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It's ALL THINGS CONSIDERED from NPR News. I'm Audie Cornish.
ROBERT SIEGEL, HOST:
And I'm Robert Siegel.
Tomorrow, the Patient Protection and Affordable Care Act turns two. That's the health care overhaul law that President Obama championed and Republicans opposed. The law is headed to the Supreme Court on Monday, where the justices begin hearing three days of arguments about the constitutionality of the law.
We asked listeners to submit their questions about the law and its potential repeal, and we received many.
Today, we've invited NPR health policy correspondent Julie Rovner to the studio to help answer some of those questions. Hi.
JULIE ROVNER, BYLINE: Hi.
SIEGEL: And here is one of our most asked questions from our listeners, Julie.
CAROL CAMBRYN: My name is Carol Cambryn(ph), and I'm from Leawood, Kansas. Here's my question. If the health care law is found unconstitutional or even repealed, are there any contingency plans?
SIEGEL: Julie, contingency plans.
ROVNER: Well, no. If the Supreme Court strikes down a law, then the law goes away. Now, in this case, it is considered highly unlikely that the Supreme Court would strike down the entire law. The most likely thought is that they might strike down part of the law. In this case, it would probably be the individual mandate, that requirement that most people have health insurance or pay a fine, starting in the year 2014.
Now, if that happened, the court might also invalidate another piece of the law, some things that are inextricably linked to that mandate. That would include the requirement that insurance companies sell policy to people with pre-existing health conditions. Insurance companies say that without the requirement for everyone to participate, they'll go broke if they have to sell policies to sick people.
SIEGEL: Would a revised law, then, have to be reapproved by Congress? Or could the country just have what's left of the Health Care Act?
ROVNER: Well, it depends. If the Supreme Court were to just strike down the mandate and leave that requirement in place, for insurance companies to sell to people with pre-existing conditions, the insurance companies might come back to Congress and say: We'll go broke unless you fix that. In that case, Congress might feel that it would have to do that. But technically, when the Supreme Court acts, Congress doesn't have to do anything.
SIEGEL: Several listeners wanted to know if the Supreme Court leaves the law as it is, if it upholds it, what's the timeline? What starts happening?
ROVNER: Well, there's not that much that happens for the next year or so. The one thing that that happens later this summer is that for the first time, insurance companies have to start paying rebates if they fail to spend at least 80 cents of every dollar on actual medical care rather than administrative expenses. So some people might be getting a check to help pay for their summer vacations.
But other than that, there's really not that much that takes effect until what people in the health policy world refer to as the really big stuff, and that happens in the fall of 2013. That's when people can start using the new marketplace - it's called health exchanges - to shop for health insurance. That starts January 1, 2014. Of course, that's also when the requirement for most people to have health insurance begins, when Medicaid expands to cover about 16 million more people, and when insurance companies have to start selling to people with pre-existing health conditions.
SIEGEL: Listener Linda Miltner in Cincinnati, Ohio, wants to know what parts of the law have already been enacted. She's heard about 26-year-olds being able to stay on their parents' insurance policies, but what else?
ROVNER: Well, mostly, what's referred to as the patients' bill of rights. There are restrictions on benefit limits for insurance companies. They can no longer have an annual or a lifetime limit on what they'll cover. There are new preventive benefits with no deductibles or co-payments. Insurance companies can no longer revoke your coverage after you get sick. There are new temporary plans in every state for people who have pre-existing conditions, who've been uninsured for at least six months.
And then there's some new benefits for Medicare beneficiaries. They're getting some new preventive benefits. And there's a gradual closing of the notorious doughnut hole in their prescription drug coverage where they temporarily stop getting benefits even though they keep having to pay their premiums.
SIEGEL: Now, here's a question from a listener who's also a business owner.
BRANDON MARTIN MALONE: Hi, my name is Brandon Martin Malone from Charlotte, North Carolina. I'm a small business owner with around 75 full-time workers, and I'm worried about the mandate to provide health insurance. Do I need to pay for coverage for all my employees or simply offer an affordable option?
SIEGEL: Well, with 75 full-time employees, is he covered by a mandate that says you're supposed to offer insurance?
ROVNER: Well, he is definitely covered by a requirement that he pay a share of their coverage. And if he does not and they go into the health exchange and any of his employees have low enough incomes to get a subsidy - and the subsidies go up pretty high - then he would be subject to this free rider penalty, and that would be a couple of thousand dollars depending on how many employees were getting subsidies from the government. So he'd basically have to make up what his employees are then getting from the government.
Now, smaller companies, those with 25 or fewer employees actually get tax credits to help them afford to buy insurance for their workers.
SIEGEL: But you're saying he can satisfy the requirement without paying the full freight for the insurance policies. The employee can contribute - can be required to contribute to his health policy.
ROVNER: Absolutely. And most employees are required to contribute. He doesn't have to pay 100 percent.
SIEGEL: The next question comes from Carl Backman of Auburn, Alabama, who wants to know how the new law affects the poor. Will it impact the kind of care they receive, and how much will it cost them? Those are his questions.
ROVNER: Well, this law does have an enormous expansion of the Medicaid program, which I should add is being challenged in the Supreme Court by many of the states. It will add roughly 16 million to the 60 or so million people on the program now. And for the first time, those will be people who are not - who are simply low-income - who are not low-income and something else, like a child or a pregnant woman or elderly or disabled.
So starting in 2014, anyone with an income under 133 percent of poverty, which this year is just under $15,000 for an individual and just over $25,000 for a family of three, will be eligible for Medicaid coverage. And, no, you don't - you pay very little to have Medicaid coverage.
That's not all. The law also provides nearly $11 billion over five years to expand community health centers, which also serve people with low incomes and people without insurance. It's important to remember that even though this law expands dramatically the number of people who will have health insurance, there will still be a lot of people who will be left without it: undocumented immigrants, people who are exempt from the mandate. So there will be several million people who still don't have health insurance, and they are served by community health centers.
SIEGEL: Since those 16 million people, you say, won't be contributing very much at all, where does that money come from?
ROVNER: That money comes almost exclusively from the federal government. There's a small contribution that the states will have to make. It starts at 5 percent and goes up to 10 percent.
SIEGEL: This is a question from a listener who's in his early 30s.
ED BEHN: My name is Ed Behn. I'm calling from Hyattsville, Maryland. I was wondering, does it make more sense for a young, healthy person like me - I'm only 31 - to go without insurance under the new health insurance law and just pay the tax penalty instead of having to pay insurance premiums every year?
SIEGEL: Well, what do you think of the problem Mr. Behn presents you with?
ROVNER: Well, you know, the fact that the penalty is so small actually has the insurance industry worried that young, healthy people, like Mr. Behn, will do exactly what he says and pay the fine until they find they need insurance. For most people, it's going to be about $700 a year, which is a lot less than buying insurance.
Now, that can be dangerous if you develop a major disease like cancer and you don't have insurance. You could be in big trouble. And in most cases, even though he will still be able get insurance, even though you have a pre-existing condition...
SIEGEL: Yeah, aren't you protected by the pre-existing condition clause?
ROVNER: That's right. But you'll only be able to sign up during specific open enrollment times of the year. So if you get sick at the wrong time, you could be responsible for an awful lot of medical bills before you get another chance to enroll.
SIEGEL: One listener asked us this: If the mandate is approved by the court as constitutional, what will that mean for people like him who can't afford health insurance?
ROVNER: Well, one of the reasons the law is so expensive is that it has this enormous system of subsidies to help people pay for health insurance. It doesn't just say you have to go out and buy it and then leave them no way to pay for it. In addition to this big expansion of Medicaid, for people up to 133 percent of poverty, there are subsidies that go up to 400 percent of poverty. Now, that's $92,000 for a family of four or $76,000 for a family of three. So those are pretty hefty incomes.
Now, also remember that people who have employer-provided insurance, most of them won't be - won't have to do anything. They'll be covered already by this individual mandate. So if - and there are - you only have to spend a specific percentage of your income on it. So if you can prove that you truly can't afford it even with the subsidies, you will be exempt from the mandate.
SIEGEL: So, Julie, the big event is next week...
SIEGEL: ...at the Supreme Court?
ROVNER: Yes, it is.
SIEGEL: Three days of arguments?
ROVNER: And I will be covering it.
SIEGEL: And we look forward to hearing from you.
SIEGEL: That's NPR health policy correspondent Julie Rovner.
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