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 year, health care plans will allow young people to remain on
their parents’ insurance policy up until their 26th birthday.
* 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.
* This year, adults who are uninsured because of pre-existing
conditions will have access to affordable insurance through a
temporary subsidized high-risk pool.
* 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.
* 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.
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.
* 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.
* 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.
* 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.
* 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.
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.
* 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.
* 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.
* 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
Director, White House Office of Health Reform