Parts of health law in effect

October 4, 2010

Sept. 23 marked the six-month anniversary of President Barack Obama signing the Patient Protection and Affordable Care Act of 2009 into law.

Though the controversial legislative attempt at health care reform doesn’t become fully enacted until 2014 with the arrival of the mandate for purchase, certain portions of the new law, dealing with policies for children with pre-existing conditions, keeping children longer on family insurance plans, and eliminating annual and lifetime caps on benefits, have taken effect.

The law also faces a possible attempt at repeal depending on how the November general election plays out, as well as a slew of legal challenges filed by some states.

Missouri made national news in the August primary with a 3-to-1 vote on Proposition C, which sought to block the federal government’s right to impose a tax penalty on uninsured individuals after the 2014 deadline.

The Kasier Family Foundation, a nonprofit group that has done weekly tracking polls since the law passed, found in September 49 percent of Americans have a favorable view of the law, versus 40 percent unfavorable.

The full results are available at

The group also found that opinion is evenly split among likely voters, 46 percent in favor and 45 percent opposed; and among all voters, 26 percent favor repeal.

Travis Ford, a Missouri Department of Insurance spokesman, said state officials are focusing on reviewing new plans generated by Missouri insurance providers.

“The main thing our office is doing is making sure companies file policy forms that are in compliance,” he said. “Before an insurance company product can be offered, it has to be approved. Right now we are reviewing a lot of policies.”

Ford said most people would see changes in 2011 as people with employer-provided insurance work through annual enrollment periods.

He said people who make no changes to their existing plan this year will be “grandfathered” until 2014, when all plans must meet federal guidelines. “We have seen a lot of filings, and the vast majority comply with the new rules.”

Ford said the state was aware of media reports that some companies were responding to the new changes by dropping child-only plans altogether, rather than being forced to cover children with pre-existing conditions.

“We have seen it mentioned, but companies are under no obligation to tell us they are dropping a certain product,” Ford said.

“We would like to put a stop to that and get those products back on the market. We are talking to companies and looking at some variations they could make to their plans.”

Ford said companies have expressed a “fear that now that they have to cover children with pre-existing conditions, parents will wait until their child gets sick before buying insurance,” which he equated to “a homeowner buying fire insurance while their house is on fire.”

“The system would collapse,” Ford said.

Judy Baker, regional director for Region 7 of the U.S. Department of Health and Human Services in Kansas City, said the department is aware of the prospect of companies dropping policies for children, and was critical of the choice.

“Yes we are aware. It is unfortunate some insurance companies have decided to make a business decision on the backs of children,” Baker said.

“The Affordable Care Act is trying to make that a thing of the past.”

Baker said that while the mandate and other provisions are viewed unfavorably, the changes that took effect Sept. 23 have broader support.

“Most people agree these are good changes,” Baker said, highlighting the extended coverage for children under family plans.

“What it does is require plans to cover young adults up until they are 26 on a parent’s plan.

“Young adults can be married and not even living with you, maybe still in school. They don’t have to be financially dependent on you,” Baker said.

She said the plans could play a crucial role in providing coverage for young adults who have graduated from college and are moving into jobs so “they can remain on a plan and have continuity of coverage.”  

Baker said provisions covering preventive care — including a prohibition against charges for some screenings and preventive treatments — will make it easier for people to head off long-term illnesses and should eventually lower long-term costs.

“The Affordable Care Act has numerous provisions within it that emphasize prevention. That is critical for raising the quality of health care and lowering cost in the long run and it encourages people to stay healthy,” Baker said.


What's taken effect

Here are the Patient Protection and Affordable Care changes that took effect Sept. 23:

• Insurance companies cannot deny coverage to children with pre-existing conditions.

• Insurance companies cannot cancel policies when you get sick without proving fraud.

• Young adults can remain on parents policies (except TRICARE, and stand-alone private retiree plans) until age 26 if they don’t have coverage on the job. (Employers are required to provide notice of a special enrollment period.)

• New health plans cannot charge co-pays or deductibles for preventive care.

• There are no annual limits in new plans. Lifetime limits are banned.

• New health plans provide cost-free preventive services.

• New health plans are required to let the insured select a primary care doctor or pediatrician from its network and let them see an obstetrician-gynecologist without a referral.

• In new health plans, prior approval is no longer needed to use the nearest emergency room, and out-of-network emergency room services cannot require higher co-payments or co-insurance.

• In new health plans, people have the right to appeal any denial of payment claims by insurance companies, including an external appeal to an independent reviewer.