Affordable Care Act: Get the right facts on health care reform

[NRSKarenRN, BSN, RN]

from delaware county times

published: friday, september 24, 2010

editorial: get the right facts on health care reform

...here are some more facts about health care reform measures that went into effect this week. as of thursday:

insurance companies can no longer deny children coverage because of an illness or pre-existing condition. by 2014, that pre-existing condition guarantee will be extended to adults as well.

insurance companies will no longer be able to drop clients because of innocent mistakes they made on their applications for coverage. it was a common industry practice for insurers to look for such mistakes after a person became ill and deny claims, citing fraud. no more.

lifetime coverage limits are banned. that means insurance companies will no longer be able to deny claims when their clients are sickest.

clients buying new plans will be able to choose their own doctors within the insurance company network.

insurance companies can no longer limit new clients’ choices of emergency rooms or charge them more if they go out of network.

those purchasing new policies will now be able to appeal insurance company decisions to neutral third parties, a right they never had before.

young adults will be able to stay on their parents’ policies until they turn 26, unless they are offered coverage at work.

those purchasing new plans will receive recommended preventative care with no out-of-pocket cost. insurance companies cannot charge deductibles, co-payments or co-insurance on services like mammograms, colonoscopies, pre-natal care and others.

those are the first in the wave of reforms in the law; many more will take effect by 2014. they are being phased in gradually to give the market, and the consumers, time to absorb the changes.

and here’s one more thing you need to know.

republicans running for congress this year are promising to repeal every one of those reforms.

“repeal and replace” is one of the central planks of the gop agenda this fall. oh, sure, that “pledge to america” platform they released on thursday says they’ll re-enact some of the reforms that took effect that same day … but only after doing away with the whole affordable care act first ...

[Not_A_Hat_Person, RN]

Free preventative care and screening are nice, but it doesn't help when your insurer won't pay for treatment. What good is a free mammogram if your insurer won't pay for your mastectomy? How helpful is free pre-natal care when your insurer won't pay for childbirth?

[lamazeteacher]

In response to the first reply, I'm not convinced that appropriate treatment following suspicious mammography has ever been refused, except for insurer claims that there was a preexisting condition. That is no longer allowed. (Unless, as they have with children as an entity, anyone having tests indicating a need for treatment, will not be accepted by insurers in the first place....). Insurers must cover medical expenses when indicated,with "state of the art" procedures/choices.

In the future there will be the National Medical Plan to fall back upon, that will cover anyone without adequate insurance coverage. That will be at least equal to or better than the healthcare covered by current insurers. Basically, by excluding groups of people (like children), insurers are basically drumming themselves out of existance. That can't happen too soon, as far as I'm concerned.

Unknowns are difficult to foresee, yet doctors will still see patients on the National Program, or go under, financially. Without the cost of insurance premiums, money will be saved, and healthcare will continue. Higher standards will be required, and closer monitoring of billing practises will occur.

There was a doctor reported recently in the "Fierce Healthcare" website, whose billing for 25 hours of work a day, plus $60,000 for procedures claimed to have been done in one year on a patient who was never seen by him was caught in new more responsible tracking/monitoring. That type of fraud as well as others routinely occurring in the past, will be punished appropriately and sooner. Taxpayers will not be burdened by costs of trials for such abominable acts, and patients will receive better, more appropriate health care as a result of zero tolerance for reprehensable actions such as the ones above.

How would anyone want to return to the former state of affairs, other than those who profitted by such criminal practices? Threats by those who oppose the present administration of this country are ludicrous; and their intention to erase the good done by our President and his staff and appointees to the DHHS, should not be supported by anyone who is concerned about good healthcare!