Health Care Reform: What's In It For Me?

Passage of a health care reform bill is not a done deal, but it's definitely on track to being signed into law. The House has a version and the Senate has its own version. A conference committee consisting of House members and Senators has to resolve the differences between the two versions. In order for the final version that comes out of the conference committee to pass the Senate, it will need 60 votes, so it is likely that the House will honor the lines drawn in the sand by the Senate on the public option and abortion. That's the negative but I'm still certain that the bill will retain enough good to make it count as a step forward towards a responsible, ethical approach to providing affordable health care for all.

The big question in the minds of most people is how will health care reform affect me personally? (A notable exception is Glenn Beck; his big question is, "What new idiocy can I spout to keep my ratings up?") I just received the January 11 issue of Newsweek and it quite conveniently contains a succinct summary as to how the version of health care reform likely to be signed into law will affect us.

Yes, I know that I published some of this information in the past, but I continue to have perfectly reasonable people who aren't certain if there are any price controls likely to be in the bill (yes there are) and those who still think that the loss of the public option is the end of the world. So, once more, for clarity, here is what the health care reform act is likely to mean for us based on the existing House and Senate versions of the bill (with some additional detail that I didn't cover in my last post on this matter).

1) Everyone must purchase health insurance. The way it works is that when you file your income tax return beginning in 2014, you'll have to provide proof of insurance with your return. If you fail to do so in 2014, you will have to pay a $95 fine to the IRS. In 2015 the fine increases to $350, and to $750 in 2016. So if you're really opposed to having health insurance, don't get any and pay your fines each year.

2) A public option is unlikely, so get over it. It was never a panacea to our defunct health care system; it merely provided that the federal government could offer an insurance plan to uninsured individuals and small businesses that in theory would force private insurers to lower their rates in order to compete. Here's what we get instead: individuals and small businesses will be able to buy insurance through government regulated health insurance exchanges. The legislation requires insurers to provide coverage in 2010 that cannot cost more than $5,950 ($496 per month) for an individual and $11,900 ($992 per month) for a family. Individuals earning up to $43,320 annually and up to $88,200 for a family of four will receive credits throughout the year to subsidize insurance premiums. Other costs savings measures include a cap on out of pocket expenses. The cap is based on income. For example, a family of three earning $73,240 in 2009 would pay no more than $7,733 in out of pocket expenses.

3) Currently, insurers can and do charge the elderly, women, and smokers much higher health insurance premiums. The passage of the health care reform act will put an end to astronomical premiums by setting caps on how much more can be charged based on age (a maximum of three times the rate for younger people) or smoking status (no more than 1.5 times more than nonsmokers), and eliminates any consideration of gender as a risk factor in determining health insurance premiums. It's not perfect. As a person approaching being elderly, I'd prefer there be no additional charge allowed based on age. However, this is an improvement over current practices that allow insurers to declare you to be uninsurable and then offer to deign to supply you with insurance if you sell your family into bondage to raise enough money to pay the monthly premiums. Those of you who have been with me for a while know my tale of exploring going into private practice and discovering that the best health insurance package that I could get was $3,700 per month. No, I don't have some rare tropical fever; I am a type 2 diabetic with hypertension and chronic a-fib, conditions with which I've been living for ten years and are managed with medications. However, the diabetes alone makes me uninsurable under current standards and health insurers can charge me exorbitant  premiums  even though I haven't been hospitalized for any of these conditions in ten years.

4) Which brings me to my favorite provision, health insurers cannot deny you coverage because you have a preexisting condition (na-na-na-na-na to the health care insurers). This regulation doesn't go into effect until 2014 so until then the government will subsidize a high risk pool for people with preexisting conditions who have been uninsured for more than six months. (Under current health insurance practices, if you've been uninsured for a period of time, as little as 90 days, even if you get a job with insurance benefits, the employer's insurance plan does not have to cover your preexisiting conditions for as much as six months after you begin employment.)

5) Medicaid for more people! Anyone under 65 who makes less than $14,440 per year will be eligible for Medicaid. Under the current system, only certain specified categories of people with low incomes are eligible for Medicaid.

6) Drug manufacturers will be required to offer brand name drugs at a discount of 50% for people spending between $2,700 and $8,154 per year on prescriptions (addresses the Medicare coverage gap or doughnut hole).

7) If you have children, you will be able to keep them on your insurance up to age 26 (statistical data indicates that 30% of the uninsured are people in their 20s).

8) To discourage "cadillac plans" with high premiums, health insurers will have to pay a 40% tax on the portion of a premium that is more than $8500 annually for an individual and more than $23,000 annually for a family.

9) If the health care reform act passes, 30 million uninsured people will have health insurance.

Sources: "Back Story," Newsweek, January 11, 2010.
Senate health care reform bill, available online.

P.S. I've become rather annoyed with my progressive brothers and sisters who have elevated the public option to the status of the holy grail. The House bill is 1,018 pages (trying to open the website froze my computer twice) and only 12 pages deal with the public option. The PO is a good idea but it is not the only nor most significant piece of the health care reform bill. I venture a guess that most people don't really have a clue as to the precise details of the public option whose demise they are lamenting. It's not the wailing and gnashing of teeth that disturbs me; it's the irrational response of, "Let's just call the whole thing off, that will show Joe Lieberman and those mean Republicans," that's making me really want to shake some folks like a rag doll.To read a rational and objecive analysis of the failed public option, click here.