Health Care Reform Kicks In: More Benefits, Bills, and Battles to Come

Major provisions of the landmark health care reform legislation go into effect today as insurers, Republicans, and other opponents ramp up their war against the legislation. That makes it both a big, short-term personal story (what do you need to do now about your coverage?), and a big, long-term, national story (will it be repealed?). Here are some thoughts, big and little:

• The new provisions are consumer friendly. Starting today, your insurance company can't drop you after you've become sick (unless it proves fraud on your part.) Insurers have to allow you to put your adult children, up to the age of 26, on your family policies. They have to eliminate lifetime coverage limits and are no longer permitted to deny children coverage because of pre-existing conditions. And they have to cover preventive medicine, like annual checkups, mammograms and immunizations, for free.

• It's going to cost you. The problem not fully addressed by the legislation is how those reforms will affect premiums. The news isn't good -- insurance companies (and insurance-providing employers) are raising the cost of coverage like crazy. Just an example: In California, Aetna is raising premiums on individual plans by an average of 19 percent. Who can afford that? Here's a question: How much of that premium-hiking is necessary to cover the higher costs of coverage, and how much of it is political? Some studies say that fully phased in, the entire legislation shouldn't add more than 1 or 2 percent to health insurance premiums. But another answer is, their motivations may not matter: The extra dollars you'll pay will be real, either way.

• There's a war going on. Republicans HATE this legislation. It's hard to overstate by how much. Some 20 states are suing to overturn the bill, saying either (1) it's unconstitutional to fine people for not buying health insurance; or (2) implementing it puts an unaffordable burden on the states. The Obama administration is preparing to argue that the buy-health-insurance-or-face-a-fine mandate is simply a tax, something the federal government has legal authority to levy. Meanwhile, many in Congress are vowing to overturn the health care legislation. "It is time to... repeal this bill and start over," said Rep. Phil Gingrey of Georgia, co chair of the House GOP doctor's caucus (who even knew there was such a thing?) Frankly, I just don't see that happening. It couldn't happen until 2013 at least, since Obama would never sign it, and would require a Republican takeover of the White House as well as the House and the Senate. A more likely prospect would be for future Republican Congressional leadershp to de-fund the legislation, choking off the ability of federal agencies to enforce its mandates. But those mandates would still be on the books.

• You need to comparison shop. With employers raising workers' share of the costs and consumer protections getting better, it's no longer certain that your company plan is your best option. Find out what else is out there in your state, by shopping at sites like ehealthinsurance.com or contacting your state's insurance regulator. Don't even assume that adding your 24 year old newly-graduated child to your policy is the way to go: It may be cheaper to buy a separate policy for him or her; in most states, it's cheap to insure a young person. And read everything insurance-related that comes in the mail, too: Your insurer is likely to make a few changes in your policy to comply with (or undercut?) the new rules, and you'll need to make sure you know what's going on. Check to see what your insurer defines as free "preventive" care and what's not included.

• Cover your kids. Children now have pretty complete health care coverage protection, a fact that has prompted companies like Aetna, Cigna, and Golden Rule to get out of the child-only business altogether. Classy! If you are reading this and you don't have coverage yourself, at least go out and buy a policy for your children while those policies still exist. Even relatively healthy kids usually end up needing a fair amount of immunizations, amoxicillin, and stitches over their childhood careers.

Food and Drug Administration photo.
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