Health Care Reform: Your Frequently Asked Questions

As we continue implementing the newly enacted health care reform law, I want to make sure Washington individuals, families, and businesses understand how the law will impact their care and coverage.  I appreciate that some of these changes can be confusing and folks are dealing with a variety of health situations, so I'd like to hear your questions and provide you with timely answers.  Head over to my contact page, and send me your questions about this landmark legislation.  Be sure to select 'Health Care FAQ' as the topic of your question.  I will post the most frequently asked questions below as they come in, so be sure to check back.

As we continue implementing The Patient Protection and Affordable Care Act (PPACA), new provisions will be come into effect that result in lower health care costs, increased access to care, and more affordable insurance options.  As this happens, you will probably have more questions and I will work to provide you with the answers you need.  You can also turn to the new website HealthCare.gov for answers and more affordable health care options.  I am enthusiastic about the ability of this law to increase health care quality and affordability and look forward to keeping you up-to-date on how it will benefit you and your family.

Best,

I’ve heard that the health care law is going to take effect at the end of September.  Is this true? 

September 23, 2010, marks six months since the new health care law was signed by President Barack Obama.  Several provisions in the law took effect on that date then, including the following:

• Eliminating Pre-Existing Condition Exclusions for Children: Bars health insurance companies from placing pre-existing condition exclusions on coverage for children through age 18 for any new plans.
• Extending Coverage to Young Adults: Plans that provide dependent coverage to children must now make that coverage available until the child turns age 26.  This provision could allow up to 20,500 Washington youths to retain coverage through their parents’ health insurance.
• Abolishing Lifetime Limits: Prohibits insurance companies from imposing lifetime limits on benefits so that the 3.8 million Washington residents with private insurance coverage will never have to worry about their coverage running out.
• Covering Preventive Health Services:  All new plans must provide FREE coverage for over 100 preventive services, including mammograms for women over age 40, screenings for colorectal cancer for those over age 50, depression, smoking cessation programs, and autism for children age 18 months to 24 months.  879,000 Medicare beneficiaries in Washington will also now receive free preventative services and other benefits.
• Improving the Appeals Process: Requires that new group or individual health plans offer an effective process for appealing coverage decisions, such as refusals to cover procedures partially or at all. Consumers first file an internal appeal with their insurers, but if they are not satisfied they can appeal to an impartial reviewer. 
• Prohibiting Rescissions: Prohibits the abusive practice whereby health insurance companies rescind existing health insurance policies when a person gets sick as a way of avoiding covering the costs of enrollees’ health care needs.  Under this provision, 3.8 million Washingtonians are now protected from rescissions.
• Enhancing Ability to Choose Your Own Doctor: Expands consumer choice by ending the insurance company practice of limiting a consumer’s ability to choose a doctor in her own insurer network. 
• Ending Restrictions on Emergency Room Care: For new plans, consumers can no longer be charged more for emergency services obtained out-of-network. 

Provisions of the law will continue to come into effect into 2014.  For more information, please visit this timeline, which shows exactly when each part of the PPACA will be taking effect. 

When does the health care reform law come into effect?
President Obama signed the Patient Protection and Affordable Care Act into law on March 30, 2010.  Key parts of the historic reform bill have already taken effect:

• Pre-Existing Condition Plans (PCIP) are now available for individuals who do not have insurance due to a pre-existing condition. 
• The first $250 rebate checks were mailed in June for seniors who hit the “donut hole” in their prescription drug coverage. 
• The website HealthCare.gov was launched on July 1, 2010, to bring unprecedented transparency to the health care industry. 

Parts of the PPACA will continue taking effect over the next four years, with the biggest changes happening in 2014.  For more information, please visit this timeline, which shows exactly when each part of the PPACA will be taking effect. 

How will the new health care law impact Washington state’s Basic Health Plan? 

Maria authored a key provision that will enable states to set up their own BHPs, like Washington’s innovative BHP, instead of setting up state exchanges.  The BHP is a federally-funded program that empowers states to negotiate with private-sector insurance providers for the lowest possible rates – much the way large private-sector companies do now in obtaining lower rates for their large work forces. By giving states the ability to negotiate directly with private plans, states can provide individuals and families who do not have employer-provided insurance with access to more affordable, higher quality coverage choices.  Because states negotiate directly with private insurers, administrative and other costs are lowered, resulting in lower costs to the consumers. The BHP provides essential benefits and includes preventive care like diabetes education.  Washington’s BHP saves enrollees 30-40% off the cost of individual insurance coverage. BHP programs would be available to individuals and families who do not qualify for Medicaid and with incomes up to 200% of the poverty level, covering a large portion of today’s uninsured population.

Maria has also championed the state’s eligibility to receive an 1115 waiver, which will allow the state to receive federal funding to cover those BHP enrollees up to 133% of the poverty level.  This could help ensure the long-term fiscal viability of the Washington’s BHP, with the state potentially receiving up to $300 million for year 2011-2013.  Learn more here.

I heard a rumor that next year my W-2 form will include my health insurance, meaning the cost of my insurance will be considered income and my taxes will go up.  Is this true?

Current tax law explicitly states that health insurance cannot be considered taxable income. Health care reform did nothing to change this, and health insurance will not be considered taxable income in the future.

Beginning in tax year 2011, employers will be required to report the cost of health insurance they provide their employees on W-2 forms.  Employees will see this value on the W-2s they receive in 2012, BUT it will not be added to an employee’s gross income and therefore cannot be considered taxable income. Reporting the cost of health insurance on W-2 forms will help the IRS keep track of which individuals have health insurance through their employer, and whether they have health insurance for themselves and dependents.