Health Care

Ten Things To Know About The Health Care Law

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This past weekend's congressional vote to reform health care was historic, but many Americans don't know how it translates into their everyday lives. To find out what to expect next, guest host Allison Keyes speaks with Anna Wilde Mathews, reporter for the Wall Street Journal, and Adolph Falcon, vice president of the National Alliance for Hispanic Health.

ALLISON KEYES, host:

I'm Allison Keyes, and this is TELL ME MORE from NPR News. Michel Martin is away.

Coming up, a dozen states are planning to file lawsuits against the federal government over the new health care plan. We'll talk about one such effort with the state attorney general of South Carolina. That's in just a few minutes.

But first, days after Congress voted to approve a dramatic overhaul of the health care system, many Americans are still unsure about what exactly that means for them.

Joining us to talk about the changes you might see in coverage is Adolph Falcon, the vice president of the National Alliance for Hispanic Health. Also with us is Anna Wilde Mathews. She's a reporter for the Wall Street Journal. Welcome to the program.

Ms. ANNA WILDE MATHEWS (Reporter, Wall Street Journal): Thank you.

Mr. ADOLPH FALCON (Vice President, National Alliance for Hispanic Health): Thank you.

KEYES: Anna, let me start with you. Is all of this overhaul thing final or are there more changes coming up?

Ms. MATHEWS: Well, there could be more changes coming up. What's happened is that both the Senate and the House have passed the bill, which people tend to call the Senate bill. But the House has also passed a package of changes that it would like to see made to the Senate bill. And the Senate is now going to take up that package of changes. But even while the Senate does that, President Obama is expected to sign the underlying Senate bill that has already passed both Senate and House.

KEYES: Adolph, what kind of immediate changes should people be looking out for?

Mr. FALCON: Well, I think parents are going to see some of the first changes. Preexisting conditions will no longer be allowed for children. So children who have serious illnesses have often had a lot of problems getting health insurance. And as you can imagine, a parent who's dealing with the issues that come with a serious illness, worrying about how to pay for the needed care for the child is a worry they don't need. And they're not going to have that any longer because preexisting conditions will no longer be allowed for children upon signing of this bill in the first six months.

The other thing is this is good news for all those parents out there who have college age kids. I know my niece is just getting ready to graduate from college and where she was going to get her health insurance was an issue. Now, children can stay on their parents' health insurance - if they don't have health insurance, also, through an employer - up to age 26. That's going to be an immediate big help.

KEYES: Okay, Anna, what kind of effect on the opposition to this plan do you think the timing of when things happen is going to have? There's been some argument that people will be so bowled over by the immediate benefits that they'll back off being against parts of this.

Ms. MATHEWS: Well, my guess is that that's what supporters hope. It's hard, obviously, to predict. I think some of the people who are opposed to this are so deeply opposed to it that any benefits that might kick in, even if they help them in the first six months or so won't really change their opinion.

KEYES: Anna, you also just wrote an article talking about some of the things that people should do to help make the transition into this health care easier, and some of them sounded a bit like warnings.

Ms. MATHEWS: Well, warnings might be a strong statement. I would say that I suggested that people, as boring and maybe unpleasant as it might be, might need to do some homework. This bill does affect almost everyone in some way, a lot more for some people than for others, obviously. But people really need to take the time, again, boring as it might seem, to delve into the details because they need to know how it's going to affect them.

A lot of the biggest effects don't kick in until 2014, so you have some time. But as we were just hearing, some of the effects kick in earlier.

KEYES: You also suggested that people try to find a doctor now as opposed to later.

Ms. MATHEWS: Yes. I think that it's good advice to at least think about that. In certain parts of the country there are already a certain there is already a certain shortage of primary care physicians. The bill does try to address that. There are efforts in the bill to boost the supply of primary care physicians, but it takes a while to make a new doctor. And the bill moves forward even while that process is underway.

So, we're talking about a boost of possibly 32 million new insured people, while I think probably everyone thinks that's a wonderful thing. The other side of that is that the supply of doctors, at least in certain parts of the country, might not keep up. So, it might be a good idea to get on someone's dance card now before that big influx begins in 2014.

KEYES: Adolph, we were talking about the coverage for children with preexisting conditions. If you are a parent of such a child, what is it that you should do now?

Mr. FALCON: Well, what you should do if you have not been able to get health insurance is to tune in. The Department of Health and Human Services is going to make rules very quickly, certainly within this first year and probably within these first six months to no longer allow that practice by health insurance companies. The market will then become open to you, and it's time to start shopping.

And there's help out there as well. You know, one of the things that people should look at are a number of the Web sites that are available to do that. But what they should also know is the Department of Health and Human Services, this first year, is also going to be setting up standards for how people get information about health care insurance policies. So there's going to be a lot more help coming within a year on how to shop for health insurance.

KEYES: Can you talk to us about some of the changes in Medicare?

Mr. FALCON: Well, one of the first things in Medicare that people are going to see is for those recipients who are in the infamous donut hole that is once Medicare stops paying for medications because the level has gotten too high, which kicks in after you've had total expenses of around $2,700. You then have to pay for all of your prescription medications.

KEYES: Wait, I'm going to stop you for just a second. For those who don't understand the donut hole, what does that mean?

Mr. FALCON: When we passed Medicare drug reform and started offering prescription drugs, there was a point where the federal government said, we won't be paying for your medications. We'll pay for your medications up to a certain point. After that point, we stop. That point is around $2,700 and continues until about $6,000 of prescription medication cost. So, during that whole period, you're getting no assistance if you're a Medicare recipient to pay for your drugs.

You're going to start getting some assistance phased in. Immediately, if you're in that donut hole this year, you're going to get a $250 rebate check. That's going to be the first help. Next year, you're going to get, if you're in that donut hole again, next year you'll get a 50 percent discount on your drugs, so your bill will be cut in half. And that will continue on until about the year 2020 the donut hole will go away.

KEYES: Anna, if you are uninsured right now, what should you be looking out for in this bill? Is there any immediate help for you?

Ms. MATHEWS: Yes, there might be. If you are uninsured and you have a preexisting health condition, the bill includes a high-risk pool. It sets aside $5 billion to back it. That will be set up it's supposed to be set up in 90 days. So it's one of the earliest things to kick in with the bill. I think it's a complicated process to set up a high-risk pool, but you definitely should be watching on the HHS site, which is HHS.gov that's the Health and Human Services Department site and maybe healthreform.gov, which is an associated site for information about what that's going to look like and how you might sign up for it if you are eligible.

KEYES: And, Anna, if you are already insured, does this blow up your current plan or are you pretty much grandfathered in as to where you are?

Ms. MATHEWS: You are grandfathered in. Some of the early things do actually even affect grandfather plans. That includes, for instance, an end on lifetime dollar caps on benefits. But your plan is grandfathered and you're not going to see any kind of huge change immediately.

KEYES: If you are just joining us, this is TELL ME MORE from NPR News. We're talking about what you need to know about the health care overhaul. With us is Adolph Falcon from the National Alliance for Hispanic Health, and Anna Wilde Mathews from the Wall Street Journal.

Adolph, talk to us a bit about what this plan is going to mean for immigrants.

Mr. FALCON: Well, that's the downside of this plan. In the original House version, immigrants were going to be able to buy health insurance on the health insurance exchange with their own money. Just like anybody in this country can buy any product, groceries, clothes, pay the sales tax on it, immigrants are going to be allowed to buy - with their own money - in the health exchange. That is no longer true.

So, there is no health for immigrants. That's certainly, as we move forward, is one of the main things we're going to be looking at.

KEYES: And just were I'm clear, we're talking about...

Mr. FALCON: We're talking about undocumented immigrants. You know, one of the big fallacies that was going on throughout the entire debate was that immigrants somehow were eligible or somehow were getting access to government health benefits, that was never true. But we're taking it a step further, and we're not even allowing undocumented immigrants using their own money to be able to buy health insurance on the exchanges.

KEYES: Okay. What are organizations like yours going to do about that? I mean, the reform's already written. Are there changes that you still would like to see in it?

Mr. FALCON: Well, that's the wonderful part of a democracy, you can always make things better. And we certainly intend to be working with Congress to revisit that House rule that would allow immigrants to buy health insurance with their own money. One of the things people don't know is that undocumented immigrants right now, about 40 percent have a health insurance policy. They are buying health insurance.

I mean, look, this is better for the entire country. The most people you have in the health insurance pool, the risk is spread across a larger number of people. And your rates are going to be lower. Your rates are going to be more secure and more steady, the larger group of people that you have covered.

KEYES: Anna, talk to us a little bit about the tax changes many Americans could be looking at under this.

Ms. MATHEWS: Well, the first thing to kick in tax wise will affect people who use indoor tanning facilities.

KEYES: You got to be kidding.

(Soundbite of laughter)

Ms. MATHEWS: Get ready. There's a 10 percent levy on indoor tanning services that (unintelligible).

KEYES: No.

Ms. MATHEWS: I know. I know. Devastating for some, I'm sure. Although, I don't mean to make fun of indoor tanning.

KEYES: Me either.

(Soundbite of laughter)

Ms. MATHEWS: But the more serious, maybe things kick in a little later. Under the Senate bill and the reconciliation package, for those individuals making more than $200,000 or couples more than $250,000, there would be an increase in their Medicare payroll tax. That same year under the House's reconciliation package which, again, has not yet passed the Senate, there'd be a new tax of 3.8 percent on what's called unearned income, which includes interest and dividends that's above those same income thresholds.

Also, the reconciliation package caps the amount that you can put in your tax free flexible spending account at $2,500 a year. The Senate bill does the same, actually, a little earlier, the Senate bill in 2011, and the reconciliation package would do it in 2013.

KEYES: Really briefly, Anna, some of the bigger changes for this don't kick in until 2014, right?

Ms. MATHEWS: That's correct.

KEYES: In other words, you won't be mandated to buy insurance until then or you won't face penalties until then which is it?

Ms. MATHEWS: Both. The insurance individual mandate kicks in in 2014, as do the penalties designed to give that mandate teeth. Also, the requirement that insurers issue a plan to anyone regardless of their preexisting health condition, that also kicks in in 2014.

KEYES: Anna Wilde Mathews is a reporter for the Wall Street Journal. She joined us by phone from Los Angeles. And Adolph Falcon is the vice president of the National Alliance for Hispanic Health. He joined us here in our Washington studios. Thank you both much.

Mr. FALCON: Thank you.

Ms. MATHEWS: Thank you.

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