Healthcare reform: Changes help individuals
Email 
Print
When told she needed a colonoscopy last year, Katrina Nevitt followed her doctor’s orders. At the time, Nevitt, a McDonald’s employee from Monticello, Kentucky, was working full-time and had insurance. Still, though she was diagnosed with ulcerative colitis, her claims weren’t paid. Nevitt suddenly owed more than $6,000 in unexpected medical bills. Soon after, to make matters worse, she lost her job.
“Now I have bill collectors calling me for money I don’t have,” said Nevitt, 35, who earns $87 a week in unemployment pay. “What bothers me the most is that I had insurance.”
Nevitt (pictured left with her fiancé) had run up against her health plan’s annual limit, the maximum her insurer is obligated to pay in claims each year. About 120 million Americans have health coverage with either annual or lifetime caps. Starting September 23, such thresholds will be phased out under the Affordable Care Act of 2010, the President’s sweeping health reform passed last March.
Set to benefit most at first are individual policyholders. While the majority of Americans receive coverage through their employers, about 15 million individuals buy their own plans, a figure that has risen in recent years as joblessness has gone up. These consumers often face some of the toughest buying decisions when purchasing health insurance.
“Buying on the individual market can be very expensive and challenging,” said Sara Collins, an economist at the Commonwealth Fund, a New York City-based healthcare think tank. “But, with the reforms, they will likely see real benefit firsthand before many people on employer-based plans.”
Most people will have to wait until January 1 for these changes to come online when most plans start their new year. Or, if their plan reboots earlier, anytime after September 23.
In addition to eliminating caps, the legislation prohibits insurers from canceling coverage once a policyholder falls ill. Rescission, as this practice is known, is most common in the individual market. Only about 10,700 people annually had their policies rescinded, according to the U.S. Department of Health and Human Services, but these cancellations often led to dire financial and health consequences.
“Individuals who were already dealing with serious illness suddenly had no insurance, usually by no fault of their own,” said Ron Pollack, executive director of Families USA, a group that supported health reform. “Ending rescissions was the morally right thing to do.”
A 2009 investigation by Congress found that some insurers in the past went as far as automatically reviewing health histories when an enrollee developed a chronic disease, such as asthma or arthritis, to find reasons to cancel policies. With rare exception, fraud or misrepresentation will be the only reasons an enrollee’s plan can be canceled and 30 days notice is required.
Consumers will be guaranteed added benefits starting September 23, too. Preventive services must now be covered and without any cost-sharing, such as co-pays or coinsurance. This includes immunizations, mammography, blood pressure and cholesterol checks as well as screenings for depression or sexually transmitted diseases. Plus, children under 19 can no longer be denied coverage for pre-existing conditions.
One hitch is that several of these provisions will affect only new policies as opposed to what are known as “grandfathered” plans. “The law assumes most consumers will see the changes and choose to migrate to new plans by 2014 anyway,” Collins said.
Lifetime coverage limits will be eliminated immediately. Annual caps, however, will disappear more gradually. Over the next year, plans cannot limit coverage for less than $750,000. In September 2011, that number rises to $1.25 million and then $2 million in 2012 before going away completely in January 2014.
Of course, like most Americans, those on the individual market can expect the biggest changes to arrive as 2014 draws nearer. This includes subsidies for those who, like Katrina Nevitt, can’t afford to pay for individual coverage.
In 2008, a Commonwealth Fund survey found that 57 percent of those who wished to buy private insurance couldn’t find a plan they could afford. Individual plan premiums average about $3,600 per year for basic coverage, according to the Kaiser Family Foundation.
Nevitt, for one, is going uninsured for now. Unable to afford the $60 it costs to see her doctor, she relies on the local ER for emergencies and otherwise goes without treatment for her ulcerative colitis, hiatal hernia, and diabetes.
“I need to go to the doctor. I need my medicines. But what I am supposed to do? I can’t afford insurance,” Nevitt said. “So I neglect myself because I don’t have any other choice.”
Photo: Katrina Nevitt with her fiancé, Jeffery Fulton are pictured in this undated handout photo. REUTERS/Handout
Comments RSSPost Your Comment
The not so good thing about this bill is that the real benefits kick in later on. In between time, some will continue to distort facts. What we need is more and more of these actuall real life stories. Those who represent the interests of big businesses and the wealthy will be seen for who they are.
A $6,000 colonoscopy clearly shows the need for cost containment. As long as all companies associated with health care are jacking up prices for excessive profitability, health care will never be affordable except for those who are relatively or grossly affluent.
Guaranteeing (forcing) benefits in an insurance plan do nothing but continue to raise premiums in relation to the added cost of carrying out the new benefits. Why would a young healthy and responsible male need mammograms or STD testing covered? These “one size fits all” plans do not address the main problem of healthcare, they force an individual to purchase a plan with unnecessary benefits. If insurance companies were allowed to sell catastrophic plans with a higher deductible than the resulting premiums would be lowered since no other expenses would need to be accounted for.
It is hard to believe that the Republican party would want to roll back the health care bill for people who can least afford health insurance. Most of the people that I saw at Tea party gatherings demonstrating against the Obama health care bill looked to me like they were of an age to be on Medicare but of course they do not want that rolled back. I will respect their views when they renounce their Medicare benefits.