Voices for Reform Newsletter

San Diegans for Healthcare Coverage

Voices for Reform
Working Together Towards a Healthier Community


September 22, 2010


San Diegans for Healthcare Coverage (SDHCC) is a coalition for health, the trusted community leader and unbiased resource: Convening the community, providing the voice, and serving as the navigator to achieve optimal health coverage and care for all San Diegans.


New Provisions of Healthcare Law Take Effect This Week
September 23 is an important date for health reform, as several new provisions of the Patient Protection and Affordable Care Act (PPACA) become law.  This Newsletter highlights a few of the most significant provisions effective September 23: 
• Young adults. If they lack coverage, they can stay on their parents' plans until they turn 26.
• Children.  Children may not be denied healthcare coverage if they have a pre-existing medical condition.
• Tax credits. As many as 4 million small businesses are eligible for tax credits of up to 35% of their health insurance costs.
• Lifetime and Annual Limits on Costs. Lifetime limits of healthcare costs are eliminated, and minimum standards for annual limits have been set for the next few years, until all limits are eliminated on January 1, 2014.
• High-risk coverage. People with pre-existing conditions, and  who have been uninsured for at least six months can apply for health coverage through a new California high-risk pool established by PPACA.

Each of these new provisions is discussed in more detail below.  As if often the case, the devil is in the details, and there will still be instances when individuals may not receive the benefits of these new changes.  For additional information, please go to www.healthcare.gov and if you have questions and/or problems with these provisions, please call 877-734-3258, the San Diego Consumer Center for Health Education and Advocacy.
Read More >


Extension of Coverage of Adult Children to Age 26
• All health plans must permit adult children to remain on their parents' plans until age 26. It makes no difference if the young adults are married or financially independent, students or not.  As long as children don't have an offer of coverage from their own employer, parents can keep them on their plan.
• If you want to put an adult child on your plan, you'll be given an opportunity to do so during a special enrollment period. At most companies that will coincide with open enrollment, say benefits consultants. Even if it doesn't, insurers and employers are required to notify you of the special enrollment period. Look for that notice.
• Under the law, plans can't charge more for adult children than for dependents younger than 19. But they can increase the cost of family coverage overall, and many will do so, according to an employer survey released last week by the benefits consulting firm Mercer. The survey found that more than half of employers that plan to shift more costs onto employees' shoulders will do so by disproportionately increasing the cost of family coverage compared with employee-only coverage.   (Kaiser Health News, 9/14/2010)
Read More >

Coverage of Children under 19 with Pre-existing Conditions
After September 23, 2010, health plans that cover children (under age 19) can no longer exclude, limit, or deny coverage solely based on a health problem or disability that the child developed before applying for coverage. This new rule applies to all job-related health plans as well as individual health insurance policies issued after March 23, 2010. The rule will affect your plan beginning at its next open enrollment period on or after September 23, 2010.

• This rule applies whether or not your child’s health problem or disability was discovered or treated before you applied for coverage.
• The new rule doesn’t apply to “grandfathered” individual health insurance policies. A grandfathered individual health insurance policy is a policy that you bought for yourself or your family (and is not a job-related health plan) on or before March 23, 2010 (the date that the new law was passed).
• These protections will be extended to Americans of all ages starting in 2014.

Since this rule was announced, several health plans have decided they will not issue child only policies on the individual market.  In that instance, the child could be covered only under a family policy, assuming that the adult applicant is accepted for coverage.
Read More >

Tax Credits for Small Business
The Affordable Care Act helps small businesses and small tax-exempt organizations afford the cost of covering their employees.  If you have fewer than 25 full-time equivalent employees and provide health insurance you may qualify for a small business tax credit of up to 35% (up to 25% for non-profits) to offset the cost of your insurance. This will make the cost of providing insurance much lower.  An excellent explanation of the tax credit and a calculator tool to determine your tax impact can be found at http://www.smallbusinessmajority.org/tax-credit-calculator/index.php
Read More >

Lifetime and Annual Coverage Limits
Lifetime coverage limits will be eliminated as health plans renew their coverage for the coming year, after September 23, 2010. 

Annual limits will not be eliminated until January 1, 2014, but beginning September 23, 2010, employer plans can't impose annual coverage limits of less than $750,000 for "essential" health benefits, including hospital services, drugs, emergency services and maternity and newborn care.  This limit will be increased every year prior to 2014, at which time there will be no annual limits permitted.
Read More >

California’s New High Risk Pool
Under PPACA, California has established a new high risk pool for individuals (www.Pcip.ca.gov)
who have been denied care or offered unaffordable coverage due to pre-existing conditions, have been uninsured for at least six months, and are citizens or legal residents.  Applications for this new pool, called the Pre-existing Condition Insurance Plan (PCIP), are now being accepted.

The premium cost is listed on the application form:  for example, an eligible 18 year old person living in San Diego would pay a monthly premium of $181, a 42 year old in San Diego would pay $306/month, and a 60 year old would pay $723/month.

California will receive $761 million in federal funds to operate PCIP through the end of 2013.  It is possible that funding will not cover everyone who requests coverage, so submit your application as soon as possible.  Interested individuals can apply on-line at http://www.pcip.ca.gov/Publications/PCIP_Supplemental_Application.pdf
Read More >


Healthcare reform should be here to stay - The Miami Herald, 9/22/10
OUR OPINION: Need for health insurance mandate has grown
Just as the federal healthcare reforms are set to kick in this week, fresh evidence arrives from the Census Bureau that underscores the genuine need for fundamental change in the way Americans receive medical attention: The number of uninsured in America reached nearly 51 million people in 2009, compared to 46.3 million in 2008. That was an increase from 15.4 percent of the population in 2008 to 16.7 percent in 2009.

Many of these newly vulnerable Americans don't fit the conventional stereotype of people who don't have, and can't get, insurance. They're middle class, and either recently unemployed or simply unable to access the health insurance market for one reason or another. According to the Census Bureau, of the 4.4 million newly uninsured, roughly half have incomes of $50,000 or more.

This is part of the population that the Patient Protection and Affordable Care Act -- ``Obamacare'' -- that Congress passed earlier this year was meant to protect. Unfortunately, the law's mandate that all Americans have health coverage does not go into effect until 2014.

That was a compromise designed to win support for the law. With joblessness lingering and the economy recovering far too slowly, it's a good bet that when the mandate kicks in, the need will be just as great, if not greater, than it is today.

As reported by The Miami Herald's John Dorschner this week, many other features of health reform changes will take effect on Thursday, and not a minute too soon for those with the greatest need.

Among them are the elimination of co-payments for a variety of preventive services and screenings, eliminating lifetime insurance caps, high-risk pools for those who can't get insurance elsewhere and coverage for children up to age 26 through their parents' policies.

Another provision eliminates denial of coverage for children with pre-existing conditions, but already some insurance companies are trying to diminish its impact. Three major insurers -- WellPoint, Cigna and CoventryOne -- have said they would stop offering new child-only insurance plans rather than comply with new rules that require these plans to start accepting children with pre-existing medical conditions after Thursday.

Children who already have child-only policies will not be affected, and kids with pre-existing conditions will be accepted in new family policies. Still, the insurance companies' tactic points to a need for Congress to tweak the law next year.

Indeed, there are many reasons to revisit the package, if only to eliminate confusion and improve guidelines. The requirement that insurance companies spend 85 percent of premiums on healthcare needs better definitions of what constitutes administrative costs, for example.

But tweaking the law and trying to get rid of it altogether, as a lawsuit filed by Florida's attorney general and others aims to do, are two different things. The law is an investment in the health and future of the American people. It can be improved, but it should become a permanent feature of American society.

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