A Health Reform Q&A with Health Secretary Kathleen Sebelius

How the New Affordable Care Act Affects Parents
By Jackie Burrell, About.com


Kathleen Sebelius, U.S. Secretary of Health and Human Services

The 2010 Affordable Care Act will have a profound impact on U.S. families with young adults, who are notoriously underinsured. Young adults, ages 18-26, are the least likely to have full-time jobs that include health insurance. One in six has a chronic health condition, such as asthma, cancer or diabetes. And even those who go to college, which allows their parents to keep them on the family insurance plan, find themselves insurance-less on graduation day. In short, some 30% of young adults do not have health coverage of any kind. It’s untenable, says Kathleen Sebelius, President Barack Obama’s Secretary of Health and Human Services. All it takes is one accident or one health crisis to push them – and their parents – into bankruptcy.

“For years, getting a diploma also meant losing your health insurance,” Sebelius said in a May 10, 2010 post on her White House blog. “And whether you went on to college or not, it was often hard as a young person to find affordable coverage. Overall, Americans in their twenties were twice as likely to go without health insurance as older Americans. I saw this firsthand as a mom.”

Under the new health reform legislation, which takes effect September 23, 2010, parents will be able to keep their grown children on their family’s health insurance plan up to age 26.

I joined three other About.com guides - to college life, health insurance and patient empowerment - in a conference call with Sebelius on May 11, so we could discuss the new legislation and what it means for families. Here is what she had to say:

Q: In the past, parents could not keep their grad students or other non-dependent 20somethings on their health insurance plans. How does the reform bill affect dependents vs. non-dependents?

A: “What the new bill does is redefine dependency to include anyone’s child or stepchild, up to 26 years old,” Sebelius says. “It’s no longer tied to full time students or aging out. It opens plans to people who have been knocked off (their parents’ insurance) by college graduation or a certain birthday.”

Q: The new bill goes into effect in September, but my child is graduating now. What now?

A: Every major insurance company – more than 65, including Blue Cross, Aetna and Kaiser – and several major self-insured companies have pledged to provide gap coverage this summer. Sebelius calls it "great news for graduating seniors and their families," and says premiums are expected to rise by just 0.7%.

Q: Most insurance is based on managed care plans. What if my college student or 20something doesn’t live in the same city or state as his family?


A: Check with your insurance provider, says Sebelius, “Every plan has slightly different provisions, but lots of plans have companion programs in other states – Blue Cross is in Maine and California and New York. There are out-of-network providers. It’s not unusual to have plans in place for travel and school.”

Q: What about students with pre-existing conditions? Children are covered - and by 2014, everyone with pre-existing conditions will be - but now?

A: Sebelius recommends checking with your insurer and state insurance commissioner, as the transition progresses. The idea is that the new insurance marketplace will include a high-risk pool.

Q: What about married 20somethings?

A: The policy applies to married young adults, as well as single ones, but not your child’s spouse nor their children.

Q: What do we need to do now?

A: Ask your insurance company about your options now, whether your child is just graduating or has already been dropped from your policy. If your employer or insurance company does not offer gap coverage, watch for special open enrollment notices around September 23, 2010, when the new plan goes into effect.

Looking for more information?

•The White House Health Reform Act home page
•Secretary Kathleen Sebelius’ White House statement on how the reform act affects young adults
•Health Insurance for Your Not-Yet-Employed Child
•A perspective from Kelci Lynn, About.com’s Guide to College Life
•A perspective from Michael Bihari, MD, About.com's Guide to Health Insurance

Understanding Healthcare Reform


Rethinking the Business of How Americans Receive Their Healthcare
By Trisha Torrey, About.com Guide
Updated March 26, 2010


Healthcare Bill 2010

Medical Reform Plan
[Updated after passage of the healthcare reform law, March 2010.]

Most of us equate "health care reform" with "universal healthcare."

In fact, not only are they NOT the same thing, health care reform is actually comprised of at least a dozen components, and "universal healthcare" is not even one of them. Universal healthcare is one of the answers to one of the questions (see "Coverage" below), albeit the question regarded by many people to be the most controversial.

Most Americans understand that the healthcare system doesn't work efficiently or effectively, but few understand the scope of the problems involved. This guideline can help you understand what the problems are, and the questions that must be answered in order to fix the system.

There is a four-step process to understanding healthcare reform and its associated issues.

1. Understand the problems in the current system.
2. Understand the concept of healthcare rationing.
What most of us don't understand is that the bigger picture questions of coverage are all about cost and rationing. The more people, and the more services paid for, the more we will all be affected by rationing. Please take a few moments to understand the concept of rationing, then move on to the overall discussion of healthcare reform below.

3. Understand the ripple effect each decision has on the others.
The many aspects of healthcare reform are related to every other aspect. Decisions about coverage will affect cost and payment, which will also affect patient safety and tort reform. Decisions about electronic medical records will affect privacy issues, and so forth. Further, the problems of the uninsured affect far more than our wallets. This is the reason healthcare reform is such a difficult puzzle to solve.

4. Grasp the big picture of healthcare reform issues.
Here are the questions involved in the overall topic of healthcare reform. Their order does not necessarily indicate their level of importance in the larger picture. You can learn more about each by following the links provided.

Coverage:
Should all Americans be guaranteed access to basic health and medical care? Should the child of an unskilled hourly worker have access to the same care options as the CEO of a large corporation, or a U.S. Congress member or a retired union member? Should there be differences in the care available from state to state?
Included in the questions about coverage are these issues:

Who should be covered?
What are the differences between universal healthcare, single payer healthcare, and socialized medicine?
Pre-existing conditions - denial of health insurance for those who already have a medical problem
Denial of care - what medical tests, treatments and services should be, or should not be, paid for?
Types of services that should be covered (mental health? dental or vision?)
Primary care and the shortage of primary care physicians
Preventive care issues such as stop smoking campaigns, or overcoming childhood obesity problems
Portability of care- with an employer-based system such as exists today, workers sometimes find they cannot move or change jobs without fear of losing their insurance


Payment Systems and Costs:
Today there are an estimated 47 million people in the United States that have no payment system for their health care. There are an additional estimated 25 million underinsured, meaning, 72 million people are at risk of losing their financial foundation should their medical care cost more than 10 percent of their income.
This is mostly based on the concepts of private vs public, or regulation of private insurance. Only one of the answers is "universal healthcare."

Included in the questions about payment systems and costs are these issues:

What aspects of healthcare should be paid for by individuals, employers or the government?
Consumer-directed healthcare including Health Savings Accounts
Cost transparency - currently patients have little idea of what healthcare really costs, which is considered to be one of the reasons healthcare in the United States is so expensive.
Billing fraud and overcharging for services - this takes place in both government payment systems and private
Costs of drugs and devices - Patients in the United States pay more for drugs and medical devices than patients anywhere else in the world
Payments to doctors by pharmaceutical companies and medical device companies
Ownership of equipment and facilities
Use of technology
Patient Safety:
As each of the above listed challenges have become more difficult for professionals, facilities and patients to cope with, patients are more at risk of further problems as they access the system. Patients die or are further debilitated by the very system that is supposed to help them heal or be cured. Healthcare reform needs to improve the system to reduce the numbers of medical errors and deaths.
Included in the questions about patient safety are these issues:

Transparency in error reporting
Tort reform - should patients be allowed to sue when mistakes are made? should there be caps on the amount they can sue for?
FDA oversight - which has missed the mark in protecting Americans on too many occasions in the past several years
Health Information Technology:
Using our traditional paper-based record keeping system impacts not only the cost of care, but the quality of care as well. What problems can be solved during reform by the use of electronic medical records?


Medical Research, including Stem Cell Research:
In recent years, government funding for medical research has been cut dramatically, leaving major questions about the quality of privately funded research by pharmaceutical and device makers.

2010 Health Insurance Reform Law
The first sweeping changes to the laws that govern health and medical care in the United States were signed into law by President Barack Obama on March 23, 2010. Many, but not all, aspects of reform listed above were addressed and will be phased in over a five-year period.



Link:
http://patients.about.com/od/patientempowermentissues/a/hcreform-hub.htm?nl=1