With President Barack Obama due to sign the last piece of a sweeping new health care law today, many of us are still scratching our heads. What just happened? How and when will we start feeling its effect?

In the long term, the legislation will require most Americans to obtain health insurance.

Although the biggest changes will not take effect until 2014, some provisions will begin as early as June, while others will kick in by the end of the year. The controversy surrounding one of those provisions dimmed Monday, when health insurers agreed not to oppose Obama's insistence that requirements to insure children with pre-existing conditions begin this year.

Here are answers to some questions about the health care changes coming within the next year.

Q) I don't have health insurance. How soon will the new law help me?

A) The answer depends on your age and reasons for not having insurance. If you haven't had insurance for six months, and you can't afford or don't qualify for insurance because of a pre-existing medical problem, you may be eligible for a new federal "high risk" pool to be offered by the end of June.

The cost of the monthly premiums hasn't been announced, but the rates are to be based on a "standard population," suggesting they will be based on a healthier group than typically used to calculate premiums for high-risk plans. On average, an enrollee won't pay more than 35 percent of covered benefits, and annual out-of-pocket costs won't be more than $5,950 for individuals and $11,900 for families. In addition, there are no lifetime limits -- meaning the policy won't be canceled if someone requires expensive medical treatment

Q) How many people can sign up for the new plan?

A) Until national health officials specify the premium costs and exactly what will or will not be covered, nobody knows how many people can sign up. The $5 billion set aside by Congress must last until 2014, when other options become available. By comparison, 35 states already spend a combined total of $2 billion annually on high-risk insurance pools that cover 200,000 people.

Q) How will the law affect children with pre-existing conditions?

A) Beginning in September, the new law is expected to stop insurance companies from rejecting children or excluding coverage because of pre-existing medical problems. That's what happened to Diane Knight, 52, of Orem, Utah, when she tried to get health insurance for her 17-year-old daughter.

Although Knight and her husband had family insurance in the past, they lost it when they left their jobs to start a small business. When they discovered that they were unable to get new insurance because both had a past cancer diagnosis, they sought an individual policy just for their daughter. But she was rejected, too, because she had used expensive prescription acne cream when she was younger and the insurance company did not want to pay for that in the future.

"To deny a perfectly healthy 17-year-old girl, and then for the rest of her life she has to say, 'Yes I've been denied health insurance' -- that's unacceptable," said Diane Knight, who returned to teaching public school to obtain insurance for her family. "I'm a conservative Republican, but I have lived the nightmare of health insurance."

Q) Will Medicare recipients receive any immediate benefits?

A) This year Medicare recipients with high drug costs will get a rebate of up to $250. In 2011, the plan will pick up a larger share of brand-name drug costs. In addition, Medicare recipients won't be charged co-pays or deductibles for preventive care like immunizations and cholesterol screening.

The drug rebate is the first step in a 10-year plan to close the "doughnut hole," the gap that occurs because Medicare Part D stops reimbursing for prescriptions after the first $2,830 in costs a year. The retiree must then pay all drug costs until they reach $6,440, at which point Part D pays again.

Rosale Bertrand, a 69-year-old Medicare recipient in Salt Lake City, says that early in the year, her 10 prescriptions for diabetes, high blood pressure, asthma, ulcers and chronic depression cost her about $200 a month because Part D covers much of the cost. But the doughnut hole starts in late March or April, and she must spend $600 a month until Part D kicks in again in the fall, she said.

To maintain her prescriptions, Bertrand has twice borrowed against her home and has maxed out her credit cards. Under the new law, she will save about $250 this year and about $540 next year. "It's a start," she said. "I was very relieved anything good could come out of it."

By Tara Parker-Pope

New York Times
Posted: 03/29/2010 07:31:58 PM PDT
Updated: 03/29/2010 10:27:05 PM PDT