Welcome back for the second half of my interview with journalist Margie Burns. How close does any of the proposed legislation come to
dealing with health insurance abuses, especially given the fact that we don't
really know how widespread they are, besides for anecdotally?
The House bill, H.R.3200, includes Title I, Protections and Standards for Qualified Health Benefit Plans. Protections in the bill include the following, according to the Congressional Research Service:
prohibiting preexisting condition exclusions;
providing for guaranteed coverage to all individuals and employers and automatic renewal of coverage;
prohibiting premium variances, except for reasons of age, area, or family enrollment;
prohibiting rescission of health insurance
coverage without clear and convincing evidence of fraud.
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The bill imposes the following standards for qualified health benefits plans, again according to CRS:
requiring qualified health benefits plans to provide essential benefits;
prohibiting an essential benefits package from imposing any annual or lifetime coverage limits;
requiring services covered including hospitalization, prescription drugs, mental health services, preventive services, maternity care, and children's dental, vision, and hearing services and equipment;
limiting annual out-of-pocket expenses to $5,000 for an individual and $10,000 for a family.
The Senate
bill, S.1679,
- prohibits preexisting condition exclusions;
- limits premium variances;
- provides for guaranteed coverage of every employer and individual and automatic renewal of coverage;
- limits cost-sharing for preventive care;
- requires coverage of a dependent child until 26 years of age;
- prohibits lifetime or annual limits on benefits; and
- prohibits group health plans from establishing eligibility rules based on salary of the employee.
Every law depends on enforcement. Once a law is passed, it has to be backed up by the courts, but the courts have to have something to work with in the first place. These are all good provisions. Prohibiting denial of coverage for preexisting conditions, for example, should also deter insurance companies from falsely claiming a condition pre-existent when it was not, as with a woman who wrote to me about her daughter, a college student who contracted meningitis. Her university "health plan' carrier tried to assert that the meningitis was a preexisting condition. The company lost that one, fortunately.
The work is by no means done. But people who dismiss this legislation are being careless at best. The very fact that the U.S. Senate has enunciated a principle, to be implemented through law, that employees cannot be excluded from a group health plan based on their salary is monumental. Limiting to $5,000 the amount a covered individual can be forced to pay for medical bills is also a huge saving grace.
