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Health care reform and reading between the lines, part 1

03-24-2010 by Colleen King

Okay, health care reform–woo hoo! now what? Today’s Los Angeles Times has a good brief overview of some major points of change and I’ve included some of them here. Along with some questions that I feel still need to be answered.


* Provides a $250 rebate to Medicare prescription drug plan beneficiaries whose initial benefits run out. This is good because that whole ‘donut hole’ thing doesn’t make a lot of sense, particularly for people on limited incomes.


* Provides immediate access to high-risk insurance pools for people who have no insurance because of preexisting conditions. Well, we already have a high risk pool in California, referred to as MRMIP. Problem is, it’s really expensive and half the time, you can’t get anyone on it due to a lack of funding.


* Bars insurers from denying people coverage when they get sick. What does this really mean–ANY coverage, or high cost services, or things that weren’t going to be covered to begin with?

* Prevents insurers from denying coverage to children who have preexisting conditions. Children, not adults yet. And what about rates? Anything about cost containment included in here?

* Bars insurers from imposing lifetime caps on coverage. There are some low end plans that have ridiculously low limits, either lifetime or per year. Most though, at least in the California individual market, have limits of $3-7 million lifetime. Most of us won’t ever come close to that, so this isn’t always as big as it may initially sound. Once again, for me, this means you really need to look at what you are buying and have a good agent you can talk to about what you are buying.

* Requires insurers to allow young people to stay on their parents’ policies until age 26. Well, most plans they could already stay on until 22 or 23 if they were full time students. If they have health issues, this is good. Depending on the family, if they don’t, it could be more cost effective to put them on their own plan.


* Requires individual and small group insurance plans to spend at least 80% of premium dollars on medical services. Large group plans would have to spend at least 85%. With most carriers, that is almost happening now the majority of the time. Problem is, don’t you still want to look at cost containment? If you HAVE to spend it, it will be spent, but what about waiting for a rainy day and keeping something in reserves?


* Increases the Medicare payroll tax and expands it to dividend, interest and other unearned income for singles earning more than $200,000 a year and joint filers making more than $250,000. Really makes you want to go out and achieve, doesn’t it? This moves the tax up to 3.8%


* Provides subsidies for families earning up to 400% of the poverty level to purchase health insurance.

* Requires most employers to provide coverage or face penalties.

* Requires most people to obtain coverage or face penalties.

On all three of these for 2014, let’s hope the economy has turned around otherwise there will be a ton of people on that subsidy level.

Be well!


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