Health Care Reform: Your Questions Answered
- What is the current status of the health care reform law?
Answer:
A year ago, President Obama signed into law the Affordable Care Act, and the law is very much in progress. It's the law of the land. It was not repealed. There was a vote in the House of Representatives [to repeal] but the Senate kept the law in place, and the president would never sign a bill that would repeal the Affordable Care Act. So we are implementing, each and every day. A lot of the insurance reforms that were available in 2010 are in place, and we will hopefully get to talk about some of those changes for family policy so parents can keep young adults on their plan, children with pre-existing health conditions now can have access to insurance. It's against the law for a company to turn down a child with pre-existing health conditions. Seniors have some more benefits with Medicare, including lower-cost prescription drugs, and screenings like colonoscopies and mammograms that are provided free of charge, and an annual wellness visit. So those insurance reforms are in place. Companies have to follow a new set of rules, and there is some help available to both employers who are providing coverage for their retirees and employers who are in the small business market who are providing insurance coverage for their employees, tax credits available. So one at a time, these benefits are beginning to connect with the American public. Finally, if anyone wants to see what is happening, going to the web site healthcare.gov and finding out what's going on this month, next month, and what's available in your market by ZIP code, by price, is a really good idea. So healthcare.gov gives you a one-stop shopping opportunity to see what it is that's coming on board with the law this month and this year, and what's available in the market.
- The changes are being phased in through 2014, correct?
Answer:
That's correct. Actually, over the course of the next 10 years. So closing the so-called doughnut hole for Medicare beneficiaries will take place gradually. There is a 50% discount this year and gradually over the course, the plan will be 100%. The new state-based insurance exchanges, the new insurance markets, will be up and running by 2014, so one of the things that healthcare.gov helps people to do is take a look at the timeline of what it is that happens each and every year, and where we are with the benefits in the bill.
- Do state lawsuits or other efforts to repeal the law affect people's current health plans or access to care?
Answer:
Right now, there are a number of state attorneys general who have filed a suit about one particular provision of the bill that actually doesn't even come into effect until 2014. We have had five federal judges rule: three that the law is fully constitutional, two that the provision is not constitutional. But in all cases, the judges said continue to implement. And this is a case that will work its way to the United States Supreme Court. Again, it doesn't impact people’s ability today, tomorrow, probably this year and into next year to achieve the benefits. And the one issue that is being challenged doesn’t even become effective until 2014, so really, nothing has changed in the law. The congressional vote in the House does not impact our ability to implement because in order to become a repeal bill, it has to pass the House, pass the Senate, and be signed into law by the president, and that has not occurred. So the Affordable Care Act, a year later, is being implemented every day. There are benefits available to Americans and their families, and we really want to make sure people understand the new rules that their insurance companies have to follow, the new benefits that are available, and the fact that there's going to be a new competitive marketplace in 2014.
- Do you expect the lawsuits to be decided by the Supreme Court?
Answer:
Yes, I think there's no question. These have been filed in federal court. The court of appeals and a couple of jurisdictions will hear arguments this spring, but not until this case gets to the Supreme Court and they make a decision will we have a final word on, again, one specific provision of the bill. The rest of the bill will be in effect one way or the other depending on this court decision. I think it is confusing to follow. A lot of what is happening in Congress is more about people making political statements than having an impact on folks' health benefits, but I think it's unfortunate because a lot of people are very confused. The Affordable Care Act remains the law, here on March 23, 2011. We will continue to implement that law. We will continue to get the word out throughout the country about what kind of benefits people can look forward to.
- "What can I do if my premiums skyrocket and I can literally no longer afford insurance?" -- Carolyn
Answer:
Well, Carolyn, it's a great question and unfortunately, there aren't a whole lot of options. But let me tell you what's available between now and 2014. One is, please visit the web site, healthcare.gov. For the first time ever, we have pulled together all of the plans in the market and gotten prices for them that we put online, side by side. So Carolyn can visit the web site, healthcare.gov, type in her ZIP code, and pull up in an easy-to-read fashion what options she might have in the marketplace. What plans are out there, what they cost. What happens if she is willing to raise her deductibles a bit? What does that do to her premiums? How can she save some money? That information has never been available in an easy-to-use fashion. So I would also recommend highly that people shop on the web site a little bit and find out what's going on. The Affordable Care Act also has allowed us to give some additional resources to state insurance commissioners, and that's where the insurance market is regulated. They're the ones responsible for looking at the rates that companies are charging and making sure that those rates actually are going to pay for health care. Thanks to the Affordable Care Act, this year, a new rule is in place. Companies have to spend 80% of the premiums collected, so 80 cents of every dollar, have to be spent on health costs, not on paying their presidents' huge salaries, not on bonuses, not on overhead, not on marketing, but on health costs. If they don't indeed spend that 80% on health costs, they owe the customers a rebate and we will be looking at that data very carefully. But the state insurance commissioner's office is also a consumer advocate and could be helpful to Carolyn as she looks for shopping options and actually look to see whether or not the rates that her company is charging are in accordance with the law. The third thing is that starting in 2014 there will be a new marketplace. It will be state-based insurance exchanges, companies who have to compete against each other for customers. And those who are lower income will have the opportunity to get tax credit help to purchase insurance. That market is particularly important for people who are shopping for insurance on their own for themselves and their families in the so-called individual market or small business owners who often are really paying a very high premium because they don't have the leverage that their large competitors have to negotiate lower rates. They'll suddenly be in a bigger pool and those rates will be negotiated in advance. So in the short run, go to the web site, talk to your insurance commissioner and in 2014, there should be a new market.
- "I am currently unemployed and on COBRA, which will be running out in a few months. What health insurance options do I have?" -- Heather
Answer:
Again, the web site is the best way to answer that question because every part of the country is a little bit different. Healthcare.gov: Go to the web site, type in your ZIP code, and what's available on the web site is not only what companies are selling policies and what the average cost is, but also for someone who is unemployed, you may well qualify, based on now the fact that you don't have an ongoing income, you may qualify for one of the public programs in your state that's available. That information is also pulled up at the same time and how to enroll. So people who may not have qualified for Medicaid in the past, or whose children didn't qualify for the Children's Health Insurance Program, they now because of the downturn in the economy, because they have lost their employer health coverage and their job, may actually meet those qualifying rules. So when you go to the healthcare.gov web site, type in your ZIP code, a couple of questions will be asked about income level, about job status, about your insurance coverage, and you'll have access to information about all the programs, public and private, that are in your location and that you're eligible for.
- "How much will I be fined if I refuse to get insurance?" -- Oshunsgirl, NYC
Answer:
Well, the question deals with -- in 2014, two very important rules change. The most important is that insurance companies will be forbidden by law from denying coverage to Americans with pre-existing health conditions. Right now, insurance companies can lock people out of the market or price people out of the market. That will no longer be allowed come 2014. People will, with a pre-existing health condition, be able to buy coverage, be able to participate in a pool. In order to make sure that that happens, and that we have a solvent insurance pool, there is an additional feature that says everyone needs to participate. So most people right now have access to employer-based coverage, or indeed carry their own coverage, or they qualify for a public program. A limited number of people are not in those categories at all, and most of those folks don't have the finances to buy insurance coverage on their own, so starting in 2014, there will be a personal responsibility provision that says everybody needs to participate. If you are in the exchange and need some financial assistance based on your income, that will be available. If you have employer coverage, you're covered. If you are purchasing insurance on your own, you'll have an opportunity to purchase that coverage in the insurance exchange. If you qualify for public programs, you're covered. So we think that the vast majority of people, and this has been the case in Massachusetts where they have an exchange set up with very similar rules, the vast majority of people who don't have insurance really would love to have coverage for themselves and their families, they just can't afford it. And those days will be over. If indeed somebody can afford coverage when we get to 2014 and refuses to pay for coverage, there is a financial penalty and it's really paying for the health service that that person and their family may well access. What we know is if someone has an automobile accident and is taken to a hospital, they're going to get health care. If they have a stroke or if a family member has cancer, they will have health care. They just will be shifting those costs onto everyone else, onto taxpayers, and hospitals and everyone who buys coverage. So there is an employer responsibility piece, there is a government responsibility piece, and there's an individual responsibility component of the new health care law.
- "What mechanisms are there to challenge an insurance company's decision?" -- Zinny. Follow-up question: "If you feel your health insurance company is not following the new law, who do you contact?" -- J.P., North Carolina
Answer:
Great question. Now there is some new consumer assistance help on the ground in every state. Again, the Affordable Care law provided some resources to every state in the country saying that one of the things that a lot of people need is help battling denial of coverage or care, help with questions about rates that seem to be skyrocketing, help with what they thought would be their insurance plan and turns out to be something very different. So there are really two places that a listener can go. One is to the state insurance commissioner. Every state in the country has an insurance commissioner. Those folks have consumer representatives who are ready to go to battle. The second is the consumer assistance entity that is in your state, and the best way to learn about that again is to go to the web site, healthcare.gov, look up consumer assistance, and it will make it clear if you live in Connecticut who to call and what the phone number is vs. living in California because in each state, those grants are with a different entity. But it's an independent third-party group who is very knowledgeable about insurance, very knowledgeable about health insurance, and their whole job is to help consumers navigate what is often a very complicated and cumbersome system through that fine print, figure out where to file an appeal, and how to make sure that your case is heard.
- "I have no medical insurance. Am I eligible for a free mammogram and if so, how and where?" -- Sue
Answer:
Well, the provisions about the preventive care really deal with insurance plans that are in the market. So what the Affordable Care Act did was say starting with plan years, Jan. 1, 2011, from that point on as plans are renewed, individuals will no longer pay a co-pay for everything from getting their kids' immunizations to having mammograms or cancer screenings because we really want to encourage people to get checkups in advance, to get situations identified which may cause serious health problems and get them found. In a case where someone like Sue has no health insurance at all, the best possibility really is to find the nearest community health center, and community health centers are throughout the country, talking to her health department about where is the closest community health center. Community health centers are being expanded through the Affordable Care Act, but they are community-based providers of primary care and preventive care who deal with individuals who have full insurance, who have partial insurance, and people who have no insurance coverage at all. Everything from cancer screenings, often there's dental care available and checkups for kids. It's very high-quality, low-cost care and that would be the best option for Sue.
- "I know it sounds over-simplified, but like car insurance, there should be a way to have low premiums if you are healthy and have few doctor visits, except for checkups (e.g., no accidents, your car insurance premiums stay low or the same)." -- Violet
Answer:
Actually, Violet is right on target and there are dozens of insurance companies who do that right now. So if you are not a smoker, you get a discount on your health insurance. If you actually are a safe driver, your health insurance is often lower. There are lots of plans in place that if you participate in a health screening and are on some kind of a health and wellness program, you can get, again, a lower rate in the marketplace. So Violet is absolutely right, getting and encouraging people to participate in the kinds of strategies that we know reduce the chronic conditions. What we have right now in this country, is we know that obesity and smoking contribute to our very high rate of chronic disease, about 75 cents of every health dollar is spent treating Americans with chronic diseases. If we can convince people and they take some steps to lower their weight, to eat healthier meals, to get some exercise, and certainly to either never smoke in the first place or to stop smoking if you are a smoker, we could have a much healthier country. And indeed, there are lots of insurance companies who give direct rewards and encouragement to citizens who do just that.
WebMD Ask the Specialist Transcript
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