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Health Reform: What's In, What's Out and What It Will Cost

5 years ago
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With congressional passage of a "fix-it" bill to accompany the landmark health law that President Obama signed Tuesday, work is finally done on his signature health care reform initiative. Now we can tell you for sure some of the changes that are coming. Here's a subject-by-subject look at how the new health laws affect health insurance, Medicare and other aspects of the U.S. health care system:
What's in:

Insurance mandate: The bill would require almost every American to purchase health insurance, either through an employer or through new health insurance exchanges created by the bill.

In order to encourage businesses to provide insurance for their employees, companies with more than 50 employees will pay fines to the government if they do not.

Health care exchanges: The new health care exchanges will include for-profit and nonprofit insurance companies and will be run by states or multistate cooperatives. At least two plans will be run by the Office of Personnel Management, which now handles plans for federal employees. Individual customers can shop for insurance in the exchanges, in some cases across state lines.

Insurance rules: Insurance companies will be required to include a minimum level of coverage for all customers and will be prohibited from dropping or denying coverage based on a customer's medical history. Companies also cannot implement caps on lifetime coverage.

Federal subsidies: If a person or family cannot afford coverage, the federal government will subsidize the cost of coverage for families making up to $88,000 a year.

Medicaid: The bill will also expand Medicaid to include as many as 15 million more people living just above the poverty line.

Medicare: The measure also eliminates Medicare co-payments for preventive and screening services and phases out the so-called "doughnut hole" that leaves some prescription drugs uncovered, starting with an immediate $250 rebate in 2010.

Dependent care: Also starting immediately, parents will be able to keep dependent children on their health plans until they are 26 years of age, and insurance companies will have to cover children with pre-existing conditions.

"Cornhusker Kickback": There is no longer special aid to Nebraska to cover expansions in Medicaid, Instead, the federal government will pay for 100 percent of the Medicaid increase for all states through 2018, and a declining share after that.

Taxes and credits: Employers will pay a 40 percent excise tax on expensive insurance policies starting in 2018.

There will be a Medicare payroll tax increase on earnings over $200,000 for individuals and $250,000 for married couples, and a new 3.8 percent tax on unearned income that kicks in at the same levels.

For small businesses, $40 billion in tax credits would help employers pay for insurance for their workers.

GOP contributions: A number of Republican ideas were incorporated into the health reform package during committee work, including new steps to combat fraud and abuse in the Medicare and Medicaid programs. On March 2, the president said he was open to four more proposals from GOP lawmakers. They are: Using undercover investigators to detect Medicare fraud, adding $50 million for medical malpractice demonstration programs, encouraging wider use of health savings accounts, and possibly increasing Medicaid reimbursement rates to doctors. For procedural reasons, it is not clear yet whether all four will be in the final package.

Abortion: Obama opted to keep the Senate's more liberal language on abortion funding in the bill. It would require at least one option on every heath care insurance exchange to provide coverage for elective abortion services and allow women who choose that coverage to pay for it, as long as they use their own money. Federal subsidies could not directly pay for abortion coverage.

Immigrants: Undocumented immigrants will not receive federal subsidies and will not be allowed to use their own money to buy insurance on the exchanges.

What's gone:

Public option: The House passed a public option, or government-run insurance plan, in November, but it did not make it into law.

Costs: The Congressional Budget Office has estimated that the new law will cost $940 billion over 10 years. Taking into account new savings and taxes, CBO says the new law will cut the deficit by $138 billion in the first 10 years and more than $1 trillion in the next 10 years.
Filed Under: Health Care Endgame

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