Sunday, December 27, 2009


How will the Senate health reform bill affect you?


How will the Senate health reform bill affect you?

By Bill Graves, The Oregonian

December 24, 2009, 4:30AM

   The U.S. Senate is expected to adopt a hard-fought, 2,000-page health care reform bill early this morning. It then goes to a committee of senators and representatives to resolve the differences in their bills, and the final version must pass in the Democrat-controlled House and Senate before President Barack Obama can sign it into law. Here are some questions and answers about the Senate's plan for overhauling health care in America:


Q.: How does this affect me if I already have insurance with my employer? 



Nothing would change. But if your share of the insurance is more than 9.8 percent of your family income or 41 percent of the premium, you would have the option, by 2014, to buy insurance through a state-based marketplace called an insurance exchange.

Oregon earlier this year passed a health reform plan that calls for establishing an exchange. You would be able to continue to see the doctor you see now.

Insurers would be subject to some new restrictions. For example, children could stay on their parents' insurance up to age 26, effective six months after the bill is enacted. Beginning Jan. 1, 2011, insurers would be required to spend at least 85 cents of every premium dollar on medical care for large businesses and 80 cents of every dollar for small businesses. They also would be required to cover wellness and prevention and exempt them from deductibles and copays.


Q: What if I don't have insurance? 


You wouldn't be able to shop for insurance in the Oregon exchange until 2014. If you are earning up to 133 percent of the federal poverty level ($22,050 for a family of four), you would be eligible for Medicaid, the government health insurance program that helps pay for the Oregon Health Plan. That would open the plan to more foster children, families on welfare, and low-income adults.

Federal tax credits also would be available to subsidize people with incomes up to 400 percent of the poverty level. But the subsidies taper off substantially for middle-class families. For example, a family of four with an income of $66,000 a year would qualify for a small tax credit but still have to spend about 10 percent of its income on premiums.


Q: When will insurance companies be barred from denying me insurance for a pre-existing condition? 

The legislation bars insurers six months after enactment from denying coverage to children based on a pre-existing condition. Insurers can keep denying adults, however, until 2014.

Insurers could not charge higher premiums for pre-existing conditions or gender. Insurers only would be able to vary premiums on the basis of family structure, geography, tobacco use, participation in health promotion programs and age. Insurers could charge older people no more than three times what they charge the young.


Q: How would the bill affect my Medicare? 

You would see no change in your guaranteed benefits. Medicare Advantage (Part C) plans, managed health care versions of Medicare, would see a 14 percent cut in federal subsidies. But that would be offset for Oregon plans because of additional federal funds the state would receive to reward efficiency and to help rural areas, says Jerry Cohen, director of AARP in Oregon.

Brand-name prescription drug costs would be cut by 50 percent in 2010. The Medicare Part D drug coverage gap would be narrowed by $500 in 2010. The gap, the so-called doughnut hole, begins when total annual drug costs reach $2,700 and ends when they hit $6,154, after which Medicare coverage resumes.

Beginning Jan. 1, 2011, Medicare beneficiaries will receive a free annual wellness visit and will have all cost-sharing waived for prevention services. Medicare payments also would be adjusted for regional disparities that would benefit Oregon health providers.


Q: What about my taxes? 

Most people would see no tax increases under the Senate bill. Medicare payroll taxes would be raised 2.35 percent on incomes over $200,000 a year for individuals and $250,000 for couples.

The bill also would impose a 10 percent tax on tanning salons and a 40 percent excise tax on employer-sponsored group health plans with high premiums, the so-called "Cadillac plans." Those generally involve premiums above $8,500 for individuals and $23,000 for family coverage. The tax is effective in 2013.


Q: How will this bill affect employers? 

Employers are not explicitly required to offer coverage, but those with more than 50 employees must pay a tax of $750 per employee if any of their workers get subsidized health care coverage in the exchange. A tax credit for up to 50 percent of total health insurance premiums will be available to small businesses with fewer than 25 workers whose average wage falls under $50,000.


Q: Will I have to buy insurance if I don't have it? 

Yes, if you do not get insurance through an employer, you must shop in the exchange, unless you qualify for Medicare or Medicaid. If you don't buy insurance, you would be fined $95 in 2014, $495 in 2015 and $750 in 2016.

Exceptions are made for religious objectors or those under the federal poverty level.


Q: Can I wait until I get sick to buy insurance? 

Yes, starting in 2014. But you would have to pay the annual fine.


Q: What happened to the "death panels"?

Neither the Senate nor the House health care reform bill calls for boards that would decide who gets critical or end-of-life care.


Q: What about coverage for abortions? 

The Senate bill would allow states to prohibit abortion coverage in the benefit plans offered by insurance companies in their exchanges.

In state exchanges that allow abortion coverage, people receiving subsidies on their insurance would have to pay for abortion coverage in a separate premium. Insurers would have to keep money collected for abortion coverage in separate accounts segregated from federal funds.

-- Bill Graves

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