Health Care Reform Provisions Begin, but…

Today is the beginning of several of the provisions of the Affordable Care Act.  That’s a good thing for America, but sadly, greedy insurance companies are spoiling the celebration.  Here is what’s happening, and what needs to be done.

First the new provisions:

Yesterday, Nancy-Ann DeParle of the Office of Health Reform joined bloggers for a conference call to highlight the provisions of the Affordable Care Act that go into effect tomorrow, six months after enactment of the law. Those changes:

• Ban on discriminating against children with preexisting conditions: as of tomorrow, insurance companies can’t deny coverage to children under age 19 for a pre-existing condition. The ban will go into effect for adults in 2014.
• Ban on rescission: insurers will be prohibited from dropping a customer when they get sick or to search for errors in customers’ applications to use as a basis for rescinding coverage or denying payment for services.
• Ban on limiting coverage, lifetime caps: Insurers will no longer be able to impose lifetime dollar limits on benefits–particularly hospital stays or expensive treatments for chronic diseases, cancer, etc. By 2014, they will phase out annual caps.
• Ban on limiting doctor choice in new plans: insurers will have to allow primary care physician status for OB/GYNs and pediatricians so that patients don’t have to get pre-authorization or referrals to see these providers.
• Ban on restrictions on emergency services: insurers will have to cover all emergency care, in or out of network.
• Guaranteed right to appeal insurer decisions to independent third party in new plans;
• Young adults can stay on their parents’ plans til 26 unless they have access to coverage in their workplace;
• New plans will cover preventive care with no customer costs–well-baby, mammograms, colonoscopies, etc. will be covered with no co-pays or deductibles.

… [emphasis added]

Inserted from <Daily Kos>

All of these reforms are good for America, but note that some of the provisions apply to new plans only.

Sadly, greedy pigs that they are, insurance companies have found a loophole in one of the most important provisions.

Major health insurance companies in California and other states have decided to stop selling policies for children rather than comply with a new federal healthcare law that bars them from rejecting youngsters with preexisting medical conditions.

Anthem Blue Cross, Aetna Inc. and others will halt new child-only policies in California, Illinois, Florida, Connecticut and elsewhere as early as Thursday when provisions of the nation’s new healthcare law take effect, including a requirement that insurers cover children under age 19 regardless of their health histories.

The action will apply only to new coverage sought for children and not to existing child-only plans, family policies or insurance provided to youngsters through their parents’ employers. An estimated 80,000 California children currently without insurance and as many as 500,000 nationwide would be affected, according to experts… [emphasis added]

Inserted from <LA Times>

I warned that insurance companies would look for and find loopholes in this law.  State legislatures can pass laws requiring insurance companies to honor this provision as a precondition for selling new policies in that state, but Republican legislatures won’t pass it and Republican governors won’t sign it, leaving those children at risk.  And that does nothing for the next loophole.

Consider this:

You come home and find a burglar stealing your valuables.  You call 9-1-1 and the dispatcher says, “Your police insurance does not cover preexisting conditions, and you have valuables in your home.  We can’t help you.”   Ridiculous?  Aren’t you glad you have universal single-payer police protection?

You come home and find your home starting to burn.  You call 9-1-1 and the dispatcher says, “Your firefighter insurance does not cover preexisting conditions.  Your home has a wood frame.  We can’t help you.”  Absurd?  Aren’t you glad you have universal single-payer firefighter protection?

Health care is a need as universal and the need for police and firefighters.  It is a need far too important to leave to greedy insurance, who care everything about profit and nothing about health.  America needs universal single payer health protection.