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What Will Happen Under Health Reform--And What's Next? A Resource for Journalists from The Commonwealth Fund


Newly enacted national health reform will begin, almost immediately, to transform the U.S. health care system in ways large and small. The changes will increase the number of people with health insurance, and affect how many of us obtain coverage, how care is paid for and delivered, and how it is regulated. The Patient Protection and Affordable Care Act of 2010 preserves the current private–public system of employer-based coverage, Medicare, and Medicaid and creates income-based subsidies to make coverage affordable to low- and middle-income families without employer coverage. Many major features of reform begin to take effect in 2010:

  • New insurance rules: Insurance companies will be banned from rescinding people's coverage when they get sick, and from imposing yearly and lifetime caps on coverage.
  • High-risk pool: People with preexisting conditions who have been uninsured for at least six months will have access to affordable insurance through a temporary, subsidized high-risk pool. Premiums will be based on the average health status of a standard population. Annual out-of-pocket costs will be capped at $5,950 for individuals and $11,900 for families.
  • Protection for children: Insurers can no longer deny health coverage to children with preexisting conditions or exclude their conditions from coverage.
  • Coverage for young adults: Parents will be able to keep their children on their health policies until they turn 26.
  • Small-business tax credits: Small businesses (fewer than 25 employees and average wages under $50,000) that offer health care benefits will be eligible for tax credits of up to 35 percent of their premium costs for two years.
  • Preventive care: All new group and individual health plans will be required to provide free preventive care for proven preventive services. In 2011, Medicare also will provide free preventive care.
  • Early retirees: A temporary reinsurance program will help offset the costs of expensive premiums for employers providing retiree health benefits.
  • "Doughnut hole" rebates: Medicare will provide $250 rebates to beneficiaries who hit the Part D prescription drug coverage gap known as the "doughnut hole."
  • Annual review of premium increases: Health insurers will be required to submit justification for premium increases to the federal and relevant state governments before they take effect, and to report the share of premiums spent on nonmedical costs.
  • Access to care: Funding will be increased by $11 billion over five years for community health centers and the National Health Services Corps to serve more low-income and uninsured people.

Over the next decade, health reform will help all Americans—young, old, poor, middle-income, working, and unemployed—get and keep affordable health care coverage, while putting in place mechanisms to slow the growth in health care costs and improve quality. Following are key questions that journalists and others might have about how reform will change the way health care is paid for and delivered.

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What Will Happen Under Health Reform--And What's Next? The Commonwealth Fund, Columbia Journalism Review, May 2010 supplement.