Today, the six-month anniversary of the signing of the health bill, a number of key provisions officially kick in. For the past few months, health reporter Michelle Andrews has been writing about various aspects of the law for her weekly feature "Insuring Your Health," and Jackie Judd sat down with her to discuss what today could mean for consumers.
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Jackie Judd: It’s been six months since President Obama signed the health care reform bill into law. Many provisions go into effect on this day, September 23rd, let’s talk about a few of them, starting with the provision that allows young adults, up until the age of 26, to stay on their parents’ health insurance plans. As straight forward as how I’ve just described it?
Michelle Andrews: Not quite. Though the provision becomes effective September 23rd, it actually happens when health plans renew their coverage, and that could be anytime afterwards. It could be January—for many companies it will be January; it could be next July—some companies have summer renewals; for some companies, it could be as late as next September, before they actually kick in this provision.
JJ: And is it for any and all children up until the age of 26, or are there some who still would not be eligible to stay on their parents’ policies?
MA: It applies to virtually all adult children. The only exception would be children who have an offer of health insurance through their own employer.
JJ: And if I have two children, one is 17, one is 22, would I be paying different premiums for them because of their ages, or does it have to be the same?
MA: The law doesn’t allow for different premiums because children are younger than 22, for example. But, what it does allow, and what many employers are considering doing, is charging more for all dependents. So as long as you charge the same amount, you can charge more.
JJ: How popular do you expect this provision to be?
MA: It seems that this provision is very popular, because it’s difficult, sometimes, for children when they graduate, and particularly in this economy, they may not get a job, they can’t find work, and then they don’t have any health insurance, and they believe, as we know, that they’re invincible, and they don’t really need health insurance, and so this way parents can step in and cover their child if they want to.
JJ: There is another provision that kicks in September 23rd, having to do with children, and this case, mostly younger children, but those with pre-existing conditions, who, in the past have been, or could have been prohibited from joining their parents’ plan or another policy. How does life change as of today?
MA: Those children can no longer be denied coverage because of their pre-existing condition. That will also happen as the health plan renews for the following year. But if a child has had cancer or some other serious illness, they will no longer be excluded from coverage.
JJ: How widespread was this, to exclude some children with pre-existing conditions?
MA: I don’t think it was widespread. Though, I think that when you look at the individual market and the small group market, where they essentially take each person and evaluate their health before they decide whether to cover them, they underwrite them, essentially, it did happen, and I’ve talked to families where it has happened.
JJ: And, under this new provision, is it still possible that the insurance for this child would still be out of reach for many parents?
MA: I think that that may happen, because there is less regulation and restraint on price here in this reform bill than there is in some of the coverage areas.
JJ: And the final provision that kicks in today that I wanted to discuss with you, I think there probably are 20, but we’re only going to discuss a few today, and that has to do with the removal of lifetime caps. Walk us through that.
MA: What happens is that, again, as health plans renew, they can no longer have lifetime limits on coverage, which a significant proportion of companies still have. Usually they’re in the two million range, up to five million, but those are all eliminated, which, for most of us, doesn’t matter, because we’ll never hit those caps, but if you get sick and you need a lot of chemotherapy, or you have a serious car accident, you can go through that coverage, and so for those few people who really need the coverage it will make a big difference.
JJ: And do you think that with the lifting of that ban, or that exclusion rather, will there be an increase in insurance premiums because of that?
MA: I think there may be some increase in premium tied to it, but when you ask employers whether this is a provision that costs them a lot of money, usually they say not really very much, because, again, so few people actually end up using up their benefits, that to add this unlimited coverage—to go from five million to unlimited coverage—really doesn’t cost much.
JJ: So few people, yet it is the type of story that consumers hear about, that sounds so horrible, so it really resonated with the public when this was being debated on Capitol Hill.
MA: Absolutely. I think that this is everyone’s worst nightmare, is, something awful happens to you, and your insurance runs out.
JJ: I know you get letters from consumers yourself, have you received letters from people who will be impacted by this final provision we just discussed?
MA: Yes, people write in, and they’re concerned, because they don’t really know how this will impact them, and this provision applies to every type of health plan. There’s no exception; it’s not if you’re in an individual policy or a group plan, it will apply to all of them.
JJ: And it automatically kicks in, people do not have to worry about, for example, filling out more forms, or something like that?
JJ: So that is as straightforward as it sounds.
MA: It is.