Health Care Reform – The Six Month Mark

September 27, 2010

September 23, 2010 may well prove to be a particularly important day in the health care reform journey. On that day, six months after the Affordable Care Act was signed into law, several key provisions went into effect that were designed to help people see some immediate benefits in advance of the full blown implementation of the law starting in 2014. The most significant provisions that went into effect included the:

• End to lifetime limits on health benefits;

• Ability of young adults to stay on their parent’s health policies until age 26 regardless of whether or not they are legally dependent on their parents;

• Prohibition of the exclusion of children from health coverage based on pre-existing conditions;

• Requirement that certain preventive services be include in health benefit plans without copays or deductibles; and,

• Beginning of the phase out of annual limits on health benefits.

The first two provisions are likely to have the most positive, short term impact on individuals and families. The first provision will most particularly affect a small but important segment of the population – those with a serious disease. These are individuals who have diseases like hemophilia, where the cost of the clotting factor necessary to sustain life is in excess of $50,000 per year. Or, those like the family profiled in the New York Times on Sept 23, 2010 whose daughter was born with spinal muscular atrophy and whose care had cost more than $2 million by the time she was three. These are individuals and families who have been desperate for this provision to take effect so they no longer have to fear that they will run out of benefits when they need it the most.

Young adults and parents of those to age 26 are another segment of the population that has been looking forward to the  six month anniversary of health care reform. Families USA has estimated that the ability to stay on a parent’s health policy will affect two million young adults in the country (33,000 here in Michigan). In talks I have done on health care reform, I have had employers – those who purchase health benefits – come up to me to tell me that they have just been waiting for this provision to take effect so that they can get affordable coverage for their own children. They felt they could not make this change in their health benefit plans unilaterally but are looking forward to this now since all plans (i.e., all employers) are equally affected.

These are the kinds of stories the architects of the health reform law have been waiting for in hopes that they will help the public see the benefits of the law. But, it’s too soon to tell and there are some concerning signs that this might not be the case.

First of all, other provisions of the law went into effect over the summer/early fall and did not have the kind of positive effect on public opinion that many had hoped. These included $250 rebate checks to senior citizens who had reached the “doughnut hole” in their prescription drug coverage and the launch of the temporary high risk pools designed to help people who had been excluded from coverage due to pre-existing conditions. These were important provisions of the Affordable Care Act but did not seem to register with people as having resulted from health reform.

The second concerning sign has been the reaction of some for-profit insurers to the new provision. Some of these health insurers greeted September 23 by announcing the elimination of “child only” policies, resulting in the loss of coverage for some children. When families called to express their concern, they were told that they should “blame [loss of coverage] on President Obama.” And, while this should no longer be an issue come 2014, four years is a long time for many families to wait for affordable health coverage.

It is hard to tell at this moment whether the positives that many families will experience from the provisions that went into effect on September 23 will be enough to offset the confusion and negative press that has been the focal point of much of the coverage of health reform to date (exacerbated by the politics of the mid-term elections). But, it is certain that one way or the other, September 23, 2010 was an important date in ever unfolding story of health reform and the Affordable Care Act.