Will I Be Able to Keep the Insurance I Now Have?

Probably not. Employers can drop your coverage altogether and pay a fine that costs as little as one-seventh the cost of insuring you and your family.

• Fourteen million employees will lose their employer plan, according to Medicare actuaries.
• Although some plans may avoid costly regulations because they are "grandfathered," up to 80% of
  small businesses won't be able to keep their current plan.
• Within three years, more than 100 million people will be forced into a health plan more costly and more regulated than the one they have today.

How Much Will My Health Insurance Cost?

Coverage in 2016 will average about $5,800 for an individual ($15,200 for a family
of four), according to the Congressional Budget Office.

In the government-regulated exchange, the out-of-pocket premium will be limited
to a percent of your income up to about $43,000 ($88,000 for a family
of four). If you earn more, you will have to pay the full premium yourself.

There will be no new subsidies if you get insurance at work, but your premium
may be limited to a percent of your income.

So, How Will My Employer or Health Insurer Know What My Income Is?

The government will require you to give your employer your most recent tax return, revealing your total family income -- including any nonwage income as well as your spouse's income.

What Benefits Can I Expect?

• Starting this year, all new health plans must provide mammograms,
  Pap smears and many other preventive services, with no copay
  or deductible.
• Starting in 2014, many people will get government subsidies to buy insurance they could not otherwise afford.
• If you have a pre-existing condition, you will be able to buy insurance for the same premium people in good health pay.
• If you have a very expensive, chronic health problem, there will be no lifetime limits on your health insurance coverage.
• As many as 34 million people will become newly insured.

What Other Costs Can I Expect?

• More than half the costs of the reform will be paid for by reduced spending
  on the elderly and disabled on Medicare.
• There will be new taxes on drugs and on such medical devices as wheelchairs, crutches, pacemakers, artificial joints, etc.
• A 40% tax on the extra coverage provided by expensive "Cadillac" plans
  will apply to about one-third of all private health insurance in 2019, and it will eventually reach every health plan.
• Scores of other items will be taxed, ranging from tanning salons to the sale of
  your home, in some cases.

There are also hidden costs:

• Health insurers will have to raise premiums for everyone in order to charge those with
  pre-existing conditions less than the expected cost of their care.
• Most employers will have to reduce what they pay in wages and other benefits in order to afford the required coverage.
• The extra burden on employers could cost as many as 700,000 jobs by 2019.

How Will Government Enforce the Requirement to Buy Insurance?

The enforcer of health reform is the Internal Revenue Service.

Will I Be Able to See a Doctor?

With millions of newly insured people trying to obtain more care, Medicare actuaries predict that you may
not be able to see a doctor when you need help.

In Massachusetts, with a similar health reform:

• New patients in Boston wait an average of 63 days to see a family doctor.
• More people than ever are seeking care at hospital emergency rooms.

Another problem: Giving everyone all of the newly promised free preventive services would leave every family doctor in America with no time to do anything else that doctors do!

What If I Am on Medicare?

According to Medicare's chief actuary:

• Medicare Advantage members will lose $1,267 in Medicare payments in
  2014 -- resulting in lower benefits and higher premiums.
• One of every two Medicare Advantage members (7.4 million) will lose their
  plan entirely.
• One in seven hospitals may go out of business, and doctors may not take new patients because of cuts in their fees.

There are a number of new promised benefits, including:

• Medicare will pay for an annual checkup.
• Deductibles and copayments will be eliminated for many preventive services.
• If you are in the prescription drug "doughnut hole" and you are not getting other drug subsidies, you may qualify for a $250 rebate.
• Eventually (in 2019), the doughnut hole will be eliminated.

However, for each $1 in new benefits, there will be $10 in reduced Medicare spending. Also, there is no funding to make sure all the promised services will be available. If everyone on Medicare took advantage
of a free annual checkup, for example, we would need 23,000 extra doctors just to meet the demand.

How Will Medical Care Change?

Some insurers are already offering plans that keep premiums down by restricting which doctors you
can see.

Also, the new law encourages doctors to form Accountable Care Organizations (ACOs) -- a new type of
HMO that rewards doctors for meeting government guidelines. In an ACO:

• Doctors and nurses will practice in teams, and you will not necessarily see the same ones on each visit.
• You will not be allowed to get care from doctors outside of the ACO.
• Although care is supposed to be higher quality, the ACOs will get to keep any money they save
  by giving you fewer tests and services.