A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Happy ½ Birthday, National Health Care Reform. Now Let's Stop Using the "Grandfathering" Loophole.

Happy ½ Birthday, National Health Care Reform. Now Let's Stop Using the "Grandfathering" Loophole.

September 23, 2010

Today's 6-month anniversary of health care reform is more than a time to celebrate - it's also a time to begin reaping the real rewards of policies that begin taking effect, helping people get insurance coverage that provides real health security. Many of the Patient's Bill of Rights provisions take effect today. A quick summary of the new provisions are at healthcare.gov.

Even in Massachusetts, which implemented a number of insurance reforms in the 1990s and as part of the 2006 chapter 58, these changes will make a real difference. One of HCFA's student interns will now be able to join her parent's coverage, since she was not eligible under the weaker Massachusetts version of the young-adults-can-stay-on-their-parents-plan law.

A critical new federal provision taking effect today is the requirement that plans not charge copays or impose deductibles for preventive services (read the summary; or see full list of which services are covered). Co-payments for preventive care are a deterrent to getting appropriate health care. This Affordable Care Act provision will remove a barrier for many patients who need preventive care and find the costs unmanageable.

However, there's a catch. The no co-payments provision goes into effect only for new plans starting after today. If a plan is does not have significant changes, the insurer could consider it "grandfathered" under federal law, and exempt from the requirement.

We have heard from two carriers that they are going beyond the requirements of the ACA on this issue: Harvard Pilgrim is implementing a no co-payments policy for all individual and group plans with fewer than 2000 members. Blue Cross Blue Shield is also allowing no co-payments for individual and group plans with fewer than 100 members. Unfortunately, at the time of writing this blog, we had not heard back from the other major carriers in the state (plans: feel free to comment here regarding your policy). While these carriers have taken bold steps and we support them, we feel that more could be done for the residents of Massachusetts.

All carriers doing business in Massachusetts should reject the loophole and eliminate co-payments for preventive care regardless of whether a plan is technically grandfathered or not. Preventive care often pays for itself. More importantly, it is a huge step on the path to integrated care that focuses on keeping people healthy and out of more expensive treatment.
-Georgia Maheras