FACTS regarding Health Care Reform

Here are a few FACTS regarding Health Care Reform. All or most of them, Republicans and Tea Partiers don’t like to talk about or have misrepresented.

Our new law:

1. Leaves medical decisions in the hands of you and your doctor.

2. Keeps Medicare financially sound for almost 10 more years.

3. Reduces the United States deficit by an estimated $143 billion.

4. Offers immediate tax credits to help small businesses buy insurance for employees.

5. Helps 32 million more Americans obtain health insurance.

6. Makes preexisting conditions a thing of the past. Insurance companies can no longer deny coverage for children (now) and adults (in 2014).

7. Guarantees basic benefits for everyone with Medicare, makes preventive services free for most, and slowly closes the doughnut hole in the Medicare Part D program.

8. Sets up a temporary program (in July) to help people with preexisting conditions get insurance coverage.

9. Provides for health coverage for adult children until age 26.

10. Requires most people to have coverage by 2014.

11. Offers subsidies for those with moderate or low income and makes more people eligible for Medicaid.

12. Creates state-run insurance exchanges (in 2014) offering a menu of private insurance plans for people who are uninsured, self-employed or unemployed.

How will my health insurance be impacted if I receive insurance from my employer?

1. You can keep the plan you have now. You will not be forced into a government plan (none exists).

2. Insurance companies can no longer place annual [Start in 2014] or lifetime limits [Start in September ‘10] on what they will pay for your care.

3. Insurance companies will have to spend a large part of the money you pay for your coverage on medical care, not profits or overhead [Start in January ‘11].

4. All new plans must provide many preventive services and screenings for free. All of the details regarding this provision have not yet been worked out.

5. If your insurance offers a family plan, your adult children can be covered until age 26.

6. No child under 19 can be denied coverage because of a preexisting condition [Start in Fall ‘10].

7. If your employer takes part in a long-term care insurance plan, you can choose to pay monthly premiums through payroll deductions, which after five years entitle you to cash benefits toward the costs of services (home aides, wheelchair ramps, etc.) that help you remain in your home [Start in 2011].

8. If you take early retirement, the government will provide money to help employer health plans cover retirees ages 55 to 64 and to reduce retirees’ costs [June ‘10 through 2013].

9. If you have a flexible spending account (including health savings accounts), the maximum you can contribute will be reduced to $2,500 per year. You will no longer be allowed to use them to buy over-the-counter medicines not prescribed by your doctor [Start in 2013].

10. Employers will be allowed to offer employees discounts of up to 30% on their insurance costs if they participate in a wellness program or meet certain health goals [Start in 2013].

11. If your employer coverage is too expensive or inadequate, you can switch to one of many plans offered through state-run exchanges. You may be able to get subsidies to help you buy the insurance [Start in 2014].

12. Insurance companies must pay an excise tax on the most expensive employer plans. The 40% tax applies only to the value of the plan above certain amounts [Start in 2018].

If I’m on Medicare now, how will the new law affect me?

1. The new law guarantees that your existing basic benefits will not change.

2. If your in traditional Medicare, you can get an annual physical and many preventive services free [Start in 2011]. If you’re in Medicare Advantage, you’ll need to check your plan to determine if these will be free.

3. If you enter the Part D doughnut hole this year, you will receive $250 toward your drug costs. Starting in 2011, you will get a 50% discount on all brand-name and biologic drugs you buy in the doughnut hole. Discounts will gradually increase until the doughnut hole closes in 2020.

4. Over the next 10 years, more people will likely be required to pay higher-income Part B premiums because the current income levels on which they are based will be frozen until 2020. Levels start at $85,000 for a single person or $170,000 for married couples filing joint returns.

5. People with higher incomes (the same as Part B) will pay higher Part D premiums [Start in 2011].

6. You will not be required to buy Medigap supplemental insurance.

7. The two-year waiting period between qualifying for Social Security disability and becoming eligible for Medicare remains unchanged.

8. Medicare currently pays more for people enrolled in Medicare Advantage plans than in traditional Medicare. This system will be phased out and replaced with a payment system that rewards plans that meet certain standards for care and service. Starting in 2014, plans must spend 85% of the money they take in from premiums on medical care. They will no longer be able to charge higher co-payments than Traditional Medicare for certain services.

I own a small business. How will the new law affect me?

About 80% of businesses in the United States employ less than 10 people. Less than half of these small businesses offer health insurance. About 85% of the businesses that employ between 25 and 100 people offer no health insurance coverage. The new law will help you provide health insurance for your employees. The new law also allows your employees to change jobs without fear of losing their health insurance.

1. Small business employees (with health insurance) will receive the same new benefits and protections as those who work for large corporations with group health plans.

2. Businesses with less than 25 full-time employees that pay an average wage of $50,000 or less per year will get a tax credit of up to 35% on health insurance premiums they pay for employees’ health insurance [Start now]. This credit will increase to 50% in 2014.

3. Small businesses can offer cafeteria plans, which allow employees to transfer before-tax earnings into accounts that can be used for medical expenses [Start in 2011]. Businesses with fewer than 100 workers can buy insurance for their employees through a state-run exchange [Start in 2014]. Note: Businesses with 50 workers or more will pay an annual penalty if they don’t provide insurance coverage.

4. Employees can buy health insurance for themselves and their families through a state-run exchange if they work for a business that doesn’t provide coverage. Subsidies or tax credits will be available to those with low and moderate income.

I’m self-employed and have no health insurance. How will the new law affect me?

If you are self-employed, buying insurance for yourself and your family, or have no insurance at all, you are part of a group that the new law helps the most. Millions of Americans currently pay the highest rates for health insurance because they buy it on their own. Others (especially those ages 50 to 64) can’t buy coverage at any price due to preexisting conditions. Making private insurance easier to purchase and more fair for consumers is a main objective of the new law.

1. If you have a preexisting condition and have been uninsured at least six months, you’ll be eligible to buy insurance through a temporary high-risk program [Start in July ‘10]. This program will end when state-run exchanges are available in 2014.

2. Insurers can no longer drop you if you’ve paid your premiums. Insurers can no longer limit what they will spend on your health care during your lifetime. Insurers can no longer place limits on your annual health costs [Start in 2014].

3. Children cannot be denied coverage due to preexisting conditions [Start in September ‘10]. Adults receive the same protection in 2014.

4. If your employer offers a family plan, unmarried children can be covered under your policy until age 26 [Start in Fall ‘10].

5. You can select a private health plan (yearly out-of-pocket expenses will be limited) from a menu of choices offered through your state-run insurance exchange [Start in 2014].

6. Health plans cannot deny you coverage or make you pay more for your insurance because of your health, gender, or past medical problems [Start in 2014]. Exception: Insurers can raise premiums by up to 50% for people who smoke.

7. Health plans you buy on your own must cover certain preventive services, screenings, and vaccinations free of charge [Starts when you join the plan or when your current plan’s next year coverage begins].

8. Insurers can charge older people no more than three times the amount they charge younger adults (currently, insurers are allowed ten times the amount).

I work at a minimum wage job. How will the new law help me buy insurance?

1. The new law provides subsidies or tax credits to reduce the cost of buying insurance through a state exchange. The subsidies and credits will be will be given to people on a sliding scale, if your income is below a certain level. This would include individuals with incomes of $14,403 to 43,320 and families of four with incomes of $29,326 to $88,200 (current rates).

2. The new law limits out-of-pocket costs (deductibles & copays) of insurance bought through an exchange for people with moderate incomes. Example: a family of four now earning $60,000 per year would spend no more than $11,900 out-of-pocket for health care in a year.

3. The new law expands Medicaid to cover any low-income legal residents under age 65 with annual income under a certain level ($14,403 for a single person - $19,378 for a married couple).

I’m beginning to understand how the new health care law will affect me. How will it affect members of Congress and illegal immigrants?

1. Beginning in 2014, members of Congress will be required to buy health insurance through the state-run insurance exchanges.

2. Illegal immigrants are prohibited from buying health insurance through state-run exchanges or from getting subsidies.