Last Thursday the first changes associated with our nation’s overhaul of the greatest health care system in the world took effect.
Six months after H.R. 3590, the Patient Protection and Affordable Care Act, was signed into law, the first elements of one of the most sweeping changes to U.S. domestic policy in recent history were implemented.
The new changes include the following:
• Insurers will be required to allow parents to keep their children on the family health insurance until they reach the age of 26 unless the child is offered coverage through an employer.
• Insurers may no longer be able to deny children coverage for pre-existing conditions.
• Insurers will not be allowed to terminate coverage for any other reason than customer fraud.
• Insurers will no longer be able to cap the amount of benefits and treatment a person can receive in a lifetime.
• Insurers must pay for such preventive services like mammograms, recommended immunizations and colonoscopies without charging consumers deductibles, co-pays or co-insurance fess.
While all this sounds great, as my lawyer friends would say “the devil is in the details.”
For instance, even though these changes went into effect last week, many won’t apply to most people since the changes won’t take effect until a consumer buys a new policy or renews an existing one.
And some of the requirements, such as the free preventive services, can be avoided by insurers if they don’t make significant changes to their current plan.
However, beginning in 2014, all plans will have to comply with these new provisions.
While some of these provisions are new to states, some are only extensions of existing state laws.
For instance at least 25 states have laws that extend benefits to dependent young adults.
In Georgia, as long as a dependent child of an insured is a full-time student, group policies must offer coverage through age 25. The primary difference here is that state laws do not apply to self insured plans, which cover 57 percent of U.S. employees, whereas the federal law will.
But perhaps the most important detail of all is the question of who will pay for all these changes.
Obviously, with mandates for broader coverage being imposed on them, insurance companies will be forced to raise premiums in order to offset these extra costs or eliminate coverage altogether.
In fact, two weeks ago the second largest health insurer in Connecticut was granted rate hikes that will be well over 20 percent for some plans.
In our own state of Georgia, it has been reported that all but two health insurance companies have plans to withdraw from offering maternity benefits and only a few companies will still write “child only” health insurance plans.
It’s important to understand that, like most people, I am not a fan of the big insurance companies. As a pharmacist, I have witnessed the transition of drug therapy being determined not by doctors or pharmacists, but instead by insurance companies who decide what they will and will not pay for. I watch people suffer for days waiting on their insurance companies to grant prior approval to pay for a medication not included on their formulary.
However, as much as I despise these practices, I still believe in the free market system. Insurance companies are in business to make a profit and self-insured companies are trying to save costs so their company can make a profit — that’s how a free market system works.
But while the changes we witnessed last week may be appealing and seem to be necessary to correct the abusive insurance industry and provide better healthcare, in its simplest form it is government mandating coverage to private insurers.
As this law moves forward look for premiums to rise and choices to decrease until ultimately, perhaps, we have a one payer system.
And as the government becomes more involved in the economy and the free market system dissipates, let us all beware.
Economic control can easily become political control and, while we all want better health care, what price are we willing to pay?