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PPACA: Sept. 23 is Nigh

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Health insurance rates and children’s access to health coverage are some of the hot topics this week as an important Affordable Care Act implementation deadline nears.

The Patient Protection and Affordable Care Act (PPACA) , the core of the Affordable Care Act package, was signed into law March 23, and many insurer-consumer relations provisions will start to take effect Thursday.

Some of the provisions about to spring to life include:

- A mandate requiring plans that offer dependent coverage to let young adults stay on parents’ coverage up until age 26.

- A ban on use of information

about pre-existing conditions when an insurer is selling coverage to children.

- New restrictions on rescissions of health insurance policies.

- A ban on lifetime benefits limits and new restrictions on annual limits.

Insurers and group health plans must apply those new rules during plan or policy years that start on or after Thursday.

If an insurer sells an entirely new plan or policy on or after Thursday, or a policyholder changes coverage enough to lose grandfather status, the plan or policy must:

- Pay for a bundle of in-network preventive care services without requiring the payment of a deductible or applying other cost-sharing features.

- Let enrollees choose their own doctors, as long as the doctors are in-network.

- Charge the same amount for emergency services obtained in network and out of network.

- Comply with new internal and external appeal rules.

Many insurance producers and health carrier executives are skeptical about the new mandates and are asking whether the people who created them understand the principle that, “There ain’t no such thing as a free lunch.”

Other people with an interest in the mandates, including some in the insurance industry, say they believe that the effects of the new rules will be mostly positive.

Bruce Bodaken, chairman of Blue Shield of California, San Francisco, has issued a statement saying he believes that, starting Thursday, “health care in America will change for the better.”

Bodaken is expressing pride in the amount of resources California Blue is devoting to Affordable Care Act compliance: The company has assigned 250 employees to 20 PPACA implementation work groups.

The Office of the Actuary at the Centers for Medicare & Medicaid Services has estimated that PPACA is increasing overall U.S. health spending by about 1.2 percentage points this year, and Towers Watson Company, New York (NYSE:TW), has predicted the act will add 1 percentage points to 2 percentage points to the health plan cost increase rate.

Federal regulators have accused some insurers of sending letters to consumers blaming much higher premium increases on PPACA.

Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, and Sen. John Rockefeller IV, D.-W.Va., chairman of the Senate Commerce, Science and Transportation Committee, have sent a letter to executives at 5 large health carriers – Aetna Inc., Hartford (NYSE:AET); CIGNA Corp., Philadelphia (NYSE:CI); Health Care Service Corp., Chicago; UnitedHealth Group Inc., Minnetonka, Minn. (NYSE:UNH); and WellPoint Inc., Indianapolis (NYSE:WLP) – “demanding more transparency in calculations of premium increases.”

“The era of egregious insurance company abuses is over,” Baucus says in a statement. “Independent experts have concluded that the law does not cause large premium increases, the American people deserve to know that and we’ll keep working to make sure they do.”

In related news, Health Care for America Now (HCAN), Washington, an advocacy group says large health carriers in California, Colorado, Missouri and Ohio have stopped selling coverage for children because of the PPACA ban on using pre-existing conditions as a basis for rejecting coverage applications submitted on behalf of children.

“We’re just days away from a new era when insurance companies must stop denying coverage to kids just because they are sick, and now some of the biggest changed their minds and decided to refuse to sell child-only coverage,” HCAN Executive Director Ethan Rome says in a statement. “The latest announcement by the insurance companies that they won’t cover kids is immoral, and to blame their appalling behavior on the new law is patently dishonest.


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