Health care reform explained

This is a letter to a constituent from Senator Jay Rockefeller, explaining some of the benefits of the health care reform law (aka "Obamacare"). It's remarkable that the Democrats couldn't turn these benefits into a winning campaign. But there was no hiding the sellout to the pharmaceutical and insurance industries. -MH

Thank you for contacting me to share your thoughts about the passage of health care reform. I know there are a lot of questions about this new law, and I appreciate this opportunity to be in touch.

On December 24, 2009, I voted to support passage of the Patient Protection and Affordable Care Act (H.R. 3590). My vote reflects the urgent need to improve the health care coverage people have today, expand access to affordable care for the uninsured, control runaway health care costs, and end unfair health insurance industry practices. H.R. 3590 was subsequently passed by the House of Representatives on March 21, 2010, and signed into law by President Obama on March 23, 2010. A second bill, which included improvements to our health care system – the Health Care and Education Reconciliation Act (H.R. 4872) – was signed into law by President Obama on March 30, 2010. The Patient Protection and Affordable Care Act, together with the Health Care and Education Reconciliation Act, will provide Americans with more affordable and comprehensive coverage options, improve the quality of health care that all Americans receive, and reduce the federal deficit by $143 billion over the next ten years.

The legislation is not perfect – no law is – and it may not address every concern. There are many who thought we should go much further, and there are many who thought we should do far less. However, there has always been broad agreement that reform is necessary because our current system is broken and needs to be fixed. The health reform law gets us much closer to that goal.

Many have asked what health care reform will mean for West Virginia. As we begin the process of implementation, I truly believe this groundbreaking new law is major step towards building a stronger health care foundation for our great state. I am proud to share that West Virginians are already seeing the benefits of health care reform, including:
o West Virginian seniors that fall in the Medicare prescription drug coverage gap will receive a $250 rebate. Medicare covers 75 percent of the first $2,830 in prescription costs (in 2010), but seniors must pay the full cost after that until out-of-pocket spending reaches $4,550. This gap in coverage is referred to as the "doughnut hole." Health reform will completely eliminate the doughnut hole by the year 2020. In the meantime, the new law will provide financial help to seniors who fall into the doughnut hole each year. Seniors who hit the doughnut hole in 2010 will receive a $250 rebate, and the doughnut hole will be completely closed by 2020. Already this year, 12,800 West Virginia seniors have received the rebate. For more information, please call 1-800-MEDICARE (1-800-633-4227) or visit http://www.medicare.gov/Publications/Pubs/pdf/11464.pdf to view a brochure about this rebate from the Centers for Medicare and Medicaid Services (CMS).

o Tax credits to make health coverage more affordable for West Virginia's small businesses. This year, small businesses in West Virginia will have access to tax credits for up to 35 percent of the cost of health coverage for their employees. This law will help as many as 20,000 small businesses in West Virginia afford to offer health coverage. For more information on small business tax credit eligibility and enrollment, please visit http://www.irs.gov.

o Financial Assistance for West Virginia's Employers to Help Them Maintain Coverage for Early Retirees. The Early Retiree Reinsurance Program provides $5 billion in temporary financial assistance to employers and unions to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare. As many as 41,500 retirees in West Virginia could be eligible for assistance. Applications are being approved each day, and the U.S. Department of Health and Human Resources has already approved several organizations in West Virginia.

o West Virginians who are uninsured due to a pre-existing condition now have access to affordable insurance options through a new Pre-Existing Condition Insurance Plan (PCIP). You can learn more about and apply for the Pre-Existing Condition Insurance Plan online at https://www.pcip.gov/.

o As of September 23, 2010, health care reform brought some of the worst abuses of the insurance industry to an end. Insurers are not longer be able to:

o Deny coverage to kids with pre-existing conditions. Health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a pre-existing condition like asthma.

o Put lifetime limits on benefits. Health plans can no longer put a lifetime dollar limit on the benefits of people with costly conditions like cancer.

o Cancel your policy without proving fraud. Health plans can't retroactively cancel insurance coverage – often at the time you need it most – solely because you or your employer made an honest mistake on your insurance application.


o Deny claims without a chance for appeal. In new health plans, you now have the right to demand that your health plan reconsider a decision to deny payment for a test or treatment. That also includes an external appeal to an independent reviewer.

o As of September 23, 2010, West Virginians now have new health care rights, benefits, and protections. Consumers in new health plans are able to:

o Receive cost-free preventive services. New health plans must give you access to recommended preventive services such as screenings, vaccinations and counseling without any out-of-pocket costs to you.

o Keep young adults on a parent's plan until age 26. If your health plan covers children, you should now be able to add or keep your children on your health insurance policy until they turn 26 years old if they do not have coverage on the job. Young adults just starting out will no longer be ignored by our health care system, and will have more affordable options available to them.

o Choose a primary care doctor, obstetrician or gynecologist and pediatrician. New health plans must let you choose the primary care doctor or pediatrician you want from your health plan's provider network and let you see an OB-GYN doctor without needing a referral from another doctor.

o Use the nearest emergency room without penalty. New health plans cannot require you to get prior approval before seeking emergency room services from a provider or hospital outside your plan's network – and they cannot require higher copayments or co-insurance for out-of-network emergency room services.

These are just some of the benefits that are available from health care reform now, and this is only the beginning. In the coming months, even more provisions will be implemented that will have real benefits for West Virginians. To learn more about the new health reform law – including the text of the bill, descriptions of specific provisions, and an implementation timeline – please visit http://www.healthcare.gov. If you do not have a computer in your home, you may access the Internet at your local library, free of charge.

As we continue implementation of this new law, your views and experiences will be critically important to me. Thank you again for writing. I wish you all the very best.


With Warm Regards,Jay Rockefeller