What Health Reform Means for You

Nearly every American will be hit, whether by getting more coverage or by paying more money.

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Parts of the Affordable Care Act, health reform's official name, have already taken effect. Young adults now can stay on their parents' health policies up to age 26, for example, and at a more mundane level, sessions at tanning salons may cost more because of a 10 percent tax on tanning services imposed last July 1. What has happened so far that will matter to individual Americans, and what is coming in 2011 and beyond? Here's a quick rundown.

1. What's happened so far. Health insurers can no longer impose lifetime caps on coverage, a boon for those with expensive chronic health problems like cancer or heart failure who find themselves bankrupt after their insurance runs out. Parents who have group policies through their employers are allowed to continue coverage for their unmarried children, as noted above—a pressing need especially now, with unemployment sky-high among recent college graduates. Health insurers must cover certain preventive services like osteoporosis screening for women over 65, smoking cessation counseling and interventions, colonoscopies, high blood pressure screening, and screenings for diabetes and sexually transmitted diseases. Seniors were previously required to pay part of the cost of Medicare services, including cancer screenings and annual physicals, but the law makes such preventive services free for most beneficiaries. People with serious health conditions that have prevented them from obtaining coverage will be eligible to purchase a policy from a high-risk pool in a government-subsidized exchange, at a cost similar to what healthy folks pay for their premiums. (Private insurers can still deny applicants based on pre-existing conditions up until 2014, when the exchanges open.)

[New Members, New Look at Health Reform]

2. You will have to purchase health insurance if you don't have any, or face a penalty. As of 2014, anyone who is currently uninsured must purchase a policy or pay a penalty. Individuals who don't qualify for government subsidies should expect to pay about $5,000 a year for a policy on the exchange, while families should expect to pay about $15,000, according to John Goodman, president of the National Center for Policy Analysis, a nonprofit public policy research organization based in Dallas. (Subsidies to reduce these premiums will be available for individuals making between about $15,000 and $43,000 and for families making up to nearly $90,000 on a sliding scale based on income. Subsidized plans for a family of four, for example, range from $1,300 per year up to $8,400 per year.) The penalty starts at $95 or up to 1 percent of income for individuals, whichever is greater, and in 2016 rises to $695 or 2.5 percent of income, whichever is greater. Families pay heftier fines—$2,085 or 2.5 percent of income by 2016. "Many are arguing that these fines aren't high enough," Goodman says, "and that middle-class families may simply choose to go without insurance and pay the fine."

3. You won't lose coverage if you suddenly get sick, or be denied a new policy because of a pre-existing condition. Starting in 2014, insurers won't be able to deny applicants based on, say, an earlier diagnosis of breast cancer. And they're already no longer able to drop existing policyholders unless they can spot a clear case of fraud—like someone who failed to disclose that earlier case of cancer. In the past, insurance companies often rescrubbed policies after individuals were diagnosed with expensive health conditions.

4. You can expect longer waits to see a new doctor. That's the downside of providing millions of Americans with more access to care without concurrently increasing the number of healthcare workers. In Massachusetts, where health insurance is universal, Boston residents have to wait about twice as long to see a doctor as people in any other U.S. city, says Goodman. Over time, though, increased demand and employment opportunities could bring more doctors and nurses flooding into the workforce, helping to alleviate this problem.


Corrected on : This story was originally reported on March 22, 2010. It has been updated.