by Rachel Kelley, ’12
“Obamacare” is a term that’s used with both affection and derision. It’s actually a nickname for the Patient Protection and Affordable Care Act. More important than how you call the policy, however, is what’s in it. Here’s a rundown of some of the consumer protections that are being added between now and 2014.
Now: Insurance companies do not have to cover “pre-existing conditions.” That means if you apply for an insurance plan – but you’re a diabetic, or have cancer, or even acne – your insurance company can tell you that it will cover all your health costs except those having to do with your diabetes/cancer/acne, etc. The result is that many Americans are paying into an insurance plan that refuses to pay for the health care they need.
2014: Insurance companies will have to cover any paying customer, regardless of pre-existing health conditions. Many health insurance plans will also be required to offer a “standard benefits package” that covers a basic set of health care (annual physicals, diabetes care, hospital visits, etc.) to all customers.
Now: Insurance companies can place a limit on how much money they will pay to cover the care of any of their customers. Once the customer exceeds that limit, the company stops paying. A person with this kind of policy can find themselves without a way to care for an expensive illness (like cancer or a traumatic injury) just when they need it the most.
2014: Annual dollar limits on care become illegal. Lifetime limits became illegal in 2010.
Before 2010: Insurance companies could retroactively decide not to pay for their customers’ health expenses. Several companies used this practice, called “rescission,” to avoid paying for newly-diagnosed breast cancer and HIV+ patients.
Now: Rescission is only allowed in cases of fraud.
This post is the second post in a series. Coming up next: a summary of affordability measures.
Rachel Kelley studies Human Biology with a concentration in community health policy. She spent last spring working for a health care advocacy organization in Tennessee, where she met many people who need the health care system to change.