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'Bill of Rights' Is Law at Long Last, Dems Crow

By John Reichard, CQ HealthBeat Editor

June 22, 2010 -- The White House announced publication Tuesday of a package of "Patients' Bill of Rights" regulations issued under the health care overhaul law that includes a three-year phase-out of annual limits on medical care payouts by insurers.

Under the phaseout, plans issued or renewed starting Sept. 23 can't set annual limits below $750,000, $1.25 million a year after that and $2 million two years later.

Annual limits would no longer permitted in 2014, according to a White House summary of the regulations issued under the health care overhaul law.

Otherwise, many of the basic provisions in the regulations have been widely reported. But the Obama administration is intent on using every opportunity to crank up the White House publicity machine to promote the benefits of the law in the face of repeated Republican attacks blaming it for premium increases. Publication of the regs created that opportunity. For the most part, the protections take effect in plan or calendar years beginning after Sept. 23.

Another big White House message of the day was that insurers shouldn't jack up premiums, and that greater scrutiny of rising premiums is paying off. After a meeting with insurance regulators and insurance company executives about the law, President Obama said that companies "shouldn't see [the law] as an opportunity to enact unjustifiable rate increases that don't boost care and inflate their bottom line."

HHS Secretary Kathleen Sebelius said in a telephone press briefing later in the day that the cumulative impact of the regulations would likely raise insurance premiums less than 1 percent.

The regulations eliminate limits on lifetime benefits, cancellation of coverage after a policyholder becomes ill and denial of coverage of children under 19 based on pre-existing medical conditions. They also bar insurers from denying specific benefits for children, such as chemotherapy coverage in the case of children with cancer, said Jeanne Lambrew, head of the HHS Office of Health Reform.

Other new regulations assure access to pediatricians and obstetrician-gynecologists without a referral for enrollees in new insurance plans or in those that lose "grandfather" status in the overhaul law. That status allows Americans to keep their current coverage.

Except in the case of grandfathered plans, the provisions also end insurer requirements for pre-approval to get emergency care in an out-of-network emergency room.

'Further Than We Could Have Dreamed'

Congressional Democrats offered statements describing the regulations in historic terms, saying they put into effect many provisions of the failed attempt in the 1990s to enact consumer protections in so-called Patients' Bill of Rights legislation.

"Because of the work of President Obama and HHS Secretary Sebelius, we've gone even further than we could have dreamed a decade ago," Michigan Democrat Rep. John Dingell said. "Millions of Americans will now receive the timely medical care they need and deserve without fear of insurance company rascality."

"We have worked for more than 15 years to secure these protections and the robust policies we were able to achieve in this Bill of Rights represent a victory for patients across the country," said Senate Finance Committee Chairman Max Baucus, D-Mont.

In his comments after the meeting with insurers and regulators, Obama highlighted the cases of individual Americans who would benefit from the ban on lifetime limits. He also said states are more actively reviewing rate increases.

"We're already seeing a wave of change that's lifting up consumers and leveling the playing field," he said. "Maine rejected a proposed 18 percent rate hike there. Pennsylvania is investigating premium increases made by nine of the state's largest insurers. New York recently passed a law granting the state the authority to review and approve premium increases before they take effect. And we're working with other states and the state insurance commissioners here today to support similar efforts."

Sebelius said that in her previous work as Kansas state insurance commissioner she was "very familiar with companies alleging costs well in excess of what they ended up being. Every single mandate passed in my experience at the legislative level was always estimated to be well more costly than tended to be the reality."

Insurers kept a low profile after the meeting but America's Health Insurance Plans issued a statement emphasizing that premiums are going up not because of profits and administrative costs but because of big underlying increases in the cost of doctor, hospital and pharmaceutical treatment.

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