‘Bill of Rights’ Brings Hope, But Also Frustration

The regulations in the Patient Protection and Affordable Care Act's Patient's Bill of Rights, which address preexisting condition exclusions, retroactive rescissions, lifetime limits, annual dollar limits and other consumer-protection mandates, aim to "put American consumers back in charge of their health coverage and care," according to a healthreform.gov fact sheet.

However, after a week to digest the legislation's interim final rules, EBA's health reform panelists are left wanting more.

For Dave Lapka, president of logistics consulting company D360, the issue begins with the title.

"Interesting choice of titles: ‘Patient's Bill of Rights.' The definition of rights as applied in the U.S. Constitution represent things that the government can't take away from states or citizens," he says. "The term ‘rights' in this application is really just a listing of minimally acceptable cost levels. It then includes the possibility of waivers, so that significant cost increases or coverage limitations don't occur. So you might have changes or you might not - a bureaucrat will decide once the political winds are determined. If policies are ‘waive-able' were they ever really rights?"

Lapka refers to a provision in the rules that allows for plans with an annual dollar limit, such as limited medical plans, to seek a waiver that would allow for a delay in compliance as long as the plan "can prove that its current annual limits are necessary to prevent a significant loss of coverage or increase in premiums," according to a Hewitt overview.

Conversely, from the National Association of Health Underwriters' perspective, the waivers are "a positive development," says Peter Stein, NAHU's VP of congressional affairs, that allows time for other options to become available for those currently enrolled in limited medical plans.

The waiver option is available from now until 2014, but it remains unclear whether, once attained, the waiver will remain in effect until 2014 - "which would be preferable to minimize disruption" - or if it will need to be renewed on an annual basis, Stein adds.

As for the Patient's Bill of Rights as a whole, NAHU finds a disconnect between its intent to protect Americans with preexisting conditions by prohibiting exclusions for both benefit limitations and coverage, and the reality "that as many as 500,000 individuals with preexisting conditions - more than twice as many individuals as would benefit from these new health provisions - would not be able to obtain coverage in the new federal high-risk pool due to under-funding this program," says Stein, adding that "it is still not clear by how much these new patient protections will raise premiums - and therefore insurance bills - for all Americans, just like the other new mandates in the law, many of which are yet to be defined."

Nonetheless, the Patient's Bill of Rights is a start, says Kris Marohn, an administrator with McCall, Parkhurst & Horton, LLP, in Dallas. "I remember when there was a 10-month wait for pregnancy coverage. Medicare was a mess when it began many years ago and we are still amending it today. We had to start somewhere," says Marohn.

As president of the Center for Health Value Innovation, Cyndy Nayer knew health reform would require plenty of rulings, clarifications and translations, but "while they will purport to add clarity to the 2,700 pages of health care legislation, the effect will be more hoops to jump," she says.

In Nayer's home state of Florida, due to "the combination of unmet expectations and already high rates of uninsured and under-insured," she says, "I can report that the anger is rising. There are so many rules that many of the local brokers are having a hard time keeping up; the small businesses are frustrated, and the people who are attempting to reclaim their health and health care are finding there is little to no coverage."

The result is a feeling of betrayal on both sides of the aisle, says Nayer. "The rules that should be clarifying how this will benefit the citizens are not delivering on affordable and accessible care, and the [Obama] administration does not appear to be focused on easing the transition," she says. "Hats off to those who can translate the legislation - but that should not be the goal. The goal should be healthy, employed workers, who can access affordable health care before 2014.

"Pushing employers who have benefits into chaos and frustration is not helping, and while the national focus is on the large employers, the small employers who supply and support those large employers are having a very tough time providing the insurance coverage that will promote healthier and quicker economic recovery. We can expect more ER use, more escalation of chronic conditions and less preventive interventions in the short term - definitely not what we need right now."

Click here for more information.

Return to all news

Evolve News & Events

>> May 28, 2013
Model Health Insurance Exchange Notice Issued by Department of Labor
>> Aug 2, 2012
Medical Loss Ratio Rebates

Read all news

©Copyright Evolve Consulting Group 2009 All Rights Reserved