| Legislative News
By Peggy Hathaway
The new health care reform legislation provides that people with disabilities and other preexisting conditions can purchase health insurance. How is it expected to work? Two different measures go into effect at different times. Temporary high risk pools (described below) are expected to cover people starting shortly.
Effective January 1, 2014, the law prohibits all exclusions due to pre-existing conditions and there can be no caps on annual or lifetime benefits. In the meantime, lifetime caps are prohibited and the Secretary of Health and Human Services (HHS) may restrict caps on annual benefits. While the temporary provisions are not perfect, they are a big improvement over existing law which allows insurers to deny coverage to people with pre-existing conditions altogether, charge them much higher premiums, offer coverage that excludes treatments related to their pre-existing conditions, and impose caps on annual and lifetime benefits.
Temporary High Risk Pools
Who is eligible?
US citizens and legal residents with pre-existing conditions who have had no health coverage for at least 180 days. What will be the costs to those insured? The good news is that premiums must be calculated at the standard rates charged to the general population. They cannot be set higher just because the pool will be 100% people with known health issues. There will be subsidies for some people with lower incomes who do not qualify for Medicaid or Medicare, but the particulars of these subsidies have not yet been determined. The bad news for older people is that premiums may vary 4:1 by age. That means that a person with a disability who is older can be charged up to 4 times as much as a young person with a disability. The limits on out-of-pocket expenses are not much comfort for many people. They must be consistent with high-deductible health savings accounts plans: currently $5,950 for an individual and $11,900 for a family.
Where can someone apply for coverage?
The answer to this is not presently known. It is likely to be either your state of residence or the federal government through the Department of Health and Human Services (HHS). Currently, 35 states already have high risk pools, though the premiums are often very costly and there are often long waiting periods to enroll. HHS Secretary Kathleen Sebelius has asked states to specify by April 30, 2010, what they would like to do. To the extent that states do not choose to have a high risk pool that complies with the requirements of this new legislation, HHS will either help establish one in that state or residents of that state will be eligible for a national high risk pool.
When will coverage be available in the high risk pools?
Funds become available in June for this program. While it is uncertain when it will go into effect in the various states, HHS hopes it will be shortly. Another problem is that HHS has $5 billion to cover this program. Because it is unlikely that $5 billion will be enough for all the costs, it is possible that funds will run out before 2014, leaving people without this coverage until the permanent provisions kick-in.
To voice your concerns about health care and other public policy issues, please go to www.spinalcordadvocates.org
Peggy Hathaway is vice president for Public Policy.
This article also appeared in Able News.
