EDITORIAL: Health reform begins

By NEMS Daily Journal

The first implementation of the Patient Protection and Affordable Care Act – the health insurance reforms passed and signed into law earlier in 2010 – took effect Thursday with almost passing notice, and many people aren’t expected to do anything differently about health insurance issues until policy renewals, usually Jan. 1 of each year.
The provisions, described as consumer protections, eventually will materially affect insurance practices – some think for the good and some convinced they portend a disastrous national policy.
Nationwide, Pollster.com, an online poll reporting site, said on Thursday that 47.8 percent of people surveyed oppose the reforms and 39.6 percent favor them.
For all plans – including individual and group policies as well as employer-sponsored plans, as reported in The Washington Post – insurers will no longer be permitted to:
• Deny coverage to children with pre-existing conditions, but the law does not necessarily prevent higher premiums. Insurers are also prohibited from excluding coverage of medical bills arising from a child’s preexisting condition. Americans of all ages will be able to get the protections after 2014.
• Put lifetime limits on benefits. A plan can still put a lifetime dollar limit for health services that the government deems non-essential, as do some private and corporate insurance policies.
• Cancel a policy retroactively without proving fraud. The rule is designed to deal with a practice by which insurers could cancel coverage as a person got sick, on grounds that they or the employer provided inaccurate information. The Post further reported that “innocuous” inaccuracies will have to proven to be more than an honest mistake.
Additional provisions guarantee:
• The right to appeal denial of claims. People have a right demand a health plan reconsider a decision to deny payment.
• Free preventive services. Many plans already have preventive coverage, but the law requires access to a range of recommended preventive services without cost.
• Young adults can stay on a parent’s plan until age 26. The age is usually 25, so one additional year is mandated.
• Choice of primary care doctors, obstetrician/gynecologists and pediatricians remains with patients within provider networks, as is widely the case now, and will allow an ob/gyn appointment without required referral from another doctor.
• The right to use the nearest emergency room without penalty. Plans can no longer require pre-approval for seeking emergency room services outside a plan’s network. We hope this rule is not abused by patients.
As with all complex government programs, the finer print will come into play with use, and that’s when the federal government, state insurance commissioners and health care providers should be fully able to provide explanations – and all patients should try to understand the rules.
The website www.healthcare.gov provides information, as does the Mississippi Department of Insurance website, www.mid.state.ms.us.
We hope, in good faith, that the new law provides relief, help and better care for millions of Americans, as promised, and if it doesn’t work, then congressmen in both parties should change the law to make it effective.
Polls have found that many of the provisions that took effect Thursday are popular, and we hope they increase fairness and diminish distrust of private-sector insurers, which are overwhelmingly reliable.
A government report shows that the recession raised the number of uninsured Americans to 50.7 million in 2009, up 10 percent in a year.
We hope the relief is as real as the need.

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