ROBERT SIEGEL, host:
From NPR News, this is ALL THINGS CONSIDERED. Im Robert Siegel.
MELISSA BLOCK, host:
And Im Melissa Block.
The health care overhaul is now law and people have plenty of questions about how it will affect them and their families. Earlier this week, we asked you to share some of your questions and now it's time to get some answers.
Joining me in the studio is NPR health policy correspondent Julie Rovner.
And, Julie, the most popular question by far came from parents with young adult children. Let's take a listen to the question from Patricia Fontana Norell(ph) from Berkeley, California.
Ms. PATRICIA FONTANA NORELL: My son is going to turn 23 in June and we've already received notice that he's going to get booted from our plan. Under health reform he can stay on our plan till he's 26, but I've heard this doesnt go into effect for six months. Whats going to happen to my son's coverage in the meantime? Do we have to enroll him in alternative insurance or will he be allowed to stay on the plan continuously?
BLOCK: So what about that gap?
JULIE ROVNER: Well, this is going to disappoint a lot of people. This is a provision that doesnt take effect for six months, that'll be September. And actually, for most people they won't have a chance to enroll their children in their plan until their next open season. So for some people it's not going to be until next January.
So, yes, you're going to have to find other insurance. Now, a lot of people will be able to COBRA their young adult children. But COBRA can be very expensive. And, you know, for healthy young people, you can probably find some cheaper insurance for them in the intervening months. So eventually you'll be able to get them onto your plan but not as fast as I think a lot of people are hoping.
BLOCK: Okay, let's move on to another popular topic that we heard about: pre-existing conditions. Here is Sarah Tamor(ph) of Santa Monica, California.
Ms. SARAH TAMOR: This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary subsidized high-risk pool. Can you explain the high-risk pool? Do you know who will be eligible for it? How do you apply? How much does it cost?
If, for instance, I get covered through this high-risk pool because of an illness, will my husband and daughter be able to be covered also, as they were through my employer?
BLOCK: Julie, what about that high-risk pool?
ROVNER: Well, this is a well-informed listener. There will be a national high-risk pool. It's supposed to start in 90 days. There's $5 billion to help subsidize it, but the premiums could still be pretty high, as they are in most of the state high-risk pools that exist. And the premiums could vary by age, so older people can be charged four times as much as younger people.
You have to have been uninsured for six months in order to be eligible and I think the husband and daughter probably won't be allowed to join unless they are also high-risk. But they probably wouldnt want to because, once again, the premiums will be high, because everybody in that high-risk pool will by definition be high-risk.
BLOCK: Here's a question from Audrey Hagan(ph) of Jackson, Wyoming. She says both she and her husband have insurance but because they both have health problems they can't change plans. And here's what she writes.
It looks like with the news law we can find a policy in the risk pool right away if we were uninsured for six months. But if we have insurance, even if it is inadequate, we can change until 2014, when the adult pre-existing conditions go away. Are these really our only options, she wants to know.
ROVNER: Yeah, Im afraid so. I mean, you know, it's not - this new interim risk pool that we were just talking about, as I mentioned, you need to be uninsured for six months. The premiums are likely to be high. These are for people who have no other options. The idea is to give people something in the interim.
But this couple has insurance, even though they dont think it's adequate. But this new risk pool is for people who really have nothing and want something to tide them over until 2014, when insurers will no longer able to turn people away because they have pre-existing conditions.
BLOCK: Okay, a question now from the other end of the other end of the country.
Ms. CATHERINE MCCOLL: This is Catherine McColl(ph) from Conway, Massachusetts. I am the owner of a small business that I've had for about four years. I pay for my health insurance under my business name. Every year my premium has gone up by at least 25 percent. And I try to keep the cost of the premium down by signing up for a plan that has fewer benefits or higher co-payments, and/or higher deductibles. Will the new health care law help someone like me keep the cost of health insurance down?
ROVNER: That is certainly the hope. No one I think believes that this will actually bring premiums down. The idea is that it will help premiums stop going up as fast. Certainly for small businesses there is a large effort in this bill. There's a tax credit that takes effect right away, that will be 35 percent of the premium going up to 50 percent of the premium. So that will help this listener.
There are these new exchanges that will begin in 2014 that will hopefully help create competition, that will help keep premiums lower, if not low. And there are a lot of other things in this law that are - hopefully will create changes in the way health care is delivered and paid for, that will help stem the growth of health care costs. But no one is suggesting that this is the magic bullet.
BLOCK: Julie, we also had several versions of this next question, which is this: How does the new law affect people who have insurance through the TriCare program? And thats the private insurance plan for Defense Department workers and military families.
ROVNER: I actually had to do a little bit of research on this. And it turns out that people on TriCare will not be affected by this new law, and that's both good and bad. It's good in that if you have TriCare, you won't have to go out and buy any other insurance. It is sufficient to cover the requirements of the individual mandate that you have insurance.
It's bad in that if you have an adult child who's 24 or 25, you won't be able to keep them on your TriCare, because TriCare only covers dependents up to age 23. Interestingly, a lot of people are upset by that. And there's already been a bill introduced in the House that would allow people on TriCare to keep their dependents on their TriCare plan until theyre 26 also.
BLOCK: We've been hearing questions from patients and now here is a question from a doctor-to-be.
Mr. JOSH ROARKE: My name is Josh Roarke(ph) and I am from Alexandria, Virginia. Im a medical student who feels a little left out of this whole debate. I've heard from some doctors that reimbursements may decline. For those of us who have the choice of going into primary care or specializing, what will the economic incentives be?
Im going to be taking on over $150,000 in debt in order to treat patients. What I really want to know is where Im going to stand economically due to this health care bill once I begin practicing.
BLOCK: Julie, what would you tell the future Dr. Roarke about that?
ROVNER: Well, we haven't talked about this a lot but it has been a large concern for the lawmakers writing this bill, a lack of primary care doctors to take care of all these newly-insured people. So in fact there are incentives in this new law to enlarge the pool of primary care doctors. One big one - and this was added very late - Medicaid, the program for the poor, they're going to increase payments for Medicaid doctors, primary care doctors up to what Medicare pays. That will be a big increase.
There is increased loan forgiveness for up to $50,000 a year for primary care doctors who join the National Health Service Corps. They go off and practice in underserved areas. Thats a big boost. There's going to be more primary care residency slots. So there will be other inducements for more primary care doctors.
There's also, as I mentioned earlier, changes in the way doctors are paid, health care is organized. Those will be other kinds of longer term changes in really the medical care system, all of which are intended to encourage doctors to become primary care doctors. Those will take a little bit longer to be phased in. But yes, there's all kinds of encouragement to expand that pool of primary care doctors.
On the other hand, there's not that much to be done about the fact that medical school is very expensive and specialists are still on balance to be paid more than primary care doctors.
BLOCK: We heard also from Lisa Kantrowitz(ph) of Malvern, Pennsylvania, with a question about how all this is going to be paid for. She asks, when will the Cadillac plan taxes come into play, and who will it affect? She also asks, how do you know if you have a plan considered to be Cadillac?
ROVNER: Well, this was something that was changed in the bill thats being finished just now, the budget reconciliation bill. This doesnt take effect until the year 2018. Your plan has to be worth more than $10,200 for a single person and $27,500 for family coverage, thats both what you and your employer pay if its employer provided insurance.
And those plans can be worth even more if you're a retiree or you're in a high-risk profession, like a police officer or a firefighter. And dental and vision coverage don't count toward those totals, by the way. So these are very, very high-end plans.
BLOCK: Julie, we've been wondering, and we certainly heard from listeners too about this, about how the health care law is going to be enforced. Who figures out if insurance companies are doing what they're supposed to be doing? What do you know about that?
ROVNER: Well, the main enforcement, and those who will write the rules will come from the Department of Health and Human Services. They will be assisted by those at the Department of Labor. But people are correct when they say that the Internal Revenue Service will play a role in this, because you will have to declare on your income taxes whether or not you have health insurance thats this individual mandate. And if you don't have health insurance, that's how you'll pay the penalty that will be required, with your taxes.
BLOCK: And who figures out, yes, insurance companies are not cherry-picking, they're not dropping people with preexisting conditions?
ROVNER: That will be the Department of Health and Human Services.
BLOCK: Julie, thanks very much.
ROVNER: You're very welcome.
BLOCK: NPR health policy correspondent Julie Rovner.