Skeptical optimism


It seems as though everyone’s talking about health-care reform, but few are getting to the heart of what the new bill does.

After all the hoopla, political posturing and name calling, does HR 4872, the 150-page Health Care and Education Affordability Reconciliation Act of 2010, even affect anyone?

Well, yes and no. And maybe not for a while.

Some of the immediate benefits, which will go into effect within six months, ban insurers from denying coverage to children with preexisting conditions, as well as prevents insurers from denying already-insured people coverage when they get sick and imposing lifetime caps on coverage. Other changes include a $250 rebate to Medicare prescription drug-plan beneficiaries whose initial benefits run out, and allowing young people to stay on their parents’ insurance until they are 26 if their employer doesn’t offer a plan. Also, the new bill provides access to high-risk pools for individuals who don’t have health insurance because of preexisting conditions.

By 2011, small-group and individual-market insurance plans will have to spend 80 percent of premium dollars on medical services, while large-group plans will have to spend at least 85 percent. The goal of this is to limit insurance-company profits: If they are forced to spend money on services, they can’t pocket it.

By 2014, the bill will require most employers to provide coverage or face penalties and most individuals to obtain coverage or face penalties. For the latter, there will be exemptions for low-income individuals and couples and subsidies for families earning up to 400 percent of the poverty level.

Also by 2014, insurers won’t be able to deny coverage to individuals based on preexisting conditions, such as HIV/AIDS, or charge them higher premiums.

Unfortunately, other provisions for the LGBT community didn’t make it to the version passed by the House. Specifically, there had been an effort to end taxation on health benefits for domestic partners and to permit states to offer early HIV treatment under Medicaid. Also struck was a provision to collect data on LGBT individuals to track and identify health-care disparities.

Legislators are working to include these in other bills.

As to whether the reform is a success, we probably won’t know for many years. Though some indicators will be fairly obvious — more people insured — others, such as increasing financial stability and decreasing bankruptcy due to medical bills, will be harder to track.

But, maybe now that some progress has been made, the country can think about something else — and maybe, down the line, seriously consider a single-payer system.