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Published: Monday, 7/26/2010

Reform law puts patients in control of their health care

BY KATHLEEN SEBELIUS

THREE years ago, Taylor Wilhite, of Marblehead, Ohio, was diagnosed with leukemia. Like many other American parents, Taylor's mother and father assumed their health-insurance coverage would get her the care she needed.

Unfortunately, the Wilhites' family policy came with a $1 million lifetime cap. That sounds like a lot of money, but patients with serious illnesses can easily spend that much or more.

Three rounds of chemotherapy and a bone marrow transplant put Taylor into remission, but she was approaching her policy's spending cap. Although her insurance company extended her coverage, Taylor's parents still can't get her the follow-up care her doctors recommend because they fear exceeding the cap.

Like most other families, Taylor's parents have paid their insurance premiums every month, in good times and bad. It's basic fairness that their insurance should be there when they need it.

Fortunately, the new Affordable Care Act will give Taylor and her family, and other families like them, much-needed peace of mind. These new consumer protections will help American families starting as soon as September:

No pre-existing-condition exclusions for children under age 19. Many insurers now sell coverage that excludes pre-existing conditions or refuse to sell an applicant with a pre-existing condition any health coverage.

For most plans starting on or after Sept. 23, new rules under the Affordable Care Act stop insurance companies from denying health coverage to children based on pre-existing conditions. By 2014, these protections will apply to all Americans.

No unjustified cancellations of coverage. Today, insurance companies may cancel the policies of people who become sick just because they or their employer made an unintentional mistake on their insurance paperwork.

Under the health-care reform law, insurers may no longer rescind anyone's coverage, except in cases of fraud or intentional misrepresentation of material fact. Americans who pay their premiums and act in good faith will have the security of knowing that their health coverage may not be taken away from them when they need it most.

No lifetime limits/restricted annual limits on coverage. Health plans now may limit care through annual or lifetime limits. Under the Affordable Care Act, insurance companies no longer will be able to limit the care that Americans such as Taylor need.

The law also will phase out annual dollar limits on coverage over the next three years. They will be banned outright for most plans in 2014.

Choice of doctors. Insurance companies don't have to make it easy for Americans to see the providers they want. Under the Affordable Care Act, patients will have more control over their choice of doctor.

Members of new health plans will be free to choose any available primary-care provider who participates in their network. Women won't need a referral to see an obstetrician/gynecologist.

Lower insurance company barriers to emergency services. Today, insurance companies can turn an emergency medical condition into a financial emergency for American families. Under the Affordable Care Act, insurance companies won't be able to charge you a higher co-payment or co-insurance for emergency services received outside your plan network.

These new rules will bring immediate relief to many Americans. They will provide peace of mind to millions more who are only an illness or accident away from medical and financial chaos.

American families know their insurance will be there when they need it. A huge weight has been lifted from many parents like Taylor's, who know that the new law will ban the lifetime cap that is limiting access to care.

Using the tools created by the Affordable Care Act, we will hold insurance companies accountable by requiring them to play by these new rules. In fact, we are making it a priority to work with insurers to implement new consumer protections ahead of schedule, providing even faster relief for families.

Health insurers no longer will be able to call all the shots at the expense of the health and well-being of American families. That will mean that children such as Taylor will get the care they need.

Kathleen Sebelius is secretary of the U.S. Department of Health and Human Services.



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