By LEE BOWMAN
Scripps Howard News Service
March 22, 2010
Many of what Democratic advocates call the "early deliverables" of health reform address insurance-company practices that even most Republicans agree need to be changed -- like dropping coverage due to pre-existing conditions and imposing lifetime caps on coverage.
Republicans aiming at overturning the health-reform bill either through the courts or the ballot box in this year's mid-term elections want to ignore the early changes and focus on what they consider are less popular changes, like a penalty imposed on individuals who don't buy insurance and on larger employers that don't offer it after 2014.
But Obama and his allies will be talking up the immediate benefits from the bill he's expected to sign as early as Tuesday.
Among the changes the law will make this year:
-- Starting six months after the bill becomes law, insurers could not deny coverage of a child for any pre-existing medical condition through age 19. An end to pre-existing restrictions for adults wouldn't come until the new system of insurance exchanges is set up in 2014.
-- After three months, adults with a pre-existing condition who have been uninsured for at least six months would be able to join a temporary federal high-risk pool and receive subsidized premiums. This would continue until the exchanges are established.
It's not clear how many people might get coverage through this provision. About 200,000 are covered in similar programs run by various states, at an estimated cost of $1 billion a year. Congress appropriated $5 billion in the health bill, which presumably would have to last more than four years.
-- Small businesses with no more than 25 employees and average annual wages of less than $50,000 are eligible for tax credits of up to 35 percent of health-insurance premiums starting with the 2010 tax year through 2013; the credit goes up for many firms after 2014.
-- After six months, lifetime dollar caps will be banned for all individual and group health plans and insurers will be barred from rescinding policies except in cases of fraud. Some restrictions on annual coverage limits will also be imposed before a complete ban takes effect in 2014.
-- Beginning with the 2010 plan year, insurers will have to document that at least 85 percent of what they spend from large-group premiums go to clinical services and quality improvements; 80 percent for individual and small-group plans. Plans that don't meet the threshold would have to give a rebate starting in 2011. The law also sets up a process for reviewing health-plan rate increases and provides state insurance commissioners with grants to help review and approve premium hikes.
-- Within six months, all new insurance policies will have to fully cover specified preventive-care and screenings with no co-pays or deductibles. Medicaid would start covering stop-smoking services for pregnant women starting in October.
-- Participants in the Medicare prescription-drug plan who fall into the "doughnut hole" coverage gap between $2,700 and $6,154 would get a $250 rebate this year and a 50 percent discount on brand-name drugs next year. The gap would be eliminated within 10 years.
-- Most taxes related to reform wouldn't hit until 2013 or later, but the law calls for a 10 percent surcharge on indoor tanning services starting this year, possibly as early as July 1.
-- And within a year of going into effect, the reform law orders the Food and Drug Administration to issue rules requiring chain restaurants and vending machines to post calorie and nutrition labels for each item on menus, menu boards and drive-through displays. Chains with fewer than 20 restaurants and small businesses would be exempt.
Scripps Howard News Service, http://www.scrippsnews.com
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