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By Matthew Stolle
The Post-Bulletin, Rochester MN



Key provisions
*Eliminates lifetime limits on the dollar amount of care covered. Annual limits will be phased-out over time.
*Prohibits insurance companies from dropping policy holders because of illness or for any reason other than fraud.
*Eliminates co-pays for many preventative care procedures.
*Prohibits insurers from denying coverage to children because of pre-existing conditions.
*Enables parents to buy coverage for children through age 26.



CHATFIELD - More than most, Julie Fryer knows her way around the world of health insurance, having gone a few rounds with insurers in the past.
Most of those battles revolved around coverage issues related to her 7-year-old son, Nick, who is deaf. When Fryer's insurer balked at paying for his hearing aids, she and her husband had to fight to get coverage. They waged a similar battle over the cost of his cochlear implants, which were then relatively new to the market.
So when key provisions of the Patient Protection and Affordable Care Act kicked in last week, it brought Fryer a measure of relief. It meant that when her son became an adult, a company could not deny him coverage based on a pre-existing condition.
"Prior to this bill, he would never have been able to get insurance. When he became an adult, it would have been an automatic no," Fryer said.
The law's first stage rolled out on Sept. 23 without a noticeable change in people's lives. Yet it marked a critical first step: The beginning of a multi-phased process to cover an additional 30 million uninsured Americans by 2014.
But at what cost? The answer to that question remains murky as the shake-out of the law continues.
Changes might take time
Experts say there will be a lag time before most people feel the law's effects.
"It doesn't all happen right away," said Eileen Smith, spokeswoman for Minnesota Council of Health Plans, a trade association for the seven nonprofit plans in Minnesota. "There's significant changes over time, but your life didn't change last week."
For people with employer-based insurance, the mandates won't have an effect until their policies are renewed. If a policy took effect, say, on Sept. 1, it could be another year before a person might begin to feel the changes.
And even then, they could be delayed further as a result of a grandfathering process built into the law. As long as an employer doesn't make significant changes to premiums or deductibles, the plan a person has would stay in force.
"The rules do allow them to make some changes, including some increase in premiums, but they are limited," said Dr. Doug Wood, who chairs Mayo Clinic's division of health care policy and research. "I don't think anybody will see their premiums go down. You could still see your premiums go up with any of these things."
Some aren't happy
There have already been tremors of dissatisfaction with the law. The latest came from McDonald's Corp., which warned federal regulators that it could drop its nearly 30,000 employees unless regulators waive a new requirement.
Several insurers have announced they will no longer offer "child only" policies on the individual market. The reason? Insurers worry that parents would wait until their children are sick to buy a policy for them. In response, the U.S. Department of Human Services has been working on rules to solve the problem. One possibility, Wood said, is to create a defined enrollment period for families to buy such policies.
"It's possible that some of the companies that stop selling child-only policies will come and sell them once the rules are clarified," Wood said.
Polls show that the health care overhaul remains deeply unpopular with a sizable percentage of the public. A CNN poll released this week found that 47 percent of voters and 51 percent of nonaffiliated voters want the law repealed.
Law is widely misunderstood
Dave Durenberger, a former Republican U.S. senator and founder of the National Institute of Health Policy, says considerable misunderstanding surrounds the law. A common one is that it hands Washington the power to make health care decisions for people.
That isn't necessarily the case, but until people begin to see the benefits in their own lives, the law's unpopularity will persist.
"Right now they're hearing from insurance brokers, they are hearing from employers, they're hearing from a whole bunch of people that have found something wrong with this bill," Durenberger said. "We're not hearing the good things."
Durenberger and others say one positive aspect of the law is the leeway it gives states to create health care exchanges, which give small businesses and people not covered through their employers a place to shop for insurance. It also provides a system of subsidies to help pay for coverage. A legislative body has begun to evaluate the federal law and how it might mesh with the state's system.
Work on the exchanges and other reforms under the law must be completed in 2012. The changes would have to be certified by the secretary of health and human services. If they are not, the law gives the federal government the authority to do the work for the states.
Minnesota ahead of the game
Experts point out that Minnesota is ahead of the game in several respects. The state, for instance, already maintains a high-risk pool and offers coverage options to people who can't buy plans in the private market because of a pre-existing conditions.
And in 2008, Gov. Tim Pawlenty signed a package of payment reforms that, among other things, helps people make better health care decisions.
But whether the federal law is viewed as a glass half full or half empty depends on one's perspective. Few see it as a perfect overhaul or one that won't need modifications down the road.
Wood said the law hits key benchmarks established by the Mayo Clinic Health Policy Center but falls short of others. It achieves the goal of access to affordable insurance for everyone. It gives states active roles in bringing about and managing those reforms.
In terms of the things that could be improved, the law did not take "bold steps" in ensuring payment for value, "but they are at least moving in the right direction," Wood said.
"Health care costs have been rising at an unsustainable rate. And to be able to achieve the changes in delivery and payment that will help us really obtain affordable care, they are going to take awhile. They won't happen overnight," Wood said.
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