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Health Insurance Reform:
Too Much is at Stake. ‘No’ is Not an Option
“Our daughter has a pre-existing condition, and when she cycled off our insurance, she was denied coverage because of her condition. I know things can change and the first order is to make a motion in the direction you want to go.”
Ren Thompson, Lakewood, CO
I want to take this opportunity to discuss the Health Care & Education Affordability Reconciliation Act the House passed on Sunday and why I supported it. At Government in the Grocery and events throughout the district, I heard from hundreds of my constituents who told me we cannot wait any longer to lower insurance premiums and prevent denials of care and coverage including for people with pre-existing conditions, like my daughter Alexis and Ren Thompson’s daughter. I believe what the insurance companies are doing now is unconstitutional and immoral.
Too much is at stake for thousands of people, families and small businesses in the 7th CD, and we took the necessary first steps to making quality, reasonably priced health care accessible to more people for less cost. There is still work to be done, and I am committed to continuing this work. But ‘No’ is not an option. The status quo is not the answer.
This issue touches every person in a unique way, and because of this, there are millions of different and sometimes opposing opinions and ideas. But we have to keep moving forward, untangle the knots, and try to find cost-effective ways for Americans to live healthy lives so our economy can grow and our nation can prosper again.
How will H.R. 4872 Impact the 7th CD?
The most important factor in making a decision before I vote is how this legislation will impact the hard-working people of the 7th Congressional District. H.R. 4872 will positively impact thousands of CD 7 residents. Listed below are some district-specific benefits of the health care reform legislation:
- Guarantees 16,800 residents of the 7th CD who have pre-existing conditions can obtain coverage.
- Provides insurance coverage for 95% of Americans, including 94,000 uninsured residents in the 7th CD.
- Improves coverage for 396,000 residents with health insurance.
- Provides tax credits and other assistance to up to 160,000 families and 17,500 small businesses to help them afford coverage.
- Improves Medicare for 85,000 beneficiaries, including closing the donut hole.
- Protects 1,700 families from bankruptcy due to unaffordable health care costs.
- Allows 58,000 young adults to obtain coverage on their parents’ insurance plans.
- Provides millions of dollars in new funding for 18 community health centers.
- Reduces the cost of uncompensated care for hospitals and other health care providers by $20 million annually.
Key Provisions of H.R. 4872 Take Effect Immediately
During these tough economic times people and small businesses need help and they need it now. I am proud several important provisions take effect immediately and many more in 90 days to help people pay for and obtain health insurance coverage.- SMALL BUSINESS TAX CREDITS—Offers tax credits to small businesses to make employee coverage more affordable. Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage. Effective beginning for calendar year 2010. (Beginning in 2014, the small business tax credits will cover 50 percent of premiums.)
- BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE—Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010. Effective for calendar year 2010. (Beginning in 2011, institutes a 50% discount on brand-name drugs in the donut hole; also completely closes the donut hole by 2020.)
- FREE PREVENTIVE CARE UNDER MEDICARE—Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective beginning January 1, 2011.
- HELP FOR EARLY RETIREES—Creates a temporary re-insurance program (until the Exchanges are available) to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64. Effective 90 days after enactment.
- ENDS RESCISSIONS—Bans health plans from dropping people from coverage when they get sick. Effective 6 months after enactment.
- NO DISCRIMINATON AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS—Prohibits health plans from denying coverage to children with pre-existing conditions. Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to all persons.)
- BANS LIFETIME LIMITS ON COVERAGE—Prohibits health plans from placing lifetime caps on coverage. Effective 6 months after enactment.
- BANS RESTRICTIVE ANNUAL LIMITS ON COVERAGE—Tightly restricts new plans’ use of annual limits to ensure access to needed care. These tight restrictions will be defined by HHS. Effective 6 months after enactment. (Beginning in 2014, the use of any annual limits would be prohibited for all plans.)
- FREE PREVENTIVE CARE UNDER NEW PRIVATE PLANS AND MEDICARE —Requires new private plans and Medicare to cover preventive services with no co-payments and with preventive services being exempt from deductibles. Preventative services include cancer screening, diabetes screening, colonoscopies and mammograms. Effective 6 months after enactment. (Beginning in 2018, this requirement applies to all plans.)
- NEW, INDEPENDENT APPEALS PROCESS—Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions by their health insurance plan. Effective 6 months after enactment.
- ENSURING VALUE FOR PREMIUM PAYMENTS—Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent. Insurers that do not meet these thresholds must provide rebates to policyholders. Effective on January 1, 2011.
- IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL)—Provides immediate access to insurance for Americans who are uninsured because of a pre-existing condition - through a temporary high-risk pool. Effective 90 days after enactment.
- EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS’ INSURANCE—Requires health plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy, at the parents’ choice. Effective 6 months after enactment and may be applied retroactively.
- COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years. Effective beginning in fiscal year 2010.
- INCREASING NUMBER OF PRIMARY CARE DOCTORS—Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals. Effective beginning in fiscal year 2010.
- PROHIBITING DISCRIMINATION BASED ON SALARY—Prohibits new group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. Effective 6 months after enactment.
- HEALTH INSURANCE CONSUMER INFORMATION—Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals. Effective beginning in FY 2010.
- CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled. Effective on January 1, 2011.
Congressman Ed Perlmutter |
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Washington DC Office
415 Cannon House Office Building
Washington, DC 20515
Phone: 202.225.2645
Fax: 202.225.5278 |
District Office
12600 West Colfax Avenue, Suite B-400
Lakewood, CO 80215
Phone: 303.274.7944
Fax: 303.274.6455 |
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