Since the House of Representatives voted to pass health reform legislation on Sunday night, the legislative process and its political impact have been the focus of all the newspapers and cable TV pundits.
Outside of DC, however, many Americans are trying to cut through the chatter and get to the substance of reform with a simple question: “What does health insurance reform actually mean for me?” To help, we’ve put together some of the key benefits from health insurance reform.
Let’s start with how health insurance reform will expand and strengthen coverage:
- This year, children with pre-existing conditions can no longer be denied health insurance coverage. Once the new health insurance exchanges begin in the coming years, pre-existing condition discrimination will become a thing of the past for everyone. (This will redefine health insurance to be more in line with health welfare – insurance used to be a hedge – you paid an amount that considers the cost of paying for something bad that happens and the probability that that bad thing WILL happen and add a bit on for profitability to the company. However, the odds of a PRE-EXISTING condition happening are 100%. This means that the company needs to collect MORE than 100% of the cost to stay profitable. They do this by redistributing the wealth )
- This year, health care plans will allow young people to remain on their parents’ insurance policy up until their 26th birthday. (They have to be insured anyways – this just makes it official that the parents can be held responsible for ensuring the payments are made on time. Remember, it is VITAL for this plan to work that the young and healthy get charged to help pay for the old, sick and decrepit)
- This year, insurance companies will be banned from dropping people from coverage when they get sick, and they will be banned from implementing lifetime caps on coverage. This year, restrictive annual limits on coverage will be banned for certain plans. Under health insurance reform, Americans will be ensured access to the care they need. (I actually prefer catastrophic coverage in general because it has minimal to no caps on coverage – this, combined with a health savings plan makes simple financial sense. However, I don’t expect everyone to have my needs or desires and CERTAINLY don’t think it’s wise to CHARGE people MORE for coverage they can’t afford).
- This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary subsidized high-risk pool. (Again, this is welfare, not insurance, since it is a guaranteed redistribution of wealth as opposed to a hedge against a possibility)
- In the next fiscal year, the bill increases funding for community health centers, so they can treat nearly double the number of patients over the next five years. (Luckily, the doctors who can no longer afford to have a private practice will be available to man these community health centers – at first. As more people realize that the medical profession is no longer all that profitible, expect the supply of practicioners of all levels to drop – unless, the government makes up for the loss in profits from individuals with some form of government subsidy… Oh wait! What’s this here?)
- This year, we’ll also establish an independent commission to advise on how best to build the health care workforce and increase the number of nurses, doctors and other professionals to meet our country’s needs. Going forward, we will provide $1.5 billion in funding to support the next generation of doctors, nurses and other primary care practitioners — on top of a $500 million investment from the American Recovery and Reinvestment Act. (I’m sure subsidized medicine will work out about as well as subsidized housing – and for exactly the same reasons)
Health insurance reform will also curb some of the worst insurance industry practices and strengthen consumer protections:
- This year, this bill creates a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer. (I’m actually neutral on this one – Normally I figure that this could be kept private and handled through the process of the free market eliminating insurers that don’t insure well. However, since competition is artificially stifled in the health insurance field, the free market is not allowed to function normally)
- This year, discrimination based on salary will be outlawed. New group health plans will be prohibited from establishing any eligibility rules for health care coverage that discriminate in favor of higher-wage employees. (these “discriminatory” plans are the more expensive ones that help pay for less expensive plans – this will increase the costs of the less expensive plans with no net benefit)
- Beginning this fiscal year, this bill provides funding to states to help establish offices of health insurance consumer assistance in order to help individuals in the process of filing complaints or appeals against insurance companies. (So you can pay for the frivolous lawsuits people across the country make against insurers! )
- Starting January 1, 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Insurers in the large group market will be required to spend 85 percent of their premium dollars on medical services. Any insurers who don’t meet those thresholds will be required to provide rebates to their policyholders. (Now, the only way an insurer can make more profits is to get doctors to run more tests and perform more procedures and increase your premiums accordingly – Demand goes up, premiums go up, supply goes away and no study yet has shown that any of this will improve your overall health)
- Starting in 2011, this bill helps states require insurance companies to submit justification for requested premium increases. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance exchanges. (Justification is easy – “just look at all these procedures we now cover! And look at how many operations we approved last year alone! This stuff is expensive and that money has to come from somewhere”)
Reform immediately begins to lower health care costs for American families and small businesses:
- This year, small businesses that choose to offer coverage will begin to receive tax credits of up to 35 percent of premiums to help make employee coverage more affordable. (I’m neutral on this one too – I like tax credits, but don’t like the fact that it further ties your health insurance to your employer).
- This year, new private plans will be required to provide free preventive care: no co-payments and no deductibles for preventive services. And beginning January 1, 2011, Medicare will do the same. (No co-pays and no deductibles = higher premiums – again, the money has to come from somewhere)
- This year, this bill will provide help for early retirees by creating a temporary re-insurance program to help offset the costs of expensive premiums for employers and retirees age 55-64. (Luckily, there are all these young, healthy adults around to pay for it all!)
- This year, this bill starts to close the Medicare Part D ‘donut hole’ by providing a $250 rebate to Medicare beneficiaries who hit the gap in prescription drug coverage. And beginning in 2011, the bill institutes a 50% discount on prescription drugs in the ‘donut hole.’ (“rebate” = “tax money” and “discount” = “redistributed costs to other drugs” – oh, I guess the government could just print the money, but that reduces the value of money and, in effect is a tax in itself. Redistributing drug costs is especially pernicious because it targets the middle class – the rich tend to be healthy and the poor are the ones on medicare, so that leaves the rest of us to take the brunt)
Director, White House Office of Health Reform