You may feel daunted by the number of pages in these health reform bills, not to mention the legislative language that is often impossible to decipher. But here are some important provisions in the new Senate Health Care bill that you should know about. The White House Blog has highlighted a few, and I have made some comments in "plain English" about what they might mean for you (my comments under the highlighted White House language).
Before we get into these provisions, you should know that this is far from the final version, so don't get too excited about it. The bill will change as it is debated in the Senate and ultimately combined with the House Bill passed a few weeks ago. But the provisions mentioned here are probably going to stay in the final bill because they are so popular. Probably the biggest issue for you is that you may not see as much change immediately as you would like. Some things will go into law immediately in 2010, but a lot of the changes will take a few years to put into place. So be patient, but be encouraged by the few things mentioned below.
The White House Blog
Posted by Dan Pfeiffer on November 20, 2009 at 11:30 PM EST
• On page 78 you'll learn that the Patient Protection and Affordable Care Act ends discrimination based on pre-existing conditions.
What this means for ordinary folks is that no longer do you need to worry about whether or not you can get insurance if you lose your job or have been uninsured because of some treatment or condition you had in the past. Some insurance companies have denied access for conditions as minor as allergies or a rash. This practice has caused people to lie about their past conditions or apply for insurance and sweat it out.
• On page 17, it makes preventive care completely free, with no cost-sharing. (This might be of particular interest to those who have chosen to seize on concerns about the U.S. Preventive Services Task Force Recommendations on mammograms to spread baseless myths and advance their own political agenda.)
It's true that the reaction to the new guidelines for mammograms has been distorted and extreme. Most of the distortion has come from using a single case as an example of the problem. The only hitch here is that the preventive services in the legislation that will be covered free of charge will be services that the U.S Preventive Services Task Force has given a score of A or B, meaning the evidence supports the level of screening that is being recommended. So the new guidelines will have an impact. Most likely mammograms and other services will be covered for certain age groups. There will undoubtedly be controversy over this for some time to come, but the intent of the legislation is to make preventive services much more available and not to screen people unnecessarily, thus increasing the chance that too much treatment will be delivered. (Note this good article by Gina Kolata on history of mammogram guidelines in the NY Times.)
• Flipping back to page 16, you'll find that insurance companies are prohibited from dropping your coverage or watering it down when you get sick and need it most.
This practice of reducing or dropping coverage when a person most needs it is one of the worst insurance practices ever. It is a shame we need to ban it. It should never have existed. But this should give people a lot of peace of mind about the coverage they have.
• Also on page 16, you might notice that it puts an end to lifetime caps on coverage.
This is a big deal. Lifetime caps are often around 1 million dollars. That sounds like a lot, but it actually is not so much if you have a serious and debilitating disease. In my career working with large employers on their benefit packages, there were times when the employer had to decide to cut someone off coverage because they had reached their million dollar limit. The family usually was in dire straits already, and the decision was very painful for the employer. But if the employer had a policy and made an exception for one individual, then it was likely the policy would have to be amended for everyone, and that would drive up costs. This absolute cap on lifetime expenses is truly important to know about. You can rest much more easily if you know that there is no arbitrary amount hanging over you or your family in case you have a catastrophic disease.
• Page 18 is where the bill extends family coverage eligibility for young Americans through the age of 26.
This provision is super important for any family with a young adult who can't get insurance coverage any other way. I personally know a family whose 24 year old son got cancer and with their current policy, he was going to be knocked off just when he needed his insurance the most. So many entry level jobs do not have insurance benefits, so this is good news for families with children in this category.
• On page 83 it requires insurance companies to renew any policy as long as the policyholder pays their premium in full - that means they can't refuse to renew your coverage just because you get sick.
It is important that there be a requirement that the company cannot drop you if you pay your premiums, even if you get a serious disease. This is all part of the "game" that insurance companies play with your coverage, and you really want to have government behind you in these cases.
• Page 307 is home to tax credits for small businesses to help them afford insurance for their employees.
There are quite a lot of provisions to help small businesses of fewer than 100 employees help pay for insurance coverage. Small businesses do not have to provide insurance, but if they do there are credits for doing so. The formula is pretty complicated, but if you are a small business it would be worth reading this section carefully.
• And folks looking to scare our senior citizens about what reform means for them might be interested to check out page 923 and learn that it provides a 50% discount on drugs for seniors in the so-called donut hole.
For all eligible patients, Medicare covers 75 percent of the first $2,250 worth of drugs. But after that, coverage drops to zero -- and doesn't resume until the patient hits $5,100 in expenses. Then Medicare kicks in again, paying 95 percent of costs. But it's this gap -- of almost $3,000 -- that many sick and disabled seniors call unaffordable. So this provision in the bill to cut the costs of drugs in this donut hole in half, will help a lot of poorer Medicare beneficiaries.
Bottom line? There are quite a lot of things to like about the way health reform legislation is playing out. And there are things to worry about as well. But if you are already employed or retired (and have Medicare), little will change for you. If you are, however, one of those whose insurance is precarious, have a pre-existing condition, want to change your jobs, don't have any insurance at all - what these bills will offer you next year will help a lot.
Update: An article by Ron Brownstein in The Atlantic, in which he interviews an economist from MIT, supports my view that there is much to admire in this health care bill. Some of the comments below have asked where the cost containment is in this bill. Read this article and you will see where it is.