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THE UNINSURED

Q: If I don't have health insurance, will the health care reform law provide it?

A: Yes. It is expected to provide insurance to 32 million Americans who lack coverage.

Effective 2014, individuals and families will be eligible for Medicaid if their income is at or below 133 percent of the federal poverty level, or $14,404 for individuals and $29,326 for a family of four.

Also starting in 2014, the bill provides subsidies to buy private insurance for U.S. citizens and legal residents with incomes above the Medicaid thresholds but below 400 percent of poverty, or $43,320 for individuals and $88,200 for a family of four.

The subsidies would work on a sliding scale, with those who earn more getting less help than those who need assistance the most. In addition, for those with income below 400 percent of the poverty level, total out-of-pocket health expenses would be limited.

Q: Where will uninsured individuals buy coverage?

A: The government plans to establish on the Internet and elsewhere places called exchanges, where consumers can purchase and compare different policies, including quality ratings, from private insurance companies.

Insurers that sell policies on the exchanges will be required to offer a minimum set of standard benefits, with four levels of coverage that vary based on premiums, out-of-pocket costs and additional benefits.

The law gives states some flexibility in how the exchanges are set up. But it requires insurers to offer plans with standardized formats, definitions and enrollment applications.

A person could also buy insurance from companies outside the exchanges.

Q: I have had arguments with health insurance companies over coverage, including being denied a policy because of a pre-existing medical condition. Will any changes reform how insurers do business?

A: Reforms to the insurance industry are a key component of the new law.

All insurance plans will be prohibited from imposing lifetime caps on the amount of coverage, and there will be restrictions on annual limits on coverage. Insurers will no longer be able to cancel insurance except for cases of fraud. And insurers will have to sell policies to individuals regardless of their health history, with the price of premiums varying mainly on the basis of age and tobacco use, and not a person's medical condition.

Q: Does the law require everyone to have health insurance and, if so, why?

A: All individuals will be required to have insurance, with some financial hardship exceptions, beginning in 2014.

Here's the thinking behind this requirement: Without an individual mandate to purchase insurance, Americans could wait until they got sick to buy a policy, leading only sick people with the biggest bills to buy insurance and to even higher premiums.

Advocates of the individual mandate say that having everyone in the system spreads the risks, keeps the average cost of premiums under control and builds on the principle that all people -- young or old and healthy or sick -- eventually will need medical care.

Q: Is there a penalty if I don't have health insurance?

A: Most people who do not have coverage will be required to pay an annual financial penalty.

The penalty for individuals would start in 2014 at $95, or up to 1 percent of income, whichever is greater, and increase to $695, or 2.5 percent of income, by 2016. Families have a penalty limit of $2,085.

The law includes exemptions from the penalty for religious beliefs, native Americans, people who have been insured for less than three months, individuals and families with income below a certain level or if the least expensive insurance costs 8 percent of a person's income.

Q: Is there anything for the uninsured that takes effect right away?

A: Starting this year, the law appropriates $5 billion for a temporary national high-risk pool to help purchase coverage for people with a medical condition who have gone uninsured for more than six months. But it's not clear yet what share individuals would pay for the coverage.

Health reform also increases federal funding for community health centers -- $11 billion over the next five years -- allowing them to see more uninsured and poor patients.

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>"What worries me is the idea of mandating that uninsured people have insurance ..."

Tuona M. Batchelor is a graduate student in urban planning at the University at Buffalo. She became uninsured last fall when she turned 25 and was dropped from her mother's health insurance policy.

"Health insurance is something I've thought about since I was 18. That's when I wanted to take time off from school but was reluctant to do it, and one of the reasons was being without coverage.

"Being uninsured doesn't have a big effect on me at the moment. I stockpiled prescriptions for the things I need -- a medication I use for my eczema and another one for sinus infections -- that should last to the end of the year. The sinus drug would cost $70 without insurance, and that's a financial strain for a student.

"I'm hoping to find a job with health insurance, although with the economy the way it is, I don't know what will happen. I have friends who graduated last May from the program who are still looking for work.

"The day the health care bill was signed into law, the issue was all over Facebook. Some of my friends think it's great. Others think it's horrible. I'm not sure it's enough. Health care will still be expensive even with reform.

"What worries me, is the idea of mandating that uninsured people have insurance and the idea of penalizing them if they don't have it. I wonder if the coverage will be affordable enough.

"Just because the bill doesn't affect me today, it may be my source of insurance tomorrow.

"You know what else I like? My grandmother will get $250 for prescriptions for that Medicare doughnut hole. It's not a lot, but it's something she wasn't getting before."

-- Henry L. Davis

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