Seven Health Reform Provisions That Could Take Effect This Year

Although the House and Senate negotiators are still hammering out their plans for healthcare reform, lawmakers and healthcare stakeholders are playing a numbers game: carefully eyeing when specific projects are to be implemented and gauging how they can meet the deadlines.

As far as healthcare leaders are concerned, meeting some of the timelines—especially for 2010—may be, in the words of one, "challenging."

Under the proposed healthcare reforms before the House and the Senate, both have differing expectations, as well as differing deadlines, with some to take effect this year and others to continue through at least 2018.

"Changes that take effect in 2010 need to be carefully rolled out to avoid disruption for those with existing coverage," says Tom Epstein, vice president for public affairs, Blue Shield of California.

Epstein says Blue Shield of California, similar to other insurers, are taking steps internally to prepare for the changes.

"Some deadlines may change as a result of the negotiations that are currently underway," Epstein says. "We are forming a broad-based reform implementation group this month to begin planning for transition."

If Congress passes health reform soon, some changes may be implemented in 2010 under the legislative proposals. The plans for relatively quick implementation include:

• Provisions to prohibit health insurance rescissions when a person gets sick
• New limits on pre-existing condition exclusions
• Proposals to prohibit insurance companies from placing lifetime caps on coverage
• Creation of new long-term care programs
• Creation of a health benefits advisory committee
• A $5 billion fund to finance an immediate temporary insurance program for those who are deemed uninsurable because of pre-existing conditions
• Proposals for incentive payments to states that enact alternative medical liability laws

The "reforms scheduled for 2010 may be challenging," Epstein said. He adds, however, "we should be able to meet the deadlines for reforms that take place in 2013 or 2014. From an operational perspective, there is little difference between 2013 and 2014."

Diane Boyle, vice president of the National Association of Insurance and Financial Advisors, says NAIFA has concerns about reforms implemented this year because "we have lots of policies in place and no room for adjustments." The NAIFA has actively opposed proposed amendments to repeal long-standing provisions of the McCarran-Ferguson Act related to health and medical malpractice insurance.

Inevitably, as healthcare leaders prepare for changes that may be imposed, "timing will depend on conference and any agreements between the House and Senate on their respective bills," says Matt Fenwick, senior associate director for the American Hospitals Association (AHA). "If/when an agreement is reached, we will work with our members to understand what they need for any transition," he says.

In a Jan. 7 letter to Senate Majority Leader Harry Reid, D-NV, and House Speaker Nancy Pelosi, D-CA, the AHA said it strongly urged conferees to adopt some earlier implementation dates in the House proposal as opposed to the Senate version. Major provisions of the House bill would take effect in 2013, while those in the Senate version would go into effect a year later under the proposals.

For instance, the Senate version of the health plan staggers the implementation of reforms, such as prohibition on coverage of those with pre-existing conditions and lifetime and annual limits—until 2014. "While covering the uninsured is a crucial element of health reform, it also is critical that already insured people are able to keep their coverage," the AHA said in the letter. "Insurance market reform is the area where the greatest consensus lies."

Under the House bill, insurance plans in existence before 2013 would have five years to adopt new requirements to tighten them, while the Senate would exempt such plans from the new rules.

The dates of implementation are among the topics being discussed in the Capitol. "To the extent there are differences between the Senate and House, they are still up for discussion," says Stephanie Lundberg, spokeswoman for House Majority Leader Steny Hoyer, D-MD.

By 2019, there will still be millions of people uninsured in the U.S. regardless of the legislative outcome in Congress, according to the Congressional Budget Office. How many vary by the reform proposal. Under the Senate plan, there will still be 23 million uninsured. The House proposal would cover 5 million additional uninsured people, leaving 18 million uninsured in 2019, according to the CBO.