Healthcare Reform Turns One: Understanding the Law Dividing the Nation, Pt. 1

It’s the law that has divided the country.  Even its name causes controversy.Officially, it’s called the Patient Protection and Affordable Care Act (PPACA).  But you may know it as the Affordable Care Act.  Or Obamacare.  Maybe even “socialized medicine”.

And today is its first birthday.

When President Barack Obama first mentioned health care reform on the campaign circuit, the idea seemed vague, far off – impossible.  And yet, one year ago today, amidst both fanfare and fury, Obama signed the Act into law, and the government began laying down the foundation for free health care nationwide.

But for or against, hopeful or scared, nearly everybody on both sides of the issue also met the law with uncertainty.  That hasn’t changed.  A recent Kaiser poll shows that 53 percent of Americans are still confused by the law.  Many don’t feel like they’ve gotten enough information to be able to determine how it will affect them personally.

Put simply, it’s complicated.  This law is big – nearly a thousand pages worth of reform, amendments, and bureacratic jargon.  It’s a lot to wade through, but at the same time, it’s vital that people at least have a basic understanding of the changes that are being put into place.

Over the next few weeks here at AskDrManny, we’ll be explaining which provisions have been put into effect, which are soon to come, and the controversies and lawsuits that have erupted over the past year since the law has been signed.

We’ll start today with the changes already in place to ensure “consumer protection”, and how these changes are affecting your family today.  Check back in the next few days for the rest of the changes that have gone into effect of the past year.

The Provisions for Consumer Protection In Effect As of March 2011

Putting Information for Consumers Online.
The government has put up a website (http://finder.healthcare.gov/) to help match customers with insurance plans.  A health-insurance “finder” asks a few short questions – what state you live in, your age, your medical status, your health insurance status, and whether or not you have trouble affording insurance.  From there, the website offers a number of options you can pursue to get insured.  Some options are feasible and some are not – for example, even after marking that you have no current health problems, the site will still recommend that you may qualify for a “Pre-existing conditions/High risk pool”.  Effective July 1, 2010.

Prohibiting Denying Coverage of Children Based on Pre-Existing Conditions.
In this case, children includes everyone under the age of 19.  In 2014, the law will expand to include people of all ages.  But there’s a catch – certain individual coverage plans (“grandfathered” plans) are exempt from the law, meaning that families might have to apply for entirely new policies in order to get their child insured. Effective for health plan years beginning on or after September 23, 2010 for new plans and existing group plans.

Prohibiting Insurance Companies from Rescinding Coverage.
This provision makes it illegal for insurance companies to search for an error, or other technical mistake, on your application and use the error to declare the policy invalid and deny payment for services when you sick.  However, insurance companies may still rescind coverage if you intentionally put false or incomplete information on your insurance application.  Effective for health plan years beginning on or after September 23, 2010.

Eliminating Lifetime Limits on Insurance Coverage.
Insurance companies can no longer place lifetime dollar limits on essential benefits.  Essential benefits include “ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.”  Companies can still put dollar limits on benefits deemed non-essential.  The plan also aims to phase out and eventually prohibit annual limits for essential benefits by 2014, though again, some policies existing before March 23, 2010 have been grandfathered in, and do not have to follow the annual limits regulations.  Effective for health plan years beginning on or after September 23, 2010.

Appealing Insurance Company Decisions.
The provision is meant to provide consumers with a way to appeal coverage determinations or claims to their insurance company – in other words, it lets you ask that your plan reconsider its decision not to pay for a service or treatment.  After internal review, if the company comes to the same decision, you can appeal to an independent reviewer not associated with your health plan. Appeal rights, however, vary by state, and some company plans have more than one internal review before you can seek an external one.  Effective for new plans beginning on or after September 23, 2010.

Establishing Consumer Assistance Programs in the States.
Essentially, this provision gives federal grants to states to help consumers educate themselves about the private health insurance system.   As it stands now, the government has given out nearly $30 million dollars under this provision. This money is funding programs that are meant to help consumers file complaints and appeals; enroll in health coverage; and get educated about their rights and responsibilities in group health plans or individual health insurance policies. They will also collect data on the types of problems consumers have, and file reports with the U.S. Department of Health and Human Services to identify trouble spots that may require further oversight.

Visit this site http://www.healthcare.gov/news/factsheets/capgrants_states.html for a state-by-state breakdown of how exactly the money is being spent. Grants Awarded October 2010.