summary and timeline for introduction of various features of the HCR law - USA Today

[JohnWxy]

This is a pretty good summary of the various features of the Health Care Reform Law and when these features will be introduced. Some start within 6 months of enactment (i.e. Sept 2010) such as No Denial of coverage of children with pre-existing conditions, coverage of dependent children up to age 26 and a temporary high-risk insurance pool for those "with pre-existing medical conditions who have been uninsured for at least six months".



http://www.usatoday.com/news/washington/2010-03-22-health-you_N.htm

2010 -----

Temporary high-risk insurance pool: A $5 billion pool would be created to provide health to individuals with pre-existing medical conditions who have been uninsured for at least six months. Effective date — June 2010 (expires Jan. 1, 2014)

Pre-existing conditions: Insurers would be barred from denying coverage to children who have pre-existing medical conditions. Effective date — Six months after enactment

Adult dependent children: Insurance companies would have to provide coverage for dependent children up to the age of 26. Effective date — Six months after enactment

Insurance coverage limits: Insurance plans would be prohibited from placing lifetime limits on how much they pay out to individual policyholders and from rescinding coverage except in cases of fraud. Effective date — Six months after enactment

Preventive services: Health insurance plans would be required to cover preventive services such as immunizations for children and cancer screenings for women. Effective date — Six months after enactment

Medicare drug rebates: Medicare patients who face a gap in prescription drug coverage would receive a one-year, $250 rebate to help pay for medication. Effective date — Immediately

2011 -

Insurance rebates: Health insurance companies would be required to provide rebates to enrollees if they spend less than 85% of their premium dollars on health care as opposed to administrative costs. Effective date — Jan. 1, 2011


2014
 
Individual mandate: Most Americans would be required to buy health insurance or pay fines of $95 per individual up to $285 per family or 1% of taxable household income, whichever is greater. Effective date — Jan. 1, 2014

Employer requirements: Companies with 50 or more employees would pay a fine if any of their full-time workers qualified for federal health care subsidies. Effective date — Jan. 1, 2014

Health insurance exchanges: A state-based health care exchange -- a marketplace where uninsured individuals and small businesses could comparison shop for insurance policies -- would be created. Effective date — Jan. 1, 2014

(more)

While under 2014 they did point out: "Individual mandate: Most Americans would be required to buy health insurance or pay fines" ... What they left out was that this "Individual mandate" also means - No Denial of Coverage for Pre-existing Conditions for everyone ... because these are two sides of the same coin. You can't have "No denial for Pre-existing Conditions" unless you also have Individual Mandates.

THis is fairly important as this is the essential feature which was most wanted by everybody. THis feature is what makes this law Health Care REFORM ... stopping the denial of coverage due to pre-existing conditions.


.... BUT Note also, the Insurance Rebates - a not very much mentioned feature of the law which will require Health insurance companies to provide rebates to enrollees if they spend less than 85% of their premium dollars on health care as opposed to administrative costs. Effective date — Jan. 1, 2011

You may recall the oft mentioned number of 21% as the administrative costs of health insurance companies. Interestingly enough a week or so ago, on PBS Newsour they were interviewing an expert on Health Care and she said that the insurance companies typically pay out 60% of the premiums dollars they receive for medical claims.(???). So, although the administrative costs have been quoted as 21% they actually are keeping 40% of the receipts of premiums for Admin costs and PRofits. That would make profits to be 19%!! Either that or profits are 5% as the insurance companies have claimed and administrative costs are 35% ...defined in this functional way.

THis also would mean that if the insurance companies continue to pay out 60% of what they take in in premiums - on medical claims, on average a person with insurance should be expecting a 25% rebate (85% - 60% = 20%) in 2011. Either that, or see their premiums at least stabilize or perhaps go down.












 

[Mme. Defarge]

1. First time I have heard

of the rebate. Thanks!