The What And When Of Health Care Overhaul

The major health bill President Obama just signed has lots of moving parts — many of them take years to kick in. But there are a few key provisions that start helping people quickly.

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LINDA WERTHEIMER, host:

This is MORNING EDITION from NPR News. I'm Linda Wertheimer.

RENEE MONTAGNE, host:

And I'm Renee Montagne.

Fourteen months of debate, the health care overhaul is law - or at least part of it. But the 2,700-page Senate bill President Obama signed yesterday doesnt take effect all at once.

We're joined by our resident expert, NPR's Julie Rovner, for a little timeline about what parts of the new law take effect and when.

Good morning, Julie.

JULIE ROVNER: Good morning, Renee.

MONTAGNE: Why dont we start with who sees the first benefits of this new law?

ROVNER: Well, interestingly, and not coincidently, one of the first benefits goes to people who already have insurance - those would be seniors on Medicare. You know, with all the talk about cutting Medicare, one of the first pieces of this bill to take effect - and this is assuming that the bill that's now in the Senate is approved this week - is the start of the closing of that notorious donut hole in the Medicare prescription drug benefit.

The several million seniors who will exhaust the first few thousand dollars of drug benefits this year and fall into that donut hole, they will get a $250 rebate this year. Over the next several years, they will close that entire donut hole. So they will have just continuous drug coverage.

Another early benefit goes to another group that's been complaining loudly about this bill. That would be owners of small businesses. Theyll get tax credits starting this year to help provide health insurance to their workers.

Now, it's important to note that small businesses are not required under this law to provide health insurance. The requirement is for individuals to have insurance. But the hope is that with these tax credits, more small businesses will be able to afford to provide insurance to their workers.

MONTAGNE: And what about some of the insurance industry abuses that weve heard so much about? When do those sorts of things stop happening?

ROVNER: Well, a lot of the restrictions that have been touted dont take effect until the major parts of the law start in 2014. But some key provisions do start later this year. For example, insurance companies won't be able to practice what's called rescissions anymore - that's cancelling your policy, usually because youve made a claim. Young adult children will be able to stay on their parent's insurance policies until they're 26.

Insurance companies will be barred from having what's called lifetime limits. Those are caps, usually a million or $2 million. That's very important for people who have very serious illnesses. And insurance companies won't be able to deny coverage of raise premiums for children with preexisting conditions starting this year. That won't be the case of the rest of the population until the year 2014. But Congress really wanted to show people some help before this year's elections.

MONTAGNE: Well, is there any help for the rest of the population between now and four-some years from now?

ROVNER: Yes. There's $5 billion in the bill to help create new high-risk pools for the rest of the population with health problems and can't get insurance now. This was an idea originally floated by Senator John McCain in the campaign in 2008. There are already existing state high-risk pools in most states, but premiums are generally very expensive, and the coverage often has long waiting periods of their own. So the hope is that this money will help bolster those high-risk pools until the rest of the bill takes effect.

MONTAGNE: Okay, Julie, let's jump, then, to 2014. What starts kicking in then?

ROVNER: Well, that's when the bulk of the bill takes effect, the requirement that everyone have insurance, these new insurance exchanges where individuals and small businesses will be able to go to buy that insurance, and the overall ban for insurance companies on denying people coverage because of preexisting conditions. That's also when most of these new taxes will take effect to help pay for this bill.

Now most of the taxes are on the health care industry, this Cadillac tax that we keep hearing so much about on generous insurance plans. That actually won't take effect until the year 2018. That was delayed as a result of some of the negotiations.

MONTAGNE: Now, with 2,700 pages, I feel like there must be more.

ROVNER: There are lots more provisions to this bill, you know, interesting things like requiring calorie counts to be printed on menus. And we will be hearing more and we will be telling you more in the days and weeks to come.

MONTAGNE: Julie, thanks very much.

ROVNER: Youre very welcome.

MONTAGNE: NPR's health policy correspondent, Julie Rovner.

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