The Top Ten Immediate Benefits Americans Will Receive When Health Care Reform Passes

Today, the Democratic Caucus of the House listed the
provisions of the health reform bill that will take effect
“as soon as
health care passes,”

 The legislation would:

  • Prohibit pre-existing condition
    exclusions for children

    in all new plans;
  • Provide immediate access to
    insurance for uninsured Americans who are uninsured because of a pre-existing
    condition through a temporary high-risk pool
  • Prohibit dropping people from
    coverage when they get sick

    in all individual plans;
  • Lower seniors prescription drug
    by beginning to close the
    donut hole;
  • Offer tax credits to small
    to purchase coverage;
  • Eliminate lifetime limits and
    restrictive annual limits

    on benefits in all plans;
  • Require plans to cover an
    enrollee’s dependent children until age 26;
  • Require new plans to cover
    preventive services and immunizations without cost-sharing
  • Ensure consumers have access to
    an effective internal and external appeals process to appeal new
    insurance plan decisions
  • Require premium rebates
    to enrollees from insurers with high administrative expenditures and
    require public disclosure of the percent of premiums applied to overhead

enacting these provisions right away, and others over time” the Caucus declares,
“we will be able to lower costs for everyone and give all Americans and small
businesses more control over their health care choices


15 thoughts on “The Top Ten Immediate Benefits Americans Will Receive When Health Care Reform Passes

  1. Hi Maggie:
    From Obama’s proposal to the House Reconciliation, the max payment went from 9.5% of income to 11%. They stuck to their guns on this ppart.

  2. All that “new plan” talk scares me. Will the regulations apply to all plans in 2014? Also, have you heard if rate increase oversight is included? Last I heard, it was cut.

  3. run: can you please explain your comment? I’m not understanding it. I’m hoping I’m getting it wrong so b/f I add another item to my Reasons to be Sad About this Bill List, I want to be sure.

  4. eRobin
    Almost everything you read about new regulations applies only to people who don’t have employer-sponsored insurance and now buy their own insurance(and will be buying it in the future on the Insurance Exchange.
    What you read also applies to some people who work for very small companies who often pay higher group rates because too many people in the company are older or sicker. (Under reform, those higher rates will be eliminated)
    If you now have group health insurance from a large employer, that should remain rougly the same. No need to worry.
    Granted, over the next 2 or 3 years, premiums (and the amount you have to pay toward premiums are likely to continue to rise, as they have in the past.
    Reform won’t regulate insurers until 2014.
    And, as I have said in the epast, reining in teh cost of insurance is not so much a matter of regulating insurers as it is a matter of bringing down the underlying cost of care .
    I think that this is oiekly to begin to happen over the next 3 years as Medicare begins to rein in health care inflation.
    Run 75441–
    I’m going to have to take a very close look at the final bill.
    Not sure why raising payment from premiums from 9.5% of income to 11% is a good thing???
    At what income level?
    Best, Maggie

  5. Maggie, You keep saying Medicare will regulate and rein in costs, that seems like a fantasy. We have been having SGR fix issue for Doctors pay for past 10 years, not a thing has been done and looks like they kicked it down the road again.They did tweek some radiological studies this past January and it is not a significant change, people will do more tests to make up income. Primary care got a miniscule 3-5% raise for evaluation. I have said this before – Primary care pain will foil the reform in the end and the only solution I see is we import large number of foreign doctors for primary care to fill the need.

  6. hi Maggie:
    I went through the first 200 pages of the House Reconciliation Bill here: just to get an idea of how it compared to the Senate Manager’s Amendment and Obama’s proposal. It appears the House is sticking to there guns of what they originally proposed for subsidies as shown on page 137 or 400% of Poverty with the maximum being 11%. This is higher than Obama’s 9.5% and the Senate’s 9.8% of income. I didn’t imply it was a good thing and I don’t view it as much of a reconciliation between all three proposals.
    Cost Sharing appears on page 28 and does not include preventative or well baby expenses (good thing). Insurance picks those two items up. The caps are $5000 for individuals and $10,000 for families on cost sharing.

  7. They left one out. In both the House and Senate bills there is a provision that will allow Medicaid HMOs — that is, privatized carriers serving Medicaid — to receive the same rebates on prescription drug purchasing that the state agencies get when purchasing drugs for the Medicaid fee-for-service populations. This is actually huge, and one of the “gives” on the part of Big Pharma. Medicaid HMOs will now get 36-42 percent rebates on brand-name AND generic meds where they had previously only been able to negotiate about 6 percent.
    This measure in the bill is immediately enacted in the House version, and actually retroactive to 1/1/10 in the Senate version.
    I guess they left it out because it was way too wonky, too insider-baseball, and not directly visible to consumers.

  8. gas28man: I wish they had made a big deal of that drug provision. I think people would understand it very quickly. I worked on reforming Medicare Part D and not allowing the gov’t to negotiate for lower prices was one of the points that people picked up on the quickest. The other stuff is great, but it’s not going to affect most people for a relatively long time. Driving down Medicaid costs means driving down taxes and that’s a winner.

  9. Why is it that I keep thinking that accepting healthcare insurance applicants regardless of pre-existing conditions is the equivalent of allowing homeowners to wait until the house is on fire before purchasing insurance?

  10. Buyers, beware: President Barack Obama says his health care overhaul will lower premiums by double digits, but check the fine print.
    Premiums are likely to keep going up even if the health care bill passes, experts say. If cost controls work as advertised, annual increases would level off with time. But don’t look for a rollback. Instead, the main reason premiums would be more affordable is that new government tax credits would help cover the cost for millions of people.
    Listening to Obama pitch his plan, you might not realize that’s how it works.
    An analysis by the Congressional Budget Office of earlier Senate legislation suggested savings could be fairly modest.
    It found that large employers would see premium savings of at most 3 percent compared with what their costs would have been without the legislation. That would be more like a few hundred dollars instead of several thousand. …
    The budget office concluded that premiums for people buying their own coverage would go up by an average of 10 percent to 13 percent, compared with the levels they’d reach without the legislation. That’s mainly because policies in the individual insurance market would provide more comprehensive benefits than they do today.

  11. Has anyone heard about trying to slip into the health care bill a provision that the banks will be cut out of the student loan process, thus saving the government $65 billion per year? Currently, the government-backed loans take all of the risk while bands take all of the fees. The government would become the lender.

  12. Tom, gas28man, eRobin, run 75441ray
    Tom– Under health care reform, everyone will have to buy insurance–or pay a penalty. (I suspect penalities will rise.)
    This is to address the problem you raise; unless we require that people buy insurance, many would wait until they were sick, and we would wind up with a veyr expensive pool of mainly sick people, making insurance unaffordable for everyone.
    You are correct that many of the people suffering from pre-existing conditions who will be allowed into the pool under reform will be expensive.
    (Though others are not now sick– they were sick at some point in the past, but survived. Sometimes “pre-existing condition” simply means that a woman had a lumpectomy 15 years ago.)
    The important point is this: in most cases, It Is Not Their Fault That They Don’t Have Insurance Insurers refused to sell to them because they have a pre-existing condition or charged so much that they could not possibly afford the policy.
    They didn’t choose to wait until they were sick to apply for insurance.
    Obviously we don’t want to leave someone out of the pool because they have cancer (or had cancer) so we have to insist that insurers take them as customers, and charge them no more than they would charge anyone else in their age group in their community. (We don’t want to punish people for being sick.)
    We’re doing this for children starting this year, and for everyone else in 2014.
    Thanks for pointing this out.
    Yes this is a very important provision.
    I’m afraid they left it off because most middle-class and upper-middle-class people are not interested in programs for the poor.
    They are interested only in programs that affect them.
    Though, as Robin points out, this helps all of us because it makes Medicaid less expensive, and we all help pay for Medicaid.
    eRobin– You’re right.
    See my reply to gas28man.
    But I still wish they would let Medicare negotiate for discounts on drugs. I suspect that will happen as
    separate legislation (or an amendment to something) sometime between now and 2014.
    Drugs are simply too expensive–esp. cancer drugs.
    run 75441-
    Thanks for the info. I agree, there shouldn’t be co-pays for preventive or well-baby care. If memory serves, “preventive care” means care recommended by the U.S. Preventive Services Task Force as effective.
    Also, just so no one is confused: the caps on out-of-pocket expenses ($5,000 max for individuals and $10,000 max for family) in any give year are set on a sliding scale. Low-income and lower-middle class families will find that their out-of-pocket expenses are capped at a lower amount.
    ray– I’ve written about this in previous posts.
    Briefly, the “SGR” fix was always a very stupid idea because it called for an across-the-board cut in fees to all doctors for all services.
    This is a very crude way to reduce spending. We need to make cuts with a scalpel, not an axe.
    Everyone in Congress knew that we don’t want to cut fees to primary care docs by 10% — or 20%.
    We want to cut fees in areas where docs are over-paid and/or the service provides little or no benefit to the patient, and may put him at unnecessary risk.
    Medicare has already laid out some cuts it plans to make over the next 4 years to oncologists as well as cardiologists and docs doing certain diagnostic tests. Meanwhile Medicare has announced pay hikes for primary care and nurse practitioners.
    Congress doesn’t get to vote on these cuts. Congress can object–but if it does, it then has to find a way to save an equal amount of money in some other area of Medicare.
    And it has a very short time period in which it can object. (It hasn’t objected to this year’s cuts, and the window has already passed.)
    Everyone knew that the SGR cuts were never going to be made because they were such a dumb idea. Bush kept them in his budget every year to make his budget look better. (In other words, he showed the SGR cuts for the upcoming year as savings, so that his budget wouldn’t’ look as expensive. )
    As soon as Obama took office he took the mythical SGR savings out of his budget, acknowledging that it was never going to happen.
    In recent years the Medicare Payment Advisory Commission (MedPac) has explained why the SGR cuts are a bad idea in its bi-annual reports.
    MedPAC has been calling for targeted cuts– the type of cuts that Medicare is now making.
    The Bush administration wouldn’t make those cuts because it didn’t want to tangle with the lobbies that represent the best-paid specialists.

  13. Folks:
    Has it been determined if the insurance industry supports or opposes this bill?
    I just heard Shadegg state that insurers support this bill, because the mandate is the most effective way to get people to buy their defective products, the very industry which help put us in this mess.
    He would rather see the public option provide the competition over simply handimg over to the “monopolists” the business they could not legitimately procure.
    This is simply corporation takeover of the government.
    Well, folks, this is what usually happens when special interests make decisions, versus the self interest of individuals.
    As Niebuhr stated “I trust individuals to make better decisions than large groups.”
    Don Levit

  14. Don–
    As the president has indicated, it is quite likely that we will have a public option before health care reform rolls out in 2014.
    In addition, that insurers that are most likely to thrive under regulation are the non-profits.
    The best non-profit insurers put patients first, and will continue to do so.

  15. I think that the current discussions about healthcare are shortsighted. They do not look to the future.
    Healthcare initiatives to date have focussed on providing healthcare to the needy. This is good. But what about addressing the prevention of ill health. Poor personal health practices is responsible for creating the need to address healthcare at this time.
    It is said that it is better to teach a starving man how to fish than it is to give him fish to eat.
    Much has been written about the obesity epidemic. Obesity, of course, leads to ill health and exacerbates the need to address healthcare.
    Why is noone talking about educating children in the subjects of fitness and nutrition in schools? Doing so would contribute to improved health in future generations and therefore diminishing pressure on the healthcare system in the future.
    In the meantime, a way needs to be found to educate the current generation in these matters . Information similar to that which is contained in the article about
    Fat Burning Exercise needs to be taught to the general population.