What Health Care Reform Means

President Obama said he signed health insurance reform "On behalf of my mother." Photo by Lawrence Jackson, courtesy whitehouse.gov

Last month President Obama signed much debated legislation “to provide affordable, quality health care for all Americans and reduce the growth in health care spending.”

Tennessee’s Senators Lamar Alexander (R) and Bob Corker (R) both voted “no” on the insurance reform bill, as did every single Republican member of the House and Senate.

However, Murfreesboro’s delegate to the House of Representatives said he voted for health insurance reform legislation to bring down the skyrocketing costs of health care.

“We’ve debated this issue for almost a full year. Now is the time to move forward, look at how it benefits families and small businesses, and address the economic challenges our communities are facing,” said Congressman Bart Gordon (D).

Health care accounts for one out of every $5 of the U.S. federal budget. According to the nonpartisan Congressional Budget Office, the health care reform package passed by the House will reduce the deficit by $143 billion over the next 10 years and $1.2 trillion in the 10 years after that.

Gordon encouraged Middle Tennessee families to learn how the bill may affect them, and his office offered these tips to understanding the bill:

If you and your family currently have health insurance and you are happy with your coverage:

These reforms will have no effect on your current health plan, choice of insurance company or choice of doctor.

If you and your family are self-insured or currently uninsured:

Beginning in 2014, you may receive a tax cut to help you purchase your own insurance from the private sector. A family of four with an income of up to $88,200 would qualify for the credits.

You will be able to purchase an insurance plan from private insurance companies competing in an exchange. Individuals participating in the exchange will receive group rates similar to those enjoyed by employees at large companies or members of unions.

Because the bill will not create a government-run insurance program or public option, you will not be applying for government-run care. You will be choosing from a menu of options from existing private insurance companies, similar to those available to Members of Congress through the Federal Employee Health Benefits Plan.

If you have health insurance and develop a serious illness:

Your health insurance provider will not be permitted to drop your coverage because you get sick. Insurance plans will be prohibited from placing lifetime caps on your coverage beginning in September 2010.

For Young Adults
If you are under 26 and do not have health insurance through an employer:

Your parents will have the option of keeping you covered by their existing family policies as a dependent until age 26, as of September 2010.

If you are under 30 and do not have health insurance through an employer:

The bill will establish new, inexpensive catastrophic insurance policies that offer protection in case of catastrophic health care costs. These policies will meet the bill’s requirements about minimum coverage for individuals under 30.

For Small Businesses
If you own a small business with 50 or fewer employees and average wages of less than $50,000:

You are not required to provide health insurance coverage to your employees.

If you choose to offer health insurance, you will be able to join with other small businesses to purchase private insurance at lower group rates through a purchasing pool, or exchange, as of 2014. Through this exchange, your employees will have a wider choice of plans, group rates and lower administrative costs.

Qualified businesses that purchase insurance through this exchange will be eligible for a tax credit of up to 50 percent of the cost of their part of the premium, as of 2014.

If your business has 25 or fewer employees and average annual wages of less than $50,000:

All of the benefits listed above apply.

In addition, if you choose to offer your employees health insurance, you will be eligible for a tax credit of up to 35 percent to cover the cost beginning this year. In 2014, these tax credits will increase to 50 percent and will be expanded to all small businesses with fewer than 50 employees.

If any of your employees are currently expensive to insure because of their age, a pre-existing condition, or a serious illness:

Insurance companies will be prohibited from charging you higher premiums due to these conditions.

For Those With Pre-Existing Conditions
If you have a pre-existing condition such as diabetes, cancer or heart disease:

Beginning this summer, individuals without health insurance will be able to seek health insurance by enrolling in a temporary high-risk pool, which will offer immediate assistance until the bill’s provisions take full effect in 2014.

Your health insurance plan will not be permitted to place a lifetime cap on coverage, including caps specific to certain diseases, as of September 2010.

No health insurance plan will be able to deny you coverage as of 2014.

If you want to change health insurance plans, you cannot be denied coverage or charged a higher rate because of a pre-existing condition, as of 2014.

If your child under 18 has a pre-existing condition:

Your health insurance plan will no longer be able to deny your child coverage because of a pre-existing condition, as of September 2010.

If you or a family member has health insurance and is diagnosed with a serious illness:

Your health insurance plan will not be able to drop your coverage when you get sick, as of September 2010.

Beginning 2010, annual limits in new policies will be heavily restricted. As of 2014, no insurance policy will be able to impose annual limits, such as disease-specific annual caps.

For Seniors
If you are a senior receiving Medicare:

You will no longer be charged copayments for preventive services such as screenings. Preventive services will also be exempt from deductibles. This provision will be effective Jan. 1, 2011.

Your access to inexpensive generic drugs at local pharmacies will be protected by a correction to Medicare’s payment formula. Reforms in this bill will protect benefits and extend the solvency of Medicare by nine years.

If you have been affected by the Medicare Part D “donut hole” gap in prescription drug coverage:

You will receive a $250 rebate for prescription drugs if you fall in the donut hole this year. You will receive a 50 percent discount on all brand-name drugs while in the donut hole beginning next year.

The donut hole will be phased out over the next 10 years and will be completely closed by 2020.

If you are a Medicare Advantage recipient:

Your premiums will decrease over the next 10 years because of a correction to overpayments to certain private plans. Medicare Advantage payments will be calculated based on local health care costs.

If you are a senior from a rural county:

Local care options will improve as primary care doctors and general surgeons are offered incentive bonuses for practicing in rural areas, beginning in 2011.


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