One of the most popular provisions of the Affordable Care Act prevents insurers from denying coverage to Americans with pre-existing conditions. But Republicans seek to repeal the law in its entirety and have gone to great lengths to oppose the new consumer protection. Just ask Georgia Rep. Tom Price, a medical doctor, who has introduced a replacement bill which would not require insurance companies to accept people with pre-existing conditions. When asked why he omitted that provision, Price was blunt in his assessment:

They are even divided over whether some of the popular pieces of Obama’s health law are a good idea. For example, most Republicans support the health law’s requirement that insurance companies accept all applicants — but the replacement plan put forward by the most prominent Republican ignores that idea.

“It’s a terrible idea,” Rep. Tom Price (R-Ga.), the sponsor of the plan, told POLITICO. He said Democrats only enacted the provision in order to require exactly what kinds of insurance Americans must have. He would rather expand coverage voluntarily.

Price may think opening coverage to Americans who need it most is a “terrible idea,” but for many of those Americans, it is a matter of life or death. As many as 122 million Americans have an illness which could result in an insurer denying them coverage; they paid as much as $4,844 more a year for health care than those without pre-existing conditions. And a study from 2009 found that 45,000 Americans a year died because they don’t have access to care.

Despite some Republican claims that this provision would somehow do more harm than good, children up to the age of 19 are already receiving care regardless of pre-existing conditions as a result of the law. By 2014, that provision will extend to everyone. If, on the other hand, the individual mandate is repealed, health insurers have already said they will return to the practice of denying coverage to sick Americans.

-Zachary Bernstein

One of the things Americans like most about the Affordable Care Act is that insurance companies can no longer deny people coverage because of a pre-existing condition like cancer or diabetes. That provision will take effect in 2014, but in the meantime, individuals and families with pre-existing conditions can enroll in temporary high-risk insurance pools that provide coverage for those who are can’t find insurance elsewhere.

Since large groups of sick people are very expensive to insure — they spend the premiums they pay into the risk pool — enrollment has lagged behind expectations, as high risk pools attracted the sickest (and more desperate) individuals willing to pay a hefty price for coverage. But since the federal government instituted a series of reforms, enrollment has picked up. In Alabama, for instance, the size of the state’s pool increased six-fold over the last year, when premiums were cut by 40 percent. Other states also saw tens of thousands more Americans join their state’s pools:

The U.S. Department of Health and Human Services reports that as of the end of February, 389 people in Alabama were on the special insurance, an option for people with illnesses that make them a high risk, such as cancer or diabetes. Last February, there were 61 enrollees. [...]

Alabama’s uptick in enrollment follows a national trend over the last 12 months, when enrollment grew from 12,437 to 56,257. The plans are for people who have been denied coverage because of their health status and are struggling to find affordable insurance. To qualify, people must have gone without health insurance for six months and not be eligible for Medicaid or Medicare.

“For too long, Americans with pre-existing conditions were locked out of the health care system, and their health suffered,” HHS Secretary Kathleen Sebelius said in a recent prepared statement. “Thanks to health reform, our most vulnerable Americans across the country have the care they need.”

Alabama is far from alone in seeing higher enrollment. According to the National Conference of State Legislatures, 49 states, plus Washington, DC, saw an increase in enrollment in their high-risk pools last year. (The lone outlier, Vermont, was not listed as having any enrollees in its pool, but is a “guaranteed issue state” which offers policies to all eligible applicants regardless of their health.) The federal government’s contribution to the program — $5 billion — is running out fact, but given the new enrollment numbers, the law is clearly having an impact.

-Zachary Bernstein

By requiring everyone to purchase health insurance coverage in 2014, the Affordable Care Act provides millions of new customers to private health insurers. But the law also guarantees that companies don’t swindle premium dollars away on corporate profits and CEO bonuses. Under the law, insurers have to comply with a new Medical Loss Ratio or MLR, which requires that companies spend 80 to 85 percent of premium dollars on medical care and health care quality improvement, as opposed to administrative spending.

It’s a rule Republicans have sought to repeal and water down — repeatedly — but now, a new report from the Kaiser Family Foundation finds that “consumers and businesses are expected to receive an estimated $1.3 billion by this August in rebates”:

The rebates include $541 million in the large employer market, $377 million in the small business market, and $426 million for those buying insurance on their own. Rebates in the group market will generally be provided to employers, and in some cases be passed on to employees as well.Rebates are expected to go to almost one-third (31%) of consumers in the individual market. Among employers, about one-quarter (28%) of the small group market and 19% of the large group market is projected to receive rebates. The share of consumers in the individual insurance market expected to receive rebates ranges from near zero in several states to as high as 86% in Oklahoma and 92% in Texas.

Interestingly, residents in states that are challenging the constitutionality of the law — and seeking to dilute the MLR regulations — are benefiting the most from the provision. A back-of-the envelope calculation finds that states opposing the ACA received an Average Rebate per Individual Market Enrollee of $35.76 ($21.04 in the small group market), compared to $27.43 ($19.04 in the small group market) for those who aren’t. The states that went before the Supreme Court received a total of $320,082,038 in individual market rebates ($210,713,425 in the small group market).

ThinkProgress intern Zachary Bernstein contributed to this post.

This post was filed from Doctors For America’s 2012 National Leadership Conference in Washington D.C.

Zeke Emanuel — a senior fellow at the Center for American Progress — addressed the Doctors For America’s 2012 National Leader Conference Monday morning and urged physicians to remain engaged in the nation’s health care debate. Emanuel predicted that the Affordable Care Act will succeed in expanding coverage and slowing the growth of health care spending by 2020, but stressed that the biggest changes will occur in how health care providers deliver services to patients — an area which doctors must lead in shaping, he maintained.

Health care systems around the country are already moving away from the existing fee-for-service reimbursment system and coordinating care in a way that improves efficiency and care quality. These successes contain valuable lessons for the kind of delivery reforms the ACA hopes to foster and offer a glimpse into the system of the future. Emanuel explained what those changes will look like, relying on the real-world experiences of Group Health of Puget Sound in Washington state:

1) “It doesn’t look like lone doctors working alone. It looks like health care teams of doctors working with nurses, working with public health professionals.” Specialized groups of providers are better equiped to provide personalized care to patients with multiple chronic conditions, who consume two-thirds of the health care dollars.

2)”You don’t wait for the patient to come to you. You have active outreach to patients.” Providers track their pateints’ physiological indicators and call them to ensure that they’re complying with medication and other interventions.

3) “You have electronic health records so you can track patients over time … so that you can track physician, nurse and other quality performance in your group.”

4) “You also don’t treat patients individually. You have team huddles, you have team plans. You standardize care for patients.”

5) “You also create specialized clinics for chronic problems, have the best people you have doing that over and over.”

The results have been impressive. Sine adopting the changes, Group Health experienced a six percent drop in readmissions, a six percent decrease in length of stay, decreases in physician visits, but a dramatic increase in telephone calls and email communications. Most remarkably, the new system saved $1.50 for every $1.00 invested in the re-engering process over a 21-month period.

Providers also experienced a boost in morale “because the health staff finally felt like they were practicing the medicine they were trained to and not just doctor reimbursment,” Emanuel stressed.

That’s the future providers can look forward to. And now, they have to work to make sure it becomes a reality.

Despite railing against the health care law, several of its Republican opponents are benefiting from it. This hypocrisy extends to states challenging the constitutionality of the law and even members of Congress who voted to repeal the measure.

On Tuesday, the Department of Health and Human Services released a list of 27 Accountable Care Organizations, groups that will serve Medicare beneficiaries under the law. Among them is the Accountable Care Coalition of Mount Kisco, featuring the Mount Kisco Medical Group. That organization’s CEO is Dr. Scott Hayworth, husband of Rep. Nan Hayworth (R-NY). Rep. Hayworth, for her part, worked at the clinic as a partner and received $56,800 in contributions from the group in this election cycle and $78,550 in 2010 — more money that she accepted from any other organization or company.

But Rep. Hayworth, who was endorsed by Tea Party groups, has also spoken out against the law her company is now participating in, describing it as a “disaster” :

– “The government would be making decisions about what type of care is given, what procedures can be performed, and the kind of medications prescribed. It would be a very profound change from the ideal to which we aspire.”(Newsmax, Mar. 28, 2011)

– “It will not achieve the goals that – the beneficial goals that we wanted it to have. It will add to the cost of care, it does not address the fundamental drivers of cost that are unique in this country, namely liability issues, and the fact that we like to have choice and competition, and if we ignore those things, we will raise the cost of care.” (Fox Business, Mar. 14, 2012)

– “This massive law that has its second anniversary has already resulted in skyrocketing health care premiums for folks across the country. Small businesses, in particular in a state like New York, are finding it very, very difficult to afford to insure themselves. It’s a disaster.” (TRN Central Health, Mar. 21, 2012)

We all honor the goals of the Affordable Care Act but this law increases spending, raises taxes, and destroys jobs. With this vote to repeal we are listening to the American people and fulfilling our promise. (Politics on the Hudson, Jan. 20, 2011)

Far from being disastrous, the measure may prove to be quite profitable for Hayworth, her husband, and largest campaign contributor.

(HT: Inside Health Policy)

-Zachary Bernstein