Understanding Health Care Reform

For all the media coverage and political bantering about health care reform legislation, many people don't know what changes are in the works — or already here. It's important to find out, though, especially since the laws have benefits for kids that many parents aren't aware of or don't understand.

Even with Medicaid expansions and the State Children's Health Insurance Program (SCHIP), millions of U.S. kids, mostly from low-income and working-class families, have no or insufficient health coverage. Many don't receive immunizations or regular checkups, which could help prevent many illnesses and detect health concerns early, when they're most treatable.

The health care reform package addresses some of these important gaps and expands coverage to 32 million currently uninsured Americans.

What This Means to You

The health care reform bill (officially known as the Patient Protection and Affordable Care Act) passed in March is a massive document. So it's no surprise that many Americans don't fully grasp what it means for them.

While full insurance expansion is due by 2014, when 95% of eligible Americans will have coverage, these major benefits are already in effect or imminent:

• Kids with pre-existing medical conditions (such as asthma or diabetes) cannot be denied coverage.
• Insurance companies can't set lifetime caps on insurance coverage, which previously could mean that sick kids lost benefits when they needed them the most.
• Coverage is extended for kids under their parents' insurance plan until age 26, instead of the current state-by-state rules that usually ended coverage at age 18 or 19. This is an increasingly important benefit for post-high school or college students who don't work, don't have employer-provided insurance, or can't afford to buy coverage.
• Insurance companies can't drop someone who becomes sick (unless fraud is proved).
• Insurance companies must cover preventive health care, like annual checkups and immunizations, at no additional cost (no co-pays).
• Consumers have new ways to appeal coverage determinations or claims to their insurance company.

Some things to know and do your homework on:

• Many employers are raising workers' share of health care costs, so your job-sponsored plan might not be your most cost-efficient or comprehensive coverage option. To see what else is available, contact your state's insurance regulator or check online:
  [Please note: By clicking on these links, you will be leaving this site.]
  • ehealthinsurance
  • HealthCare.gov
• Similarly, keeping an over-18 child on your policy could be more expensive than buying a separate policy because in most states, it's fairly inexpensive to insure a young person.
• Extended coverage for kids has prompted some big insurance companies to stop selling new child-only policies.
• For more specifics on what changes affect you and your family, and when they begin, talk to your workplace benefits manager or visit HealthCare.gov.
  [Please note: By clicking on this link, you will be leaving this site.]

Reviewed by: Steven Dowshen, MD
Date reviewed: December 2010