What are you getting for your $1 billion?
August 4, 2010 12:59 PM   Subscribe

How anyone (or anyone you know) benefited in one respect or another from the provisions in the new U.S. health care bill? I'm not asking this in Fox News-ish way, I am actually curious.

What I mean to say is, as an outsider I am curious to hear if/how the bill is benefiting people on the ground, as we speak.

Of course I know that many of its most important elements don't kick in for another 5-6 years, but I do believe that there were some rules about regulating insurance practices that were to kick in immediately.

On a side note, if I were working for Fox News, I suppose I would gather a bunch of old disgruntled Caucasian folks in a room and ask them what they thought of "Obamacare", rather than putting this question out to the MeFi masses.
posted by hiteleven to Health & Fitness (27 answers total) 4 users marked this as a favorite
Shortly before the bill was signed, a friend of mine with two special-needs kids got a letter from his insurance company saying their coverage was going to be dropped soon. Shortly after the bill was signed, they got another letter saying "never mind."
posted by spilon at 1:06 PM on August 4, 2010 [8 favorites]

Response by poster: I guess I meant to say that its most important provisions kick in in another 3-4 years...for some reason I was counting back to 2008 in my mind.
posted by hiteleven at 1:09 PM on August 4, 2010

As a side note some businesses in Massachusetts ( Which has a similar plan) have dropped the benefit. Telling employees to fend for themselves on the Commonwealth Connector. Perhaps a taste of what is to come.
posted by Gungho at 1:17 PM on August 4, 2010

Probably only partially related, but my employer sent us all a letter informing us we'll be getting some new health plan choices. In addition to the present HMO/PPO options, we can choose a High Deductible Health Care Plan which includes an employer-matched Health Savings Account, or something they're calling "Employee Plus One" insurance. Details are thin at this point, but the "Employee Plus One" sounds like it's meant for, say, married couples with no kids - basically a cheaper family plan that only covers two people.

The biggest difference I noticed with these plans is that the Health Savings Account will roll over now; previously, every HSA I encountered was use-it-or-lose-it and you'd end up buying cases of contact lens solution in December to avoid losing the money.

The girlfriend's employer is switching everyone over from a PPO to one of these High Deductible plans, but that's all the detail I know about that.
posted by backseatpilot at 1:18 PM on August 4, 2010

Nothing changes for me or anyone in my family, as far as I can tell, until our plan years start in 2011. I think my state's health care act will have some impact before that, but nothing's happened yet. It's much too early to ask, I think. The biggest impact so far is that I'm now really tired of reading dry legislative language.
posted by SMPA at 1:19 PM on August 4, 2010

Yes! I am under 26 and am still covered under my father's very nice health insurance instead of having to get the much meagerer state Commonwealth Care insurance.
posted by threeants at 1:20 PM on August 4, 2010

backseatpilot: HSA's (from what I read now that I have one) are always roll-overs. FSA (Flex accounts) were use or lose.

Me, I'm on an High Deductible Plan with an HSA + employer contribution, and have been since the PPO would have started costing us money.
posted by deezil at 1:23 PM on August 4, 2010

Ah hah! Good to know.

I'd be interested in hearing about your experience with the high deductible plan through MeMail if you don't mind sharing.
posted by backseatpilot at 1:25 PM on August 4, 2010

A lot of people with pre-existing conditions who live in states without major risk insurance pools will soon live in states that do.
posted by gabrielsamoza at 1:27 PM on August 4, 2010

I can now purchase insurance.

I could not, prior to July 1st in my state due to preexisting conditions.
posted by Rendus at 1:29 PM on August 4, 2010 [3 favorites]

Response by poster: I can now purchase insurance.

I could not, prior to July 1st in my state due to preexisting conditions.

So how does this work, if you don't mind me asking? Do they simply not ask you anymore about pre-existing conditions? Have insurance companies changed their application forms?
posted by hiteleven at 1:35 PM on August 4, 2010

Dooce wrote of the impact of the bill on her family.
posted by SuperSquirrel at 1:50 PM on August 4, 2010

So how does this work, if you don't mind me asking?

I'm curious too, Rendus. I thought the pre-existing conditions provision didn't go into effect until 2014 (except for kids).
posted by Bunglegirl at 1:56 PM on August 4, 2010

Over at Reddit there was a thread on July 1st, when the pre-existing conditions part went into effect. From what I gathered when I read it a month ago, not only can they still ask you about them, they can charge you higher premiums if you have them. They just can't deny you on that basis.
posted by asciident at 1:57 PM on August 4, 2010 [1 favorite]

The only things that have changed with respect to pre-existing conditions at this point are:

*Kids (those under 18) can't be denied insurance due to pre-existing conditions

*Adults who are denied insurance due to pre-existing conditions should be able to apply for a state- or federal-run high-risk pool (depending on where they live); however, you have to have been uninsured for at least 6 months to qualify

It will be 2014 before the pre-existing conditions cease to affect the availabililty and cost of non-employer-based insurance for adults, once the state-based exchanges open up and federal subsidies become available.

Most of the big stuff that went into effect in 2010--other than ending pre-existing condition denials for kids and allowing young adults to be covered up to age 26 on their parents' policy--are things that are unlikely to be noticed by Joe Blow, since it's the absence of a shitty thing happening when someone gets sick rather than cheaper premiums or free care. It's only 5 percent of people with insurance who really end up *using* their insurance in a serious way in any given year; most people are pretty satisfied with what they have until a major illness or accident happens and they learn that they have far fewer protections than they thought. Since it's somewhat unlikely for a person in the under-65 population to have two major events like that for two years in a row, the nature of the beast is that people who get sick probably aren't going to realize the additional protections they've gained this year.

For example, as of September insurance companies can no longer comb through past claims looking for any minor error that would allow them to drop coverage when someone gets sick (e.g., "you didn't disclose that you had allergies on your application, therefore we're dropping you now that you have Stage IV colon cancer"), a practice called recission. Insurance contracts can only be revoked for knowing fraud or omission of material facts. Also, insurance companies cannot impose lifetime limits on benefits, but again that's going to be experienced as something bad that no one really expects not happening anymore, which is to say: no one will really notice.

Another important piece of context here is that the reform bill basically ended up moving a lot of the action to the state level--instead of a single, federal-level insurance exchange, we ended up with the requirement for each state to set up its own exchange. State legislatures are scrambling to pass the legislation necessary to get the ball rolling on that--no one really knows exactly how that should look, there's still no model legislation out of for legislators to base the language on, everyone is kind of flying blind--so while 2014 sounds like it's a long way off, in terms of the amount of work that needs to happen legislatively and regulatorily it's going to be a mad dash. Just one more reason why the really visible changes aren't going to happen right away.
posted by iminurmefi at 2:19 PM on August 4, 2010

Several of my close friends with anorexia/mental health issues can stop stressing about being dropped from their parents' coverage and being unable to enter treatment for a few more years. This is of particular concern to ED-sufferers because residential treatment is frequently necessary and yet, it can take a long time for that idea to sink in, leading many to delay treatment until it is no longer affordable.
posted by SputnikSweetheart at 2:20 PM on August 4, 2010

Like Rendus and no doubt many others, my mother was denied insurance on the basis of a pre-existing condition, and is now able to have coverage. I don't know the details of the denials, but she was obviously quite relieved.
posted by thermogenesis at 2:24 PM on August 4, 2010

Can I say that I have piece of mind now? I'm on group insurance, so I don't anticipate any great changes to my insurance. But I've had near constant worry since being diagnosed with a lifelong, chronic illness five years ago that I would lose my insurance and have to go without the $30,000/yr treatment that lets me live and work a normal life. Now I know that if I lose my job, there will be other options that won't completely bankrupt me.
posted by saffry at 2:28 PM on August 4, 2010 [2 favorites]

previously, every HSA I encountered was use-it-or-lose-i

You might be thinking of FSAs (Flexible Spending Accounts.) I have no idea if they're changing or not.
posted by small_ruminant at 4:54 PM on August 4, 2010

Here's the new preexisting condition stuff for Nevada as of July 1st:

posted by Rendus at 5:06 PM on August 4, 2010

I have a genetic brittle bone disorder and I just graduated from college at 23. Since I was 12 I've needed IV infusions every 3-4 months to strengthen my bones and also prescription medication to help me absorb it. There's also all the specialist doctors that go along with that, plus the need to always always have insurance to cover potential emergency room visits. The job market for social studies teachers in my area is also very close to nonexistent so a lot of my recent plans have revolved around how I can keep my health insurance. Under the previous system I was very worried about what I'd do once I aged out of my parents' health insurance. Now I have an extra year to find a job and will eventually be able to get into the state-run high-risk pool. Though there's still 6 months of down time, which is a pretty long stretch of time for someone who breaks a foot stepping off a curb wrong. (Though yesterday my doctor said I don't need to get another IV for at least 3 years!)

Likewise, raising the cutoff age to 26 delays some difficult decisions to be made about my younger, autistic brother. He will most likely never work enough to carry his own health insurance, so my parents will have to jump through a lot of hoops to keep him on their insurance.
posted by lilac girl at 5:12 PM on August 4, 2010

The cutoff for dependents of veterans getting health care used to be 23, but only if you stayed in school. Now it's 26 no matter what, not because of the bill directly, but in response to it.
posted by iarerach at 6:11 PM on August 4, 2010

I don't recall when this kicks in, but I think the thing that will be most important is that they can no longer set lifetime or even annual maximum payouts-- so being bankrupted by healthcare costs should be dramatically reduced, provide your deductible/coinsurance doesn't bankrupt you.
posted by Maias at 7:54 PM on August 4, 2010

A close relative of mine was approaching her "lifetime" limit on payouts due to thirty months of expensive cancer treatments. She and her husband no longer lie awake at night worrying whether her lifetime or her benefits would end first.
posted by Rain Man at 9:19 PM on August 4, 2010

Also, insurance companies cannot impose lifetime limits on benefits, but again that's going to be experienced as something bad that no one really expects not happening anymore, which is to say: no one will really notice.

I have, but, I was also looking at running out of coverage within a year or two due to the lifetime maximum. Cancer, and subsequent issues due to that, will rip through money like a wildfire.
posted by SuzySmith at 2:17 AM on August 5, 2010

My younger brother, age 20, was no longer covered under my parent's insurance. This was a problem because he can't find a job, and has expensive prescription medicines. Now, he is covered again by our parent's plan.
posted by Vorteks at 8:20 AM on August 5, 2010

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