Healthcare Reform 2010: What Does It Mean?

Well, it has been an intensive and heated battle. However, most people still do not know what is in the reform and what is not in the reform. This page was put together without regards to political views or political parties; just the plain words that were placed on the White House website for the public. We will do our best to keep you informed on all aspects of Healthcare Reform that was passed into law on March 31, 2010.

 

The following information is taken directly from the official White House website on the various questions that people may have about the Healthcare Reform Act.  Learn more about what is in the health reform legislation signed into law by President Obama. Reform will make health care more affordable, make health insurers more accountable, expand health coverage to all Americans, and make the health system sustainable, stabilizing family budgets, the Federal budget, and the economy.

 

What will health reform mean for you?

Take a few minutes to find out what health insurance reform will mean for you and your family. To begin, select which one describes your situation and read the information below the topic.

 

• I Have Insurance Through My Work

• I Own A Small Business

• I Have Medicare

• I Do Not Have Insurance

• I Buy My Own Insurance

 

Keep your doctor and plan if you like it, but your plan will be strengthened and you'll be protected from insurance company abuses.

Your Questions:

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• I Have Insurance Through My Work

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Q: Will my premiums / costs go up because of health reform?

A: No.

According to the independent and non-partisan Congressional Budget Office, people who get coverage through their employer today will likely see lower premiums.

Reform will lower premiums by reducing administrative costs, increasing competition between insurance companies and creating a larger pool of insured Americans.

And remember, the cost of doing nothing is high. In ten years, health care spending for each employee at an average big company will be $28,530.

 

Q: Will my coverage at work change?

A: No. If you like the health plan you have, you will be able to keep it. 

• Nothing in the health reform bill will require you to change your coverage. What the bill will do is strengthen the coverage you get at work by making it  easier to understand and adding some clear rules to rein in the worst insurance company abuses.
• Language explaining what’s in your plan will have to be simple and clear so that you know what your benefits are and what’s covered.
• Insurance companies will no longer be allowed to place a lifetime limit on the amount of care they pay for. And in some cases insurance companies with excessive overhead costs will be required to give you a rebate.    And, if your adult children are living at home up to age 26 they can be covered under your family policy.

Q: Will the government take my choice of doctor away?

A: No.

• Nothing about the President’s proposal will interfere with the choice of doctors you have today.  The legislation will not cause you to change the coverage you have at work today.

 

A: Make it simple.

• Health reform will require plans to use clear and plain language on insurance forms so that you can easily understand what benefits and what doctors are covered in your plan. And, it will standardize forms to reduce the confusing and overwhelming paperwork that all Americans have to confront today.

Q: What are you going to do about all the confusing forms I have to fill out?

A: Make it simple.

• Health reform will require plans to use clear and plain language on insurance forms so that you can easily understand what benefits and what doctors are covered in your plan. And, it will standardize forms to reduce the confusing and overwhelming paperwork that all Americans have to confront today.

 

Q: What consumer protections will I get this year?

A: Beginning in September 2010, insurers will be prohibited from placing lifetime limits on what they will pay for your medical care, and they can only apply restricted annual benefit limits. Insurers will no longer be able to arbitrarily cancel your insurance policy when you get sick, except in cases of fraud.

Insurance companies will be prohibited from denying coverage to children with pre-existing conditions. This applies to all new and existing employer plans. 

Beginning in September 2010, all new group health plans must provide coverage for preventive services.  Recommended prevention and vaccination services will be covered without any deductibles or copayments. Plans must also have a straightforward and independent appeals process so you can appeal decisions by your health insurance plan. 

Beginning on January 1, 2011, insurance companies will be required to spend most of your premium dollars on your care, not on profits and overhead -- 80 percent in the  group market and 75 percent in the individual market -- and rebate any excessive overhead to enrollees.

Similarly, starting in plan year 2011, insurance companies that jack up rates will have to disclose requested premium increases publicly.  If that rate increase is found to be unreasonable, the insurer may be prohibited from competing for your business in the new state-based exchange that will begin operating in 2014.

 

Q: I’m a parent, how will reform affect coverage for my children?

A: You will be able to get coverage for your child if he or she has a pre-existing condition, and adult children will be able to stay on family policies until age 26.

• Beginning in September 2010, it will be illegal for health insurance companies that cover children to deny coverage to your child based on a pre-existing condition.   This applies to all new employer plans, new plans in the individual market, and existing employer plans.
• Beginning in September 2010,  insurers will be required to permit children to stay on family policies until age 26.  This applies to all plans in the individual market, new employer plans, and existing employer plans, unless your adult child has an offer of coverage through his or her employer.  This requirement will take effect the next time your plan comes up for renewal.  Adult children who are on their parents’ plan now but who lose that coverage when they graduate from college will have the option of rejoining their parents’ policy in the new plan year beginning n September 2010.  Those whose parents work at self-insured companies will also be eligible if they do not have an offer of employer-sponsored insurance.  Both married and unmarried dependents qualify for this dependent coverage.  Beginning in 2014, children up to age 26 can stay on their parent’s employer plan even if they have an offer of coverage through their employer.

 

Your Questions:

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• I Own A Small Business

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You won't be required to provide health insurance to your employees, but if you choose to, new tax credits will make covering your employees more affordable. You will also have access to a new insurance exchange to find the best deal, and the entire process will be simpler.

Q: Will I be required to provide coverage that I can’t afford?

A: No.

• The President’s proposal  does not require that small businesses provide coverage to their employees. Instead, the President’s proposal  provides tens of billions of dollars in new tax-credits to small businesses to make it easier for them to provide coverage if they choose to do so.
• Today, small businesses pay up to 18 percent more than large firms for the same health insurance policy.  The independent and non-partisan Congressional Budget Office found that with health insurance reform, premiums for small businesses will go down. 
• In addition, you will be protected from sudden, arbitrary rate hikes because a worker get sick;  because insurance companies will no longer be permitted to base the cost of coverage on health status.
• Starting in 2014, only large businesses who have employees receiving taxpayer-funded health assistance will pay an assessment to help offset the cost of those subsidies to the American taxpayer. Companies whose employees are receiving taxpayer assistance will have to pay $2,000 per full-time worker. (This is less than half of the annual cost of providing health insurance to a full-time worker today).   A business is defined as “large” if it has more than 50 full-time equivalent workers, not counting seasonal workers.  The first 30 workers would be subtracted from the total when calculating the total amount of the assessment.  We estimate that fewer than 2 per cent of  large businesses will be likely to pay these penalties.

Q: Why would it be easier to provide coverage than it is today?

A: Reform will provide at least three tangible benefits that will make it easier and cheaper for small businesses to provide coverage:

• First, by allowing small businesses to buy coverage through an insurance exchange—the marketplace where you can shop for health insurance—small businesses will get the benefit of pooling together their employees with millions of others, which will lower their own exposure, lower risk and ultimately lower costs.
• Second, operating through an exchange will  reduce administrative costs for small businesses and their employees by enabling them to easily and simply compare the prices, benefits, and quality of health plans.
• Third, many small businesses will be able to get a tax credit to help cover the cost of the coverage they offer.

 

Q: Will I be able to pool with other small businesses to buy coverage?

A: Yes.

• Beginning in 2014, reform will create state-based health insurance exchanges that pool small businesses and their employees, which will spark competition and give you the kind of purchasing power that big businesses enjoy today.  The exchange will  offer the same types of private insurance choices that the President and Members of Congress will have.  Increased purchasing power and competition will make premiums more affordable.  The exchange will also reduce administrative costs for your businesses and your employees, enabling them to easily and simply compare the prices, benefits, and quality of health plans.

 

Q: Will my employees be able to buy coverage if I cannot afford to provide it?

A: Yes.

Employees at small businesses that don’t offer coverage can get tax credits to purchase coverage.

 

Q: Will my taxes go up to pay for the cost of covering the uninsured?

A: No.

Your business taxes will not go up. Instead, you may be eligible for new tax credits to help offset the cost of covering your employees.

 

Q: What are you going to do about all the confusing forms I have to fill out?

A: Make it simple.

• Health reform will require plans to use clear and plain language on insurance forms so that you can easily understand what benefits and what doctors are covered in your plan. And, it will standardize forms to reduce the confusing and overwhelming paperwork that all Americans have to confront today.

 

Q: What is the small business tax credit and how do I know if I am eligible?

A: Effective January 1, 2010, tax credits are available to qualifying small businesses that offer health insurance to their employees. So if your business qualifies for a tax credit, you are eligible right now.

About 4 million small businesses will be eligible to receive tax credits if they provide insurance.

The tax credit is worth up to 35 percent of the premiums your business pays to cover its workers -- 25 percent for nonprofit firms.  In 2014, the value of the credit will increase to to 50 percent -- 35 percent for nonprofits.

Your business qualifies for the credit if you cover at least 50 percent of the cost of health care coverage for your workers, pay average annual wages below $50,000, and have less than the equivalent of 25 full-time workers (for example, a firm with fewer than 50 half-time workers would be eligible). 

The size of the credit depends on your average wages and the number of employees you have.  The full credit is available to firms with average wages below $25,000 and less than 10 full-time equivalent workers.  It phases out gradually for firms with average wages between $25,000 and $50,000 and for firms with the equivalent of between 10 and 25 full-time workers.

 

Q: What if my small business doesn’t offer insurance today, but I choose to start offering insurance this year.

     Will I be eligible for these tax credits?

A: Yes.

The tax credit is designed to both support those small businesses that provide coverage today as well as those that newly offer such coverage.   

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Six Ways Health Reform will Help Small Businesses

Small businesses want to provide health coverage for their workers, but they face extraordinary challenges in doing so, including premiums that are 18 percent higher on average than large businesses pay for the same coverage. Health reform legislation signed by the President includes a number of important benefits to help make coverage more affordable:

 

Establishes a Small Business Health Care Tax Credit to Help Small Businesses Afford the Cost of Covering Their Workers.

• Status Quo: Small Businesses Face High Costs in Providing Health Insurance to Their Employees Small businesses face higher costs and few incentives to offer health insurance coverage to employees.
• Solution:  A New Tax Credit Takes Effect Immediately to Help Cover Premiums Small Businesses Pay.The Small Business Health Care Tax Credit can cover up to 35 percent of the premiums a small business pays to cover its workers. In 2014, the rate will increase to 50 percent. Learn more about the Small Business Health Care Tax Credit.

Creates Health Insurance Exchanges to Increase Bargaining Power and Reduce Administrative Costs

• Status Quo: Small Businesses Have Little Bargaining Power, Face High Administrative Costs. Currently, small businesses face not only premiums that are 18 percent higher than large businesses pay, but also face higher administrative costs to set up and maintain a health plan. The premiums they pay have 3 to 4 times as much administrative cost built into them as plans in the large group market. They are also at a disadvantage in negotiating with insurance companies because they lack bargaining power.
• Solution: Health Insurance Exchanges will Provide More Choice, Lower Prices, and Greater Bargaining Power for Firms with up to 100 Employees. Health reform will change this dynamic. Starting by 2014, firms with 100 or fewer workers will be able pool their buying power and reduce administrative costs by purchasing insurance through an exchange. According to CBO, coverage that small businesses purchased through an exchange “would have lower administrative costs, on average, than the policies those firms would buy under current law, particularly for very small firms.”

Ends Price Discrimination against Small Businesses with Sick Workers

• Status Quo: Small Businesses with Sick Worker Face Higher Prices, Sudden Price Increases. Currently, small businesses with just one sick worker can face significantly higher premiums, and having a worker fall ill can lead to a precipitous price increase -- raising premiums just when insurance is needed most.
• Solution: Ending Price Discrimination Based on Illness. Health reform will end this price discrimination. Starting in 2014, “community rating” rules will prohibit insurers from charging more to cover small businesses with sicker workers or raising rates when someone gets sick.

Increases Health Care Security to Unlock Entrepreneurship

• Status Quo: Health Insurance Insecurity Creates “Job Lock,” which Inhibits Entrepreneurship. Our current health care system inhibits entrepreneurship and small business formation by locking workers -- especially those with families or with any sort of health problem --into jobs at large firms that offer family coverage and have a big enough risk pool to absorb the cost of covering pre-existing conditions. This “job lock” causes many workers to stay at large firms even if they would be more productive working at a small business or becoming an entrepreneur.
• Solution: Health Security Empowers Entrepreneurship. By providing health security for every American and eliminating exclusions for pre-existing conditions and price discrimination against those who are sick, health reform will make it easier for small businesses to attract the best workers and easier for entrepreneurs to strike out on their own.

Reduces the Hidden Tax on Small Business Employees with Health Insurance

• Status Quo: Hidden Tax Adds $1,000 to Every Premium. Currently, the cost of treating the uninsured adds a “hidden tax” of over $1,000 to every health care premium.
• Solution: Reduce Hidden Tax by Dramatically Expanding Coverage. Health reform will significantly reduce this tax by covering an additional 32 million additional Americans by 2019.

Reduces Premiums in the Small Group Market.

• Status Quo: Higher Premiums Mean Coverage Is Unaffordable for Small Businesses. In a recent national survey, nearly three-quarters of small businesses that did not offer benefits cited high premiums as the reason.
• Solution: Health Reform Will Lower Costs, Making Coverage More Affordable. Taken together, the measures described above will significantly reduce premiums for small businesses. According to CBO, health reform will reduce the cost of a given plan in the small group market by 1-4 percent by 2016.

 

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Your Questions:

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• I Have Medicare
  

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Health reform protects Medicare. Medicare will be made more financially secure and seniors who hit the prescription drug "donut hole" will be protected from high costs for their medicines.

Q: Will my benefits be cut?

A: No. 

• Your guaranteed Medicare benefits will not be cut. 
• In addition, you will have benefits you don’t have today:  Preventive services like cancer screenings at no cost, and a substantial reduction in prescription drug prices if you fall into that gap in coverage known as the “donut hole”.  Over time the bill closes this coverage gap completely.  And the Medicare Trust Fund will be extended for more than 9 years, making sure that the Medicare program will be there for seniors now and in years to come.

Q: Will I be able to keep my doctor?

A: Yes, you will.  Health insurance reform will not affect the choice of doctors you have today and it won’t affect your relationship with your doctor.  

• The legislation aims to increase the number of primary care providers, giving you greater access to doctors than you have today.

 

Q: Will my quality of care be affected?

A: It will improve. 

• The Act creates incentives for providing care that relies on teams of primary care doctors, specialists, and nurses working together to coordinate and monitor care more effectively.  These new models encourage doctors to better coordinate a patient’s care, track prescriptions, and avoid duplication of treatments or tests. This will help improve the quality of care, prevent medical complications, and save money.
• The bill will also provide stronger incentives for hospitals to reduce avoidable and harmful readmissions, cut down on medical errors, and prevent healthcare acquired infections that occur too frequently.

 

Q: My prescription drug spending will push me into the donut hole this year. What relief will I get?

A: Seniors who hit the gap in Medicare prescription drug coverage known as the donut hole will be provided with a $250 rebate in 2010.

Beginning in 2011, seniors in the donut hole will receive a 50 percent discount on prescription drugs. In addition, the Medicare share of costs will increase so that the donut hole will be completely closed in 2020.

 

Q: When does my free preventive care start and what does it cover?

A: Effective January 1, 2011, proven preventive services will be free.

In addition, a new annual wellness visit that provides a personalized prevention plan services, including a health risk assessment, will be provided under Medicare.

Q: What is the reinsurance program for early retirees that is available to employers?

A: The reinsurance program provides financial assistance to employers who provide health insurance coverage to retirees from age 55 to 65 and would not otherwise be eligible for Medicare.

The program reimburses insurance plans for 80 percent of retiree claims between $15,000 and $90,000. Payments received by the plans must be used to lower the costs for enrollees – retirees as well as active workers – in the employer plan. The program begins in 2010 and is effective until January 1, 2014.

 

Your Questions:

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• I Do Not Have Insurance
  

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You will have access to new insurance choices in the same insurance marketplace where all members of Congress will buy their insurance, receive tax credits to help you afford coverage if needed, and get protections from insurance company abuses like denying you coverage based on pre-existing conditions.

Q: Can I afford coverage?

A: Clearly, the system we have today is broken. If you don’t have health coverage, there’s no limit on how much insurance companies can charge you, and they can decide to refuse to sell you a policy at their whim. Health insurance reform will change all of that.

• For the first time in history, there will be limits on how much anyone will have to pay to receive health care coverage. And depending upon your income, you may be among the tens of millions of Americans who will get a tax credit to to help pay for your coverage. 
• And for the first time in history, insurance companies will no longer be allowed to simply tell you “no”. They will be required to offer coverage regardless of your health status, and they cannot jack up rates or drop you from your coverage when you get sick.

 

Q: Can I get insurance if I have a pre-existing condition?

A: Yes.

• One of the most important aspects of this reform is to finally end the practice of insurance companies denying you coverage based on your health status.
• Soon after the law is enacted, insurance companies will no longer be allowed to deny coverage to children with pre-existing conditions. 
• This year, if you have been uninsured for 6 months and have a pre-existing condition, you will gain access to health insurance that was not previously available to you.  A new program – known as a high-risk pool – will provide affordable insurance for Americans who are uninsured and have a pre-existing condition. 
• The high-risk pool will provide temporary protection for people with pre-existing conditions until 2014, when insurance companies can no longer deny you coverage based on your health.

 

Q: Am I going to be forced into a government plan?

A: No. 

• You will be able to shop among private insurance plans that will be sold in the insurance exchange---a marketplace where you can choose what is right for you and where members of Congress will also buy their insurance.  Today many markets are dominated by one or two insurance companies.  That will change, and you will have many more affordable choices than you have today.

Q: How will I know which plan is best for me?

A: A new website will be available to provide easy to understand information that will help consumers make informed choices based on their needs. In addition, the new insurance marketplace – the exchange – will provide consumer assistance offices with trained experts to help you “navigate” the health care choices and help you enroll in the plan you choose.

 

Q: Can I buy insurance in another state?

A: Yes. 

• If you live in a State that is part of an inter-state compact, you can purchase coverage in a neighboring State. These interstate markets will continue to provide basic consumer protections, access to essential benefits, and other insurance reforms that are included in health reform.
   
  

Q: Will the government decide what treatment I can get?

A: No.   

• Treatment decisions will be made by your doctor and you, just as they are today. The government will not interfere with your relationship with your doctor.

 

Your Questions:

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• I Buy My Own Insurance

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You will have access to new insurance choices in the same insurance marketplace where all members of Congress will buy their insurance. Either way, there will be new protections from insurance company abuses, and tax credits will make coverage more affordable.

Q: Will I pay more than I am paying today?

A: No. 

• You will likely pay less---perhaps much less.  If you buy coverage like you have today on your own, premiums are expected to drop by 14 to 20 percent. If you get coverage through your job, premiums could decline by up to 3 percent.
• In addition, many Americans buying coverage in the individual market will qualify for tax credits that reduce their premiums by an average of nearly 60 percent – and they will get better coverage than what they have today.

 

Q: Will I have to pay higher co-pays and deductibles?

A: Highly unlikely.  

• Health insurance reform will limit what you have to pay out of pocket, a protection that does not exist today.  And for the first time, no one will be required to pay more than a set percentage of their income on health care coverage. 
• And, if you like the coverage you have today, you can keep it.

 

Q: Can I still see specialists?

A: Yes.

• With health insurance reform, you will have more secure and comprehensive coverage. All plans in the exchange will be required to provide a package of essential benefits ---a guarantee that is not available today--- and the package will include preventive services at no cost.  Consumers shopping in the exchange will choose from options that provide different levels of cost-sharing so that they can pick a plan that best meets their needs and financial circumstances.

Q: Will I be able to challenge coverage decisions by my insurance plan?

A: Yes.

• Every insurance plan will be required to have a process for resolving disputes around your benefits and coverage, and you’ll be able to appeal any plan decisions that you disagree with to an independent appeals process.
• Beyond that, States will receive support to set up independent offices to assist consumers with filing insurance complaints and appeals.

 

Q: What are you going to do about all the confusing forms I have to fill out?

A: Make it simple.

• Health reform will require plans to use clear and plain language on insurance forms so that you can easily understand what benefits and what doctors are covered in your plan. And, it will standardize forms to reduce the confusing and overwhelming paperwork that all Americans have to confront today.

 

Q: What will happen if my insurance company raises my rates?

A: The President’s plan requires public disclosure of the percent of premiums applied to overhead costs, so that you can be certain you are getting the best value for your premium dollars. 

• If your insurance company spends too much of your premium dollars on overhead, such as big salaries, administrative costs and marketing, they will be required to give you a rebate. 
• Until the insurance exchange marketplace is up and running, there will be a process for annual reviews of all requested increases in premiums.  Insurance companies that raise rates arbitrarily will not be allowed to sell policies in the new insurance marketplace.   This process continues even once the Exchange is up and running.

 

Q: What consumer protections will I get this year if I buy coverage in the individual market?

A: Beginning in September 2010,  insurers will be prohibited from placing lifetime limits on what they will pay for your medical care, and they can only apply restricted annual benefit limits. Insurers will no longer be able to arbitrarily cancel your insurance policy when you get sick, except in cases of fraud.

Insurance companies will be prohibited from denying coverage to children with pre-existing conditions. This applies to all new plans in the individual market. 

Beginning in September 2010, all new individual market health plans must provide coverage for preventive services.  Recommended prevention and vaccination services will be covered without any deductibles or copayments. They must also have a straightforward and independent appeals process so you can appeal decisions by your health insurance plan.
 
Beginning on January 1, 2011, insurance companies will be required to spend most of your premium dollars on your care, not on profits and overhead -- 75 percent in the individual market -- and rebate any excessive overhead to enrollees.

Similarly, starting in plan year 2011, companies that sell insurance in the individual market that jack up rates will have to disclose requested premium increases publicly.  If that rate increase is found to be unreasonable, the insurer may be prohibited competing for your business in the new state-based exchange that will begin operating in 2014.

 

Q: I’m a parent, how will reform affect coverage for my children?

A: You will be able to get coverage for your child if he or she has a pre-existing condition, and adult children will be able to stay on family policies until age 26.

• Beginning in September 2010, it will be illegal for health insurance companies that cover children to deny coverage to your child based on a pre-existing condition.   This applies to all new employer plans, new plans in the individual market, and existing employer plans.
• Beginning in September 2010,  insurers will be required to permit children to stay on family policies until age 26.  This applies to all plans in the individual market, new employer plans, and existing employer plans, unless your adult child has an offer of coverage through his or her employer.  This requirement will take effect the next time your plan comes up for renewal.  Adult children who are on their parents’ plan now but who lose that coverage when they graduate from college will have the option of rejoining their parents’ policy in the new plan year beginning n September 2010.  Those whose parents work at self-insured companies will also be eligible if they do not have an offer of employer-sponsored insurance.  Both married and unmarried dependents qualify for this dependent coverage.  Beginning in 2014, children up to age 26 can stay on their parent’s employer plan even if they have an offer of coverage through their employer.

 

Your Questions:

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Health Reform puts American families and small business owners in control of their own health care.

Over the past year the House and the Senate have been working on an effort to provide health insurance reform that lowers costs, guarantees choices, and enhances quality health care for all Americans. Building on that year-long effort, the President's final legislation included the best ideas from both sides of the aisle offered in the course of the debate.

 

Health reform will make health care more affordable, make health insurers more accountable, expand health coverage to all Americans, and make the health system sustainable, stabilizing family budgets, the Federal budget, and the economy: 

• It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today.  This helps 32 million Americans afford health care who do not get it today – and makes coverage more affordable for many more.  Under the plan, 95% of Americans will be insured.
• It sets up a new competitive health insurance market giving millions of Americans the same choices of insurance that members of Congress will have.  
• It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.  
• It will end discrimination against Americans with pre-existing conditions.
• It puts our budget and economy on a more stable path by reducing the deficit by more than $100 billion over the next ten years – and more than $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.

 

Key Provisions in Health Reform:

Health reform built off of the legislation that passed the Senate and improves on it by bridging key differences between the House and the Senate and includes several key Republican provisions.

One key improvement, for example, is eliminating the Nebraska FMAP provision and providing significant additional Federal financing to all States for the expansion of Medicaid.  For America’s seniors, the reform completely closes the Medicare prescription drug “donut hole” coverage gap.  It strengthens the Senate bill’s provisions that make insurance affordable for individuals and families, including protections for out-of-pocket costs, while also strengthening the provisions to fight fraud, waste, and abuse in Medicare and Medicaid to save taxpayer dollars.  The threshold for the excise tax on the most expensive health plans will be raised from $23,000 for a family plan to $27,500 and will start in 2018 for all such plans.

 

• Read the Overview.
• Read About the Policies in Health Reform to Improve Affordability and Accountability.
• Read About the Policies in Health Reform to Crack Down on Waste, Fraud and Abuse.
• Read About the Policies in Health Reform to Contain Cost and Ensure Fiscal Sustainability.
• Read About the Other Proposed Policy Improvements in Health Reform.

Summaries of Key Elements of Health Reform:

• Title I: Quality, Affordable Health Care for All Americans
• Title II: The Role of Public Programs
• Title III: Improving the Quality and Efficiency of Health Care
• Title IV: Prevention of Chronic Disease and Improving Public Health
• Title V: Health Care Workforce
• Title VI: Transparency and Program Integrity
• Title VII: Improving Access to Innovative Medical Therapies
• Title VIII: Community Living Assistance Services and Supports Act (CLASS Act)
• Title IX: Revenue Provisions
• Title X: Reauthorization of the Indian Health Care Improvement Act

 

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IMMEDIATE BENEFITS OF THE HEALTHCARE REFORM ACT

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Key Provisions of Health Reform that Take Effect Immediately

1) Small Business Tax Credits

Offers tax credits to small businesses to make employee coverage more affordable.  Tax credits of up to 35 percent of premiums will be available to firms that choose to offer coverage.  Effective beginning calendar year 2010.  (Beginning in 2014, the small business tax credits will cover 50 percent of premiums.)

2) No Discrimination Against Children with Pre-Existing Conditions

Prohibits new health plans in all markets plus grandfathered group health plans from denying coverage to children with preâ€??existing conditions.  Effective 6 months after enactment.  (Beginning in 2014, this prohibition would apply to all persons.)

3) Help for Uninsured American with Pre-Existing Conditions until Exchange is Available (Interim High-Risk Pool)

Provides access to affordable insurance for Americans who are uninsured because of a preâ€??existing condition through a temporary subsidized highâ€??risk pool.  Effective in 2010.

4) Ends Recissions

Bans insurance companies from dropping people from coverage when they get sick.  Effective 6 months after enactment.

5) Begins to Close the Medicare Part D Donut Hole

Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010.  Effective for calendar year 2010.  (Beginning in 2011, institutes a 50 percent discount on prescription drugs in the donut hole; also completely closes the donut hole by 2020.)

6) Free Preventive Care under Medicare

Eliminates coâ€??payments for preventive services and exempts preventive services from deductibles under the Medicare program.  Effective beginning January 1, 2011.

7) Extends Coverage for Young People up to 26th Birthday through Parents' Insurance

Requires new health plans and certain grandfathered plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy, at the parents’ choice.  Effective 6 months after enactment.

8) Help for Early Retirees

Creates a temporary reâ€??insurance program (until the Exchanges are available) to help offset the costs of expensive premiums for employers and retirees for health benefits for retirees age 55â€??64.  Effective in 2010.

9) Bans Lifetime Limits on Coverage

Prohibits health insurance companies from placing lifetime caps on coverage.  Effective 6 months after enactment.

10) Bans Restrictive Annual Limits on Coverage

Tightly restricts the use of annual limits to ensure access to needed care in all new plans and grandfathered group health plans.  These tight restrictions will be defined by HHS.  Effective 6 months after enactment.  (Beginning in 2014, the use of any annual limits would be prohibited for all new plans and grandfathered group health plans.)

11) Free Preventive Care under New Private Plans

Requires new private plans to cover preventive services with no coâ€??payments and with preventive services being exempt from deductibles.  Effective 6 months after enactment.

12) New, Independent Appeals Process

Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions by their health insurance plan.  Effective 6 months after enactment.

13) Ensures Value for Premium Payments

Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent.  Insurers that do not meet these thresholds must provide rebates to policyholders.  Effective on January 1, 2011.

14) Community Health Centers

Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years.  Effective beginning in fiscal year 2011.

15) Increases the Number of Primary Care Practitioners

Provides new investments to increase the number of primary care practitioners, including doctors, nurses, nurse practitioners, and physician assistants.  Effective beginning in fiscal year 2011.

16) Prohibits Discrimination Based on Salary

Prohibits new group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees.  Effective 6 months after enactment.

17) Health Insurance Consumer Information

Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals.  Effective beginning in fiscal year 2010.

18) Holds Insurance Companies Accountable for Unreasonable Rate Hikes

Creates a grant program to support States in requiring health insurance companies to submit justification for all requested premium increases, and insurance companies with excessive or unjustified premium exchanges may not be able to participate in the new Health Insurance Exchanges.  Starting in plan year 2011.

 

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Read the text of the Senate bill and the changes passed by the House on the Healthcare Reform Act.

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U.S. Senate Bill Download [PDF File]

 

Changes Passed By The U.S. House of Representatives