How Health Care Reform is Already Changing Lives

The final passage of health reform last week is a huge victory for people with HIV and AIDS.  Here are some of the short and long-term changes that will impact our community.

Effective in 2010

1. Employment-based and individual insurance policies will have to end pre-existing condition exclusions for children.

2. Individual and group plans will not be able to rescind coverage except in cases of fraud or intentional misrepresentation.

3. Policies can only have annual caps on benefits if allowed by the secretary of HHS

4. Children up to age 26 can stay on their parents insurance

5. Internet site will help people figure out their coverage options

6. Small employers (under 25 employees, average salary under $50,000) who offer insurance get a tax credit

7. A new national high risk pool will be available to people with pre-existing medical conditions who have been uninsured for at least six months.  Maximum cost-sharing will be limited to $5,950 for an individual in the new pool.

Effective later

1. Expand Medicaid eligibility to include everyone up to 133% of the federal poverty level ($1153 per month for a single adult)  without regard to whether they are disabled or living in a family with children.

2. Increase Medicaid payment rates for primary care to the Medicare levels.

3. End pre-existing condition exclusions and lifetime caps in all employer and individual insurance policies

4. Provide subsidies that allow people with income up to 400%  (currently $3468 a month/$41,616 annually for a single adult) of the federal poverty level to buy insurance .

5. Require large employers (over 50 employees) to offer health insurance

6. Create insurance exchanges which allow more choices and less cost in the individual and small group markets.

One client's story encapsulates how the success of health care reform is already changing people's outlook:

We met last week with a client whose 18 months of COBRA ended on December 13th.  He looked at what Illinois’ high risk pool would cost him (almost $800 a month) and went on-line to see if he could find a policy that was not quite as expensive but could still provide basic coverage until he found another job.  An eager broker based in Florida sold him a policy for $300 a month, reassuring him that he would not have a pre-existing condition exclusion since he was coming off other insurance and also promising that the new insurance would count as “creditable coverage” if he decided later to go into the high risk pool.  He says “I should have been suspicious as soon as I asked for a copy of the policy and they told me I couldn’t have one until I was enrolled.”  Sure enough, the policy is not really insurance at all, but simply an indemnity plan that allows him $300 worth of doctor visits per year, a $1000 benefit for in-patient surgery, and a $750 a day benefit if he is hospitalized.  When he realized his mistake, and called to see if he could now pay the $800 a month to enroll in the Illinois high risk pool, he was told it was too late.  That window closed 90 days after his prior insurance ended.  Now if he enrolls in the Illinois high risk pool he will have a six month pre-existing condition exclusion. 

The bad news is that our client is currently uninsured and uninsurable, except with the six month waiting period for the high risk pool.  But 90 days from now the national high risk pool will open and he will be able to be covered immediately, with premiums much lower than those in the Illinois pool.  In the meantime, he can get his medications through the AIDS Drug Assistance Program and his doctor will work with him to make sure that he still gets regular care.

A perfect solution?  Far from it. 

Better than his options a week ago?  Yes indeed.

Ann Hilton Fisher is Executive Director of the AIDS Legal Council of Chicago.