- Parents may keep their children on the family health insurance to age 26, if the child is not offered coverage through an employer.
- Insurers may no longer deny coverage to children because of a pre-existing condition.
- Lifetime limits on essential benefits like hospital stays are abolished.
- Insurers must pay for such preventive services as immunizations, mammograms and colonoscopies, without charging consumers deductibles, co-pays or co-insurance fees.
The changes imposed by the Patent Protection and Affordable Care Act, enacted March 23, won’t be immediate for most consumers. The changes won’t take effect until a consumer buys a new policy or renews an existing one. And insurers can avoid some of the requirements, such as the free preventive services, if they make no significant changes to their current plan.
“For Georgia, it really means that people are going to have more options,” said Kathleen D. Stoll, director of health policy at Families USA, a non-profit organization that favors the law. “People who have insurance will have more protections and insurance companies will treat them more fairly.”
Representatives of the insurance industry and critics of the health care law said that higher costs would inevitably result.
“Everybody hates the big, bad insurance companies, but when you raise their expenses that money is going to have to come from somewhere, and that money is going to come from increased premiums passed onto consumers,” said Vincent Frakes, an expert on health policy at the Center for Health Transformation, which was founded by Newt Gingrich.
While the intent of the law is to expand coverage, the requirements may have the effect of limiting options in some cases.
Some of the nation’s largest insurance companies said this week that they would no longer offer new child-only policies, for fear that parents would only sign their kids up for insurance when a child faced major medical bills, knowing that insurers could no longer turn down a child because of a pre-existing condition.
Most of the insurers said they would continue to offer new coverage to children as part of family policies and would not drop child-only policies they already carry.
“The intention of certain provisions might have been noble,” Frakes said, “but there are some unintended consequences that will result.”
The new provisions are kicking in at a time when Republicans are trying to dismantle key parts of the law, which is opposed by many Americans. At the same time, new figures released last week by the U.S. Census Bureau showed that the number of uninsured Americans surpassed 50 million people in 2009. The report found that 20.5 percent of Georgians lacked health coverage in 2009, the fifth-highest rate in the nation.
Georgia has not embraced the legislation: it is one of 20 states challenging the constitutionality of the law. The overhaul offered states the opportunity to run their own high-risk insurance plan for consumers with pre-existing conditions. But like 20 other states, Georgia opted to have the federal government run its plan.
Georgia was one of five states that declined to apply for a grant to help states improve their review of health insurance rates. That decision was made by Insurance Commissioner John W. Oxendine. “After careful analysis, it was determined that the department could continue its existing rate review responsibilities without money or direction from Washington, D.C.,” Oxendine’s office said in a statement.
Georgia did, however, apply for a federal grant to study the health insurance exchanges that are a critical part of the law, according to the governor’s office.
Scheduled to be in place in each state in 2014, the exchanges would set up state-based marketplaces for health plans for consumers whose employers do not offer a health plan.
“It only makes sense to be ready, even when you disagree with sort of the fundamental mandates or changes being made,” said Bert Brantley, Gov. Sonny Perdue’s press secretary. “If the changes are coming anyway, it absolutely make sense to be prepared for those.”
Around the country, consumers, businesses and health care providers are still working to understand the implications and requirements of the massive health care law as its provisions begin to appear in the fine print of insurance contracts.
Laura Lewis, a Fayetteville wife and mother of three boys, is hoping that the provisions that take effect today will help her family.
Her middle child, Ryan, was born with a serious heart defect. He had a heart transplant when he was 3 years old. He’s now 6, and is doing well. He’s enrolled in kindergarten, is learning to read and, like many boys his age, is obsessed with “Star Wars.”
“He is a miracle, he really is,” Lewis said.
The family buys its own health insurance coverage directly because Lewis’ husband, Chuck, is a self-employed business owner. The family policy that cost $800 a month three years ago costs $1,600 a month now.
Because of Ryan’s condition it was impossible, until now, to even consider searching for a cheaper alternative: no insurer would have taken them, given Ryan’s costly medical bills.
“If it works the way that they say, it’s going to be fabulous and definitely help a lot of families,” she said. “I don’t want to get too excited until I see exactly what it is going to mean and if there are going to be exclusions. I want to see it work.”
Lewis had worried about the family’s ability to afford its coverage, if its premiums continued to rise steeply.
“These are the things that keep you awake at night,” she said.
Lewis said she not only worried about paying for the current policy but about eventually reaching a lifetime cap on benefits.
Although many consumers aren’t aware of it, most health policies in the past limited what they would pay out for one patient. The new provisions ban such limits, which many consumer advocates say is a huge improvement for the small number of families who have exceeded the limits and found themselves responsible for gigantic medical bills, often to care for a seriously ill child.
“That meant bankruptcy in the past,” said Cindy Zeldin, director of Georgians for a Health Future, a nonprofit based in Atlanta.
Lewis said the staff at Children’s Healthcare of Atlanta has been wonderful and has given her the sense that they will always be there for Ryan. But she said the new health care provisions could help her gain some peace of mind.
“We have so many question marks in our lives,” she said. “We have had so many worries. To have one less thing to worry about is great.”
Kenneth E. Thorpe, a professor and health policy expert at Emory University, said the health care law is filled with elements that many consumers will embrace.
“There is so much in this legislation that people aren’t aware of that is really beneficial that’s going to improve the quality of how they get their health care provided and is going to provide better access to health care to people who are sick or who have pre-existing conditions,” Thorpe said.
He said the plan is also intended to place more focus on prevention.
Frakes, the expert at Gingrich’s Center for Health Transformation, said the elements taking effect this week “are some of the better provisions of the bill.”
But Frakes said the center, which generally supports coverage for everyone at the lowest possible cost, believes the law did not achieve proper reform of the system and says he is wary of some of the provisions that will take effect in the years to come.
“There is a lot in the rest of the bill that is incredibly onerous,” he said. “You have heard very little about these things that are upcoming.”
