Health law already affecting consumers, insurers, brokers

The New York Times profiles one man's current insurance dilemma, one which is not likely to happen in the future under the new health law: "Ever since Thomas DeLorenzo was accepted to three law schools outside his home state of California, he has spent entire days on the phone with health insurers in other states, compiling information that he enters on a giant spreadsheet." DeLorenzo, "who has AIDS, will lose his health coverage in California if he moves out of state. To replace it, he has found policies that seem to promise comprehensive coverage, but actually cover only catastrophic events like car crashes and major surgery. One plan looked attractive but did not cover the drugs he needed." Because of the new health law, starting in 2014 insurers would no longer be allowed to refuse coverage to customers such as DeLorenzo because of their existing health issues, and policies would have to meet "a clearly defined package of essential health benefits" (Rabin, 5/17).

Kaiser Health News/Washington Post begins a new weekly feature on consumer issues and the new law: "If you're sick - or have ever been sick - and can't get insurance, the new health-care law promises fast relief: access to guaranteed coverage through a special federally funded insurance program starting in July. The goal is to provide comprehensive and affordable coverage to more people." But details remain unclear about the cost, benefits and availability of coverage under the plans (Andrews, 5/18).

The Wall Street Journal: "Among the first to feel the effects of the nation's health-care system overhaul are insurance salespeople, whose commissions for selling policies to individuals and small groups are themselves getting overhauled." A requirement of the new law that 80 percent of premium dollars go to medical care - as opposed to administrative costs - may put a dent in commissions, which fall in the latter category (Schoofs and Johnson, 5/18).

Bloomberg Businessweek: "Insurers led by UnitedHealth Group Inc. and Humana Inc. may share in an estimated $2.5 billion in yearly bonuses if their U.S-backed Medicare plans rate four or five stars under a system created to improve quality of care." But, for now, United Health has earned only three to three and half stars for most of its Medicare Advantage plans, under the system that assigns one to five stars for 33 criteria including clinical outcomes and costumer satisfaction. A spokesperson said the firm had begun an "improvement push." A better rating, and more reward money, could help offset the effects of $136 billion in cuts over 10 years  to the Medicare Advantage program overall  (Armstrong, 5/18).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.