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Saturday, June 30, 2012

Health Care Reform Questions and Answers - Who Gets Covered Under Health Reform? -

Of course, this is all subject to Change, at any time in the next several years...


WebMD's Health Insurance Navigator Answers Your Questions

WebMD Health News
Reviewed by Louise Chang, MD

June 29, 2012 -- The Supreme Court's decision on the health care reform law left many people confused about their health insurance and what will happen in the future. Here, WebMD answers some of the most common questions that came in from readers after the ruling.

How does this decision affect those with a preexisting condition?

Starting in 2014, insurers will no longer legally be allowed to deny coverage to anyone because of their medical condition or charge them more for that coverage.

How will it affect people that already have good health insurance and a preexisting condition?

If you already have private insurance or you're enrolled in Medicare or Medicaid, you will not be required to buy new or additional insurance because of the health reform law. Generally, you can stay with your current plan if you're happy with it.

Many people who buy insurance on their own (meaning they don't get it at work) and have a preexisting medical condition, however, have held onto pricey coverage because their health condition prevents them from switching plans. Starting in 2014, these people will have greater freedom to shop for coverage and to determine if another plan better suits their needs, because insurers will no longer be allowed to deny people coverage based on prior medical diagnoses.

How can I afford to buy health insurance if I am currently uninsured?

One of the law's major goals is to make health insurance more affordable.

If you don't get insurance through your job, you will be eligible to buy coverage through state-based insurance marketplaces scheduled to be up and running for open enrollment by fall 2013 for insurance coverage that will start in January 2014. To make insurance affordable for millions of Americans, tax credits will be available for people with incomes that are between 133% and 400% of the poverty level (up to $92,200 annually for a family of four in 2012).

There will also be caps placed on how much people will be required to spend in total out-of-pocket costs, including deductibles, co-pays, and co-insurance. These amounts will also be determined based on a person's income.

"The bottom line is there is help to pay for out-of-pocket costs and help to pay for premiums," says Mila Kofman, JD, a research professor at Georgetown University's Health Policy Institute.

In addition, the law expands the number of people who qualify for Medicaid, the state and federal health insurance program for people with low incomes. That means millions of people who don't qualify for Medicaid today will in 2014. An individual that makes less than $14,856 or a family of four that earns less than $30,657 will be eligible.

I thought the Supreme Court changed something about the Medicaid expansion rules.

It did. The Supreme Court's decision now gives states the freedom to decide for themselves whether they want to expand their Medicaid program. "They don't have to," Kofman says.

People who live in states that choose not to participate may find themselves without insurance coverage in 2014. However, Kofman says, states will likely be under pressure from hospitals and insurance companies that rely on that money to expand their Medicaid programs to include more people.

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Who Gets Covered Under Health Reform?

As the debate rages over 'Obamacare,' here's a look at what the changes will mean.
WebMD Health News
Reviewed by Louise Chang, MD

June 29, 2012 -- The Supreme Court decision to uphold key provisions in the Affordable Care Act, or ACA, cleared up one question: Will the law stand (for now)? But for many people, that was about all they found clear.

There's still a lot of confusion about who will be covered, will the goal of insuring the uninsured be met, and what happens if I have preexisting conditions?

The court's decision did put a kink in President Obama's plan to extend health insurance to an estimated 32 million uninsured Americans.

More than half of the people meant to gain coverage under the health reform law were supposed to get free coverage under a major expansion of the Medicaid program.

That means, if you're struggling to make ends meet, you wouldn't pay a dime.

Now there's a hiccup in that plan.

After yesterday's decision, states cannot be forced to participate in the Medicaid expansion. That could leave millions of Americans without the coverage promised under the law.

"You've got a lot of conservative governors saying, 'You can't force us to expand Medicaid this way. We can't afford it,'" says Robert Laszewski, president of Health Policy and Strategy Associates in Alexandria, Va.

"Now the court has said, I think very appropriately and fairly, the feds can't take the original Medicaid funding away if you don't do the expansion," Laszewski says.

In effect, the ruling forces states to "put up or shut up," he tells WebMD.

"You don't want the money? You don't have to have the money. But then you go face your constituents and tell them why you didn't expand Medicaid like the other states," he says.

Who Pays for What?

Here's what the numbers look like. From 2014 to 2016, the federal government pays the entire cost of the Medicaid expansion. After 2016, the portion of the costs paid by the federal government begins to decline. By 2020, states would have to kick in 10%.

Ten percent may not sound like much, but some states are saying it could be financially crippling.

In Georgia, a state that sued to block the ACA, Gov. Nathan Deal says he's weighing his options.

''Even with federal help, the state would have to find another $4.5 billion over the next 10 years to pay for the Medicaid expansion.

In Indiana, Gov. Mitch Daniels said in a statement that the expansion would put 1 in 4 Hoosiers on the Medicaid rolls at a cost to the state of $2 billion over the next 10 years.

"I think states will turn it down," says Marc K. Siegel, MD, an infectious disease expert at New York University's Langone Medical Center in New York City, and also the physician coordinator of Doctor Radio.

"In New York, it's a billion dollars or more to administer the Medicaid expansion. So a key problem here is not in terms of Medicaid, which the feds are picking up the cost of for the most part, but the administration of the additional Medicaid patients," Siegel says.

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