Now that the big health bill is law, people have more questions than ever. How will it affect their families and their health care? NPR's health policy correspondent, Julie Rovner, explains some of the key provisions in the new law.
My son is going to turn 23 in June. Under the new health bill, he can stay on our plan until he's 26, but I've heard this doesn't go into effect for six months. Do we have to enroll him in alternative insurance in those intervening months, or will he be allowed to stay on that plan continuously? — Patricia Fontana of Berkley, Calif.
This is a provision that doesn't take effect for six months, and actually, most people won't have a chance to enroll their children in their plans until their next open season. For some people, it won't be until next January.
So, yes, you're going to have to find other insurance. For those with employer-provided insurance, under COBRA they can pay to add their young adult children to their plan, but this can be very expensive. For healthy young people, you can probably find some cheaper insurance for them in the intervening months, and that's what most people are going to have to do.
This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance though a temporary subsidized high-risk pool. Can you explain the high-risk pool? If I am eligible, will my husband and daughter be covered, too? — Sarah Tamor of Santa Monica, Calif.
A national high-risk pool is supposed to start in 90 days to cover those who have been uninsured for six months and have pre-existing conditions. There's $5 billion to help subsidize it, but the premiums could still be pretty high, as they are in most of the state high-risk pools that exist. And the premiums can vary by age — older people can be charged four times as much as younger people.
You have to have been uninsured for six months in order to be eligible. I don't think your husband and daughter will be allowed to join unless they are also high-risk, and they probably wouldn't want to because premiums will be high.
Insurance companies won't have to insure those with pre-existing conditions until 2014, so a national high-risk pool will be there in the interim.
It looks like with the new law, we could find a policy in the risk pool right away if we were uninsured for six months, but if we have insurance — even if it is inadequate — we can't change until 2014, when the [restrictions on] adult pre-existing conditions go away. Are these really our only options? — Audrey Hagan of Jackson, Wyo.
I'm afraid so. In this new interim risk pool that we were just talking about, you need to be uninsured for six months, and premiums are likely to be high. These are for people who have no other options. The idea is to give people something in the interim. But this couple has insurance, even though they write that it's inadequate.
This high-risk pool is really for those who have nothing and want something to tide them over until 2014, when insurers can't turn them away for pre-existing conditions.
I am a small-business owner, and every year my premium has gone up by at least 20 percent. Will the new health care law help keep the cost of health insurance down? — Katherine MacColl, Conway, Mass.
That is certainly the hope. It's doubtful anyone really thinks this new law will bring premiums down. The idea is that it will stop premiums from going up as fast.
There is a large effort in this bill to protect small businesses. There is a tax break that goes into effect right away that will be from 35 percent of the premium up to 50 percent of the premium. There will be these new exchanges that will begin in 2014 that will hopefully help create competition that will help keep premiums lower, if not low. That will help small businesses, again.
There are a lot of things in this law that hopefully will create changes in the way health care is delivered and paid for that will help stem the growth of health care costs. But no one is suggesting this is the magic bullet.
How does the new law affect people who have insurance through the TriCare program? That's the private insurance plan for Defense Department workers and military families.
It turns out that people with TriCare won't be affected by the new law, and that's both good and bad.
It's good in that if you have TriCare, it means that you won't have to go out and buy any other insurance. TriCare is sufficient to cover the individual mandate that you have insurance.
It's bad if you have an adult child who's 24 or 25 — you won't be able to keep them on your TriCare, because TriCare only covers dependents up to age 23. A lot of people are upset by that, and there's already been a bill introduced in the House that would allow people on TriCare to keep their dependents on TriCare until age 26.
I'm a medical student. I've heard from some doctors that reimbursements will decline. For those of us who have the choice of going into primary care or specializing, what will the economic incentives be? — Josh Roarke of Alexandria, Va.
In fact, there are incentives in this law to enlarge the pool of primary care doctors. One big one, which was added very late, is that they are going to increase payments for Medicaid primary care doctors to what Medicare pays. That will be a big increase.
There is increased loan forgiveness — up to $50,000 — for primary care doctors who join the National Health Service Corps. They go off and practice in underserved areas.
There's going to be more primary care residency slots, and there will be other inducements for primary care doctors. As I mentioned earlier, there will be changes in the way doctors are paid and health care is organized, so those will be other kinds of longer term changes in the medical system that are supposed to encourage doctors to become primary care doctors. On the other hand, there's not that much to be done about the fact that medical school is very expensive and that specialists will still be paid more than primary care doctors.
When will the "Cadillac" plan taxes come into play, and who will they affect? How do you know if you have a plan considered to be "Cadillac"? — Lisa Kantrowitz of Malvern, Pa.
The tax applies to very high-end plans, and it doesn't take effect until the year 2018. Your plan has to be worth more than $10,200 for a single person and $27,500 for family coverage — that includes both what you and your employer pay if it's employer provided insurance. Those plans can be worth more if you're a retiree or in a high-risk profession, like a police officer or firefighter. Dental and vision coverage don't count toward those totals.
How will the health care law be enforced? Who's determining the rules and regulations, and who'll be helping them with their specific cases?
The Department of Health and Human Services, with assistance from the Department of Labor, will be largely responsible for enforcement. But people are correct when they say that the Internal Revenue Service will play a role in this, because you will have to declare on your income taxes whether or not you have health insurance — that's the individual mandate. If you don't have insurance, that's how you'll pay the penalty that will be required — with your taxes.
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