Health provisions begin phasing in Thursday

Insurers can no longer set a dollar limit on the amount of care they'll provide over a person's lifetime or deny coverage to sick children. Young adults can stay on their parents' health plans until age 26. And consumers get greater rights to appeal insurers' decisions.

"It's really putting in place long overdue consumer protections," Health Secretary Kathleen Sebelius said in an interview with USA TODAY. "It's getting rid of some of the worst rules of the industry that prevented people from getting covered at all or, at a time they needed coverage the most, limited the coverage they had."

Many people, however, will have to wait until Jan. 1 for the changes to help them. That's because most of the new provisions apply to insurance policies that begin on or after Thursday. Many plans operate on a calendar year, and this fall will begin enrollment for next year.

"It's not like a switch gets flipped and everything gets changed on Sept. 23," said Jennifer Tolbert, an associate director at the Kaiser Family Foundation, a health policy group.

Some changes won't apply to plans that are considered "grandfathered" under the law, meaning they existed when the law was signed March 23 and haven't substantially changed. Those plans are supposed to notify policyholders of their grandfathered status, Tolbert said.

Once plans make a substantial change — such as significantly raising co-payments or significantly reducing benefits or the amount an employer contributes — they are no longer grandfathered.

The Thursday changes are designed to help consumers between now and 2014, when the most significant provisions of the health law take effect. That's when new health insurance marketplaces, called exchanges, will be created and most Americans will be required to purchase insurance. "This is sort of a bridge strategy," Sebelius said.

Sebelius said some insurance companies have recently begun notifying policyholders that their premiums will increase in 2011 because of the benefits that take effect this week. Karen Ignagni, president and CEO of the industry group America's Health Insurance Plans, said, "The fact is if you increase benefits, you increase costs."

Ignagni said the new law contributes to insurance rate increases, as do other factors, such as the rising costs of prescription drugs and medical care, and a growing number of Americans who are older or require care for chronic health conditions.

Sebelius sent a letter this month to Ignagni alleging that insurers are sending letters to consumers "falsely blaming premium increases for 2011" on the health law and warning that the Department of Health and Human Services (HHS), in partnership with states, "will not tolerate unjustified rate hikes."

She said analyses of the law's impact by various groups — including HHS, the Urban Institute and the Pennsylvania insurer Highmark — estimate a 1% to 2% impact on premiums.

Steve Findlay, a senior health policy analyst at the non-profit watchdog group Consumers Union, said consumers need to focus on the law's benefits, "what it does for them and their loved ones — rather than listen to politically driven criticisms and attempts to undermine the law."