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It's going to be another year before most of the really big changes coming with the 2010 health law known as Obamacare take effect. That includes things like the ban on denying coverage to people with pre-existing conditions and the requirement that most Americans have insurance. Still, as NPR's Julie Rovner reports, some notable changes are now under way.
JULIE ROVNER, BYLINE: One of the changes that will affect everyone with private health insurance actually took effect last September. But most people won't see it until they renew or apply for new health insurance. It's called a summary of benefits and coverage. And the idea, says former Health and Human Services official Jay Angoff, is to help people actually understand what's in their insurance policies.
JAY ANGOFF: There's a standard format that allows people to compare benefits to make apples-to-apples comparisons not just on price but on benefits.
ROVNER: Health plans will also have to provide consumers a glossary of insurance terms if they ask for it.
ANGOFF: Now, it's still harder than some people would want. It's still a complicated area. But I think HHS has really done a very good job in making it as simple and meaningful as possible.
ROVNER: Later in 2013 will also bring a key launch date for the law, says Angoff.
ANGOFF: October 1, 2013 is when open enrollment begins.
ROVNER: That's when people can start signing up for their 2014 coverage through the new health exchanges or marketplaces that the states and federal government are creating right now. Angoff, who used to head the office that's in charge of building those exchanges, says he's confident that things will happen on time.
ANGOFF: HHS has met all statutory deadlines until this point, and I have confidence that HHS will continue to meet those deadlines.
ROVNER: But most of what happens on January 1, 2013 are changes that pay for the changes in 2014, in other words, tax increases and cuts in tax deductions. People will only be able to put $2,500 pretax dollars into flexible spending accounts. Marilyn Moon of the American Institutes for Research explains that these accounts are generally used for items insurance doesn't cover.
DR. MARILYN MOON: So, for example, if they buy eyeglasses, if they pay co-pays on drug benefits or to their physician, they can submit those claims and be reimbursed from the pre-tax dollars that they set this up.
ROVNER: Moon says that while the change may hurt some people with very high out-of-pocket spending not covered by insurance, lawmakers decided this was a fair way to raise some of the money needed to pay for the rest of the law.
MOON: This is a benefit that largely accrues to higher-income individuals who can afford to set aside a certain amount of money every year to pay towards their health care spending.
ROVNER: There's another tax change for wealthy individuals earning more than $200,000 a year and couples earning more than $250,000. They'll see a nearly 1 percentage point increase in their Medicare payroll tax. And they'll also have to pay a 3.8 percent Medicare tax on their nonwage income. Moon says that represents a big change.
MOON: The payroll tax usually applies only to wages. And now, this law will extend it to investment income as well.
ROVNER: Those who take deductions for medical expenses on their income taxes will also see a change starting in 2013. Right now, expenses in excess of 7 1/2 percent of adjusted growth income are deductible. That's going up to 10 percent. It will impact some people who spend a lot on medical care, says Moon, but the new law should also reduce the number of people with those very large bills.
MOON: Because if everyone has health insurance, many fewer people should have to pay large amounts out of pocket on health care. Ten percent would not affect very many people in the future, one would hope, when they get better insurance coverage.
ROVNER: Finally, there is a key change made by the health law for 2013 that will affect only the poor. State Medicaid programs will be required to reimburse doctors who provide primary care at Medicare rates, which are substantially higher. The idea is to get more doctors into the Medicaid program, which will itself expand in 2014.
Julie Rovner, NPR News, Washington.
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