On Tuesday, after a year-long battle, Obama signed health care reform into law. The complex legislation has many components that kick in at different times and have wide-ranging impacts on how Americans interact with the health care system. Here's a look at what will change — and when — because of health reform:
What are the basic aims of health care reform?
Its primary goals are to insure 95 percent of Americans, stem insurance industry "abuses," start reining in the skyrocketing costs of health care, and reorient the medical profession toward a style of care that incentivizes outcomes, not expensive procedures. How effective this particular bill will be at meeting those goals is a matter of intense debate, of course.
Will anything change right away?
Most of the big changes start in 2014, but a number of smaller things would kick in over six months to a year.
What smaller changes?
Democrats tout several immediate changes they think will be popular: uninsured people with pre-existing conditions will get temporary affordable coverage; children will be protected from exclusion for pre-existing conditions, and will be able to stay on their parents' plans until age 26; preventative care, like checkups, won't cost anything out-of-pocket; there won't be any annual or lifetime caps on coverage; and some Medicare beneficiaries will get more help buying prescription drugs, among other perks.
Any other near-term changesy?
Democrats have been less vocal about the fact that insurance companies, medical device makers, and drugmakers will be subject to hefty new taxes, and they could pass on the costs.
Will my premiums go up?
Quite possibly, if you buy your own insurance — though, depending on your income, you still may end up paying less than you do now, thanks to new federal subsidies. If your insurance is covered through your employer, the legislation should have very little effect on your premiums.
Why would premiums rise?
Mainly because the law would require insurers to offer more comprehensive coverage. The higher costs getting more coverage are partly offset by the larger pool of people buying insurance. Obama claims that premiums will actually fall 14-20 percent, but that only applies to people who buy their own insurance and who opt for plans with similar coverage to what they currently hold.
How about my taxes?
Your taxes will go up, starting in 2013, if you as an individual make more than $200,000 a year, or as a couple, $250,000. In theory, the law could indirectly raise everyone's taxes, if it ends up adding to the federal deficit.
Will health reform explode the deficit?
That's a point of heated debate. Citing the non-partisan Congressional Budget Office, the White House says the law, which costs almost $1 trillion over 10 years, will actually reduce the deficit by $130 billion by 2019. But critics say those savings are illusory or based on iffy assumptions.
What about the individual mandate?
This is perhaps the most controversial part of the bill for individuals. Starting in 2014, almost everyone — some low-income people will be exempt — will be required to have health insurance or pay a fine. That year will also see the start of health insurance exchanges, where individuals will be able to comparison-shop for a private health-care policy.
What else happens in 2014?
If your employer doesn't already offer health insurance, they'll have a strong incentive to start doing so: For companies with 50 or more employees, there will be $2,000 fee for each worker who gets government-subsidized insurance. Beginning in 2014, insurers are no longer able to deny anyone coverage due to pre-existing conditions. The government also stops subsidizing private Medicare Advantage programs, potentially forcing the seniors enrolled in them to pay more or switch back to traditional Medicare.
And what are the biggest potential drawbacks?
There are, of course, deficit worries. Some critics don't like that it tightens regulations on insurance companies, while others say it doesn't do enough to contain skyrocketing medical costs. The addition of tens of millions of people to the health care system also has raised some concerns that there will be longer waits for doctor's visits and surgeries. People who wanted a government-run public insurance option or even a single-payer Medicare-like system for everyone are also disappointed at the limited scope of this plan.
In 10 words or fewer, what's the point?
It will insure 31 million people who don't have insurance.
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