As of today, millions more Americans can get and keep health insurance — although they may pay a hefty price for it — as significant provisions of the health care reform act take effect.

The provisions kicking in on this six-month anniversary of the Patient Protection and Affordable Care Act generally open the market to more consumers while restricting insurance companies' ability to sift out others.

The key new provisions will:

• Eliminate lifetime limits on the dollar amount of care covered. Annual limits will be phased out over time.

• Prohibit insurance companies from dropping policyholders because of illness, or for any reason other than fraud.

• Eliminate co-payments for many preventive-care procedures.

• Prohibit insurers from denying coverage to children because of pre-existing conditions.

• Enable parents to buy coverage for adult children through age 26.

Even as the changes nudge the country toward the 2014 full implementation, insurance companies and regulators, along with consumers, are bracing for their impact.

The question vexing many, though, is what that impact will be.

The provisions taking effect today should offer a greater sense of protection to anyone who needs health insurance or health care, said Dede de Percin, executive director of Colorado Consumer Health Initiative, which advocates for health care consumers.

"These reforms will bring security, stability and peace of mind," and make the insurance market "more predictable, fairer and more transparent," she said.

But as of this week, at least six of Colorado's major providers, including Humana, Anthem, Aetna and Cigna, have said they won't write new individual policies for children.

Insurers seeking rate increases this year cite the new regulations as one reason for the hikes.

"This new law mandates that all policies include coverages that just

weren't being purchased by small businesses and families before, and additional benefits do incur additional costs," said Ben Price, executive director of Colorado Association of Health Plans, in an e-mailed statement.

But Jo Donlin, director of external affairs for the state's Division of Insurance, said many things cause rate hikes.

"It's important for consumers to understand that the rate increases they are getting are due to many factors, not just the federal health care reform," Donlin said.

Rate increases related to the law may come later, though. Many insurers are awaiting more federal analysis before they set new rates, she said.

To help it cope with all these changes, the Insurance Division received a $1 million federal grant, Donlin said.

Some of that went to hire new staff, including someone to handle consumers' questions and complaints, and some will be used to educate people about the new law.

One of the new provisions, which requires that parents have the option to cover adult children through age 26, could bring as many as 2 million largely healthy new customers to insurance companies.

Currently, that age group is among the most likely to not have health coverage. In Colorado, nearly 39 percent of residents 19 through 24 are uninsured, according to the Lewin Group, an independent health care analysis firm.

One important provision to kick in today won't affect most people — if they're lucky, de Percin said.

"Most folks are really healthy so they won't notice what doesn't happen anymore — the rescissions, the caps."

Rescission is insurance-speak for canceling a policy when a policyholder becomes too expensive — in other words, when they get sick.

As for lifetime caps, Nathan Wilkes of Englewood certainly has noticed them.

Wilkes' son Thomas is only 7, and already he has hit those caps twice.

Thomas has hemophilia, and his father says he is, in most respects, a "normal, happy second-grader." But the medication Thomas needs daily to stay that way costs $40,000 a month, his father said.

After Thomas maxed out of Cover Colorado, the state-run high-risk coverage of last resort — it too has a lifetime cap — Wilkes started his own information technology consulting business in order to get insurance for his family, he said.

That small-business option was available because of a 2008 Colorado law that prohibits companies from raising everybody's rates in a small coverage group because of one person's expensive care.

The federal provisions that take effect today extend that protection nationwide, he said.

It's a start, Wilkes said. But for all the controversy it's generated, he doesn't think the reform package goes far enough.

"I'm on the board of Healthcare for All Colorado, a group seeking to get actual true universal coverage."

Karen Auge: 303-954-1733 or kauge@denverpost.com

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Political impact

Many of the big changes, such as the new purchasing pools and the requirement for everyone to carry insurance, don't kick in until 2014, but Democrats hope that the more voters learn of the benefits, the more they'll like the bill. With every House seat and a third of the Senate up for re-election in six weeks, there are plenty of candidates who are being called to account for their votes on the health care legislation. And in almost every case, the ones on the defensive are Democrats.

The Associated Press

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Questions?

Consumers seeking more information about changes to insurance regulations can contact the Colorado Division of Insurance at

303-894-7499 or, from outside Denver, 800-930-3745, or online at dora.state.co.us/insurance