With this reform, every insured American gets valuable consumer protections, and every uninsured American can become insured.
Days before President Barack Obama signed the health care reform bill into law, U.S. Rep. Lloyd Doggett, D-Austin, delivered a speech on the House floor saying "you can certainly sum up our many, many pages with four words: 'You've got health care.' "With this reform," Doggett said March 21, "every insured American gets valuable consumer protections, and every uninsured American can become insured." We wondered if Doggett accurately characterized those many pages of the law. Let's start with his proclamation of consumer protections. Sarah Dohl, Doggett's communications director, pointed to 11 consumer protections in the Patient Protection and Affordable Care Act that Obama signed on March 23, plus the House reconciliation bill he signed March 30. This year, for starters, adult children can stay on their parents' health insurance policies until they turn 26. Second, insurers are prohibited from rescinding coverage except in cases of fraud. Third, insurers can't refuse coverage for children for a particular illness — say, asthma — if the child is accepted into a plan or is currently covered on a plan. There's more: Insurers can no longer place lifetime caps on how much they'll pay out. Consumers in private plans will have access to an independent appeals process to contest decisions made by their insurers. Also, insurers won't be able to deny coverage or charge higher premiums because of a person's gender or pre-existing medical conditions. What about Doggett's statement that every uninsured American can now become insured? Keeping in mind that "can" is not the same as "will" and that some parts of the new law will take years to kick in, more people do stand to be insured. Today, some 83 percent of Americans — excluding illegal immigrants — have coverage either through their employer, the private market or government programs such as Medicaid and the Children's Health Insurance Program. The new law is expected to increase the share of insured Americans to 94 percent by 2019, according to the non-partisan Congressional Budget Office. As of June, people with pre-existing medical conditions can get coverage from a temporary national high-risk pool set to last until 2014 when insurers will be barred from denying coverage to anyone for any reason. Also starting in 2014, most people will be required to have health insurance. There are a handful of exceptions, but individuals who aren't exempt and refuse to sign up with a plan will be required to pay an annual penalty of the greater of $695 per person, up to a maximum of $2,085 per family, or 2.5 percent of household income, whichever is greater. Other aspects of the new law are aimed at easing access to insurance. In 2013, the federal government will create the "consumer operated and oriented" plan to foster the creation of nonprofit, member-run health insurance cooperatives in each state and the District of Columbia. Come 2014, individuals and small businesses with up to 100 employees can purchase coverage administered by a governmental agency or nonprofit organization. That year, Medicaid will be open to anyone under 65 making up to 133 percent of the federal poverty level — which this year is $14,404 for an individual and $29,327 for a family of four. According to the nonpartisan Kaiser Family Foundation, which has analyzed all the major health care proposals: "This expansion will create a uniform minimum Medicaid eligibility threshold across states and will eliminate a limitation of the program that prohibits most adults without dependent children from enrolling in the program today." Per current law, undocumented immigrants won't be eligible for Medicaid. Another future change, according to Kaiser: Individuals whose incomes are greater than 133 percent of the poverty level who don't have access to affordable coverage through their employer will be able to purchase it through a state-based exchange by 2014. 2014 is the year when Doggett's characterization will prove true. John Greeley, a spokesman for the Texas Department of Insurance, told us that every Texan can already obtain insurance if they choose to do so. Greeley pointed to the Texas Health Insurance Risk Pool, a high-risk pool created by state lawmakers to provide health insurance to residents who lose coverage under a group plan or who can't obtain coverage from an insurer on the private market because of a pre-existing medical condition. (Texas is one of 34 states that have such high-risk pools.) But Stacey Pogue, senior policy analyst at the left-leaning Center for Public Policy Priorities, noted that access to insurance is not always a cinch. An individual may not qualify for coverage, she said, or may not be able to afford it. Per the Texas Insurance Code, the pool's premiums rates are double the rates premiums offered by private insurers,in the private market, to avoid competition with them. As of March, 26,564 Texas residents were insured through the pool, and 6.1 million residents were uninsured, according to the U.S. Census Bureau. Now, where does that leave us with Doggett's floor statement? He's right about the law introducing consumer protections. Also, the law is expected to ease access to coverage, though not everyone benefits immediately. Still, starting in 2014, every American will be able to sign up for insurance. We rate Doggett's statement as True.
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