Monday, November 11, 2013

The Same Rules Wiping Out the Individual Healthcare Market Apply to the Employer Market

People are finally awaking to the fact that comprehensive health insurance reform impacts them directly.  Millions of people in the private, individual market are losing their coverage.  PPACA, or Obamaare, requires every policy to have certain minimum essential benefits.  A very narrowly written and interpreted grandfather clause allows a few people to keep their insurance even without the new required coverage.

"My employer provides insurance coverage, I don't have to worry because Obamacare does not affect me."  Wrong.  Because the President suspended enforcement of the employer mandate, 2014 employer-provided policies do not have to have the minimum essential benefits.  But in 2015, barring major changes in the law or a continued promise not to follow the law, they will.  Here's what an employer-provided plan has to have:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services 
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Many employer-provided plans lack maternity coverage, mental health and substance abuse coverage, and prescription drug coverage.  Many policies may fail for failing to provide pediatric dental and vision care.  If your policy lacks even one of the things on that list, it's likely illegal under Obamacare.  Maybe the grandfather clause will save you, but so far it has saved few people in the individual market.


Recent soothing words from the government may lead people to believe that only a few people are impacted and will lose their current policies and provider networks.  Barring major changes, that's not true.  Take steps to protect yourself now, or better yet, contact your members of Congress and ask them to repeal or fix the law.

Now for Today's Obamacare Headlines.

Rightwing Rants

Obamacare is an "old" "new program"

This is what betrayal looks like

Obamacare not worth the cost to young people

Leftwing Cheerleading

Where things stand after the big Obamacare apology

Hard News

Obamacare enrollment data to be released

Republicans blast cancellations

For Industry Insiders

5 states where Obamacare subsidies matter most

Medicare beneficiaries confused about enrollment

Actuary analyzes risky PPACA policies

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