TUESDAY, March 23 (HealthDay News) — Since the historic passage of the health-care reform bill by the U.S. House of Representatives on Sunday, and its signing into law by President Barack Obama two days later, many Americans are still wondering, “What’s in it for me?”
The new legislation expands coverage to the uninsured, of course, but other consumer groups will also be affected, including seniors, young adults and people with employer-sponsored health insurance.
Most Americans who are currently uninsured will be required by law to buy insurance, typically through one of the new state-run insurance exchanges.
Obama signed the heath-care reform measure into law midday on Tuesday, while a separate bill containing changes and improvements to the legislation is pending Senate action.
Already, Republican opponents have introduced bills to repeal the health-reform package, and state attorneys general are questioning the legality of a new federal mandate requiring most U.S. citizens to carry health insurance coverage.
HealthDay consulted experts with very different points of view for their take on how the legislation stacks up for consumers. Here’s what they said:
People with employer-sponsored health insurance
Throughout his campaign for health reform, Obama insisted that if you like your health plan, you can keep it.
Sara Collins, vice president of the Affordable Health Insurance Program at The Commonwealth Fund in New York City, said that still holds true for people who get their health insurance coverage through a large employer. “Right now, if you’re in an employer-based plan, the world doesn’t really change for you,” she said.
People who get their benefits through small employers, however, may encounter some upheaval. The Congressional Budget Office (CBO) estimated that 8 million to 9 million individuals, mostly lower-wage workers and people who work for smaller employers, could lose their employer-sponsored coverage as a result of the legislation.
The reason: “There will be real economic incentives to move average- and lower-income employees” into newly created health insurance ” ‘exchanges,’ ” said John C. Goodman, president of the National Center for Policy Analysis in Dallas, a proponent of free-market reforms.
The uninsured
The legislation expands health insurance to 94 percent of non-elderly Americans. That may not be universal coverage, but it will reduce the ranks of the uninsured by 32 million by 2019, according to the CBO analysis.
Collins described the two ways that people will gain subsidized coverage. One way is by expanding Medicaid eligibility — up to nearly $30,000 for a family of four. The other way is by subsidizing private coverage through the new insurance exchanges. Families with incomes between $30,000 and $88,000 a year should be eligible for those subsidies.
Young adults
About 30 percent of young adults are currently uninsured, Collins said. To help close the gap in health coverage, lawmakers included a provision in the health-reform package that allows young adults to remain on their parents’ health insurance plans up to age 26. That measure, which takes effect this year and enjoys broad bipartisan support, should help close the insurance gap, she noted.
“I have a feeling that the young-adult benefit will be very popular,” Collins said. “There’s no restrictions on income, so this really addresses what families across the income spectrum really do face with young adults.”
Goodman agreed that the coverage extension is good for young adults who are sick, but said that requiring insurers to accept all comers and to charge similar rates regardless of health risk will undermine the individual insurance market.
“If you’re a young adult and you’re out buying your own insurance, this is going to be a minus for you because premiums are really going to go up,” he contended.
People with pre-existing conditions
Beginning this year, people with pre-existing health conditions who have been denied coverage and have been uninsured for six months will be eligible for subsidized coverage through a national high-risk pool program. The pool serves as a temporary fix until the insurance exchanges are up and running, Collins said.
And by 2014, insurers may no longer charge individuals and small businesses higher premiums or deny coverage on the basis of pre-existing conditions.
While health groups hailed the changes, Goodman said the new rules could create problems for insurers if people stay out of the market (and pay penalties for not having insurance) until they are sick. “The fine is quite low compared to the cost of the insurance,” he explained.
Medicare beneficiaries
The legislation contains several Medicare enhancements. For example, seniors currently share the cost of preventive services, but beginning in 2011, those tests and treatments will be covered in full.
Medicare Part D’s notorious coverage gap — the so-called “donut hole” — will also be eliminated by 2020. Currently, many beneficiaries have to foot the bill in the coverage gap, which begins after the enrollee has incurred $2,830 in drug spending and ends only after drug costs exceed $6,440. As part of the new legislation, seniors who reach the coverage gap in 2010 will be eligible for a $250 rebate.
However, the legislation also slashes subsidies to private health plans that serve seniors — so-called “Medicare Advantage” plans — and Goodman said the fallout from those cutbacks could become the Obama administration’s worst nightmare.
“Right before they vote in November, seniors will be getting letters from insurers telling them their plan is going to be cancelled and they’ll have to go back to traditional Medicare,” he predicted.
More information
To read the health-reform legislation and changes approved by the House of Representatives, visit the House Rules Committee.