The DC publication Politico is highlighting an area of implementation for the recently passed health care reform that could impact some associations’ members for the worse, and shows the continued need for association advocacy during the implementation of the Patients Protection and Affordable Care Act.

The legislation included a ban on annual caps for insurance reimbursement, meaning that insurance companies cannot limit what they will pay out for health insurance.  The goal of this provision is to prevent insurance companies from denying further coverage for people with high-cost illnesses such as cancer, who otherwise would have incomplete coverage during treatment and would have to pay out-of-pocket.

A group of trade associations and businesses last week sent a letter to the Department of Health and Human Services, however, arguing that the ban on caps would harm their ability to continue providing insurance to low-wage workers.  The group – which included the International Franchise Association, National Restaurant Association, and the National Retail Federation – asked in the letter that subsequent regulations on the ban would allow for in-place low cost plans to continue offering coverage.

Many businesses, especially in the food and retail industries, offer a low-cost insurance plan to low-wage, seasonal, or temporary employees that would allow these employees to have some level of insurance coverage.  While these plans would have a limit on the number of allowed doctor’s visits or insurance pay-out, they would allow some coverage that would otherwise be unavailable to employees that could not afford a full medical plan.  These employees would be eligible to receive low-cost insurance and a federal subsidy through the health insurance exchanges, but these will not be in place until 2014.  If the low-cost plans are outlawed, these employee groups fear over one million employees could lose their coverage between now and 2014.

This issue highlights the need for associations to be aware of the regulatory process in the implementation of the health care reform bill.  Associations can keep visiting The Power of A to keep apprised of overall health care implementation as well as share their stories or issues.

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