New Rule Might Help Workers Keep Health Benefits

For U.S. workers who change or lose their jobs, a new rule issued by the Bush administration just before the end of 2004 could provide better access to group health plan coverage – in keeping with changes Congress agreed to eight years ago.

The new rule, which becomes effective for health care plans starting July 1, is meant to implement more of the 1996 Health Insurance Portability and Accountability Act by making it easier to obtain group health coverage.

It limits when pre-existing medical conditions can be excluded from coverage and requires group health plans and group health insurance issuers to offer “special enrollment” in certain cases.

The law, pushed through Congress by President Clinton, was intended to guarantee access to health insurance for small businesses with 50 or fewer employees, and to require that insurers renew coverage for a person or group regardless of the health status of any member of the group.

“In an era when American workers often change jobs, and even careers, several times in the course of their lives, it is important that they are able to respond to the modern workplace without having to fear for their health insurance,” Health and Human Services Secretary Tommy Thompson said this week.

Three federal agencies jointly issued the new rule based on the 1996 law. Bush administration officials said their rule “does not significantly modify the framework” the Clinton administration issued in April 1997 for implementing this part of the law.

Yet it took another 7 1/2 years for the rule to be made final.

“We have listened to public comment and worked to craft a rule that will provide maximum protection for consumers, while minimizing the burden on health plans,” said Medicare chief Mark McClellan.

When Clinton signed the law, his administration said it would affect about one in 10 U.S. workers – then an estimated 25 million Americans – and their families. Those were workers switching jobs, self-employed or with pre-existing medical conditions. The law was sponsored by Sen. Edward Kennedy, D-Mass., and former Kansas Republican Sen. Nancy Kassebaum Baker.

The Bush administration changed the health insurance rule “to bolster … consumer protections while minimizing the burdens imposed on group health plans and group health insurance issuers,” Thompson’s agency said in a statement.

Among other things, those changes would require group health plans and group health insurance issuers to give workers a statement about their rights under the law.

On the Net:

Department of Health and Human Services: