Health-care reform to impact some residents more than others

Washington –– If you like your health-care plan, President Obama says, nothing will change under the new health-care reform law as it goes into effect.

But that may not be completely true for some Connecticut residents, who might see their premiums and coverage change.

As Connecticut and Washington officials implement the Affordable Care Act, subtle changes are occurring in the way Americans receive care — and bigger changes lie ahead, as the law approved by Congress in 2010 is phased in.

The latest change took effect Wednesday, as insurers were required to provide women with eight new preventive health-care benefits that include contraceptive care, breastfeeding counseling and domestic violence screening. These services are no longer subject to co-payments or deductibles.

There are more changes to come, and the full impact of reform won’t be felt until the state’s insurance exchange is operational on Jan. 1, 2014.

Beginning that day, most individuals and small businesses will be required to carry health insurance or pay a tax penalty. Also on that day, insurers will no longer be permitted to deny coverage to people with pre-existing conditions and will have to offer a basic plan with elements selected by the state — known as a “benchmark” — in their individual and small group policies.

But even the federal government doesn’t fully know how those changes will impact Americans.

For example, it’s not clear how the 585,000 Connecticut residents covered under Medicaid, the government-run health program for the poor, would have their coverage changed because of the benchmark’s mandates.

“We plan to offer future guidance on that,” said Alper Ozinal, spokesman for the U.S. Centers for Medicare and Medicaid Services.

But Ozinal said he’s “not certain” when that guidance will be issued.

Some things are known, however.

If you work for a company that self-insures, or doesn’t change your policy, or are covered under a large group health plan, you may experience little or no change.

That’s because those who renew their current policies will be able to “grandfather” their coverage. Self- insured and large group health plans are also exempt from the benchmark mandate.

But if you purchase an individual policy or are a small company seeking to cover your workers under a new policy in 2014, that policy must include the benchmark’s mandates.

Connecticut’s health exchange board estimates as many as 750,000 state residents will see their health-care coverage change under that mandate.

The board last week settled on the benchmark all insurers selling policies in Connecticut must offer, whether they participate in the insurance exchange or not.

Those policies will be required to offer coverage for doctor visits, emergency services and hospital stays. They must also provide drug coverage, pediatric dental care and maternity services.

Other benefits that will be included in health insurance plans in Connecticut:

  • Habilitative services to help autistic children improve language skills
  • Colorectal, breast, cervical and prostate cancer screening
  • Wigs for those receiving radiation treatment
  • Breast reconstruction for women who’ve had mastectomies
  • Smoking cessation treatments
  • Drug and alcohol treatment
  • X-rays, CT scans, MRIs, PET scans and ultrasounds
  • 90 days of skilled nursing home care a year
  • 20 visits to a chiropractor a year
  • Psychiatric and psychologist care
  • Marriage therapy
  • Infertility treatments
  • abortion services (optional)

While the goal of the exchange is to give health-care consumers a wide choice of plans whose costs are driven down by competition, no one knows how many insurers will participate in the exchange or how much they will charge for their policies.

Those now covered under less-generous plans may see premiums rise when they purchase a new plan in 2014 as insurers are required to meet new coverage mandates.

“Premiums may be bumped up,” said Connecticut’s Deputy Insurance Commissioner Anne Melissa Dowling, a member of the exchange board.

That’s a concern to insurers, who worry they won’t be able to offer reasonably priced policies that include all of the coverage required by the mandate.

“The basic principle of economics is when you add benefits, it increases cost,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans. “Some individuals may see a significant bump-up.”

To help defray the cost of buying a policy, the Affordable Care Act will require Connecticut’s health-care exchange to offer “platinum,” “gold,” “silver,” or “bronze” coverage options. The platinum option would have the lowest deductibles and co-payments and cost the most. The bronze would have the highest deductibles and co-payments and cost the least.

The ACA also allows people who are younger than 30 to buy a “catastrophic” policy that is much cheaper than the ones that include the benchnmark’s coverage. This policy would cover major medical expenses after an individual pays at least $5,000 out of pocket for medical care in a year.

The ACA will also offer subsidies to low- and middle-income individuals and families to help defray costs. Small businesses that qualify would receive tax breaks to cover their workers.

But those subsidies and tax breaks could not be used to purchase abortion coverage — the only benefit in the benchmark that’s optional to insurers.

There is a ban on using federal funds to cover abortion services.