Saturday, May 22, 2010

Brief Summary of Health Insurance Changes

* Provides immediate access to high-risk insurance pools for people who have no insurance because of preexisting conditions.

* Bars insurers from denying people coverage when they get sick. What does this really mean--ANY coverage, or high cost services, or things that weren't going to be covered to begin with?

* Prevents insurers from denying coverage to children who have preexisting conditions. Children, not adults yet.

* Bars insurers from imposing lifetime caps on coverage, i.e. aggregate limit. There are some low end plans that have bottom limits, either lifetime or per year.

* Requires insurers to allow young adults to stay on their parents' policies until age 26.

* Requires individual and small group insurance plans to spend at least 80% of premium dollars on medical services. Large group plans would have to spend at least 85%.

* Increases the Medicare payroll tax and expands it to dividend, interest and other unearned income for singles earning more than $200,000 a year and joint filers making more than $250,000.

* Provides subsidies for families earning up to 400% of the poverty level to purchase health insurance.
* Requires most employers to provide coverage or face penalties.
* Requires most people to obtain coverage or face penalties.

A few items to think about: Cost-containment: pre-existing illness, chronic illness..where’s the cut off to help prevent out of control premium? High rates: premium no longer affordable. Multi-million dollar lifetime limits. Which chances are may never be reached, What about keeping something in reserve and using dollars wisely? Increased taxes: to help offset the increased addition of people w/o insurance, pre-existing and chronic costly illness. Cost-effectiveness: where is it? All added together places increased strain on small, medium and large sized employers, the policy holders and the medical community.

It pays to be healthy.
Trisha M. Pacenti RN, BSN