The 90-day anniversary of President Obama's signing of the Affordable Care Act was marked today with a White House meeting with stakeholders, including insurers, state insurance commissioners and administration officials. Additionally, HHS released the first set of regulations for the new law. In the meeting, Obama warned insurers against rate increases.
"Our concern is that they not try and, under the cover of the act, get in under the wire here on rate increases," Obama's senior adviser David Axelrod told the newspaper.
The White House is concerned insurers will blame the new law for premium increases that really are intended to maximize industry profits, the newspaper said....
On Monday, a survey released by a non-profit healthcare group said insurers are raising prices by an average of 20 percent for working age adults who buy their own policies.
There is some help now in the regulations, in the form of $51 million in grant funding to states to pay for more stringent review of insurance premiums. Congress could, and should, still act on this by taking up the rate review legislation introduced by Diane Feinstein. This provision was backed by the White House in the late debate on the bill, but didn't meet the budget rules for reconciliation, so wasn't included in the final package. It would allow HHS to oversee rate increases on a national level. If today's threat against insurers is going to be effective, it should include the threat of consequences, not limited to this rate review authority under HHS, but including the possibility of a Medicare expansion or public option.
Today's action wasn't limited to this warning to insurers. The administration also released the first set of regs for the parts of the Act that will be implemented this year, and what they are calling the "New Patients’ Bill of Rights." Here's a fact sheet [pdf] from HHS outlining those regs and the benefits for consumers being implemented this year.
Today, the Departments of Health and Human Services (HHS), Labor, and Treasury issued regulations to implement a new Patient’s Bill of Rights under the Affordable Care Act – which will help children (and eventually all Americans) with pre-existing conditions gain coverage and keep it, protect all Americans’ choice of doctors and end lifetime limits on the care consumers may receive. These new protections apply to nearly all health insurance plans.
How These New Rules Will Help You
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Stop insurance companies from limiting the care you need. For most plans starting on or after September 23, these rules stop insurance companies from imposing pre-existing condition exclusions on your children; prohibit insurers from rescinding or taking away your coverage based on an unintentional mistake on an application; ban insurers from setting lifetime limits on your coverage; and restrict their use of annual limits on coverage.
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Remove insurance company barriers between you and your doctor. For plans starting on or after September 23, these rules ensure that you can choose the primary care doctor or pediatrician you want from your plan’s provider network, and that you can see an OB-GYN without needing a referral. Insurance companies will not be able to require you to get prior approval before seeking emergency care at a hospital outside your plan’s network. These protections apply to health plans that are not grandfathered.
Here's a quick summary of the remaining points:
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Reviewing Insurers’ Premium Increases. HHS recently offered States $51 million in grant funding to strengthen review of insurance premiums....
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Getting the Most from Your Premium Dollars. Beginning in January, the Affordable Care Act requires individual and small group insurers to spend at least 80% and large group insurers to spend at least 85% of your premium dollars on direct medical care and efforts to improve the quality of care you receive – and rebate you the difference if they fall short....
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Keeping Young Adults Covered. Starting September 23, children under 26 will be allowed to stay on their parent’s family policy, or be added to it....
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Providing Affordable Coverage to Americans without Insurance due to Pre-existing Conditions: Starting July 1, Americans locked out of the insurance market because of a pre- existing condition can begin enrolling in the Pre-existing Condition Insurance Plan (PCIP)....
New Consumer Protections Starting As Early As This Fall
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No Pre-Existing Condition Exclusions for Children Under Age 19. ...The new regulations will prohibit insurance plans from denying coverage to children based on a pre-existing conditions....
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No Arbitrary Rescissions of Insurance Coverage....Under the regulations, insurers and plans will be prohibited from rescinding coverage – for individuals or groups of people – except in cases involving fraud or an intentional misrepresentation of material facts....
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No Lifetime Limits on Coverage....The regulation released today prohibits the use of lifetime limits in all health plans and insurance policies issued or renewed on or after September 23, 2010....
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Restricted Annual Dollar Limits on Coverage.... The rules will phase out the use of annual dollar limits over the next three years until 2014 when the Affordable Care Act bans them for most plans. Plans issued or renewed beginning September 23, 2010, will be allowed to set annual limits no lower than $750,000. This minimum limit will be raised to $1.25 million beginning September 23, 2011, and to $2 million beginning on September 23, 2012....
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Protecting Your Choice of Doctors.... The new rules make clear that health plan members are free to designate any available participating primary care provider as their provider....
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Removing Insurance Company Barriers to Emergency Department Services.... The new rules make emergency services more accessible to consumers. Health plans and insurers will not be able to charge higher cost-sharing (copayments or coinsurance) for emergency services that are obtained out of a plan’s network. The rules also set requirements on how health plans should reimburse out-of-network providers....
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