Latest From Jimmy: Health Reform

From Jim Himes:

Himes Announces Key Health Reforms to Take Effect

WASHINGTON, D.C. – Congressmen Jim Himes (CT-4) today marked the six-month anniversary of the comprehensive health care reform law by announcing a slate of key patient rights and protections that will take effect Sept. 23. The “Patients’ Bill of Rights” are provisions contained in the Affordable Care Act enacted into law last spring. These new rights will improve the health coverage for people who already have insurance while providing the stability and flexibility that families need to make the choices that work best for them.

“The provisions now going into effect will put individuals and their doctors in charge of their health care decisions. Prior to enactment of health care reform, patients were often denied coverage when they needed it most,” said Himes. “These new protections are only the beginning of reforms that will be phased-in through 2014 that will deliver the promise of affordable health care to all Americans and any effort to repeal health care reform would result in the elimination of these important protections.”

The Patients’ Bill of Rights taking effect tomorrow will:

• Extend Coverage for Young People to Age 26. The new law requires insurance plans that offer family coverage to allow young people up to their 26th birthday to remain on their parents’ insurance plan, at the parent’s choice.

• End Rescissions. The new law prohibits insurance plans from dropping an individual’s coverage when they get sick.

• End Discrimination Against Children with Pre-Existing Conditions. The new law prohibits health plans from denying coverage to children with pre-existing conditions or who become sick. Beginning in 2014, this prohibition will apply to all persons.

• Ban Lifetime Limits on Coverage. Until now, over 100 million Americans have been enrolled in insurance plans that impose lifetime limits on coverage – meaning that when a catastrophic illness strikes, they were in danger of bankruptcy when their health costs exceed the limit. The new law outlaws lifetime limits; no longer will a family go broke or lose their home just because a loved one has an accident or becomes ill.

• Ban Restrictive Annual Limits. Even more egregious than lifetime limits are annual dollar limits on what an insurance company will pay for health care. The insurance plans of millions of Americans have had such annual limits. The new law phases out the use of annual limits; ensuring that the coverage of hundreds of thousands of Americans will no longer be cut off right when they need it most.

• Guarantee Patients’ Choice in Primary Care Doctors. Before today, it wasn’t always easy for individuals to see the doctor of their choice. Under the new law, patients are guaranteed their choice of primary care doctor within their plan’s network of doctors, including OB-GYNs and pediatricians without a referral.

• Limit Charges for Emergency Treatment. Each year, thousands of Americans have gotten hit with exorbitant charges when they got sick or injured away from home and used an out-of-network emergency room. Under the new law, insurance plans will not be able to charge higher cost-sharing for emergency services that are obtained out of a plan’s network.

All of these provisions take effect for the next plan year starting on or after Thursday, September 23. Many of these reforms will be expanded over time and build on protections already in place. For example, once the exchanges come into operation in 2014, the prohibition against denying coverage for pre-existing conditions for children will be extended to adults and annual limits on coverage will be prohibited.

Starting next year, insurance companies will be required to put more premium dollars into health care and seniors will receive free preventive coverage through Medicare. Seniors struggling with the high cost of drugs have already seen significant relief thanks to the new health reform law; more than one million seniors and other Medicare beneficiaries, including nearly 13,000 Connecticut residents, have now received tax-free, $250 donut hole checks to begin to close the prescription drug coverage gap. Beginning in January 2011, seniors in the “donut hole” – a coverage gap created by the 2005 prescription drug law – will receive a 50 percent discount on brand name drugs. By 2020, the donut hole will be completely closed.

For more information on benefits scheduled to phase-in under the comprehensive health care reform law, please see


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