KCUR News
11:47 am
Mon September 20, 2010

New Health Law Provisions Take Effect This Week

Kansas City, MO – The Patient Protection and Affordable Care Act was signed into law six months ago. Ron Pollack, head of the consumer advocacy group, Families USA, recently visited Kansas City to discuss the details of the legislation. Pollack, who's been deeply involved in developing and supporting the law, told KCUR's Elana Gordon that several of its provisions are already taking effect - many of which begin this week.

POLLACK: For young adults, people under 26, they're the ones most likely to be uninsured. And they now will have the protection that they can stay on their parents' policy - which is a really big deal. Of course, now they're going to have to be nice to their parents, so their parents are willing to do that.

We're going to see significant changes in what insurance companies are supposed to do. Insurance companies for those under 19 years of age, cannot deny coverage to someone because they've got a preexisting condition. They can't rescind somebody's policy just because somebody who's paid for insurance for months and years now all of a sudden contracts cancer or has a stroke - insurance companies often want to drop them from coverage. That will be prevented. Insurance companies will no longer be able to say, 'here's a lifetime amount of money that we're going to pay for your care, but no more than that.'

For adults who've got preexisting conditions and who can't get insurance, they'll be able to join one of these pools that's for people who are currently excluded from coverage due to pre-existing conditions. That's going to be very helpful. Small businesses are starting to get tax credits so that it will be more affordable for them to provide coverage.

Even for those people who've got coverage but they're having fights with their insurance company - maybe an insurance company refuses to pay a claim or says you're not covered for x and y and you feel you're being done dirty in some sort of way - you now can file for an external appeal, and so you can get an objective decision made as to whether the denial is appropriate or inappropriate.

So, while the largest changes occur on or around 2014, there are significant changes that happen now.

GORDON: It seems like there's also a lot of catches to these programs. It's complicated in and of itself, it's not totally straightforward. You've got the type of insurance plan your parents may have [affecting whether or not you're eligible to be on their insurance plan], or the cost of the high risk insurance plans may be out of your limit even though there's an intent to help. What do you make of these complications in the bill itself?

POLLACK: I don't know of anybody, including people like myself who are supporters of this legislation, who say this is perfect. I don't know of too many things that go through a legislative process that are perfect. It is a product of compromise.

What I like to remind people about is, when you ask what you think is the most significant piece of legislation that was passed in the United States in our history, on everyone's list - whether it's one, two, three or ten - will be the Social Security Act of 1935. And what people don't remember or know is that when the Social Security Act passed in 1935, it didn't include farmer workers. It didn't include teachers. It didn't include domestic laborers. It excluded over half the women in the workforce. It excluded over two thirds of the people of color in the work force. Well, it created a foundation, and over the years since 1935 improvements have been made so the problems I just described no longer exist.

That is what this health reform legislation does. It makes some significant improvements for a good number of people right away, but it creates the foundation for which we're all going to strive to improve over time.

GORDON: Given that there are still a lot of unknowns, in that what you're saying is that this is a start, what needs to happen next, and what are the sorts of things in this process where we're at now that could affect how this develops from here?

POLLACK: First, let's make sure that the health reform law gets implemented effectively and properly.

GORDON: How?

POLLACK: Well, it means all of us are going to look carefully and work with the Departments of Health and Human Services, and the Department of Labor, and the Internal Revenue Service to make sure the rules that get promulgated pursuant to the legislation are effective.

But I'll tell you, most of the action is going to be at the state level. The states are going to be the place where this gets implemented. And so all of us have a challenge to make sure, in state after state, that the states do an effective job in implementing the laws.

GORDON: What are some of those things that could affect the way that we see health care or health insurance changing, based on what Missouri does, or what Kansas does, or what happens at the local level?

POLLACK: Well, let me give you one area as an example. I think it's very important that as many people who are eligible for coverage, who can get subsidies or can get coverage through the Medicaid safety net receive it. Well, will people receive it who are eligible for it? You know the history of some of these safety net, means tested programs are not great. Often lots of people who are eligible don't get it. Well, the determination as to whether people will get these benefits will be based on structural decisions made by the states.

I'll give you examples: Does a person have to take a day off from work in order to get enrolled? Does somebody have to go both to the Medicaid office and the exchange office because they don't know which they're eligible for in order to get certified? Is the application form going to be simple and short? Will the application form be in multiple languages so that somebody who's primary language is not English can actually apply? Can you apply at a point of health service, like a hospital or physician office or drugstore or community health center?

That and a phalanx of other decisions are systems decisions. The state will make those decisions. For a state that actually makes good decisions and uses some of the best practices that we know about, almost all people are going to get enrolled because it's not going to be inconvenient for them to get enrolled and it won't be too cumbersome. For a state that doesn't do that, then a lot of people who need help, who are eligible for help, who are entitled for help are not going to get it. So, that's a prominent example of how state decision-making is going to rule the roost in terms of the effectiveness of how this is implemented.

GORDON: Ron Pollack, Director of Families USA, thanks for speaking with me.

POLLACK: Happy to talk to you, thanks for inviting me.

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