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Yesterday, Nancy-Ann DeParle of the Office of Health Reform joined bloggers for a conference call to highlight the provisions of the Affordable Care Act that go into effect tomorrow, six months after enactment of the law. Those changes:

  • Ban on discriminating against children with preexisting conditions: as of tomorrow, insurance companies can't deny coverage to children under age 19 for a pre-existing condition. The ban will go into effect for adults in 2014.
  • Ban on rescission: insurers will be prohibited from dropping a customer when they get sick or to search for errors in customers' applications to use as a basis for rescinding coverage or denying payment for services.
  • Ban on limiting coverage, lifetime caps: Insurers will no longer be able to impose lifetime dollar limits on benefits--particularly hospital stays or expensive treatments for chronic diseases, cancer, etc. By 2014, they will phase out annual caps.
  • Ban on limiting doctor choice in new plans: insurers will have to allow primary care physician status for OB/GYNs and pediatricians so that patients don't have to get pre-authorization or referrals to see these providers.
  • Ban on restrictions on emergency services: insurers will have to cover all emergency care, in or out of network.
  • Guaranteed right to appeal insurer decisions to independent third party in new plans;
  • Young adults can stay on their parents' plans til 26 unless they have access to coverage in their workplace;
  • New plans will cover preventive care with no customer costs--well-baby, mammograms, colonoscopies, etc. will be covered with no co-pays or deductibles.

Many of these changes will not apply to existing plans. Health plans that existed on March 23, 2010 are "grandfathered," meaning they are exempt from implementing these new provisions. So free preventive care, unrestricted provider choice, level charges for emergency care, and the right of appeal do not apply to existing plans. Additionally, the coverage for adult children on family plans can only be extended if an employer plan is not available to them.

The White House unveiled the reforms with a new Web site.

Today, President Obama is celebrating the six month anniversary of the Affordable Care Act. To help celebrate, we are unveiling a new website –  that provides critical information regarding the Affordable Care Act. The site includes 50 stories from individuals and employers in every state and new state-by-state reports that detail how reform is already strengthening the health care system in your state.

Unfortunately, some of the thunder was stolen from this roll-out by the health insurers figuring how to game one of the most important of these reform. Health Care for America Now broke the story of major insurers ending plans for children just before the regulations kick in to avoid covering children with pre-existing conditions.

Major health insurance companies in California and other states have decided to stop selling policies for children rather than comply with a new federal healthcare law that bars them from rejecting youngsters with preexisting medical conditions.

Anthem Blue Cross, Aetna Inc. and others will halt new child-only policies in California, Illinois, Florida, Connecticut and elsewhere as early as Thursday when provisions of the nation's new healthcare law take effect, including a requirement that insurers cover children under age 19 regardless of their health histories....

The action will apply only to new coverage sought for children and not to existing child-only plans, family policies or insurance provided to youngsters through their parents' employers. An estimated 80,000 California children currently without insurance and as many as 500,000 nationwide would be affected, according to experts.

Insurers, of course, say that health reform would create such huge and out of control costs for them that they can't possibly extend coverage to these children. WellPoint, the parent company to Anthem Blue Cross, had better than anticipated second quarter net income of $722.4 million. Aetna "said second-quarter earnings rose 42%."

David Dayen specifically asked DeParle about the situation, asking "How do you resolve the inherent tension of for-profit companies at the heart of the system, with every motive to subvert the law?"

DeParle responded with disappointment at insurance companies dropping child-only policies, noting that many insurance companies started doing this in April and May. “To put it in context, a few hundred thousand children are in child-only policies, because of employer plans that have coverage only for themselves and not dependents,” she said, “and insurers are not proposing to drop already written policies.” She hoped that children have more options now than before, through Medicaid and SCHIP, so that a very small number would be affected by the child-only policy shift.

As for the persistent effort from insurers to undermine the law, DeParle agreed that insurers have engaged in these efforts. She claimed that the difference now is the transparency around it. “We have new resources, new scrutiny, sunlight cast upon the regulatory framework, as well as what HHS will do to establish what a reasonable rate increase is.” In addition to the willingness of politicians to cast light on the practices of insurers, DeParle highlighted the fact that North Carolina Blue Cross and Blue Shield just announced $155 million dollars in refunds to about 200,000 customers because of the new law.

What it's really going to come down to is constant vigilance on the part of consumers, state insurance commissioners, and federal regulators to stay on top of abuses by the insurers. Public backlash, thus far, has been the most effective tool to use against their abusive practices. Until they no longer have a captive pool of customers and another option, like a public option, is available to provide competition, they will continue to find the loopholes. The Affordable Care Act does give consumers critical new protections and more tools to fight the insurers with, but the fight for universal, adequate, and affordable care is going to have to continue.

Originally posted to Daily Kos on Wed Sep 22, 2010 at 02:20 PM PDT.

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