Healthcare Reform: Are you ready for September?

It’s been a little while since we’ve talked about healthcare reform, but that doesn’t mean that the changes are coming any slower. In fact, there’s a lot happening in September. Here’s a list of changes effective September 23rd, 2010 for all new plan years starting on or after that date. I picked the topics that I believe will impact business owners the most, but this is by no means an exhaustive list:

• Young adults that are covered by your plan as dependents must be offered coverage until they reach age 26 (unless covered by an employer of their own).
• Plans must include preventive care services such as mammograms and colonoscopies for free. Co-pays, deductibles, and co-insurance are not allowed.
• Insurance companies cannot rescind coverage for someone who is ill due to a technicality or application error.
• There is a new external review process for individuals to appeal insurance company decisions.
• Lifetime benefit maximums have been eliminated
• Annual limits on essential services have been eliminated
• Pre-existing condition clauses have been eliminated for all children under the age of 19.

Those are the key changes for September and there are some additional changes that will take effect on January 1st, 2011. Those changes include:

• Large employer plans will be eligible for rebates if medical claim costs are less than 85% of the insurance costs.
• Small employer and individual plans are eligible for rebates if medical claim costs are less than 80% of the insurance costs.

The rebates are designed to limit the profit and administrative expense amounts available to insurance companies.

If you have not yet reviewed your plan for changes, I would strongly encourage you to do so soon. Additional information is available on the web at: www.healthcare.gov

Michigan’s Healthcare Reform Surprise

While at a local coffee shop this morning I came across a newspaper article on healthcare in Michigan that made me almost fall out of my chair. Believe it or not, one of our current state senators, and Republican gubernatorial candidate, has introduced legislation for healthcare reform in Michigan (SB 1242.1245). Senator Tom George M.D., from Texas Township states:

“It is no secret Michigan is struggling and health care in the United States is broken. These issues have been ongoing for years. This was an issue last year and it was an issue two weeks ago. Especially in light of recently passed federal legislation, Michigan needs to address our problems sooner rather than later.”

In a statement on his website and in a recent speech at CMU he explains that 30% of Michigan’s current budget is spent on Medicare and that it isn’t sustainable without change. He also says that we can’t wait until 2014 when many of the provisions of the recently passed federal legislation take effect.

George’s decision to introduce this legislation is absolutely amazing because not many Republicans are gutsy enough to back healthcare reform in our current political climate. He is also bucking the trend by working with a Democrat to co-sponsor the bill. (Rep. Marc Corriveau, Northville HB 6034-6037)

As a practicing physician, George clearly has some strong opinions about health care reform – this is not the first time that he has sponsored legislation on this topic.

Regardless of your opinion of the health care debate, you have to admire someone who sticks to his guns regardless of the political climate. In this case, it may be helpful that Mr. George is a physician. He’s taking a big gamble with this legislation so it’s a good thing that he has a career to fall back on. He may need it.