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Senior Citizen Politics
3 Large Insurers to Keep Features of Obamacare Even if Court Strikes It Down
Unitedhealthcare to allow children to stay on parents’ policies to age 26, will not reinstate lifetime limits on coverage,
will continue to offer cancer screenings and other preventive services without a copayment
By Julie Appleby, KHN Staff Writer
June 12, 2012 - As speculation over the fate of the health care law heightens in anticipation of the Supreme
Court ruling, at least three major insurers Monday promised to continue following some of the rules in the federal health law that are already
UnitedHealthcare, which covers about 26 million people in plans that could be affected by the regulations, was the first
to make the move. (See UnitedHealthcare's news release below this news story.)
The company said it would allow young adult children to stay on their parents’ policies up to age 26, would not reinstate
lifetime limits on coverage and would continue to offer cancer screenings and other preventive services without a copayment. It would maintain
a third-party appeals process for treatment denials and would not cancel policies retroactively.
Later Monday, Humana said it would continue those same provisions. Aetna, too, said it would retain the young adult
provision, the preventive care benefits and a third-party appeals program. The Aetna announcement did not include a reference to lifetime
limits on coverage.
These consumer provisions
score high on public opinion polls, even among people who say they don't like the overall law. None of the insurers made any comment about
other significant provisions in the law, such as the requirement that in 2014 they stop rejecting applicants with pre-existing medical
The announcements were widely seen by policy experts as good public relations moves by the insurers, which are likely
hearing from consumers worried that a court decision could mean their adult children would not remain on their policies or they might lose
access to preventive services.
"We are hoping the Affordable Care Act will be upheld" -
Stephen Shivinsky of Blue Shield of California
"They're trying to hedge against the possibility that some or all of the law will be overturned and they want to be
viewed as doing the right thing," said Chas Roades, chief research officer at the Advisory Board Company, a research firm in Washington.
And they may have been influenced by comments from some congressional Republicans who want to keep some of those rules,
even if the law itself is rejected, says Robert Laszewski of Health Policy and Strategy Associates, a consulting firm in Alexandria, Va.
"If the Republicans are going to make you do it, why not do it yourself and take credit for it? It’s smart politics and
policy," says Laszewski, a former industry executive.
Still, some insurers said they did not want to make any promises before the decision.
"We are hoping the Affordable Care Act will be upheld," said Stephen Shivinsky of Blue Shield of California. "We don't
want to say anything before the decision that would make it easier for the court to rule against the law."
The Supreme Court justices are expected to issue their decision on whether the health law is constitutional sometime this
month and could uphold the law, remove parts of it or reject the entire legislation. The outcome feared most by insurers is if the court
strips the law of its requirement that nearly all Americans buy coverage, but leave in place other rules governing the industry, including
that insurers take all applicants starting in 2014, even those with pre-existing medical conditions.
That could drive up costs if too few healthy people enroll in coverage, experts say, likely leading insurers to ask
Congress or regulators for help. Insurers could seek additional incentives to get people to enroll in coverage. They might include a penalty
aimed at consumers who delay, such as a premium surcharge or rejection for coverage for pre-existing illnesses, at least for some period of
time. But it is uncertain if Congress would act on any such requests from the industry.
Already, the law requires insurers to accept all children up to age 19, even those who are ill.
In its statement, United stopped short of saying it would continue to follow that provision for kids who are ill. While
it "recognizes the value of coverage for children," United said, "one company acting alone cannot take that step," adding that it is
"committed to working with all other participants in the health care system to sustain that coverage."
No mention was made of other rules in the health law that some insurers find onerous, including a requirement that they
issue rebates to customers if they fail to spend at least 80 percent of premiums on medical care.
What happens if all or part of the law is rejected is the subject of near-constant speculation in Washington and beyond.
Many experts believe that some practices may not change immediately. For young adults on their parents' policies, for example, insurers would
likely need to continue coverage until the policy's contract term expired.
of this information is reprinted from
kaiserhealthnews.org with permission from the Henry J. Kaiser
Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery.
© Henry J. Kaiser Family Foundation. All rights reserved.
The insurers did not disclose what retaining the provisions would cost.
"These provisions make sense for the people we serve and it is important to ensure they know these provisions will
continue," Stephen J. Hemsley, president and CEO of UnitedHealth Group, said in a statement. "These provisions are compatible with our mission
and continue our operating practices."
Timothy Jost, a consumer advocate and a law professor at Washington and Lee University, said he hoped other insurers
follow suit. One thing the United statement demonstrates, he said, is that "the provisions are not bankrupting the industry."
But, while the rules United and the other insurers mentioned tend to be popular in opinion polls, Jost said, other
provisions in the law will do more to cover the uninsured. Those include accepting people with pre-existing medical conditions and the
government tax credits aimed at helping low and moderate income Americans purchase coverage, both of which begin in 2014.
"I'm glad to hear United is doing this and I hope other insurers follow suit," said Jost. "But that doesn't solve the
problem of the uninsured, which is why we need the rest of the health bill."
Note: This story was originally released by Kaiser Health News on June 11, 2012
About writer Julie
Note: Below is News Release issued by UnitedHealthcare
UnitedHealthcare Voluntarily Extends Important Health Reform
Protections Regardless of Upcoming Rulings by Supreme Court
Company Ensures Continuity for UnitedHealthcare Consumers, Customers and Care
(June 11, 2012) – UnitedHealthcare, a UnitedHealth Group (NYSE: UNH) company, will continue to offer important health care insurance
protections that were included in the 2010 health care reform law, no matter how the U.S. Supreme Court rules in cases currently pending
before the Court.
UnitedHealthcare will continue provisions related to coverage of preventive health care services, coverage of dependents up to age 26,
lifetime policy limits, rescissions and appeals.
protections we are voluntarily extending are good for people’s health, promote broader access to quality care and contribute to helping
control rising health care costs. These provisions make sense for the people we serve, and it is important to ensure they know these
provisions will continue,” said Stephen J. Hemsley, president and CEO of UnitedHealth Group. “These provisions are compatible with our mission
and continue our operating practices.”
protections are effective immediately, and will remain available to current and future customers and members. The company is not establishing
any sunset provisions.
UnitedHealthcare recognizes the value of coverage for children up to age 19 with pre-existing conditions. One company acting alone cannot take
that step, so UnitedHealthcare is committed to working with all other participants in the health care system to sustain that coverage.
specific provisions being extended by UnitedHealthcare are:
Preventive Health Care Services without Co-Pays
UnitedHealthcare believes preventive health care services are an important component in helping people live healthier lives and in controlling
underlying health care costs. UnitedHealthcare will continue to offer a spectrum of preventive health care services that do not require cost
sharing, such as those tailored to preventive health care needs, yearly preventive medicine visits, screening for high blood pressure and
diabetes, and all standard immunizations recommended by the American Committee on Immunization Practices.
Providing Dependent Coverage Up to Age 26
UnitedHealthcare was the first company to offer coverage for dependents up to age 26 and will continue to provide that coverage. This applies
to dependents (adult children) up to age 26, regardless of their eligibility for other insurance coverage, including those who are not
enrolled in school, not dependents on their parents’ tax returns, and those who are married.
Eliminating Lifetime Limits
UnitedHealthcare does not impose lifetime dollar limits on policies – that practice will continue.
No Rescissions, Except for Fraud
UnitedHealthcare will not pursue rescissions of individual coverage except, as provided for in the Reform law, in cases of fraud or
intentional misrepresentation of a material fact. Rescissions generally are considered to be any retroactive termination or cancellation of
coverage, except when due to the failure to timely pay premiums.
Providing Clear and Timely Options for Appeals
UnitedHealthcare will continue to ensure that consumers are offered a simple, accessible external appeals channel and a process that is clear
and timely. The company will give consumers notice of available appeals processes and the opportunity to review their files and present
evidence as part of the appeals process.
UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting consumer
health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit
programs for individuals, employers and Medicare and Medicaid beneficiaries, and contracts directly with more than 650,000 physicians and care
professionals and 5,000 hospitals nationwide. UnitedHealthcare serves more than 38 million people and is one of the businesses of UnitedHealth
Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.
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