SHERMAN, TX – The politics seemed to have trumped the policy when it comes to the recently passed health care bill. It went through the Senate Sunday night with a close vote of 219 to 212, with all Republicans voting against it along with 34 Democrats. It will now go on to President Obama to be signed into law Tuesday.
But whether you’re a proponent or oppose the bill, it will still have an effect on everyone, and it’s important to understand what new laws are included in the bill. The president of the American Medical Association, Dr. J. James Rohack, says it’s just the beginning of a long process in reforming health care in America.
"This bill is not the final bill; it is another step to try and help Americans keep and have their own health insurance that's affordable,” said Rohack.
Here is a breakdown of the key points in the health care bill that could have an effect on you.
The bill is meant to extend coverage to roughly 32 million people who currently don’t have insurance. According to the bill, some of the more immediate changes are: costs would be lowered for individuals, and insurance companies would be prevented from denying coverage for pre-existing conditions, gender or if someone becomes sick, and children can stay on their parent’s plan until age 26.
But some changes will take years to go into action. Beginning in 2014, companies with 50 or more employees could face federal fines for not providing insurance coverage. And by 2016 everyone will be required to have insurance or face a federal fine of up to $695.00 or 2.5% percent of income. However there are exemptions and aid for those who can’t afford it.
"What this bill does is it says it's an individual responsibility to have health insurance. You can either purchase it, but if you can't afford then there will be tax credits that will be available that's inversely related to your income, so you can go out there and buy your health insurance on the individual market,” said Rohack.
According to the bill, if you do not receive health insurance under Medicaid or Medicare, and your family has an annual income of about $88,000 or less, then you would qualify for government subsidies to make insurance more affordable.
Under the new legislation there could be major changes to Medicare and Medicaid. The bill is intended to close the Medicare prescription drug “doughnut hole” by 2020. Currently there is about a $2,000 gap in coverage under Medicare.
But it would also cut Medicare projected Medicare spending by roughly $500 billion, in part through reductions in the Medicare Advantage program. And it will expand Medicaid to cover more low income individuals to those with a household income of 133% of the federal poverty level, or about $29,000.
But these changes in Medicare and Medicaid, an already strained service for physicians, has some concerned.
"But the changes to Medicare and Medicaid are going to be crucial. If Congress cannot find a way to ensure funding for Medicare and Medicaid, at least at the current level, then doctors are going to begin migrating away from these plans,” said local Urologist Steven Johnson, M.D.
A separate package of changes also passed the House on Sunday and still needs to be approved by the Senate. Rohack said in that package are provisions to raise the Medicaid rates up to equal those of Medicare. The bill also provides for taxes on households that have an annual income of $250,000 or more to pay for those costs.
"Quarter by quarter you can look at what the reimbursement rate is, what your bottom line is, and make a projection for the future of whether or not you're going to be able to continue to take care of people the way you always have, or if you're going to have to change your business model in providing health care to people,” said Johnson of the Medicare and Medicaid changes.
Johnson points out that physicians already see a limited number of Medicaid patients because they simply cannot afford to see more. He said while reimbursements rates are going down, their expenses as physicians are climbing.
“If Congress can take action to protect the Medicare reimbursement schedule then a lot of physicians will probably continue to provide care under this current legislation,” said Johnson.
For people who are already covered by a large employer, there would be little effect. Proponents say just about everyone might benefit from tighter insurance regulations, such as bans on pre-existing conditions.
There are exemptions to purchasing health insurance: American Indians don’t have to buy insurance, and neither do those with religious objections or financial hardship. For example, if you would end up paying more than 8% of your income for the cheapest plan available, you would not be penalized for not buying coverage. And those exempt or under 30 could buy a policy that only pays for catastrophic medical costs.
Illegal immigrants will not be allowed to buy health insurance in the exchanges, even if they pay for it completely with their own money.