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An Auspicious Anniversary for Health Care Reform

By Tracy Dingmann

Soon thousands of New Mexicans will realize the benefits of the historic health care reform passed by Congress six months ago.

With the Patient Protection and Affordable Care Act, our country’s leaders took a major step toward providing a more fair health care system; one that provides affordable quality care for all Americans, of all ages, and all incomes – especially working middle class families and children.

Americans needed health care reform to make certain that all insurance companies are held accountable for unfair practice – and to make sure they can no longer deny coverage regardless of one’s current health condition.

Several of the provisions will become active on Sept. 23, including:

  • No Pre-Existing Condition Exclusions for Children Under Age 19. Each year, thousands of children who were either born with or develop a costly medical condition are denied coverage by insurers. The new regulations will prohibit insurance plans from limiting benefits for children and from refusing to sell children coverage at all based on the fact that a child has a pre-existing condition. This critical policy will be broadened to Americans of all ages in 2014.
  • No Unjustified Rescissions of Insurance Coverage. Right now, insurance companies are able to retroactively cancel someone’s policy when they become sick, or if they or their employers made an unintentional mistake on their paperwork. Under the regulations, insurers will be prohibited from rescinding coverage – for individuals or groups of people – except in cases involving fraud or an intentional misrepresentation of material facts. There are no exceptions to this policy.
  • No Lifetime Limits on Coverage. Millions of Americans living with costly medical conditions are at risk of having their health insurance coverage disappear when their costs reach a lifetime limit set by their insurance company. No plan issued or renewed after tomorrow can use such a limit.
  • Restricted Annual Limits on Coverage. Even more binding than lifetime limits are annual dollar limits on what an insurance company will pay for health care. The rules will phase out the use of annual limits over the next three years for most health plans before banning such limits entirely in 2014.
  • Protecting Your Choice of Doctors. Being able to choose your own doctor is a central principle in the Affordable Care Act that is highly valued by Americans. The new rules make clear that health plan members are free to designate any available participating primary care provider as their primary care provider.
  • Removing Insurance Company Barriers to Emergency Department Services. Some insurers will pay only for health care provided by a limited number or network of providers – including emergency health care. Others require prior approval before receiving emergency care at hospitals outside of their networks. The new rules make emergency services more accessible for consumers. Health insurers will not be able to charge higher cost sharing (copayments or coinsurance) for emergency services obtained outside the plan’s network.

New Mexicans who want to learn more about how the historic health care reform can help them should visit these websites here, here and here.

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