Mar22: WHAT HEALTH INSURANCE REFORM MEANS FOR MAINE
Health Insurance Reform, What Does It Mean for Maine
Health care legislation passed by the U.S. House of Representatives will make health care affordable for the middle class, provide security for seniors, and guarantee access to health insurance for the uninsured – while reducing the federal deficit by over $100 billion over the next 10 years and $1.2 trillion in the second 10 years. This analysis examines the benefits of the legislation in Maine.
In Maine, the health care reform bill will:
- Improve coverage for 771,000 residents with health insurance.
- Give tax credits and other assistance to up to 359,000 families and 38,900 small businesses to help them afford coverage.
- Improve Medicare for 255,000 beneficiaries, including closing the donut hole.
- Extend coverage to 63,000 uninsured residents.
- Guarantee that 17,800 residents with pre-existing conditions can obtain coverage.
- Protect 1,400 families from bankruptcy due to unaffordable health care costs.
- Allow 90,000 young adults to obtain coverage on their parents’ insurance plans.
- Provide millions of dollars in new funding for 133 community health centers.
- Reduce the cost of uncompensated care for hospitals and other health care providers by $139 million annually.
Changes that would occur this year include:
- Dependent children could remain on their parents’ health insurance plans until age 26.
- Some senior citizens would get more help paying for drugs in Medicare.
- People with health problems that left them uninsurable could qualify for coverage through a federal program.
- Other first-year items include a ban on lifetime limits on medical coverage, more oversight of premium increases and tax credits for some small businesses.
New help for some uninsured: People with a medical condition that has left them uninsurable may be able to enroll in a new federally subsidized insurance program that is to be established within 90 days. The legislation appropriates $5 billion for this, although that may not be enough to cover all who apply; it’s not clear how much consumers would pay as their share of the cost. About 200,000 people are covered in similar state programs currently, at an estimated cost of $1 billion a year, says Karen Pollitz, a research professor at Georgetown University.
Discounts and free care in Medicare: 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 drugs in the coverage gap will go down by 50 percent. Preventive care, such as some types of cancer screening, will be free of co-payments or deductibles starting this year.
Coverage of kids: Parents will be allowed to keep their children on their health insurance plan until age 26, unless the child is eligible for coverage through a job. Insurance plans cannot exclude pre-existing medical conditions from coverage for children under age 19, although insurers could still reject those children outright for coverage in the individual market until 2014.
Tax credits for businesses: Businesses with fewer than 25 employees and average wages of less than $50,000 could qualify for a tax credit of up to 35 percent of the cost of their premiums.
Changes to insurance: All existing insurance plans will be barred from imposing lifetime caps on coverage. Restrictions will also be placed on annual limits on coverage. Insurers can no longer cancel insurance retroactively for things other than outright fraud.
Government oversight: Insurers must 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.
The big changes in the law – the ones that could affect tens of millions of people – don’t kick in until at least 2014. Those include insurance marketplaces called “exchanges”; rules requiring insurers to accept all applicants, even those with health problems, and an expansion of state Medicaid programs.
Sources: House Committee on Energy and Commerce & US Congress
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