Health Reform: Help for Families in 2010
11:51 AM EDT
Congress is on the verge of an historic achievement for which the American people have been waiting for decades: The passage of real health insurance reform that will bring stability and security to Americans with insurance and provide affordable options to those who don’t. It will protect individuals and families from unfair and arbitrary insurance practices and will at last shift the power away from insurance companies and into the hands of consumers.
Enactment of these historic reforms will be a monumental accomplishment and will be a victory for the interests of consumers against ferocious opposition from the insurance industry and others invested in the status quo. And while there are parts of reform that will take some time to get up and running, there are a great many benefits that will kick in during the very first year to help families and small businesses get control over their health and their health insurance costs.
If you or somebody in your family has a pre-existing condition, you’ll get help in 2010: Both the Senate and House bills will make it illegal for insurance companies to drop coverage for Americans who get sick. Insurance companies will also be barred from limiting the total benefits Americans can use over the course of a year or over their lifetimes. Affordable insurance coverage options will also be made immediately available through a high-risk pool for Americans who have been uninsured and have been denied coverage because they have a pre-existing condition. These options will serve as a bridge until the new health insurance marketplaces, or exchanges, are up and running.
If you or your family has insurance, you'll get help in 2010: The scales will no longer be tipped against you in your relationship with your insurance company. More of your money will start going towards your care instead of excessive insurance company profits or TV ads. Between 2010 and 2013, insurance companies will be required to report the proportion of premium dollars that are spent in areas other than medical care – including profits. If a company isn’t spending enough of its premium dollars providing benefits, it will be required to issue rebate checks to its customers to make up the difference. Insurance companies will also immediately have to begin creating effective appeals processes for customers who have been denied claims ---including independent reviews---and the legislation provides grants for states to create ombudsmen to act as consumer watchdogs on health insurance coverage.
If you want to keep your family from getting sick in the first place, you’ll get help in 2010: All insurance plans will have to begin covering preventive services. That means all Americans who purchase insurance on their own will receive preventive care from their doctor without paying a co-pay.
If you’ve got kids, you’ll get help in 2010: Insurance plans that cover dependents will also have to provide benefits to adult children up to age 26, covering young Americans at a time when they’re most likely to lack coverage.
If you’re an early retiree with coverage from your former employer, your premiums will be reduced: Employers and their retirees between 55 and 64 years of age will have lower premiums from new re-insurance helping to ensure the continuation of these essential benefits
If you’re a senior, you'll get help in 2010: Major help on prescription drug costs will begin kicking in, with dramatic reductions on the costs of brand name prescription drugs for seniors. In addition, the coverage gap, or “doughnut hole” in the Medicare Prescription Drug Program will be closed over the next few years.
So as we come to the end of this debate, it’s important to take stock of what American families and small businesses will get from reform:
- Reforms that will generate the largest deficit reduction in 12 years;
- Reforms that will rein in insurance companies and shift power to patients, doctors, nurses and American families.
- Reforms that will actually reduce premiums and save money for American families and small businesses;
- Reforms that will strengthen the financial health of Medicare while closing the prescription drug doughnut hole – the most significant boost to Medicare's solvency in more than a decade.
- Reforms that will make quality affordable health care available to tens of millions of Americans – the most significant action since Medicare.
We are on the verge of the most historic improvement in American health care in half a century.
Let's get it done.
Nancy-Ann DeParle is Director of the Office of Health Reform