you can find one near you.

What will not happen as a result of health reform, is the collapse of the health care system as we know it, despite Limbaugh's predictions. As with all major legislation, it takes awhile for change to kick in. After the first year, it will take a few years to phase in the remainder of the reform - the health insurance exchanges, the rest of the insurance reforms, changes to Medicaid (expansion of the program to include all poor adults not just women and children). There will be little if any noticeable change in Medicare - the changes that will occur will happen on the provider side, where managed care plans that serve the elderly will have to compete for business and doctors and hospitals will have to work together to figure out how to divide up Medicare payments.

Some of the more controversial elements of reform like the requirement that everyone have insurance, new taxes on Medicare for the wealthy, or taxes on companies that make medical devices, will also be phased in. It will be at least 2014 before everything is in place. It is impossible to predict how the slow pace of reform will affect opinions about health reform. Will people get frustrated if change doesn't happen quickly enough? Will opposition die down if change doesn't alter the positive elements of the health care system? Can hysterical threats of disaster maintain their intensity when there's not much disaster to identify? At the very least, we can get back to the business of trying to stay healthy without constantly hearing about health reform every day. And those of us who work in health care can get back to the business of improving the quality of health care in America.


 
 
 
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HUFFPOST BLOGGER
Linda Bergthold
Health policy consultant
09:25 PM on 03/17/2010
BREAKING NEWS:
Rep. Dennis Kucinich will vote YES on health reform. http://www.politico.com/arena/

I mention this only because so many commenters have condemned this reform based on Kucinich's objections. But I think he understands what so many of us believe, that you start where you can and you build on it. If the bill is too weak for you, then there is an opportunity to strengthen it. If you feel the bill is a government takeover, god bless you, but Kucinich's position will mean nothing.
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DuncanONeil
10:19 AM on 03/23/2010
If the foundation sucks no amount of fixing the house is worth a dam.
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HUFFPOST SUPER USER
MARYHOBE
At last! Finally!
04:04 PM on 03/17/2010
For all the disappointed moderates out there; Let us look at this legislation as a first step. Quite frankly I cannot fault the Democrats for the bill's shortcomings because the American voter was not going to go further out on the limb with this one. In any event the coming years will bring a lot more clarity to the political landscape and I strongly believe that when the voters see that the sky didn't fall on our heads it will be Chicken Little who will have the short end...
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DuncanONeil
10:21 AM on 03/23/2010
You seem to not understand that between this bill passage and action is production of "regulations". These will be done by the lead Presidential appointee with no input for the regulated. The language in the bill will pale in comparison.
This is where the hoops will be built!
10:20 AM on 03/17/2010
Actually Linda the CBO estimate is explained very well by Dr Marica Angell in her interview with Bill Moyer that another commentator had already posted, I am reposting it below. These bills are terrible and will affect female reproductive services in the long run. In addition they are discriminatory allowing up to 300% more to be charged for 'older' Americans in the Senate version. There are no caps on premiums in either bill. And as Dr Angell explains premiums will rise, they have already risen, they will continue to rise and costs will escalate out of control. What good is it if people are forced to buy crappy insurance. Insurance is NOT health care.

http://www.pbs.org/moyers/journal/03052010/watch3.html
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DuncanONeil
10:24 AM on 03/23/2010
Consider what happened to your credit cards when Congress tried to help the consumer regain some measure of control!
It is the law of unintended consequences.
We need to regain control and begin to prevent passage of "good intentions". Good intentions are not enough!
08:29 AM on 03/17/2010
ChelseaC,

thanks for the link, and I agree wholeheartedly with you both bills are worthless and will do little to reform this bloated and very corporate system of health care. All window dressing by the democrats. Give us real reform not more corporate welfare.
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DuncanONeil
10:27 AM on 03/23/2010
Do not forget! This has not really been about "health care", but
"health insurance". The providers of insurance have been deemed to be unworthy of having anyone's business because a few do not want their product or have some difficulty with the company.
So either the plan is to eliminate the industry, which has been stated, or help the few at the cost of the many.
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HUFFPOST SUPER USER
gevan
the pilgrim has landed
11:59 PM on 03/16/2010
In 2014 I will turn 65 (if I survive that long) so I guess I might get five months of use out of all this.
02:44 PM on 03/16/2010
Thanks Linda....now let's get it passed!
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DuncanONeil
10:28 AM on 03/23/2010
Fool!
06:29 AM on 03/16/2010
Lie: The American Public does not want Obama-Care.
Truth: The American Public does not want The Myth that has been passed around as Obama-Care. The Media has Spread Lies because their only objectives are to sell papers, get higher ratings and protect their corporate owners.
Conclusion: The Democrats must never assume that Republican Propaganda is too outrageous to be believed. The Democrats Must Tell the American Public what is actually in Health Care Insurance Reform and then Americans will like the bill.

Lie: Obama should have concentrated on Jobs instead of Health Care.
Truth: The Stimulus bill was a Jobs Bill.
Conclusion: The Democrats should have called the Stimulus Bill, "The Jobs Bill". The Democrats Must Spread the word that President Obama did concentrate on Jobs First.

Lie: The Democrats are trying to take over Health Care and 1/6th of the American economy.
Truth: The Democrats want to reign in the Insurance Industry which is now in control of Health Care.
Conclusion: The Health Care Reform effort should have been called "Health Car Insurance Reform". Democrats Must Tell Americans that Reforming Insurance does not mean government controlling 1/6th of the American economy.

Karl Rove said that Democrats would have to think that Americans are Stupid to believe that they would fall for Lies, but the American Public does not have to be Stupid to be mislead by a Republican Party and a Media both intent with passing around false information.

FreddieVee
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Bertalein
Human Being
02:33 PM on 03/16/2010
You are correct FreddieVee, Americans do not want Obama care. They do however want a not for profit health care system. Wake up and smell the coffee. Your tired right wing chibberish just does not work any longer. Move on.org.
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DuncanONeil
10:43 AM on 03/23/2010
The profit in the industry is miniscule!
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HUFFPOST SUPER USER
Bertalein
Human Being
02:43 PM on 03/16/2010
Lie FreddieVee, it will not be "Obama care." I
t will be "not for profit" healthcare. Your right wing slogans are becoming increasingly boring and tiring.
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DuncanONeil
10:44 AM on 03/23/2010
The Government is not permitted to operate for a profit!
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04:47 AM on 03/16/2010
The bill is for the most part a pile of corporatized dung.

Dr.Macia Angell of Hrvard University speakes frankly about so-called health care "reform" with Bill Moyers:
http://www.pbs.org/moyers/journal/03052010/watch3.html
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05:05 AM on 03/16/2010
excuse my spelling, tis' late.....
Good night.
11:16 PM on 03/15/2010
One trillion dollars of additional debt our grandchildren will be forced to pay off in return for - precious little. No real reform. And what little the bill does promise is 4 to 6 years out. What a pathetic excuse for health care reform.
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TyneCrescent
A Word To The Wise Is Sufficient
09:52 PM on 03/15/2010
Ms. Bergthold, I've followed this and your other articles, along with other sources, about healthcare. I commend you for how you breakdown the points of the proposed legislation, and the factual comments you respond with when posters pose questions. It is very informative for me as someone who's paying close attention to all the back and forth between politicians, but not a healthcare policy expert. Thank you for the very good job you do.
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HUFFPOST BLOGGER
Linda Bergthold
Health policy consultant
10:27 PM on 03/15/2010
That's really a nice comment to receive, given what many people say about what I write! Thank you!!
01:00 AM on 03/16/2010
Ms. Bergthold why are you lying to your readers? Nothing you say about Obama Care is really true in fact. It is only true in concept. Concept rarely ever materializes in concrete fact. The fact of the matter is... if Obama Care is passed in it's current form, your socialist leaning health care system will descend into financial chaos and it will not take long to realize this fact. Consequently, all the supposed benefits the left is advocating will become the health care nightmare that is just over the horizon for the American people.
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04:54 AM on 03/16/2010
This isn't socialist for the people--but for Obama's coffers--the health insurance cartel. Their about to get their scummy hads on billions of tax payer dollars.
THIS IS CORPORATE WELFARE--not people welfare.
Ms.Bergthold must not know what it's like to be sick and be at the tender mercy of and insurance cartel that ruins your life and leaves you bankrupt.
Obamabots don't care as long as "Dems win" .
If they wanted real reform--they would not stand in the way of states rights of single payer. ERISA--gone.
This bill nor story is not worth sh*t.
05:15 PM on 03/15/2010
I was please to see this breakdown of just how and how soon health insurance reform will come to pass. I'm so SICK of hearing people talk about a government TAKE OVER, often voiced by people receiving Medicare, Medicaid, Disability, WIC and/or other benefits. They know not what they do!

The one issue I have now and the past and forever is the unwillingness of anyone in the know to tackle costs. Yes, cost. Why should a doctor charge $350 for an office visit, no counting charges for any procedure he/she might actually perform during the office visit. Why is an MRI or other scan, that's be paid for over and over again, $1,000 or more. Why is saline solution over $100 a bag?

Don't hand me the crappola about covering the uninsured. If that were true WHY are so many uninsured unable to access healthcare and if they do face medical bankruptcy. Why are hospital so quick to sue patients who had no say in how their bills were run up.

Medical care is the ONLY commodity whhere we the consumer have no negotiating rights. It should be illegal.
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HUFFPOST BLOGGER
Linda Bergthold
Health policy consultant
05:28 PM on 03/15/2010
Actually, quite a lot of people in the know have concluded that this legislation will moderate costs. The CBO, for one, and also over 20 economists signed a letter to the President stating that the changes in the way Medicare pays providers (pertinent to your comments) are important cost containment provisions. As for whether or not consumers have negotiating rights -- they do. I often help friends and family negotiate medical bills. It's surprising how much you can accomplish by asking the kinds of questions you are asking. Do not despair!
05:39 PM on 03/15/2010
Please, let's hear more on negotiating medical bills. Would that be dealing directly with your health care provider?
10:46 PM on 03/15/2010
"Actually, quite a lot of people in the know have concluded that this legislation will moderate costs."

How can anyone say with certainty how much something is going to cost one, five or even ten years down the road? The CBO scoring has to take Congress at its word for some things; what if all those savings in costs attributed to eliminating "fraud, waste and abuse" are never realized? By then it's too late. What's the time gap between when taxes are increased to fund health care reform and when it actually starts?

"I often help friends and family negotiate medical bills. It's surprising how much you can accomplish by asking the kinds of questions you are asking."

The problem is that with a third-party payer most people never know what anything costs. If you take things that are not typically covered by health care plans (like LASIK), their prices have actually come down over time. Not so with things that are "covered". And why do the Democrats and Republicans still insist that the main way for people to buy health insurance is through an employer? If individuals are given the same or better tax incentives that businesses get then we could get them out of the loop. But no one wants to do that...
06:46 PM on 03/15/2010
The Japanese were tired of paying $1000-$1200 for an MRI. So several MRI macine makers re-developed their machines so that the taking of MRI's cost only $75 to $150 each. These machine manufacturers, Sony and Mitsubishi are already selling their much less expensive machines overseas. Our country could save tens of billions, if not more each year, by doing what countries who offer their citizens universal health care for so much less money do. We could save tens of billions per year through real competition, and regulating costs. As long as the insurance companies are getting paid and charging whatever they want there is little incentive for them to switch machines and devices to save the consumer money. Maybe with the passage of this health care reform law they will have to, and finally will cut costs, so they don't see a diminishing of their profits. Either way the consumer and the American government wins.
Pass this bill, and then lets pass a public option or medicare buy in for those under 65 years of age.
Also next year, cancel the deal with big pharma, and start negotiating drug prices, or importing drugs from Canada.
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DuncanONeil
10:56 AM on 03/23/2010
Do you not understand with universal health care there is no competition!!
04:59 PM on 03/15/2010
Since the government-run health care bill does not provide more doctors, nurses, and equipment to cover 20 million more people, you will get less or nothing. If you have health care coverage, your doctor will be busy caring for 20 million more people and your wait time to see him/her will increase and the availability of equipment for treatment will decrease. If you don't have health care, what you will get will not qualify as health care in this country and you will get nothing. Everyone will pay $2.5 trillion for the less or no health care that they are going to get and you will also have less money. http://bit.ly/97wkwD
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DuncanONeil
11:03 AM on 03/23/2010
That number should be $3.7 trillion vice $2.5 trillion. We pay about that now and are adding $1.2 trillion.
Consider 85% are happy with their insurance Some 280 million, spending about $2.5 trillion, or around $8,900 each. we are going to take that to some 95%. 313 million at a cost of $3.7 trillion. Cost now $11,800 each!
Does this look like a cost reduction to you??
04:43 PM on 03/15/2010
There are two groups that will be glad to see HCR go away:

1. employers -- They don't want the employment/benefits contract broken which keeps workers indentured and excuses employers from raising REAL wages.
.They won't give up their PROFITEERING off health care delivery.
Here's the stock chart of Wellpoint, the profiteering parent of Anthem/Blue Cross that wants to raise INDIVIDUAL subscriber rates 39% this year after already raising them 18% last year.
http://finance.yahoo.com/q/bc?s=WLP&t=my&l=on&z=m&q=l&c=

For the corporate, for-profit system served by our government, this 'reform' is a billion dollar give-away to the medical cartel (for-profit doctors and hospitals, Big Pharma, insurance, nursing homes and medical supply/device companies.)
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429freckles
Ex Republican Now Devoted Democrat
03:49 PM on 03/15/2010
It's time to get it done. The sooner the better. I see nothing wrong with the phasing in of reforms. Every American deserves to have access to AFFORDABLE health care. It's ridiculous that being uninsured I have to pay 20 times what my brother does to see a doctor. I support reform. I am anxious for it to happen. That being said... there is still plenty of time for wing nuts to derail or alter the legislation even MORE before the rules take affect.
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DuncanONeil
11:06 AM on 03/23/2010
You don't pay 20 time your Brother!!

Wingnuts? Well the "wingnuts" are on both sides of the political spectrum.
Perhaps the only ones wedded to this bill are the Progressives, and they will be the death knell of the country.
And no Progressive does not mean what you think!
03:38 PM on 03/15/2010
The current health care system in the US is a pre-existing condition. Not to worry. . .after the coming revolution US refugees to Canada will receive proper treatment.