Reiterating President Obama’s claim that the interim Patients’ Bill of Rights regulations shouldn’t provide insurers with an excuse to increase premiums, Washington and Lee Professor Timothy Jost takes a closer look at the text of the interim final regulations and concludes that “most of the reforms are expected only to increase premiums by tenths or hundreds of a percent.” That’s because:
- Relatively few individuals are directly affected by most of the regulations.
- Plans have the option prior to 2014 of avoiding the impact of some of the requirements by simply eliminating coverage for services or conditions (although they might lose grandfathered status by doing so).
- Some of the practices are already restricted in many states.
- Some of the regulations really do not impose additional costs (such as allowing individuals to choose their primary care provider or allowing children to be treated by a pediatrician)
“Individuals who may have benefited by some of these regulations, such as the ban on pre-existing condition exclusions for children or the removal of lifetime limits and restriction on annual limits, may be faced with high premiums when they seek to purchase or renew individual coverage,” he speculates, but “[i]n states that require some form of community rating, this barrier will be limited.” And “most insurers limit premium increases for persons in poor health to twice the standard rate.”
The most surprising aspect of the regulations, however, is the pre-existing condition provision. These interim rules prohibit insurers from denying coverage to children with pre-existing conditions; adults will receive this protection beginning in 2014, which is also when insurers will be required to offer a set of essential benefits. But before 2014, Jost notes that issuers can still get around this rule by excluding coverage for a certain conditions as long as they do not violate state law or other federal laws.
Kaiser Health News’ Phil Galewitz has more on the cost of the regulations here.