Health Law Affecting Insurers, Employers And Comparative Effectiveness Research

Kaiser Health News has a list of eight provisions in the new health law that took effect this week as insurers, businesses and employers sort out what the new changes mean for them. Insurers must now cover kids with pre-existing conditions, must allow adult children to stay on their parents’ health plan and can’t charge copays for preventive services, among other things, but “grandfathered” plans don’t have to follow some of the requirements. Grandfathered plans are plans that were in place when the provisions went into effect (Carey, 9/23).

USA Today tries to provide some clarity on what the changes mean for “grandfathered” plans. “The law contains provisions that allow some existing plans — those that don’t significantly raise prices or reduce benefits — to maintain a ‘grandfathered’ status. The goal was to help smooth the transition to major changes mandated by the law in 2014. Grandfathered plans were the law’s answer to addressing the desire by individuals and employers who like their current coverage to keep that coverage, says Steve Larsen, who heads insurance oversight at the Department of Health and Human Services (HHS). … All plans, regardless of whether they are new or grandfathered, are subject to several other provisions that take effect after Thursday. … Far fewer consumers will be in grandfathered health plans in the next few years than the federal government estimated, according to a survey released in August by Hewitt Associates, a global human resources consulting firm” (Young, 9/24).

The Wall Street Journal: “Several provisions of the health-care overhaul that go into effect on Thursday will expand the amount of coverage that many small-business owners provide their employees. But the changes are also expected to increase insurance premiums. … Just how much policies might go up will depend on the type of coverage that small businesses currently offer their employees, says Robert Zirkelbach, press secretary for America’s Health Insurance Plans, a national association in Washington, D.C., representing nearly 1,300 health-insurance providers. ‘Small businesses that don’t have many of these benefits today are going to see a bigger increase in their premiums as a result of the new mandates than those that already have them,’ he says. ‘It’s a basic principle of economics'” (Needleman, 9/23).

The Hill: In other health reform implementation news, the Government Accountability Office on Thursday announced the appointment of 19 members of a new center for comparative effectiveness research created by the new law. “The Patient-Centered Outcomes Research Institute (PCORI) is tasked with carrying out research projects to ascertain the best medical treatments. The provision was one of the most controversial aspects of the health reform debate, with critics worrying that it could lead to rationing if researchers recommend low-cost treatments that could be well-suited for most but not all patients.” The commissioners come from academia, advocacy groups and the health industry (Pecquet, 9/23).

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