Health Care Blog

The Affordable Care Act -- Benefits and Weights Being Lifted

In March 2007, doctors diagnosed Amy Wilhite’s daughter, Taylor, with Acute Myeloid Leukemia (AML), a fast-growing cancer of the blood and bone marrow. Taylor received three rounds of chemotherapy and a bone marrow transplant. The cancer treatment produced multiple side effects: problems with her heart and hip, short-term memory loss, steroid-induced diabetes, and a compromised immune system. And so as one can imagine, the lifetime limit on the insurance plan that was covering Taylor was a constant worry, and as Amy explained before introducing the President today, there was always the worry pursuing a treatment now might mean they could not afford an even more important treatment later.

Taylor Wilhite takes a photo as her mother Amy Wilhite introduces President Barack Obama for remarks on the 90-day anniversary of the signing of the Affordable Care Act, in the East Room of the White House, June 22, 2010. (Official White House Photo by Pete Souza)

The Wilhites are just one family that will benefit from the fact that the Affordable Care Act, or Health Reform as you probably know it, will prohibit all insurance companies from imposing lifetime benefit limits for plans beginning on or after September 23, 2010.  The Wilhite family can now follow doctor's orders without having to worry about hitting a limit, which Amy described as a weight being lifted.  And that was just one of the benefits that the President spoke about this morning:

The Grandfather Regulation – What They're Saying

Yesterday, the Departments of Health and Human Services, Labor and Treasury issued a new regulation that makes good on the President’s pledge that Americans who like their health care plan can keep it. The new regulation:

• Protects the ability of individuals and businesses to keep their current plan;
• Provides important consumer protections that give Americans – rather than insurance companies – control over their own health care.
• Provides stability and flexibility to insurers and businesses that offer insurance coverage as the nation transitions to a more competitive marketplace in 2014 when small businesses and consumers will have more affordable choices through Exchanges, the same choices as members of Congress.

You can read more about the regulation here.

The same opponents of reform are attacking this common sense rule – falsely charging that it will force people off their plans.  Nothing in this rule does that. The rule provides consumers with critical new benefits, it provides flexibility to allow insurers and businesses to innovate and grow and maintain their grandfather status. And it keeps the market stable as we move toward a more competitive marketplace in 2014.

Under the rule, most of the 133 million Americans with employer-sponsored health insurance through large employers will maintain the coverage they have today and many large employer-based plans already offer most of the comprehensive benefits and consumer protections that the Affordable Care Act will provide to all Americans this year – such as preventing lifetime limits on coverage – and in the future. 

People who work in smaller firms – which change insurers more often due to annual fluctuations in premiums – and people who purchase their own insurance in the individual market– a group that frequently changes coverage – will enjoy all of the benefits of the Affordable Care Act when and if they choose a new plan. 

The common sense approach of the new rule has earned support from a number of individuals and organizations across the spectrum including:

Former Republican Senate Finance Committee staffer Alec Vachon:

“Show me the numbers, proof that these regulations will cost companies more, then I'll believe it. There is no evidence that this rule will end employer coverage. Either employers tamp down on cost increases and maintain their grandfather status, or they exceed the costs and consumers pick up modest protections.”

American Cancer Society Action Network:

“This is a strong rule that encourages plans to strengthen benefits for patients and strips them of their ‘grandfather’ status if they choose to reduce benefits or substantially shift costs to patients. In the interests of patients, existing health plans should be allowed to strengthen benefits and continue to operate as they did before the law was signed. If a plan decides to substantially weaken coverage or boost costs, then patients should be given access to the full benefits provided in the law.

“People with cancer or at risk for cancer require coverage of strong preventive services, extensive treatment options, and comprehensive follow-up care. Under this rule, patients who have had adequate coverage will not see their plan change substantially, if at all. Patients with inadequate coverage in plans that lose their grandfather status will benefit from strong new requirements in the law. The rule also strengthens the law’s already strict constraints on annual limits.”

Senate Finance Committee Chairman Max Baucus:

“Health care reform puts the focus of health insurance where it belongs – on consumers.  For nearly two years, the national discussion on what this country wants from our health insurance system has proven that stability and affordability are among the highest priorities for workers and their families, and those are two principles today’s rule helps to address.  This rule allows individuals and families to keep their existing plans if they like them, and protects consumers with important benefits we included in the new health reform law.  And, the new rule provides flexibility to employers who offer quality insurance to make routine changes and still continue offering the same coverage to employees.  But this new rule also protects employees by discouraging employers from using health reform as an excuse to cut their benefits or increase their cost sharing.  This rule strikes the right balance between protecting consumers and offering the flexibility employers need.”

DeAnn Friedholm, Director of Health Reform, Consumers Union:

“This seems reasonable, balancing the need for consumer protections with the need to maintain stability in the health insurance marketplace during this transition period leading up to 2014.”

Senator John Kerry:

“This rule provides vital new consumer protections, and ensures that if you like the quality health coverage you have today, you can keep it. The Obama Administration is ending the worst insurance company abuses so they can’t jack up premiums or slash benefits without warning. Still, the same special interests and politicians who tried to kill reform are now misleading and scaring Americans about this new protection. That kind of distortion and demagoguery sides with big insurers over the working Americans who need stable access to quality, affordable health care.”

Stephanie Cutter is Assistant to the President for Special Projects