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Health Care: 18 down, 888 to go...

January 14, 2011 - Mary Ann Heath
Eighteen pages later, and I’m still alive...barely.

I’m only about a 2 percent of the way through, but I think the “Patient Protection and Affordable Care Act” is moving in the right direction to improve health care in the United States.

“Title I—Quality, Affordable Health Care For All Americans,” begins with “Immediate Improvements in Health Care Coverage for All Americans.” This section deals with the elimination of lifetime and annual limits on insurance, designates coverage of preventive health services, extends dependent coverage, calls for the development of uniform explanations of coverage and definitions, prohibits discrimination based on salary and ensures quality by developing reporting standards.  It also prevents rescissions — or cancelling an insurance policy once an enrollee is covered, even if the beneficiary becomes ill. 

• Limits: The bill does away with “unreasonable” annual and lifetime limits. It’s nice to know that if I develop cancer sometime in the future, my insurance won’t run out part of the way through treatment. Imagine fighting a devastating and deadly disease like cancer, making it 70 percent of the way through treatment and then discovering you’ve reached the lifetime limit on your insurance. Now you must foot the bill, or quit the fight and possibly even die. According to an AARP article, ten percent of cancer patients surveyed said they hit their lifetime limit and their insurers would not pay for further medical care. 

• Preventive Services: The bill says insurance providers must cover all preventive-type services and does away with copays or deductibles for these services. Whew! Now this is really a plus. Preventive services include most of the not-so-fun procedures we endure for the sake of our good health and catching nasty diseases, like cancer, early before they become life-threatening. Now, they are a little less pleasant because we don’t have to pay another $20 to $30 (on top of the money that already comes out of our paychecks for insurance) to have them done. It also eliminates one more excuse not to go visit your doctor. 

• Dependent Coverage: Insurance for dependents carried on their parents’ insurance has been extended through age 26. Too bad nobody thought of this when I was in my early 20s and got kicked off my mom’s insurance. (Too bad for my teeth, too — seven years without a check-up, I’m glad they didn’t fall out). Statistics from the National Conference of State Legislatures reports that approximately 30 percent of Americans between the ages of 19 and 29 have no health insurance. “This age group makes up 13 million of the 47 million Americans currently living without health insurance,” the NCSL website reads. The extension, already in effect, will greatly reduce that number. 

• Uniform Explanations: Within a year of the bill’s passage, the Secretary must put together standards for insurers that supply summaries of benefits for enrollees. Guidelines for these standards include that summaries be no longer than four pages and not include type smaller than 12 points. Also, the summaries are supposed to be culturally and linguistically appropriate. Hard to disagree with this. No one wants to read 7 pages of type so small it gives you a migraine. Of course, no one ends up reading it, which is the point. The fine print is traditionally how companies pull a fast one on you. These summaries must also include definitions of insurance terms, and other important information, like cost-sharing provisions and exceptions. My “COBRA,”  is “actuary” very excited. He has “coinsurance,” and will attend “capitation.” (I have no clue what any of these terms mean, do you?) Hooray for uniform definitions! Now maybe we can understand our own insurance policies.

• Rescissions: Cancelling an enrollee’s insurance once already covered (if they haven’t committed fraud, for which there is an exclusion) isn’t only unfair, it should be criminal. Try charging someone for a product and when they need it, refuse to deliver it. We all know how that would go. So why should insurance companies get away with it? Well now they can’t. Insurance is not just for healthy people. Besides, doesn’t that defeat its purpose?

• Salary: The bill prohibits discrimination based on how much a person makes. Good. Do we really want to live in a world where money determines how good your health care is? Oh, right. We already do. Maybe the health care bill will move us closer to a world where rich or poor, health care is attainable and affordable. (Isn’t that the point?)

Based on this initial reading, it is hard to determine why everyone is making such a fuss. Of course, I still have 888 pages left to go.

Section 2718: “Bringing Down the Cost of Health Care Coverage.” Sounds promising...


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