10 Awesome Things That Would Happen If Health Reform Passes
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Within these large purchasing pools, people would be able to choose from among different insurance plans -- one a government-run "public option" and the rest offered by private insurers.
In order for private insurers to sell plans through the exchanges, they would be required to offer a standard set of benefits (which the public option would have to offer as well). They'd also be permitted to offer plans with more bells and whistles at a premium price.
For those enrolled in the public exchanges, the process would be quite similar to what employees in many large companies experience -- they would simply choose from among a variety of plans, with slightly different levels of coverage and costs.
Compared to the plans now available in the individual and small-group markets, they would pay a lot less for significantly better insurance (which, in reality, is what those "teabaggers" are protesting).
Because of pressure from Republicans and conservative Blue Dog Democrats, the public exchanges will phase in slowly, over a period of four to six years.
5. (Almost) Everyone Gets Covered
That brings us to another "controversial" -- but ultimately commonsense -- piece of the puzzle, the "individual mandate." It means that (almost) everyone would either have to buy health insurance or pay a modest penalty that would contribute to the system. In the House bill, the penalty would max out at 2.5 percent of income. Waivers would be available in the cases of economic hardship or for those who have religious objections.
There will be those who get those waivers; others will be left behind -- it's not a truly universal system. But according to preliminary projections, the result would be an uninsured rate of 3-5 percent, rather than the 16 or so percent who lack insurance today, reducing the rolls of the uninsured by some 20 million30 million.
6. Those Who Can't Afford the Premiums Will Get Help Paying
Ultimately, even if the public exchanges were to succeed in bringing the price of health insurance back to earth, a lot of people would still be priced out of the market.
All of the Democratic plans come with subsidies to help those at the lower end of the economic ladder get access to decent health care. The most generous are in the House bill, and how extensive the subsidies will be in the final legislation will be a point of heated debate.
In the House bill, individuals making less than 400 percent of the poverty line -- $43k per year and families earning under $88k -- will be eligible for subsidized coverage on a sliding scale.
Those at the lowest income levels (but who earn too much to get Medicaid) will be required to pay no more than 1.5 percent of their total income for health coverage.
Subsidies would also be available for co-pays -- also for people earning up to 400 percent of the poverty line.
Finally, many small businesses would be eligible for tax credits for insuring their employees.
7. No Free Lunch for Businesses
Currently, large employers that rely on low-skilled workforces usually offer little or no health coverage, and much of these workers' health care is already subsidized by taxpayers in the form of Medicaid and Medicare payments, other public programs and unpaid bills for emergency-room visits. Under the proposals in Congress, medium and large firms would face a simple choice: Offer their employees decent coverage or pay something into the system to offset the burden their employees' health needs impose on the American taxpayer.