Immediate Insurance Reform Benefits

(The second topic of today's bipartisan White House health insurance reform meeting is  insurance reforms.)

President Obama's proposal includes health insurance market reforms that will bring immediate benefits to millions of Americans, including those who currently have coverage.
 
Access to Affordable Coverage for the Uninsured with Pre-existing Conditions

• The President's proposal will provide $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions. This provision is effective 90 days after enactment, and coverage under this program will continue until new Exchanges are operational in 2014.

Access to Quality Care for Vulnerable Populations

• The President's proposal makes an immediate and substantial investment in Community Health Centers to provide the funding needed to expand access to health care in communities where it is needed most. This $11 billion investment begins in 2010 and extends for five years.

No Pre-existing Coverage Exclusions for Children

• The President's proposal eliminates pre-existing condition exclusions for all Americans beginning in 2014, when the Exchanges are operational. Recognizing the special vulnerability of children, the plan prohibits health insurers from excluding coverage of pre-existing conditions for children, effective six months after enactment and applying to all new plans.

Re-insurance for Retiree Health Benefit Plans

• The President's proposal will create immediate access to re-insurance for employer health plans providing coverage for early retirees, effective 90 days after enactment. This re-insurance will help protect coverage while reducing premiums for employers and retirees.

Closing the Coverage Gap in the Medicare (Part D) Drug Benefit

• The President's proposal begins to fill the “donut hole” by giving seniors a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010.

Small Business Tax Credits

• The President's proposal will offer tax credits to small businesses beginning in 2010 to make employee coverage more affordable.
• Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage; later, when Exchanges are operational, tax credits will be up to 50 percent of premiums. The full credit will be available to firms with 10 or fewer employees with average annual wages of $25,000, while firms with up to 25 or fewer employees and average annual wages of up to $50,000 will also be eligible for the credit.
  

Ensuring Value for Premium Payments

• The President's proposal will establish standards for insurance overhead and require public disclosure to ensure that enrollees get value for their premium dollars. The Managers’ Amendment tightened these standards, requiring plans in the individual and small group market to spend 80 percent of premium dollars on clinical services and quality activities, and 85 percent for plans in the large group market. Health insurance plans that do not meet these thresholds will provide rebates to their policyholders. This provision takes effect in 2011 and applies to all plans, including grandfathered plans, with the exception of self-insured plans.

Patient Protections

• The President's proposal protects patients’ choice of doctors by allowing plan members to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before and woman sees an ob-gyn, and ensuring access to emergency care. This provision takes effect six months after enactment and applies to all new plans.

Extension of Dependent Coverage for Young Adults

• The President's proposal will require insurers to permit children to stay on family policies until age 26. This provision takes effect six months after enactment and applies to all plans for young adults who are not offered qualified coverage elsewhere. 

Free Prevention Benefits

• The President's proposal will require coverage of prevention and wellness benefits and exempt these benefits from deductibles and other cost-sharing requirements in public and private insurance coverage. This provision takes effect six months after enactment and applies to all new plans and all plans in 2018.
• Beginning on January 1, 2011, Medicare beneficiaries will receive a free, annual wellness visit and will have all cost-sharing waived for prevention services.
  

No Lifetime Limits on Coverage

• The President's proposal will prohibit insurers from imposing lifetime limits on benefits. This provision takes effect six months after enactment and applies to all plans.

Restricted Annual Limits on Coverage

• The President's proposal will tightly restrict insurance companies’ use of annual limits to ensure access to needed care, effective six months after enactment for all new health plans. These tight restrictions will be defined by the Secretary of Health and Human Services. When the Exchanges are operational, the use of annual limits will be banned for all plans in 2014.

Protection from Rescissions of Existing Coverage

• The President's proposal will stop insurers from rescinding insurance when claims are filed, except in cases of fraud or intentional misrepresentation of material fact. This provision takes effect six months after enactment and applies to all plans.

Prohibits Discrimination Based on Salary

• The President's proposal will prohibit group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. This provision takes effect six months after enactment and applies to all group health plans in 2014.

Public Access to Comparable Information on Insurance Options
 

• The President's proposal will enable creation of a new website to provide information on and facilitate informed consumer choice of insurance options.

Health Insurance Consumer Information

• The President's proposal will provide assistance to States in establishing offices of health insurance consumer assistance or health insurance ombudsman programs to assist individuals with the filing of complaints and appeals, enrollment in a health plan, and, eventually, to assist consumers with resolving problems with tax credit eligibility. This provision is effective beginning with fiscal year 2010.