What Health-Care Reform Will Mean for You

No matter how the conference committee reconciles the House and Senate bills, health-care reform will usher in some sweeping new policies. Plenty of people have tried to tease out what this will mean for the average consumer. The Kaiser Family Foundation has the most comprehensive guide, looking at everything from whether the final legislation will result in higher premiums (yes and no) to whether Medicare will still cover gym memberships (no).

Still, this, like most of these analyses, is looking at the long term, with scenarios that take place after the biggest, most controversial provisions in the bills have been enacted, sometime between 2013 and 2016. Who knows if this will ever come to pass? If Republicans make substantial gains in the next elections, some of those provisions could be legislated out of existence before they have a chance to take effect. The more pressing question for health-care consumers: what is reform going to do for me in the near future?

It depends on your current insurance status. If you have coverage now, either through your employer or because you buy your own plan, there won't be many changes next year. That's by design: it ensures the political support of people who are more or less satisfied with the insurance they have, and it delays federal spending enough to keep the cost of reform over the next 10 years below or at least around $900 billion.

Two changes will affect people with current private insurance in 2010. One is that they won't have to worry about maxing out their lifetime medical benefits, because as of six months after enactment, insurance companies won't be allowed to impose those maximums on anyone. (The Senate bill also provides for similar regulation of annual limits on spending.) Since the vast majority of plans currently max out around $2 million over a lifetime, the new policy won't make any difference to most of us, because we don't get near that limit, but it will be a real boon to those with serious and/or chronic illnesses. A second is that people who are frustrated with their plans will have someone to gripe to other than their congressmen: the Senate bill calls for the immediate creation of new state offices that will handle complaints against insurance companies, as well as a new Web site that will explain some of the thornier issues around insurance. It also requires insurers to "implement an effective appeals process" for dealing with claims, although how the companies interpret "effective" remains to be seen.

Medicare beneficiaries will see more change right away. The first effect of reform, starting January 1, is the shrinking of the "donut hole," wherein Medicare covers no medical expenses between $2,700 and $6,154. (After $6,154, the program's catastrophic coverage kicks in.) The $3,454 gap will shrink by $500 this coming year and another $500 every year afterward. Also, as of July, most people who fall in the gap will get a half-price discount on brand-name drugs and biologics (a class of medicines that includes vaccines and some genetic and hormonal therapies). If you're a senior with moderately high health-care costs, you'll be getting some serious relief.

People who've been laid off and have turned to COBRA as a way of keeping their old employer-based insurance may also get a little help. Under the House bill, they'll be able to keep their COBRA until the state exchanges are ready, not just for the 18 months after their layoffs. The bill, however, doesn't help those laid-off workers pay for COBRA, which can be absurdly expensive. To get help with that, they'll need to rely on different legislation: a 15-month federal subsidy that pays 65 percent of premiums for people laid off through February 2010.

People who currently have no insurance are the ones with the biggest changes in the near future. If they've been denied coverage because of pre-existing health conditions, they'll be able to enroll in a high-risk pool—by January 1, 2010, in the House bill and 90 days after enactment in the Senate version—that will cover them until the states get their insurance exchanges up and running in 2014. (High-risk pools already exist in 35 states, but they're tiny and underfunded. The bills would funnel $5 billion in their direction.)

Even if you're not in one of those categories—you don't have a pre-existing condition and you weren't recently laid off—you may still have better access to insurance in 2010 than you do now. The health-insurance tax credit for small businesses with average wages of less than $40,000 (or $50,000, under the Senate bill) is scheduled to kick in next year. That could encourage more small-business owners to start offering insurance.

Any new health-insurance plans after July 2010 will look different from what's already on the market. They'll be required to cover kids with pre-existing conditions. They'll have to pay for preventive care without subtracting its cost from policyholders' deductibles. They won't be allowed to discriminate against low-income workers or to kick patients out of their programs unless they have specific evidence that those patients have defrauded them. And they'll have to extend coverage to a large portion of the currently uninsured: 20-somethings who don't have insurance through their jobs and can't afford to buy it or don't want it. The Senate bill allows young people to stay on their parents' plans until they're 26; the House gives them another year on top of that. (Thirty states already have similar rules, but the age limits vary widely—some extend as far as age 30 but most don't go as far as the federal bills.)

There are many big changes, but most don't apply to anyone who has insurance already. The majority of the legislation affecting the insured is further off, as are the Medicaid expansion, the Medicare payroll-tax increase, and almost all the other big-ticket items.

There's always a chance that the conference committee charged with reconciling the House and Senate versions will front-load more of the provisions—although to do so, it will almost certainly have to go over the unofficial $900 billion spending limit. Donna Shalala, a former secretary of Health and Human Services, says she expects the committee members to "try to front-load as much as they can, even if they've got to spend a few more bucks, because otherwise people won't see the effect of the reforms right away, and they'll start to wonder what this whole exercise was about."

Joe White, a Case Western University health-policy professor who's been writing about reform for Health Affairs, agrees that the committee will be under pressure to move up the start dates of some of the provisions. He's keeping an eye on the state insurance exchanges, which could theoretically be set up before federal insurance subsidies are available. Putting the exchanges in place early might cause some problems, especially if only unhealthy people with high medical costs sign up for them. But it would at least help ensure their existence for the near future, White says: "If people have already begun to sign up in 2012, it gets a lot harder to pull the plug."

Your Guide to the Guides
Where to look for analysis of the impact health-care reform will have on families once all current provisions have taken effect.

In addition to its breakdown of the basics, the Kaiser Family Foundation has a remarkable tool for comparing the various proposals made over the last few months. Over at The New Republic, Jonathan Cohn has recruited an MIT analyst to break down how the Senate bill could improve premiums and out-of-pocket costs for four-person families at five different income levels. Nate Silver has a similar family analysis in graph form. And for individuals, interactive charts—worked up by media outlets, nonpartisan foundations, and politicians with a stake—abound.

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