Consumers hoping for help from the national health-reform bill passed by Congress on Sunday must wait at least six months for some new benefits and until 2014 for the major benefits, state Insurance Commissioner Mike Kreidler said Monday.
Kreidler’s office has estimated that the number of uninsured in Washington is growing and might hit 1 million by year’s end, and President Barack Obama’s signature on a reform bill doesn’t change that trend line.
In fact, the reform’s creation of a national insurance exchange and a law against insurers rejecting coverage for pre-existing conditions don’t come into being for almost four years.
“I would anticipate that until Jan. 1, 2014, you are going to continue to see the number of uninsured continue to rise because of the economic situation,” Kreidler said in an interview.
The state Office of the Insurance Commissioner is still trying to get more details on how the short-term benefits will play out, and Kreidler thinks the reforms do deliver gains that over time bring coverage to more Americans.
In broad terms, his agency says, consumers can expect improvements in about six months or at least by January in these areas:
• An end to the exclusion of coverage for children with pre-existing conditions.
• Removal of $1 million lifetime caps on insurance coverage.
• An end to co-pays for preventive care.
• Extension of coverage for a policy-holder’s dependents until age 26.
• A 50 percent discount for seniors on name-brand medications next year; also a $250 rebate for seniors on Medicare who fall into the “doughnut” hole or coverage gap, which starts after the first $2,830 of federal benefits under the 2003 federal Medicare reform.
• Money to help make policies more affordable in so-called high-risk pools.
“For 60 to 70 percent of the insurers we regulate, these short term (elements) would be in effect by Jan. 1, 2011,” Kreidler said. “Some are going to be phased in earlier. A lot has to do with when policy renewals take effect.”
Other changes, including $13.8 billion in federal aid to help consumers afford policies, would come in 2014, according to Kreidler’s office. That is also when consumers would begin to purchase private-company policies through government-run insurance exchanges that would in some cases also give consumers subsidies.
The OIC says 2014 is also when:
• Medicaid coverage would be extended for the first time to low-income adults who are childless.
• Coverage is guaranteed and screening for pre-existing conditions ends for individuals that buy their own insurance.
• Caps limit what insurers can charge in out-of-pocket costs.
• Tax credits become available to small businesses that buy insurance for employees.
• Medicare reimbursements go up for providers including physicians.
State budget writers also are looking into what benefits the state might accrue short term, but it appears there is nothing immediate unless the state can win waivers allowing use of federal Medicaid dollars for the state’s Basic Health Plan and General Assistance-Unemployable programs.
“We are not seeing any short-term windfall for the budget, but we are still looking,” said Glenn Kuper, spokesman for Gov. Chris Gregoire’s budget office.
Senate Majority Leader Lisa Brown, D-Spokane, said the reform is news for the state’s long-term budget problems in health care, which eats up a growing share of state spending. She expressed hope for the Medicaid waivers, which the Department of Social and Health Services has applied for, but which are unlikely to be granted until sometime next year, if at all, according to DSHS.
Republican state Attorney General Rob McKenna is working with other states’ attorneys on a possible federal lawsuit to challenge the constitutionality of the reform bill’s requirement that consumers buy health insurance and the requirement that the state expand their Medicaid programs.
McKenna spokeswoman Janelle Guthrie said a report by the Washington PolicyCenter found “that the massive expansion of Medicaid required under the bill would result in an increase of 280,000 new people on Medicaid for a total cost of $36 billion to Washington taxpayer over the next 10 years.”
But DSHS officials expect the federal government to cover “almost the entire cost for the first three or four years,” said Jim Stevenson, a spokesman for DSHS’ medical programs.
As reported previously, the bill also has about $800 million to increase the Medicare payments to Washington doctors and medical providers for two years, until new rules fixing regional disparities in reimbursements are fixed in late 2012.
Kreidler, a Democrat who worked for reforms at the state Legislature and then as a congressman in the early 1990s, said he thinks the changes President Obama plans to sign into law are likely to stay on the books, despite political challenges.
“Regardless of the results of the midterm elections (in November) there is no looking back on this,” Kreidler said, calling it a “huge mistake” to undo the historic effort in the U.S. House that he watched Sunday night on television.
“There was a tear that trickled down the cheek. People just have no idea just how necessary reform is. We’re finally at the point where we recognize our health care system is not sustainable; it’s falling apart,” he said. “This is a process that passed a major hurdle last night that will help us get an answer. It won’t solve all our problems.”
Brad Shannon: 360-753-1688