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Sweating the details

The new health reform law leaves many crucial details up to the Department of Health and Human Services (HHS), and, as Kaiser Health News reports, HHS has proposed a number of rules that worry patient and consumer advocates. For example:

  • Allowing insurers to sit on boards that govern exchanges, the marketplaces created in the health law. While insurers say their expertise is needed and valuable, consumer and patient groups say that it could give patients an unfair shake in disputes.
  • Being too vague on what happens if states want to run some functions of an exchange but not others. If functions are divided between the state and federal governments, that could undermine the goal of having the exchanges be a one-stop-shop for buying insurance.
  • The new law gives patients the right to an external review if an insurer won’t pay for a medical service, but recent regulations would allow insurers to choose their own “external” reviewers.
  • The law says that people who have employer-sponsored insurance can qualify to buy insurance on the exchange and receive a federal subsidy if their employer’s insurance costs more than 9.5 percent of their income. A regulation released last month said that the 9.5 percent figure would apply only to the cost of individual coverage–rather than family coverage.

That last point is a big one. According to experts at the Kaiser Family Foundation, that there are 3.9 million dependents who would be eligible for coverage on the exchange, if the 9.5% of income limit applied to the cost of family coverage. First Focus president Bruce Lesley wrote:

“[The rule] would exclude millions of families from eligibility for subsidies in the exchange and reduce the number of children currently covered under family plans. This interpretation of the law is a serious concern and would disproportionately harm children and women.”

Remember these regulations are still in the proposal stage, so there’s still a chance they might change. Meanwhile, progressive health care advocates don’t expect to win every battle:

In the end, said Kathleen Stoll, deputy executive director of the consumer group Families USA, it’s all about perspective. “We weren’t completely pleased with the [external appeals] regulations, [but] the fact that consumer groups can get together and get a meeting to sit down around the table [with administration officials], and tell them what our feelings are, that is different from past administrations.”

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