It wasn't supposed to be like this. When Democrats front-loaded the Patient Protection and Affordable Care Act with consumer protections set to kick in six weeks before Election Day, they never imagined that health care reform would still be so unpopular. The newest reliable poll on public opinion on the new law, sponsored by the Associated Press, shows that 40% of Americans oppose the new law, with 30% saying they have no opinion and just 30% favoring it.
Opposition to the overhaul has remained strong despite efforts by the Obama Administration and health-reform advocacy groups to turn the tide. The reason, they say, is that Americans are confused about how the law will work. There's some truth to this, with polls consistently showing that although Americans dislike the law overall, they like many of its components when asked about them individually. Polls also show that misconceptions are common. The AP survey, for instance, indicates that 65% of people believe the law will probably increase the federal deficit, despite estimates that it will reduce the federal debt by some $140 billion over 10 years.
The Administration is banking on a massive public-education campaign for a set of insurance regulations that kick in on Thursday to increase support for health reform. Other numbers from the new AP poll, however, suggest how hard that will be. When asked a series of quiz-like questions about new rules that are already in place (like tax credits for small businesses), along with the popular insurance regulations that kick in on Thursday (like new coverage rules for children), most respondents were already familiar with them and understood how they work, even as they misunderstood more distant changes to the health care system. Additionally, some of the provisions taking effect are fairly narrow in scope, meaning a relatively small number of Americans will be personally affected by them.
Here's a rundown of six consumer protections that go into effect on Thursday:
1. Coverage for Children with Pre-Existing Conditions
Insurance companies are no longer permitted to exclude from coverage pre-existing conditions in enrollees 18 and under. This provision, while wildly popular in the abstract, comes with a long list of caveats. There's nothing in the law that prevents insurers from charging as much as they want to cover the costs of paying for pre-existing conditions. While all group plans, like those provided by employers, will fall under this new rule, individual policies that existed before March 23, 2010, aren't subject to it. Since new child-only plans will have to cover pre-existing conditions, some insurers have opted not to sell them at all. The government estimates that 31,000 to 72,000 uninsured children could gain coverage because of this new rule and that up to 90,000 who have insurance but with a pre-existing-condition exclusion could get new coverage for their conditions provided they can afford it.
2. Ban on Lifetime Limits and Restrictions on Annual Limits
Insurers are no longer allowed to set a lifetime limit on benefits. This is particularly helpful to people with very expensive or long-term health problems. The government estimates that about 20,000 people in the U.S. hit their lifetime limits every year. The law also begins phasing out annual limits on coverage. Except for individual plans purchased before March 23, 2010, which may have "grandfathered status," all plans issued or renewed between Sept. 23, 2010, and Sept. 23, 2011, will not be able to set annual limits lower than $750,000. (The limit is raised each year until it is eliminated in 2014.) Not all plans have annual limits, and some are already higher than this, meaning the new rule will affect fewer than 2 million plans, according to federal estimates. For plans that currently have limits below $750,000 and will therefore have to make changes, the government predicts premiums will increase by percentages in the single digits.
3. Ban on Rescissions
Insurance companies are no longer allowed to retroactively cancel policies just because people made inadvertent errors on their enrollment forms. Such action by insurers, while rare, is often egregious and a way for insurers to avoid paying for care when their customers become very ill. The new rule states that insurers can only rescind policies if enrollees are found to have committed fraud. The ban on unfair rescissions is, like coverage of pre-existing conditions in children, wildly popular but will affect only a small number of people. The government estimates that there are about 10,700 rescissions every year.
4. Coverage for Young Adults
Insurance companies must allow parents to include children age 25 or younger as dependents on their policies. Children 25 and under can join their parents' policies even if they are not listed as a dependent for tax purposes and even if they don't live with their parents. However, as with coverage for children with pre-existing conditions, there are a number of caveats that apply to this new rule. Some plans that existed before the Affordable Care Act was signed, on March 23, 2010 like those that maintain grandfathered status will not be required to extend dependent coverage to these young adults if they can get their own insurance through work. Children ages 19-25 who have pre-existing conditions may face exclusion periods. Plus, about half the states already allow adult children to be included as dependents. Still, up to about 2.5 million young adults could gain new coverage.
5. Free Preventive Care
Insurers must cover preventive care without requiring enrollees to cough up co-pays or co-insurance. The rule applies only to preventive care delivered by practitioners in an insurer's network. Plans with grandfathered status do not have to abide by this new rule. Procedures, screenings and tests that are considered preventive will be determined by the U.S. Preventive Services Task Force, the Centers for Disease Control and Prevention (for vaccines) and the Health Resources and Services Administration.
6. Other New Rules
Regulations that kick in on Thursday also allow people more freedom to choose doctors within their insurers' networks and freedom to receive covered care in emergency rooms even if they are not pre-approved. Insurers also must follow a strict set of guidelines when handling claim appeals.