Consumers Would See Impact Soon After Health-Care Bill's Enactment - WSJ

Consumers Would See Impact Soon After Health-Care Bill's Enactment - WSJ

For consumers, the vote on health-care legislation scheduled for Sunday could mean a slew of changes that would take effect within months. But the measure's biggest impact remains years away, and some of the benefits for consumers aren't assured of passage in the Senate.

If the House passes the two pieces of legislation that are up for a vote, the main bill that was approved by the Senate in December is expected to be signed shortly afterward by President Barack Obama. The other component, a package of changes sought by House members, would still need to pass the Senate before reaching the president's desk.




The primary bill would put about a half-dozen major consumer provisions in place six months after it is signed. Insurance companies would no longer be able to cancel enrollees' policies because they got sick, or to place lifetime caps on their policies' payouts. And children could stay on their parents' insurance policies until their 26th birthday.

New insurance plans would have to cover the full cost of certain preventive care, and exempt such care from deductible payments. The requirement wouldn't apply to existing policies until 2018.

Starting this year, small businesses with fewer than 25 employees and average annual wages of less than $50,000 would be eligible for tax credits to cover up to 35% of their insurance premiums.

For patients frustrated by attempts to get reimbursed for insurance claims, the government would establish an ombudsman and a claims process to help them reconcile contested medical bills.

Many other provisions that would take effect this year won't become law unless the Senate passes the companion measure. Republicans plan to introduce parliamentary challenges to that package, and the Senate's parliamentarian already has jettisoned one provision, a federal panel to regulate insurance premiums. Among other things, the companion package would provide a $250 rebate this year to seniors who face a Medicare prescription-drug coverage gap known as the doughnut hole.


Critics of the legislation say the value of any immediate benefits would be outweighed by new taxes on insurers, drug companies, medical-device makers and wealthy individuals. The latest package of changes to the main bill would delay these taxes so they wouldn't take effect until closer to 2014. A new 3.8% tax on unearned income to help fund the overhaul would hit individuals earning more than $200,000 a year and families earning more than $250,000, starting in 2013.

The most significant provisions won't take effect until 2014. That's when the government will begin requiring most Americans to carry health insurance or be hit with a fine. If the bill carrying the changes gets approved, that fine starts at $95 a year or 1% of income, whichever is greater, capped at the cost of the average health-insurance plan. By 2016, the fine would rise to $695 a year, or 2.5% of income.

In 2014, lower earners would be eligible for two types of insurance expansion.

A family of four earning up to about $30,000 a year, in any state, would be eligible for Medicaid, the joint federal-state insurance program for the poor.




For those just above that income level, the government would begin handing out tax credits to offset the cost of buying insurance. A family of four earning just over the $30,000 threshold would pay no more than 3% of its income fpr insurance. That assistance stretches up to a family of four earning $88,000 so they would spend no more than 9.5% of their income on coverage.

Insurers would be barred from denying people coverage because of a pre-existing health condition, but that provision doesn't take effect until 2014 for adults. (Children would get the protection this year.) In the meantime, the bill would set up high-risk pools to help people with illnesses buy coverage.

People who already have insurance would be able to remain on their plans, and they likely wouldn't see significant changes. Large employer plans would for the most part be grandfathered in, although certain new provisions such as the one blocking lifetime coverage limits would apply to them.

The bill also puts more pressure on large employers to help pay for insurance. Companies with more than 50 workers that don't offer health-insurance coverage would pay an assessment of $2,000 per full-time worker if any of their workers gets a tax credit to buy coverage. Employers with more than 200 employees would be required to enroll all employees automatically in their health-insurance plans, though workers could still opt out.