As I think about this massive newly enacted legislation called the Health Care Reform Bill, I get confused with information over load. For now, all I want to know are the facts of what changes have been enacted over current law. I don’t care which political party won or lost. I am not too concerned about the total cost of the bill or it’s projected savings since the numbers being quoted are full of assumptions that may or may not be accurate. Whether a majority of Americans are in favor or opposed to this bill is also irrelevant since the majority of us don’t really understand what is in the bill. For now, I just want to know what changes are going to take place as a result of this bill.

So, what I have attempted to do, is to just focus this article on the changes to the way the health insurance companies will have to operate as a result of this legislation and let you the reader interpret this information as you see fit.

What the new Bill Covers

Effective in 2010 Children with preexisting conditions can not be denied coverage in any new plan or grandfathered group plans. Beginning in 2014, this provision will apply to all persons.

Effective in 2010 Americans who are not insured because of a preexisting condition will be provided access to affordable insurance through a temporary subsidized high risk pool This temporary pool will exist until the Exchange programs are created and become functional.

Effective in 2010 Insurance companies are no longer permitted to drop people from coverage when they become ill.

Effective in 2010 Provides $ 250 rebate to Medicare beneficiaries who hit the donut hole in 2010. (The Donut hole refers to the gap in coverage from $2800 to $6400 for Medicare part d.
Beginning in 2011 Medicare beneficiaries will receive a 50% discount on prescription drugs when the donut hole applies. The donut hole gets completely eliminated by 2020.

Effective January1, 2011. Eliminates from the Medicare program co‐payments for preventive services and exempts preventive services from deductibles.

Effective in 2010 Young adults up to the age of 26 may remain on their parents health insurance policy for any new plans and certain grandfathered plans.

Effective in 2010 For retirees between the age 55 to 64, a temporary re-insurance program will be created to help offset health benefit costs of premiums for both employers and retirees. This temporary program will exist until the Exchange programs become operational.

Effective in 2010 Health insurance companies will be prohibited from creating lifetime caps on coverage.

Effective in 2010 Department of Health and Human Services will define tight restrictions on the use of annual limits so as to make sure that people can get access to all new plans and grandfathered group health plans..

Effective in 2014 Annual limits will be prohibited for all new plans and grandfathered group health plans.

Effective in 2010 Preventive services must be covered by private plans with no co-payment and exemption from deductibles.

Effective in 2010 New plans must provide an effective internal and external appeals process for decisions made by the health insurance plan.

Effective January 1, 2011 80 percent of premium payments go towards medical services in the individual and small group markets. 85 percent of the premium payments in the large group markets.
Companies that fail these thresholds must provide rebates to policyholders.

Effective fiscal year 2011 Community Health Centers will receive increased funding to allow them to treat twice as many patients over the next five years.

Effective fiscal year 2011 new investments will be provided in order to increase the total number primary health care professionals including physician assistants, nurse practitioners, doctors and nurses.

Effective in 2010 New group health plans are prohibited from creating eligibility rules that would favor higher wage employees

Effective in 2010 Aid will be given to states to assist in the establishment of insurance consumer assistance for processing appeals and complaints.

Effective in 2011 Health Insurance companies must justify request for premium increases and states will be provided a grant program to evaluate premium rate increase request. Insurance companies found to enact excessive or unjustified premium increases will be prohibited from participation in the new Health Insurance Exchanges.

Effective in 2014 Everyone will be required to purchase health insurance or face a $695 annual fine.

Employers with 50 or more employees must provide health insurance or pay a fine of $2000 per worker if the worker receives federal subsidies to purchase insurance.

Illegal immigrants will be prohibited from buying insurance in the exchanges

Abortion coverage will not be required of any health care plan.
Individuals would have to pay for abortion coverage by making two separate payments, private funds would have to be kept separate from federal and taxpayer funds.

Effective in 2010 Small business can receive tax credits up to 35 percent of premiums if they choose to offer health care coverage. The tax credit will go up to 50 percent in 2014.

As I stated up front, this is just my attempt at getting a handle on such a monumental piece of legislation that will effect all of lives in some way or another. Of course there is a great deal of detail that must be examined also, but for the everyday person on the street, we must first see the big picture unencumbered by a lot of bias opinion. After that we can begin to comprehend what is going to be implemented. At least this is how I will process this information.