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U.S. Health Reform Starts to Take Hold

By Karen Pallarito
HealthDay Reporter

FRIDAY, July 16 (HealthDay News) -- Seniors whose drug costs push them into Medicare's "donut hole" and parents whose children are uninsurable due to pre-existing health conditions are among the first Americans to see tangible effects of the nation's historic health reform law.

The public is still split -- pro and con -- over the comprehensive health legislation, polls show. But as the first provisions of the Affordable Care Act begin to take effect, consumer sentiment appears to be on the upswing. The percentage of Americans with a favorable view of the law jumped 7 percentage points to 48 percent in June, according to the latest polling data from the Kaiser Family Foundation. Forty-one percent have an unfavorable outlook.

"From an individual [standpoint], there's a lot that could be positive," said attorney Chantel Sheaks, a principal in the Washington, D.C., office of Buck Consultants, a benefits consulting firm.

The law, for example, requires individual and group insurers that cover dependents to extend that coverage to adult children until the age of 26.

"For a lot of parents, that's very positive, especially given this economy where younger adults are having difficulty finding jobs -- and finding jobs that actually have good benefits," Sheaks said.

Like many of the law's early provisions, the age-26 requirement takes effect on or after Sept. 23, 2010. For health insurance plans that operate on a calendar year, new benefits typically would take effect on Jan. 1, 2011. However, some insurers are extending health insurance to young adults ahead of the deadline, says the U.S. Department of Health and Human Services (HHS).

The sweeping health overhaul signed into law by President Barack Obama in March sets in motion a series of reforms that will be carried out over the next several years. Core elements of the reform package, including the creation of state health insurance exchanges and the availability of premium subsidies for low-income individuals and families, don't take effect until 2014.

Numerous states have filed suit or introduced legislation seeking to block the federal law or provisions of the legislation. A key sticking point is the requirement that most individuals obtain health insurance coverage or pay a penalty.

Virginia Attorney General Ken Cuccinelli contends that the federal government's mandate overreaches its authority. A federal judge is expected to rule by the end of the month on a U.S. Department of Justice motion to dismiss the state's lawsuit, The Roanoke Times reported. The Justice Department has filed a similar motion in a case brought by the state of Florida and joined by 19 states and the National Federation of Independent Business.

Missouri Lt. Gov. Peter Kinder is the latest to join the fray. His suit, filed July 7, alleges that the law will drive up the cost of health care in Missouri and force people to purchase coverage they don't want or need.

Meanwhile, many employers and insurers are moving ahead with implementation of the law. Here's how some of the initial provisions are shaking out:

Seniors with sizable drug costs

The federal law begins phasing in plans to close the "donut hole," the gap in Medicare Part D coverage during which older Americans must pay 100 percent of their drug costs. As a first step, the federal government is sending every eligible senior who reaches the gap this year -- an estimated 4 million people -- a check for $250.

The first round of tax-free disbursements went out last month. A second round of checks was mailed last week, and those mailings will occur monthly throughout 2010 as seniors hit the donut hole, HHS says.

People with pre-existing health conditions

By 2014, the law prohibits insurers from discriminating against adults with pre-existing conditions. In the interim, adults who have been uninsured for at least six months and can't get insurance because of a medical condition may enroll in a "Pre-Existing Condition Insurance Plan."

HHS began offering these plans in 21 states on July 1. The remaining 29 states are operating their own plans and will begin enrolling people by the end of the summer.

A separate provision, effective Sept. 23, does away with pre-existing condition exclusions for children.

For those who had tried to purchase individual insurance until now, there were "huge issues with trying to find coverage for people who have health problems, and that is absolutely true for children," said economist Genevieve M. Kenney, a senior fellow at the Urban Institute in Washington, D.C. "Yes, maybe you would be able to get a policy but it might exclude the very health problem that the child suffers from."

Banning pre-existing condition exclusions won't affect a large number of kids, she said, but it will be a substantial benefit to children who currently don't have access to coverage that meets their needs.

People with significant medical costs

Effective Sept. 23, insurers may no longer place lifetime dollar limits on essential benefits. The law also restricts annual limits on coverage.

"For those people who had catastrophic accidents, cancer, this is very important, and I think for security and peace of mind for people who may not have reached those limits, but know that they're there, that you'd be protected," Sheaks said.

And regulations issued Wednesday now require new private health plans to cover preventive services such as blood pressure tests and cancer screenings with no cost-sharing requirements for consumers.

More information

To learn more about the impact of the Affordable Care Act, visit this U.S. Department of Health and Human Services Web site.

SOURCES: Chantel Sheaks, J.D., principal, Buck Consultants, Washington, D.C.; Genevieve M. Kenney, Ph.D., senior fellow, Urban Institute, Washington, D.C.; Henry J. Kaiser Family Foundation, Kaiser Health Tracking Poll, June 2010; U.S. Department of Health and Human Services' Office of Consumer Information and Insurance Oversight; U.S. Department of Health and Human Services, news releases, July 1, and July 8, 2010; Office of Missouri Lt. Gov. Peter Kinder, news release, July 7, 2010; Office of the Attorney General of Florida Bill McCollum, news release, June 17, 2010; Commonwealth of Virginia, Office of the Attorney General Kenneth T. Cuccinelli, news releases, March 22 and July 1, 2010; July 2, 2010, The Roanoke Times

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