Some Americans May Not See New Health Care Provisions For Months

The first changes under the new health care law will start rolling out next month, affecting a range of issues from coverage of pre-existing conditions, to the maximum age children can remain on their parent's health care plan. But not all Americans should expect to see those benefits right away. In fact, some may not see them until well into next year.

Insurance companies are obligated to include the new measures when health insurance policies are renewed, starting on or after Sept. 23, 2010. Which means that if an insurance policy is renewed on Sept. 1, those covered under the policy may not be eligible for the benefits under the new law until Sept. 1, 2011.

Additionally, several provisions may vary depending on where people live. The way high risk pools are implemented vary from state to state, for example, as do the limits on how much insurance companies can raise their premiums.

The health care changes come at a time when states are grappling with increased economic stress and lower budgets, leading many to look toward the federal government for assistance.

The Department of Health and Human Services is giving $51 million to states to help them review increases in health insurance premiums. Meanwhile, many states have had to implement substantial changes to their own rules to give their insurance commissioners the right to enforce the consumer protection standards that HHS has called for as part of new consumer protection policies.

And there are many more challenges awaiting states as the health care law rolls out.

A recent report from the Kaiser Commission on Medicaid and the Uninsured (KCMU) found that the recession continues to have a serious impact on state Medicaid programs by increasing caseloads and spending. With the health care law expanding Medicaid to many more people by 2014, the federal government will have to pick up even more of the tab as most states continue to face a budget crisis.

"There are infrastructure challenges as well as eligibility systems issues and coordination issues that states are certainly going to have to deal with, and are already beginning to deal with," said Jennifer Tolbert, a health policy analyst at the Kaiser Family Foundation.

Experts say most of the short-term changes were anticipated by insurance companies, but it remains to be seen how more complicated elements of the health care reform law are implemented, such as the creation of an insurance exchange, a marketplace where people would be able to shop for coverage.

There is also concern that the money coming to the states from the federal government "may not be sufficient to last through 2014," said Leighton Ku, a professor at the George Washington Department of Health Policy.

But because states and the federal government, at this point, are required by law to go forward with health care reform, they will likely ask Congress for more funding to fully implement the law in the next few years.

"Given the current budget environment, and given what happens when elections come in November, that may or may not be true, but nonetheless they are all committed to pressing on with their plans," he added.

Health Care Law to Hit Six-Month Mark in September

HHS says it is working closely with states to ensure that all the deadlines of the new health care law are met, a concern that was raised earlier this summer by Republican House members.

"The administration continues to work closely with states and other partners to ensure the new benefits and opportunities of the Affordable Care Act are made available efficiently and effectively," HHS spokeswoman Jessica Santillo said. "HHS is making every effort to meet the deadlines for implementing additional consumer protections that begin taking effect on Sept. 23rd of this year."

Here is a look at the policies that will go into effect on or after Sept. 23, the six-month mark since President Obama signed the historic health care bill into law:

Extension of coverage for young adults: Under the new law, children under the age of 26 will be able to stay on their parents' insurance plans for all individual and group policies. Some insurance companies have agreed to implement this policy ahead of schedule but many Americans will not be eligible for this until their insurance plan is up for renewal, which varies by company.

No pre-existing condition for children: Insurance companies will be barred from denying children coverage based on pre-existing conditions.

Prohibition on rescinding coverage: Insurance companies will be prohibited from cancelling coverage except in cases where the policy holder commits fraud. This provision applies primarily to the individual insurance market.

Focus on preventive services: Insurers will have to provide preventive services such as mammograms and colonoscopies without cost sharing or charging co-pays.

High risk pools: Programs have already been established in some states to provide temporary insurance to those people who have been denied insurance because of pre-existing conditions for at least six months. The high risk pools and premiums differ from state to state.

Premiums can range anywhere from $140 to $900, HHS said in July, with older people having to pay more. The premiums are linked to individual health insurance costs in each state.