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Health care reform, Just the Facts: Immediate changes, others that will happen over time

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It’s all done now, except for the Tuesday morning quarterbacking and the spin. But here is a pretty comprehenisve list of what you can expect immediately after the passage of health care reform as well as some other notable changes that will occur over time.

Changes happening immediately:

  1. Adult children may remain as dependents on their parents’ policy until their 27th birthday
  2. Children under age 19 may not be excluded for pre-existing conditions
  3. No more lifetime or annual caps on coverage
  4. Free preventative care for all
  5. Adults with pre-existing conditions may buy into a national high-risk pool until the exchanges come online. These pools won’t be cheap, but they are still a lot better than being excluded. And there is expected to be some advantage due to the wider pool of the uninsured.
  6. Small businesses will be entitled to a tax credit for 2009 and 2010, which could be as much as 50 percent of what they pay for their employees' health insurance.
  7. The “doughnut hole” closes for Medicare patients, making prescription medications more affordable for seniors. The government would offer a $250 rebate to Medicare beneficiaries to help pay their prescription drug costs when they hit the “doughnut hole.” Next year, Medicare beneficiaries would see a 50 percent discount on brand-name drugs to further close that gap.
  8. All insurers will be required to post balance sheets on the Internet and fully disclose administrative costs, executive compensation packages, and benefit payments.
  9. Authorizes early funding of community health centers in all 50 states (Bernie Sanders’ amendment). Community health centers provide primary, dental and vision services to people in the community, based on a sliding scale for payment according to ability to pay.
  10. No more rescissions. Effective immediately, you can't lose your insurance because you get sick.
  11. Effective immediately would be a 10 percent tax on tanning salon services, which opponents say would lead to higher costs for indoor bronzing.

The following changes will occur over time. I have included the date of all implemented changes.

  1. By 2014, all Americans must have health care coverage or pay a fine. Subsidies would be offered to help those making less than $44,000 or $88,000 for a family of four, afford insurance. Fines would be $95 in 2014, gradually rising to $695 by 2016, or up to 2.5 percent of income.
  2. The most notable tax increase will occur in 2013, on individuals making more than $200,000, or $250,000 for couples. Taxes would be 0.9 percent on earned income above those amounts, and 2.9 percent on investment income (dividends, rents, royalties, etc.)
  3. By 2014, no adults can be denied insurance due to pre-existing conditions.
  4. Companies with more than 50 workers would be required, by Jan. 1, 2014, to provide health care for their employees or face a penalty of $2,000 per worker (exempting the first 30 workers.) Up to $40 billion in tax credits would be offered to help companies buy insurance for their workers.
  5. For individuals: Beginning Jan. 1, 2014, those making less than $44,000 annually, or $88,000 for a family of four, would be offered subsidies to buy health care. The subsidies would be on a sliding scale up to 9.5 percent of income.
  6. For small businesses: Beginning this year, companies would be offered tax credits of up to 35 percent of health premiums to buy insurance for their workers. Tax credits would rise up to 50 percent by 2014. Those businesses with fewer than 10 workers would receive a full credit to cover costs.
  7. New taxes would be imposed, on Jan. 1, 2018, on high-value health insurance plans held by individuals — the so-called “Cadillac plans” often offered to union workers or executives. The tax would be 40 percent on the value of individual plans above $10,200 and family plans above $27,500 (slightly higher, at $11,850 and $30,950, for retirees or workers in high-risk professions.) Excludes dental and vision plans.
  8. Pharmaceutical companies would face a $4.8 billion fee beginning in 2011; medical device manufacturers would be hit with a 2.9 percent fee in 2013; and insurance companies would begin to see a nearly $70 billion fee in 2014.
  9. Government payments to the Medicare Advantage program would be frozen in 2011 and decline in subsequent years.
  10. By Jan. 1, 2014, most states would establish new health care exchanges, where those without job-based insurance could purchase policies, much the way members of Congress now buy insurance from an array of suppliers.