Insurance companies could no longer deny coverage to people because they've had health problems in the past, nor could they charge hugely different rates for different groups of people (premiums could only vary by age, geography, tobacco use and family size).
The House bill bans recissions -- the insurance industry's habitual practice of collecting premiums until someone gets sick, and then digging through their histories for an excuse to cancel coverage.
Insurers wouldn't be allowed to cancel an individual's coverage for reasons other than failing to pay the premium.
Insurers would no longer be permitted to impose annual or lifetime caps on benefits.
Insurers that sell insufficient, cheapo plans that leave people vulnerable to medical crises would be required to disclose that fact to their customers.
All insurers would be required to disclose how much of their spending is on health care and how much goes to costs like overhead, advertising, etc.
The legislation (especially the Senate HELP bill) creates new tools for fighting insurance fraud and abuse.
3. Medical Bankruptcies Would Plummet
One of the most significant of these regulations is in the House bill: a cap on out-of-pocket expenses. If the measure passes, individuals would face a maximum of $5,000 in out-of-pocket expenses a year, and families no more than $10,000. For poorer families, the limits would be much lower: $500 per year, for example, for a family making less than 1.33 times the poverty rate.
In 2007, Harvard researchers studied thousands of bankruptcy filings and found that medical causes played a role in more than 6 in 10.
4. People Who Could Never Get Decent Coverage Will Finally Be Able To
So far, one of the great victories for the anti-reform movement has been convincing many small-business owners that health reform will put them under.
The reality is that small-business people, their employees, independent contractors, freelancers, entrepreneurs, part-timers and the "marginally employed" would be the biggest winners from the legislation if it passed as currently drafted. Small business owners and their employees -- as well as those other groups -- would, for the first time, be able to get decent coverage at a fair price, and if eligible, both employer and worker would be able to get extra help paying for it.
Under the current system, most of the largest employers in the country self-insure -- they pay their employees' claims directly and cut out the middleman.
Big firms that don't self-insure buy insurance on the large-group market, where risk is spread out over a large pool. Large-group plans tend to be more or less comprehensive and, relatively speaking, affordable.
But those forced to purchase coverage on the individual or small-group markets have little buying power and are routinely forced to pay budget-busting premiums for the worst possible coverage -- plans with high deductibles, caps on benefits and strict limits on what is and isn't covered.
This gets to the heart of the "public insurance option" -- the most contentious point of debate in the reform battle. It would work like this: The government would establish regional exchanges, or "gateways," that would be open to those who would otherwise be forced into the individual and small-group markets. These gateways would have relatively large insurance pools just like large employers -- and public programs like Medicare -- have now.
Within these large purchasing pools, people would be able to choose from among different insurance plans -- one a government-run "public option" and the rest offered by private insurers.
In order for private insurers to sell plans through the exchanges, they would be required to offer a standard set of benefits (which the public option would have to offer as well). They'd also be permitted to offer plans with more bells and whistles at a premium price.
For those enrolled in the public exchanges, the process would be quite similar to what employees in many large companies experience -- they would simply choose from among a variety of plans, with slightly different levels of coverage and costs.
Compared to the plans now available in the individual and small-group markets, they would pay a lot less for significantly better insurance (which, in reality, is what those "teabaggers" are protesting).
Because of pressure from Republicans and conservative Blue Dog Democrats, the public exchanges will phase in slowly, over a period of four to six years.
5. (Almost) Everyone Gets Covered
http://www.alternet.org/healthwellness/141916/10_awesome_things_that_would_happen_if_health_reform_passes/and more....38 million more!
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=132x8741163
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