NPR

How The Health Bill Could Affect You

After a year of wrangling, the House approved a bill that would eventually extend health care coverage to more than 30 million Americans. Some immediate changes include prohibiting insurance companies from refusing to insure children because of a pre-existing condition, and offering Medicare beneficiaries more help paying for drug coverage.

Expanding Coverage:

-- A big chunk of the millions of American citizens who are currently uninsured will get coverage help in 2014. That's when state Medicaid programs will expand to cover people living between 133 and 400 percent of the federal poverty level. Subsidies will also kick in to provide affordable plans on new insurance marketplaces. Individuals and businesses can shop around to buy insurance on these "exchanges."

-- The bill requires most Americans to have insurance by 2014 or pay a penalty. Some people would be exempted from the insurance requirement, because of financial hardship or religious beliefs, or if they are American Indians, for example.

-- Starting this year, dependent children could remain on their parents' health insurance plans until they turn 26.

-- All existing insurance plans will be barred from imposing lifetime caps on coverage, and restrictions will be placed on annual limits on coverage as of this year. And insurers can no longer cancel a person's health insurance retroactively for things other than outright fraud.

Getting Rid Of Pre-Existing Conditions:

-- Six months after the bill's passage, insurers will no longer be able to refuse children insurance because of illness. By 2014, the same rule will apply to adults. In the meantime, people with pre-existing conditions will soon have the chance to enroll in special insurance pools and receive subsidized premiums.

Medicare Changes:

-- Senior citizens would get more help paying for drugs. The approximately 4 million Medicare beneficiaries who hit the so-called doughnut hole in the program's drug plan will get a $250 rebate this year. Next year, their cost of brand-name drugs in the coverage gap will go down by 50 percent.

-- Preventive care, such as some types of cancer screening, will be free of copayments or deductibles starting this year.

-- Medicare Advantage — a program that uses private firms to deliver Medicare benefits — will see sharp spending cuts starting in 2011.

Taxing 'Cadillac' Plans:

-- For high-cost insurance plans, the health bill would tax insurers 40 percent on the amount of premiums above the thresholds. These plans are defined as costing more than $10,200 for an individual or $27,500 for a family (not including stand-alone vision or dental benefits).

-- The tax would not be imposed until 2018. The goal is to generate revenue to pay for covering the uninsured and to make the most expensive plans — which some argue encourage overuse of medical care — less attractive.

Government Oversight:

-- Insurers will be required to report how much they spend on medical care versus administrative costs, a step that later will be followed by tighter government review of premium increases. And insurers will now have to sell policies to all comers at rates based on community averages, writes the New Yorker's James Surowiecki.

-- Reporting By Kaiser Health News and NPR

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