By Ivanhoe/The AS Review
The U.S. House of Representatives is poised to begin debate on their version of health care reform legislation this week. Meanwhile, the U.S. Senate continues to work on finalizing its own health care reform bill.
Much is made of the legislation, but if it passes, how will it affect you? This will depend on the final version of the bill. During debate on the bills, some amendments are likely to be made, after which conference committees from each chamber of Congress will work out any differences between the bills.
Those changes notwithstanding, the House has released its full version of the bill, called the Affordable Health Care for America Act (H.R. 3962), the most complete version to date. Below is a rundown of provisions that may be likely to affect students.
People with insurance
Under H.R. 3962, many would see increases in their coverage. Insurance policies would be required to cover, at minimum, preventive care, hospitalization, hospital and clinic visits (including any related basic costs), emergency room visits, prescription drugs, medical equipment related to care (crutches, pacemakers, prosthetics, etc.), and any services related to rehabilitation, mental and behavioral health, substance abuse and maternity care. For those under 21, dental, vision and hearing care would also be required. The act would also require insurers to cover any medical conditions one had before signing a policy. Most insurance policies do not currently cover such pre-existing conditions.
The act would also require insurance companies to guarantee continued coverage to anyone who continues to pay their premiums. Most insurance providers currently have the right to cancel an insurance policy if they feel a policy-holder becomes a greater health risk or files a claim for costly health procedures. This practice, called rescission in the insurance industry, would be banned. Those covered under a parent’s policy would be allowed to continue the same level of coverage until their 27th birthday, while those who receive insurance as part of an employee benefits package would be allowed to keep their coverage if they lose their jobs, so long as they take responsibility for paying the premiums.
Under the law, there would also be government subsidies on the cost of insurance premiums and out-of-pocket medical expenses for families making less than 400 percent of the poverty level set by the Department of Health and Human Services (HHS). Co-pays would no longer be charged for some preventive services, including screenings for certain sexually transmitted infections (STIs).
People without insurance
H.R. 3962 would require most people who are currently not covered under a health insurance plan to get one. The bill has several provisions designed to make this possible.
Medicaid, a federal program similar to Medicare that provides health coverage for the poor, would expand its coverage under the act. Medicare currently covers families with children and pregnant women living below the poverty line. The new law would extend coverage to any individual or household making less than 150 percent of the poverty level. Using the 2009 poverty level, Medicaid would cover any individual living alone who earns $16,245 a year or less.
The bill would also create a new federal program called the Health Insurance Exchange to offer health coverage to anyone not already receiving health coverage from one’s employer or a government program. This would be an online marketplace where one can find and compare prices on all the insurance policies available to them. For those making less than 400 percent of the HHS poverty level, the government would provide subsidies on a sliding scale. A provision considered for addition to the bill would likely prohibit any federally subsidized plan from covering abortions.
H.R. 3962 also creates a federal health insurance plan that would be offered through the Health Insurance Exchange. The nonprofit insurance option would be self-sufficient (not supported by tax dollars) and would compete with private insurance plans with the hopes of reducing the cost of all insurance policies in the exchange through competition. This insurance option would not be available outside the exchange.
Under the act, anyone who does not have insurance and still cannot afford health insurance could be given a hardship waiver exempting them from the requirement to have insurance. Anyone else who chooses not to purchase health insurance would be penalized with a fine amounting to what one would have paid in insurance premiums if they had purchased health insurance. There would be no criminal penalty for not paying such fines, but the government could collect from tax refunds, social security benefits or other federal payments owed to the individual.
Not all provisions would take effect immediately. Creation of the Health Insurance Exchange and expansion of Medicaid benefits would not be ready until 2013. However, a temporary insurance program would be available until then for those who have been uninsured for several months or have been denied a policy due to pre-existing medical conditions.
Money for medical students and other programs
The bill would increase financial support for National Health Service Corps scholarships and student loan repayment programs. New investments would also aim to increase the number of primary care (non-specialist) physicians, nurses and public health professionals.
It would also direct more funding to community health centers, state, local and tribal health departments and new health clinics in public primary and secondary schools.
How much it will cost
Some critics of H.R. 3962 worry that it is too expensive and will add to the federal budget deficit. The nonpartisan Congressional Budget Office (CBO), a team of financial analysts and economists hired by Congress to provide unbiased cost analyses on federal legislation, reviewed the legislation and made some preliminary projections with regard to these concerns. Such projections are subject to some uncertainty, and a more detailed analysis will likely follow.
The CBO believes that the bill will cost $1,055 billion to implement over the next 10 years and that revenues from penalties for non-compliance would reduce that amount to a net cost of $894 billion. Predicted savings from reduced spending due to efficiency measures would offset that amount by $426 billion and new revenue sources, including a tax on high-income households, would raise an estimated additional $572 billion over the same period, they said. The CBO finds that H.R. 3962 would probably pay for itself and reduce the federal budget deficit by about $100 billion over 10 years.
Another fear among critics is that the bill will fail to cover everyone. The CBO projects that, as a result of the bill, the share of “nonelderly” residents of the United States with health coverage would rise from 83 to 96 percent, excluding unauthorized immigrants residing in the United States, who would not qualify for any federal assistance for health coverage. “Legal” immigrants would receive the same benefits as resident U.S. citizens.
The Democratic Congressional leadership have set a goal to have a finished bill ready for President Obama’s authorizing signature by year’s end, but with potentially no support from Republicans and several conservative and liberal Democratic members of Congress still expressing reservations about specific provisions in the bill, there is no guarantee that the bill will pass in either chamber.