Health care reform 'Cheat Sheet'



It’s been six months since the health care reform law was passed, and parts of it are being phased in. It’s an overly complicated law, thanks to all the wrangling it took to get the thing passed, and progressives are still pissed that the law doesn’t include a public option — but it’s at least a big step in the right direction. NC Policy Watch has produced a useful “Cheat Sheet,” explaining the basics of health care reform, where it stands as of now, and what’s to come in the future. If you go to the NC Policy Watch site, you can also link from there to "Health Reform Hits Main Street," a balanced, no-nonsense video produced by the Kaiser Family Foundation that gives even more information, as well as a virtual timeline for the whole reform process.

You'll find the text of the “cheat sheet" below, but the whole document from NCPW is worth linking to, as well as the video.

Meanwhile, I hope you'll come to the Tribute To Novello reading tonight at the Levine Museum of the New South at 7 pm. Authors at tonight's reading will be Tom Hanchett, Mary Kraft, Mike Lattimer, and yours truly. It's free.

Health Care Reform "Cheat Sheet"

Of course, videos and virtual timelines are nice, but sometimes it's also useful to have a brief and handy list that one can refer to when discussing the issue with friends, colleagues and under-informed relatives. Here, therefore, are 10 key things to know about this important achievement in American public policy making:

#1 - Law is being phased in gradually - Though it was enacted in March, the health care reform law will take several years to fully implement. Right now, we're still just getting started. It will undoubtedly take years to have its full impact. Still, several important improvements have been implemented already. These include, among many others, numbers two through six below:

#2 - Pre-existing conditions - As of last week, insurance plans may no longer deny children coverage based on pre-existing medical conditions or include pre-existing condition exclusions for children. For adults, this protection becomes effective 1/1/14. Until then, there will be "high-risk pools" that will provide at least some coverage to folks with pre-existing conditions.

#3 - No more lifetime limits - As of last week, individual and group health plans are now prohibited from placing lifetime limits on the dollar value of coverage or rescinding coverage except in cases of fraud. Annual limits have also been restricted and will be eliminated in 2014.

#4 - Dependent coverage raised to age 26 - As of last week, all insurance plans must now allow young adults to remain on their parents' health insurance up to age 26.

#5 - Improved Medicare and Medicaid drug coverage - The new law provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010. Further subsidies and discounts that ultimately close the coverage gap begin in 2011. It also ups rebate percentages for a variety of drugs under Medicaid.

#6 - Several other changes are already being implemented - These include new small business tax credits, several improvements to Medicare and Medicaid, and improvements to prevention and medical effectiveness.

#7 - January 1, 2014 is the big day - Though changes and reform will continue to be implemented in 2011 through 2013, 2014 is the year in which the final big changes take effect. These include numbers 8 through 10 below.

# 8 - The individual mandate - This is the biggest, most controversial and most important change. As of the January 1, 2014, all U.S. citizens must have qualifying health coverage or face a tax penalty. The premise behind the mandate is simple: If insurers are going to be required to serve everyone (that is, the law will now say that there will be no more denying coverage to anyone) and place no dollar limits on coverage, it's only fair that people not be allowed to wait until they get sick to buy in.

So long as we're going to have a system funded through insurance premiums paid to private insurers rather than a tax-funded system, everyone must be in the "pool." Otherwise, of course, people would have an enormous incentive to simply wait until they get sick to buy. In other words, the individual mandate is the price we pay for retaining a private insurance company-based system rather than following the lead of so many other advanced democracies and simply covering everyone in a unified, taxpayer-funded system.

#9 - Health "exchanges" and subsidies - The new law will take several steps to make it possible for all Americans to comply with the individual mandate. Two, however, stand out: a) the new law will create state-based "exchanges," administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. Exchanges will have a single form for applying for health programs, including coverage through the Exchanges and Medicaid and CHIP programs; b) the law will also provide refundable and "advanceable" tax credits and cost sharing subsidies to eligible individuals. Premium subsidies are available to families with incomes between 133-400% of the federal poverty level to purchase insurance through the exchanges, while cost sharing subsidies are available to those with incomes up to 250% of the poverty level.

#10 - Medicaid expanded dramatically - Finally, the new law expands Medicaid to all individuals not eligible for Medicare under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% of the federal poverty limit and provides enhanced federal matching payments for new "eligibles."

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