Opinion Editorials, March 2010

US Historic Health Insurance Reform

By Lee Goodall

Al-Jazeerah, ccun.org, March 22, 2010

Landmark legislation will end abusive practices by insurance industry, extend coverage to 32 million Americans, reduce cost of care for families and businesses

RALEIGH —

Organizing for America-GA Director Lee Goodall released the following statement today regarding the U.S House of Representatives’ passage of the Patient Protection and Affordable Care Act (H.R. 3590) and Reconciliation Act of 2010 (H.R. 4872):

“Today, President Obama and Congressional leaders scored a major victory for middle-class families and the small businesses that are the engine of our economy. Thanks to their leadership—and the efforts of millions of citizens who made phone calls and engaged in critical discussions in communities across the country—the U.S. House of Representatives has now passed one of the most significant and sweeping health insurance reform measures in our nation’s history. After decades of effort and a year of substantive debate, the decisive vote made by Members of Congress this afternoon will effectively end the worst and most abusive practices of insurance companies; extend coverage to 32 million more people; guarantee families and businesses have more control over their health care choices; and ensure all Americans see our health care costs fall.

“The impact of this historic bill will be felt immediately by millions of Americans.

Insurance companies will no longer be permitted to deny coverage to children and adults due to a pre-existing condition. Insurance companies will no longer be permitted to kick students off of their parent’s health insurance when they reach the age of 26. And insurance companies will no longer be permitted to drop insurance for hard-working people all across the country because they get sick.

“We have much to be proud of—and even more to look forward to in the coming weeks and months. Health reform will create 4 million jobs and reduce our national deficit by $130 billion dollars over the next decade alone. At the same time, by passing reform—succeeding where so many others before us have failed despite their best efforts—we are keeping this country moving in the right direction and setting ourselves on the path to future prosperity.

“On this historic and momentous day, OFA-GA supporters join Georgians in thanking President Obama and Congress for their leadership—and for ensuring quality, affordable health care is a reality for every American.”

The Patient Protection and Affordable Care Act and the Reconciliation Act of 2010, which are expected to be signed into law by President Obama within days, will offer immediate benefits to millions of Americans through key provisions including:

1. SMALL BUSINESS TAX CREDITS—Offers tax credits to small businesses to make employee coverage more affordable. Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage. Effective beginning for calendar year 2010. (Beginning in 2014, the small business tax credits will cover 50 percent of premiums.)

2. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE—Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010. Effective for calendar year 2010. (Beginning in 2011, institutes a 50% discount on brand-name drugs in the donut hole; also completely closes the donut hole by 2020.)

3. FREE PREVENTIVE CARE UNDER MEDICARE—Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective beginning January 1, 2011.

4. HELP FOR EARLY RETIREES—Creates a temporary re-insurance program (until the Exchanges are available) to help offset the costs of expensive premiums for employers and retirees for health benefits for retirees age 55 to 64. Effective 90 days after enactment.

5. ENDS RESCISSIONS—Bans insurance companies from dropping people from coverage when they get sick. Effective 6 months after enactment.

6. NO DISCRIMINATION AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS—Prohibits new health plans in all markets plus grandfathered group health plans from denying coverage to children with pre-existing conditions. Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to all persons.)

7. BANS LIFETIME LIMITS ON COVERAGE—Prohibits health insurance companies from placing lifetime caps on coverage. Effective 6 months after enactment.

8. BANS RESTRICTIVE ANNUAL LIMITS ON COVERAGE—Tightly restricts the use of annual limits to ensure access to needed care in all new plans and grandfathered group health plans. These tight restrictions will be defined by HHS. Effective 6 months after enactment. (Beginning in 2014, the use of any annual limits would be prohibited for all new plans and grandfathered group health plans.)

9. FREE PREVENTIVE CARE UNDER NEW PRIVATE PLANS—Requires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles. Effective 6 months after enactment.

10. NEW, INDEPENDENT APPEALS PROCESS—Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions by their health insurance plan. Effective 6 months after enactment.

11. ENSURING VALUE FOR PREMIUM PAYMENTS—Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent. Insurers that do not meet these thresholds must provide rebates to policyholders. Effective on January 1, 2011.

12. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL)—Provides immediate access to affordable insurance for Americans who are uninsured because of a pre-existing condition through a temporary subsidized high-risk pool. Effective 90 days after enactment.

13. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS’ INSURANCE – Requires new health plans and certain grandfathered plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy, at the parents’ choice. Effective 6 months after enactment.

14. COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years. Effective beginning in fiscal year 2010.

15. INCREASING NUMBER OF PRIMARY CARE DOCTORS—Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals. Effective beginning in fiscal year 2010.

16. PROHIBITING DISCRIMINATION BASED ON SALARY—Prohibits group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. Effective 6 months after enactment.

17. HEALTH INSURANCE CONSUMER INFORMATION—Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals. Effective beginning in FY 2010.

18. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide home and community-based services to adults who become functionally disabled. Effective on January 1, 2011.

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Organizing for America (OFA) is a grassroots project of the Democratic National Committee. OFA's network of volunteers and staff is actively working in all 50 states to promote the President's proposals to strengthen America's middle class by creating jobs, passing health insurance reform, building a clean energy economy, improving education, and reining in the excesses of Wall Street.

Contact: Joanne Peters, 202-465-9546, [email protected]