January 2012

Health Care Reform Bill Summary: A Look At What's in the Bill

By CBS News Capitol Hill Producers Jill Jackson and John Nolen Cost:

$940 billion over ten years.

Deficit:

Would reduce the deficit by $143 billion over the first ten years. That is an updated CBO estimate. Their first preliminary estimate said it would reduce the deficit by $130 billion over ten years. Would reduce the deficit by $1.2 trillion dollars in the second ten years.

Coverage:

Would expand coverage to 32 million Americans who are currently uninsured.

Health Insurance Exchanges:

The uninsured and self-employed would be able to purchase insurance through statebased exchanges with subsidies available to individuals and families with income between the 133 percent and 400 percent of poverty level. Separate exchanges would be created for small businesses to purchase coverage -effective 2014. Funding available to states to establish exchanges within one year of enactment and until January 1, 2015.

Subsidies (Financial Assistance):

Individuals and families who make between 100 percent - 400 percent of the Federal Poverty Level (FPL) and want to purchase their own health insurance on an exchange are eligible for subsidies. They cannot be eligible for Medicare, Medicaid and cannot be covered by an employer. Eligible buyers receive premium credits and there is a cap for how much they have to contribute to their premiums on a sliding scale.

Federal Poverty Level for family of four is $22,050 Paying for the Plan:

Medicare Payroll tax on investment income -- Starting in 2012, the Medicare Payroll Tax will be expanded to include unearned income. That will be a 3.8 percent tax on

January 2012 investment income for families making more than $250,000 per year ($200,000 for individuals). Excise Tax -- Beginning in 2018, insurance companies will pay a 40 percent excise tax on so-called "Cadillac" high-end insurance plans worth over $27,500 for families ($10,200 for individuals). Dental and vision plans are exempt and will not be counted in the total cost of a family's plan. Tanning Tax -- 10 percent excise tax on indoor tanning services.

Medicare:

Closes the Medicare prescription drug "donut hole" by 2020. Seniors who hit the donut hole by 2010 will receive a $250 rebate. Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs. The bill also includes $500 billion in Medicare cuts over the next decade.

Medicaid:

Expands Medicaid to include 133 percent of federal poverty level which is $29,327 for a family of four. Requires states to expand Medicaid to include childless adults starting in 2014. Federal Government pays 100 percent of costs for covering newly eligible individuals through 2016. Illegal immigrants are not eligible for Medicaid.

Insurance Reforms:

Six months after enactment, insurance companies could no longer denying children coverage based on a preexisting condition. Starting in 2014, insurance companies cannot deny coverage to anyone with preexisting conditions. Insurance companies must allow children to stay on their parent's insurance plans until age 26th.

Abortion:

The bill segregates private insurance premium funds from taxpayer funds. Individuals would have to pay for abortion coverage by making two separate payments, private funds would have to be kept in a separate account from federal and taxpayer funds. No health care plan would be required to offer abortion coverage. States could pass legislation choosing to opt out of offering abortion coverage through the exchange.

**Separately, anti-abortion Democrats worked out language with the White House on an executive order that would state that no federal funds can be used to pay for abortions except in the case of rape, incest or health of the mother. (Read more here) Individual Mandate:

January 2012

In 2014, everyone must purchase health insurance or face a $695 annual fine. There are some exceptions for low-income people.

Employer Mandate:

Technically, there is no employer mandate. Employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance. Fines applied to entire number of employees minus some allowances.

Immigration:

Illegal immigrants will not be allowed to buy health insurance in the exchanges -- even if they pay completely with their own money.

Number of people without health insurance climbs

NEW YORK (CNNMoney) -- The number of people who lacked health insurance last year climbed to 49.9 million, up from 49 million in 2009, the Census Bureau said Tuesday. Nationwide, 16.3% of the population was uninsured last year, statistically unchanged from 2009.

Uninsured in America Three groups comprised the bulk of the uninsured in 2010,
including foreign-born residents who are not U.S. citizens, young adults ages 19 to 25 and lowincome families with an annual household income of less than $25,000.

January 2012
Much of the declines in insured rates in recent years can be attributed to the loss of employerprovided coverage, which fell amid sustained unemployment and as employers continued to cut back on benefits. The percentage of people who had health insurance through their employers fell to 55.3% in 2010 from 56.1% the year before, continuing a long, downward trend. In 2000, 64.1% of the population received health insurance through their employers. "As the job market remains weak, Americans can no longer depend on their workplace for consistent affordable coverage," said Elise Gould, Director of Health Policy Research for the Economic Policy Institute, a Washington-based think tank. Poverty on the rise Some employers have stopped offering health insurance, while others are passing along more of the cost to their employees, said Gould. As a result, some workers are abandoning their employer's plans because the premiums have become too expensive, she said. The average health insurance premium for family coverage has more than doubled over the past decade to $13,770 a year, according to the Kaiser Family Foundation, a non-profit which focuses on health care policy and issues. With fewer Americans receiving health care coverage through their employers, government-funded programs like Medicare, Medicaid, military health care, the Children's Health Care Program (CHIPS) and coverage offered by various states have had to pick up the slack. In 2010, 31% of Americans relied on the government for health insurance, up from 24.2% in 1999. Many of the new government beneficiaries are children, according to Gould. Still, Census reported that 9.8% of children under age 18 are uninsured despite the government programs targeting them like CHIPS and Medicaid, which is also open to their parents. Adults without dependent children, however, are not eligible for Medicaid in most states under federal rules, said Rachel Garfield, a senior researcher on the Kaiser Commission on Medicaid and the Uninsured. It's this group that accounts for a large portion of the increase in the uninsured. Nearly one-in-four working-age adults are uninsured, said Gould. She said it won't be until 2014, when Obama's Affordable Care Act fully kicks in, that more people will be able to find affordable health care coverage. What health care reform is (and isn't) doing now Kathleen Sebelius, the Secretary of Health and Human Services, said the report is evidence that the Obama administration's health care reform is already starting to work.

January 2012
Citing a provision that went into effect last year that allows parents to keep their children on their health insurance policy until they are 26 years old, Sebelius noted that the percentage of young adults ages 18 to 24 who were insured increased to 72.8% in 2010 from 70.7% in 2009. "We expect even more will gain coverage in 2011 when the policy is fully phased in," wrote Sebelius on HealthCare.gov, a web site run by the federal government. Among the states, Texas had the highest percentage of uninsured; at 24.6%. Still, it was an improvement from the 26.1% who were uninsured in 2009. New Mexico had the second highest rate of uninsured people with 21.6%. Nevada was third at 21.3% and Mississippi's rate jumped to 21.1% from 17.3% in 2009. Despite being home to a high percentage of retirees, many of whom are covered by Medicare, Florida had an uninsured rate of 20.8% down from 21.7% in 2009. In Massachusetts, where former governor Mitt Romney instituted his controversial state-wide health insurance plan in 2006, only 5.6% of the population lacks coverage, the lowest rate of uninsured of any state. Other states that boasted a smaller percentage of uninsured included Hawaii (7.7%), Wisconsin and Maine (both 9.4%) and Vermont (9.5%).
First Published: September 13, 2011: 10:51 AM ET

What health care reform is (and isn't) doing now

By Amanda Gengler @Money August 2, 2011: 5:19 AM ET

Money Magazine -- It's been more than a year since President Obama signed health care reform into law. The act's biggest provisions, which will make it easier for the uninsured to buy coverage, don't take effect until 2014. But Congress, eager to sell the plan to a skeptical public, wrote in a few benefits that have already kicked in. You've probably heard some of them touted: Preventive care is fully covered by insurance plans. People with preexisting conditions have access to coverage. And retirees who spend a lot out of pocket on prescriptions are getting relief from the dreaded "doughnut hole" in their Medicare drug coverage.

January 2012
Here are answers to common questions about what health care reform is doing right now.

If the new law requires insurers to fully cover preventive care, why did I get a bill for my annual exam?
The Affordable Care Act does eliminate co-pays and co-insurance for some kinds of preventive care, as long as you use an in-network provider. (Those services are also not subject to deductibles.) A yearly checkup or "well" visit will often be covered, says Lori Heim of the American Academy of Family Physicians. Blood pressure checks and recommended screenings, such as mammograms and colonoscopies, should cost you nothing. Many vaccinations are also on the free list. Healthcare.gov has the full menu. There are two catches. First, your plan may be grandfathered out of having to follow this rule if it was in place before the law was enacted. The exemption lasts until your employer significantly cuts benefits or increases your co-pay, co-insurance, or deductibles. Almost a third of midsize and large group plans are exempt, according to consultant Towers Watson, but that number will fall over time. Catch No. 2? "Sometimes 'well' visits can morph into 'sick' visits," says Cheryl Gregg Fahrenholz of Preferred Healthcare Solutions, a consulting firm. Say your doc discovers an irregular mole and removes it during your visit. You may get a bill for the cut. Ditto if you mention a specific symptom that causes the doctor to run an extra test. To avoid a surprise, ask your doctor to tell you when he is doing something that is going to result in a bill.

I have a preexisting condition, and I'm having trouble finding coverage. Wasn't this supposed to be fixed?
Starting in 2014, if you have a preexisting condition you'll be able to buy a health policy on the new insurance "exchanges," which will charge both healthy and sick people the same prices. Until then, the law has provided some Band-Aids. Kids can't be turned away from most plans. And the federal government is subsidizing new programs in each state called Pre-existing Condition Insurance Plans. (PCIP.gov can direct you to your state's plan.) You'll pay rates similar to what healthy individuals do in your state -- in Florida, a middle-aged person could pay as little as $270 a month. But you can buy in only if you've gone uninsured for six months. Just 21,500 people nationwide have signed up. "The gap is just too big a risk for most people, so they'll stick with whatever they have, however inadequate," says Timothy Jost, a health law expert at Washington & Lee University.

January 2012
Why aren't PCIPs open to everyone who needs them? Running insurance plans only for the sick (with no healthy people paying in as they will on the exchanges) is ruinously expensive, so lawmakers limited who could sign up.

I'm on Medicare, and I got a $250 check to help me pay for the "doughnut hole." Will I get more of those?
No. That was a one-time payment last year. The so-called doughnut hole is the gap often found in Medicare prescription drug coverage: Once the cost of your drugs tops $2,840, you must pay out of pocket until total costs hit $6,448. Lawmakers decided to eliminate the hole, but it's happening gradually. First, you got a check if you fell into the coverage gap. This year, instead of a direct payment, you'll receive a 50% discount on brand-name drugs you buy when you're in the hole. Generics will be discounted by 7%. Those percentages will increase over time. Your bill at the pharmacy should reflect the markdown. "We were a little concerned the discount wouldn't work seamlessly for seniors, but it seems to be going smoothly," says Joe Baker, president of the Medicare Rights Center. By 2020 the doughnut hole should be gone completelyunless, of course, Congress makes yet another health care law by then.