Felicia Muftic – What’s in health legislation for me?
January 3, 2010
Given the conflicting messages on cable news and the complexity of the legislation, we are all wondering what is in health reform “for me.”
The House and Senate versions are on their way to conference committee, but they are so similar that we now can get a handle on specific benefits.
Yet to be decided are the public option and the methods of taxation to pay for the reform. While revenue will be needed to pay for the reforms, it is certain that if you make less than $200,000 a year, you will see no change in your taxes to pay for the reform.
I have been doing some digging to try to get an understanding of what is in it for us. Here is what I have learned, mostly from the non-partisan Congressional Budget Office and other government agencies.
• If you do not get insurance from an employer now and you cannot afford to buy insurance, you may be able to get tax credits to help you buy insurance through an exchange that is much like what members of Congress have. All adults must have insurance. Enrollment in the exchange is optional. This exchange will be operative in 2013 and those up to 400 percent of poverty guidelines would get subsidies to afford exchange premiums. Those under 133 percent of poverty guideline qualify for Medicaid. If you are under 26, you can stay on your parents’ insurance. (Poverty guidelines, annual income, 2009: 1 person $10,830; family of 4, $22,050).
Those not subsidized will see fierce competition within the exchange for your business.
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• If you cannot get insurance because you have a pre-existing condition like diabetes or high blood pressure, immediately when the bill is signed, you can find an affordable health plan because a high-risk pool will be established.
Immediately when the bill is signed into law, insurance companies cannot place lifetime limits on coverage, use of annual limits will be restricted, and they will not be able to arbitrarily drop coverage.
• If you have never had colorectal cancer screening or did not have a mammogram in the past two years, they will be free through your health plan. That takes effect immediately. A public health fund will be established to encourage prevention and wellness programs.
• If you change jobs or lose your job and health insurance, when the exchange is set up, you will be able to get insurance through it so that you never have to go without insurance because you cannot afford it.
• If you already have insurance through your employer, you can keep it. That your premiums will increase is a fudged fib. The Congressional Budget Office estimates that now the cost of premiums if you are in a large group plan will decline 0 to 3%; small groups could range between a 1 percent increase to a 2 percent decrease.
• If you are a small business owner, take notice. That you will have to provide health insurance or pay thousands is another fudged fib. Small businesses will be exempt from having to provide insurance or pay “fines.’ They will also receive a tax credit if they do provide insurance and they can join in an exchange pool to get better deals.(Small business defined: Senate bill: 50 or fewer employees; House bill: $500 thousand payroll or more)
• If you are a senior, the claims that you will lose benefits are an outright lie. While federal spending on Medicare will be cut, it will not touch the trust fund nor will guaranteed Medicare benefits be cut. Those of us on Medicare pay $90 a year more than we need to in order to pay for Medicare Advantage for others because the government subsidizes private insurers $18 billion a year in extra payments. Reform clamps down on those excessive payments so all on Medicare should see their costs reduced. The gap in Medicare Part D drug benefits will have a 50 percent reduction in the cost of brand-name drugs. All annual checkups, colonoscopies and recommended preventive services will be free. Home health care for those over 65 or disabled and those needing long-term care who are not otherwise covered can get a cash benefit to help pay for services via a new voluntary insurance program.
• Because of a variety of cost savings (reduction in charity care costs shifted to your premiums) and emphasis on wellness and prevention, rewards for good care, and administrative streamlining, over ten years $130 billion will be saved, according to the CBO. Those who claim trillions in cost “forget’ the savings offsets.
The Republicans have just said no to any of these benefits; remember that fact in November 2010 and beyond.
For more details on insurance premium costs and poverty guidelines, see
www.mufticforum.com/health care reform official data and http://www.cbo.gov (look for most recently dated blogs and publications)