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THE INSURED

Q: For the 85 percent of Americans with health insurance from an employer or government program, or purchased on their own, what happens to their coverage?

A: Not much, although all health plans now will be required to cover 100 percent of such preventive services as checkups, colonoscopies and mammograms.

The value of health benefits given to workers through an employer will remain untaxed, except for a 40 percent levy that starts in 2018 on high-cost health plans. The excise tax applies to the portion of the premium that exceeds $10,200 a year for individuals and $27,500 for families.

Q: How will health reform affect my children?

A: Unmarried adults younger than 26 can stay on their parents' insurance coverage as long as they are not offered health coverage at work. Currently, New York State law requires every insurer to allow employers the opportunity to elect extended coverage for dependent children to age 29 under a group health insurance policy.

Young adults also will have the option of buying catastrophic insurance that kicks in after they pay $5,950 of their annual health expenses.

Q: What will happen to my insurance premiums?

A: This is a hotly debated issue about the future without a definitive answer. However, the nonpartisan Congressional Budget Office, which analyzed the health reform proposals, determined that reform would reduce premiums for most Americans. It also concluded that providing subsidies to buy private insurance would encourage individuals to purchase more comprehensive -- and expensive -- insurance than they can currently afford.

In addition, there is a cost to doing nothing. Experts say insurance premiums, without health reform, are projected to rise at an unsustainable rate, leaving more people uninsured, driving out-of-pocket expenses higher and slowing the growth of incomes.

Q: It seems as though many of the key reforms take effect in 2014 and after. What are some of the provisions that happen sooner?

A: Health insurers will be barred from imposing lifetime caps on coverage; individuals with serious health conditions that have prevented them from obtaining coverage will be eligible to purchase a policy from a high-risk pool; health plans will be prohibited from denying coverage to children with pre-existing conditions; and health plans will be prevented from dropping people from coverage when they get sick.

Q: I'm worried about the cost of health reform. Does it include any cost controls other than the tax on high-priced plans?

A: One of the provisions of the act that gets little attention but that may have a big influence in the future is the creation of an independent Medicare commission with the authority to recommend changes in Medicare payment policies.

Proponents say such a commission would reduce political influence, bring more expertise into the decision-making process and do a better job of controlling the growth of Medicare spending.

But there are critics. Among other things they worry that a commission will increase what seniors pay for Medicare, reduce what hospitals and doctors receive for services or propose policies that limit care in certain circumstances.

Q: Are there sleeper provisions in the law that deserve more attention?

A: Yes, and here are a few:

* Drug and medical device manufacturers will be required to disclose their financial relationships with physicians and teaching hospitals.

* Hospitals and doctors will be encouraged to restructure financial arrangements to reward the quality of care instead of the quantity of services provided.

* The bill increases Medicare payment rates by 10 percent to doctors who provide basic medical care, provides $1.5 billion for the National Health Service Corps to get more primary care providers in areas where there are doctor shortages and offers new investments in training programs to produce more primary care doctors and nurses.

* Health insurers must report how much they spend on medical care versus administrative costs and, in future years, accept tighter government review of premium increases.

* Payments and penalties to hospitals will be linked to quality outcomes, including hospital-acquired infections and readmissions for conditions that should be prevented.

* The Community Living Assistance Services and Supports Act inside the health reform law would establish a national insurance program to allow voluntary prefinancing of long-term care through payroll deductions.

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>"What I worry about is the cost. Will it cost a lot like the critics say or will the plan control costs ...?"

Kathryn Regan Eskew is an associate professor of human services and rehabilitation services at Hilbert College in Hamburg. She, her husband and three children have health insurance provided through the school, although they pay for a portion of the coverage.

"The health reform law that the President signed is not an ideal plan, but it's a pretty good start. It's important we make some changes, especially expanding coverage to more people who don't have insurance.

"The plan covers young kids to age 26, and I'm glad about that. We have that benefit already in New York. But with two children in college and one preparing to go next year, I can see how much it will help others.

"Insurance companies won't be able to avoid people with pre-existing medical conditions. That's a good thing. We've had personal experiences with pre-existing conditions -- a niece, now in college, who had cancer as a child. Her parents had to battle constantly to get her the right kind of services and treatment. People in a medical crisis shouldn't have to be going through a battle with an insurance company.

"What I worry about is the cost. Will it cost a lot like the critics say or will the plan control costs like its advocates say? I don't know the truth.

"Everyone has to watch their pennies, even the government. On the other hand, I also tell myself that we're going to have debt whether or not we have health reform. We waste billions of dollars in this country on silly things, and this is something that will really help people.

"For me, I have insurance, but health reform just seems like the right thing to do. I think about my students and how it will be huge for them. When they leave college, they will be able to find insurance and manage the cost of it."

-- Henry L. Davis

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