Health Care, Reformed

President Barack Obama walks with the late Sen. Ted Kennedy. | White House photo/<a href="http://www.flickr.com/photos/whitehouse/3484051389/">Pete Souza</a> (<a href="http://www.usa.gov/copyright.shtml">Government Work</a>)


You already know about the Democrats’ big health care reform victory Sunday night, the deal it took to get there, and the debate that will come next. But if you haven’t been paying close attention, you might not know what’s in it for you. America, here’s what you’ve won (and all of this stuff kicks in this year):

  1. Insurance companies can no longer impose lifetime coverage limits on your insurance. Never again will you face the risk of getting really sick and then, a few months in, having your insurer tell you “sorry, you’ve ‘run out’ of coverage.” Almost everyone I’ve met knows someone who had insurance but got really, really sick (or had a kid get really sick) and ran into a lifetime cap.
  2. If you don’t know someone who has run into a lifetime cap, you probably know someone who has run into an annual cap. The use of these will be sharply limited. (They’ll be eliminated entirely in 2014.)
  3. Insurers can no longer tell kids with pre-existing conditions that they’ll insure them “except for” the pre-existing condition. That’s called pre-existing condition exclusion, and it’s out the window.
  4. A special, temporary program will help adults with pre-existing conditions get coverage. It expires in 2014, when the health insurance exchanges—basically big “pools” of businesses and individuals—come on-line. That’s when all insurers will have to cover everyone, pre-existing condition or not.
  5. Insurance companies can’t drop you when you get sick, either—this plan means the end of “rescissions.”
  6. You can stay on your parents’ insurance until you’re 26.
  7. Seniors get $250 towards closing the “donut hole” in their prescription drug coverage. Currently, prescription drug coverage ends once you’ve spent $2,700 on drugs and it doesn’t kick in again until you’ve spent nearly $6,200. James Ridgeway wrote about the problems with the donut hole for Mother Jones in the September/October 2008 issue. Eventually, the health care reform bill will close the donut hole entirely. The AARP has more on immediate health care benefits for seniors. Next year (i.e. in nine months), 50 percent of the donut hole will be covered.
  8. Medicare’s preventive benefits now come with a free visit with your primary care doctor every year to plan out your prevention services. And there are no more co-pays for preventative services in Medicare.
  9. This is a big one: small businesses get big tax credits—up to 50 percent of premium costs—for offering health insurance to their workers.
  10. Insurers with unusually high administrative costs have to offer rebates to their customers, and every insurance company has to reveal how much it spends on overhead.

There’s a lot more that happens down the road. But this is most of what you get now. No death panels included.

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