Health reform fact check: Keeping your insurance
By Cindy House 
| August 11, 2009 | 7:01 AM
This is the second in a series of fact checks examining allegations that have been made on both sides of the aisle about the health care reform plan heading through Congress. Read the complete text of the America’s Affordable Health Choices Act of 2009 here.
THE ALLEGATION: The bill will not force you out of your current insurance plan into a government-sponsored plan or force you to change doctors.
WHAT THE BILL SAYS: Sec. 102, “Protecting the Choice to Keep Current Coverage,” addresses “grandfathered” insurance coverage and current employment-based plans. Grandfathered coverage refers to an individual insurance plan that is in effect before the health reform regulations go into effect. For instance, if your plan year begins Jan. 1, and the rules go into effect May 1, your plan would be “grandfathered.”
However, if any of the terms of that plan change — including benefits coverage and cost-sharing — the plan would lose its “grandfathered” status. Most insurance plans update these terms annually.
For an employment-based plan — a group health plan as defined by the Employee Retirement Income Security Act of 1974, which essentially includes most plans offered by large employers — the bill establishes a five-year grace period for that plan to meet the same benefit standards as “qualified” plans. To be considered qualified, a plan must adhere to new rules regarding affordable coverage, essential benefits and consumer protection.
In Sec. 221, the bill creates a public health insurance option that matches the requirements private insurers must comply with for qualified plans. This public insurance option becomes part of the health insurance “exchange,” meaning it would be available to anyone. In Sec. 202, the bill allows employers to join the exchange and offer benefits from an exchange plan to their employees.
THE VERDICT: Although the text of the bill would not literally force you to drop your existing plan, it does put into place a structure in which it’s likely you would have to give up that exact plan after a period of time, be it within one year for individual plans or five years for employer-sponsored plans.
It also provides an incentive for employers to choose the most cost-effective plan in the government’s insurance exchange, which many believe would end up being the public health care option.
It is unclear, though, what alternative plans would be available if your current plan is no longer considered “qualified” or if your employer switches to an exchange-provided plan. It is possible that such a plan would offer better coverage than your current plan. It also could offer less coverage. The options are dependent upon many variables that are unknown right now, including how basic coverage ends up being defined and what the cost of these programs will be.
Whether you will be able to keep your doctor is unclear, too, since this will depend on which plans your doctor will accept as well as which qualified plan you end up on.
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