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Understanding the Latest Health Care Rules

Chris Levister | 10/1/2010, 8:33 p.m.

Six months later, another round of President Obama's health care law took effect last week, and it's still the subject of debate. Democrats hope voters will like changes, like the provision that lets children stay on their parents' plans until they turn 26. Republicans believe they'll win votes with a promise to repeal and replace the health care law if they win majorities in Congress.

Sometimes lost in the partisan clamor about the new health care law is the profound relief it is expected to bring to hundreds of thousands of Americans who have been stricken first by disease and then by a Darwinian insurance system.

Starting now, insurance companies will no longer be permitted to exclude children because of pre-existing health conditions, which the White House said could enable 72,000 uninsured to gain coverage.

Insurers also will be prohibited from imposing lifetime limits on benefits.

The law will now forbid insurers to drop sick and costly customers after discovering technical mistakes on applications. It requires that they offer coverage to children under 26 on their parents' policies.

It establishes a menu of preventive procedures, like colonoscopies, mammograms and immunizations that must be covered without copayments.

And it allows consumers who join a new plan to keep their own doctors and to appeal insurance company reimbursement decisions to a third party.

"The amount of vulnerability that was out there was horrendous," Mr. Obama said during a gathering of people chosen to illustrate the law's new provisions. He said he concluded that "we've just got to give people some basic peace of mind."

Mr. Obama also responded to Republican Congressional leaders who have campaigned on a threat to repeal the act. "I want them to look you in the eye," and explain their opposition to a law that is projected to cover 32 million uninsured and reduce the deficit by $143 billion over 10 years.

The Republican strategy "makes sense in terms of politics and polls," Mr. Obama said, an acknowledgment that the electorate is divided and that many swing districts are hostile. "It just doesn't make sense in terms of actually making people's lives better."

House Republicans continued to question Mr. Obama's assertions, that the law will lower premiums, pointing to double-digit increases recently announced by many insurers.

A blog posting on the Web site of the minority leader, Representative John A. Boehner of Ohio, predicted the law would "raise health care costs, explode the federal deficit and create a byzantine bureaucracy."

The administration has estimated that premiums should rise no more than 2 percent because of the new consumer protections, and warned this month that it would have "zero tolerance" for efforts to blame the law for larger increases.

It will take years to determine the act's long-term impact on American health, and on American politics.

But Democrats did manage to frontload some notable benefits, while deferring the pain of tax increases and penalties until after the election.

Polls have found that many of the provisions taking effect this month are popular, tugging at a national sense of fairness and feeding off distrust of health insurers. They bear particular appeal for the 14 million people who must buy policies on the individual market rather than through employers and are thus at the mercy of the industry. And they land on the heels of a government report showing that the recession drove the number of uninsured Americans to 50.7 million in 2009, up 10 percent in a year.

As the political battle endures, those most immediately affected are welcoming the changes with collective relief, and hoping that their promise of security is real.