How the Health Care Overhaul Could Affect You

[jefferson_dem]

Health Care, Reformed
It's over. And it's just begun.
By Nick Baumann | Sun Mar. 21, 2010 9:57 PM PDT

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You already know about the Democrats' big health care reform victory Sunday night <1>, the deal it took to get there <2>, and the debate that will come next <1>. But if you haven't been paying close attention, you might not know what's in it for you. America, here's what you've won (and all of this stuff kicks in this year):

1.Insurance companies can no longer impose lifetime coverage limits on your insurance. Never again will you face the risk of getting really sick and then, a few months in, having your insurer tell you "sorry, you've 'run out' of coverage." Almost everyone I've met knows someone who had insurance but got really, really sick (or had a kid get really sick) and ran into a lifetime cap.
2.If you don't know someone who has run into a lifetime cap, you probably know someone who has run into an annual cap. The use of these will be sharply limited. (They'll be eliminated entirely in 2014.)
3.Insurers can no longer tell kids with pre-existing conditions that they'll insure them "except for" the pre-existing condition. That's called pre-existing condition exclusion, and it's out the window.
4.A special, temporary program will help adults with pre-existing conditions get coverage. It expires in 2014, when the health insurance exchanges—basically big "pools" of businesses and individuals—come on-line. That's when all insurers will have to cover everyone, pre-existing condition or not.
5.Insurance companies can't drop you when you get sick, either—this plan means the end of "rescissions."
6.You can stay on your parents' insurance until you're 26.
7.Seniors get $250 towards closing the "donut hole" in their prescription drug coverage. Currently, prescription drug coverage ends once you've spent $2,700 on drugs and it doesn't kick in again until you've spent nearly $6,200. James Ridgeway wrote about the problems with the donut hole <3> for Mother Jones in the September/October 2008 issue. Eventually, the health care reform bill will close the donut hole entirely. The AARP has more on immediate health care benefits for seniors <4>. Next year (i.e. in nine months), 50 percent of the donut hole will be covered.
8.Medicare's preventive benefits now come with a free visit with your primary care doctor every year to plan out your prevention services. And there are no more co-pays for preventative services in Medicare.
9.This is a big one: small businesses get big tax credits—up to 50 percent of premium costs—for offering health insurance to their workers.
10.Insurers with unusually high administrative costs have to offer rebates to their customers, and every insurance company has to reveal how much it spends on overhead.
There's a lot more that happens down the road. But this is most of what you get now. No death panels included

http://motherjones.com/print/50211

Also, check out the NYT interactive at http://www.nytimes.com/interactive/2010/03/21/us/health-care-reform.html

[JTFrog]

1. K&R!

[WhiteTara]

2. can you tell me about Medicaid

coverage? When will that kick in?

[ehrnst]

5. Medicaid coverage information from the Bill:

Expand Medicaid to all individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% FPL based on modified adjusted gross income (as under current law and in the House and Senate-passed bills undocumented immigrants are not eligible for Medicaid).

All newly eligible adults will be guaranteed a benchmark benefit package that at least provides the essential health benefits. To finance the coverage for the newly eligible (those who were not previously eligible for a full benchmark benefit package or who were eligible for a capped program but were not enrolled), states will receive 100% federal funding for 2014 through 2016, 95% federal financing in 2017, 94% federal financing in 2018, 93% federal financing in 2019, and 90% federal financing for 2020 and subsequent years.

States that have already expanded eligibility to adults with incomes up to 100% FPL will receive a phased-in increase in the federal medical assistance percentage (FMAP) for non-pregnant childless adults so that by 2020 they receive the same federal financing (90%) as other states. In addition, increase Medicaid payments in fee-for-service and managed care for primary care services provided by primary care doctors (family medicine, general internal medicine or pediatric medicine) to 100% of the Medicare payment rates for 2013 and 2014. States will receive 100% federal financing for the increased payment rates. (Effective January 1, 2014)

Require states to maintain current income eligibility levels for children in Medicaid and the Children’s Health Insurance Program (CHIP) until 2019 and extend funding for CHIP through 2015. CHIP benefit package and cost-sharing rules will continue as under current law. Beginning in 2015, states will receive a 23 percentage point increase in the CHIP match rate up to a cap of 100%. CHIP-eligible children who are unable to enroll in the program due to enrollment caps will be eligible for tax credits in the state Exchanges.

[WhiteTara]

6. sounds like nothing really happens for another

few years. Am I reading that correctly?

[ehrnst]

7. Unclear about when exactly. Hopefully more detail in Senate fix package. (nt)

[vaberella]

9. Relatively. But Medicaid faces the same regulations tha private insurance does.

And most doctors will start accepting medicare because they'll be paid more under it and I believe that starts immediately.

[vaberella]

8. This reminds me of something close to single payer system. n/t

[OregonBlue]

3. OOps, I'm so sorry, I unrec'd by accident. Meant to rec.

[O is 44]

4. I rec'd for u n/t