Health Care Reform: What's Good About It?

By Communications

From What's Happening at SHARE Blog

This is my second piece about SHARE's health reform discussion held last week (click here to see the first installment, focusing on the broad outlines of the reform). Today I want to focus on some parts of the bills that appear to offer positive benefits if they pass. Remember that the Senate bill is still being debated and then both bills need to be reconciled, so the final results are up in the air as of this writing.

Mark Scherzer and Heidi Siegfried of NYFAHC discussed these issues at SHARE's roundtable discussion.

House Bill Only

COBRA benefits would be extended if the House Bill passes. Individuals would be able to buy COBRA for 4 years. New York has already passed legislation extending COBRA to 36 months.

Pre-existing condition limitations would decrease if the House Bill passes. Insurers would look back only 30 days to see if an individual had a pre-existing condition and would only exclude coverage for 3 months, whereas they currently look back 6 months and exclude coverage for one year. New York has already passed legislation that prohibits insurers from denying coverage because of pre-existing conditions.

Both House and Senate Bills

Dependent coverage would increase for both bills from 23 years old to 26 (Senate) or 27 years (House).

Insurance companies would be limited in the amount of premiums they could apply to administrative expense and profits. This would help keep premiums down or prevent them from going up as fast. While this language appears in both Senate and House Bills, the Senate doesn't improve on New York's rates, while the House does.

Essential benefits would be established, and they would apply without lifetime limits. This is important because it would mean the creation of federal definitions and rights to review of denied claims. (But we don't know if the benefits would be as generous as what NY mandates for its insurance products). These benefits would include: ambulatory care, emergency care, hospital care, maternity care, prescription drugs, mental health with mental health parity, substance abuse, rehabilitation, lab fees, preventive care, pediatric care.

Both bills would set up exchanges where people can buy insurance.  This is supposed to be a more comprehensible and easier-to-compare way of purchasing insurance than we have now. Also, the amount of benefits that would be covered would have a much wider range than we now allow in NY. There would be limits on out of pocket costs generally but more generous limits if you qualify for subsidies. The question is, will they be generous enough so that all people can afford to buy insurance?

Check back tomorrow for how the bills might affect Medicare and Medicaid, and don't forget to leave comments.

Posted December 9, 2009.