How Health Reform would affect
Brian: disabled and uninsured
Brian, 39, was recently in an accident that left him disabled. Unable to work, he lost his employer coverage. Income: $16,000 a year from disability insurance. Currently applying for Medicare health coverage for the disabled, but it takes two years before coverage kicks in. Brian makes too much to get Medicaid coverage now.
Under the Proposed Health Reform Bills:
CHOICES
- Brian will receive substantial help, but his choices differ depending on the proposal.
- Under one bill, Brian could enroll in a broadened Medicaid program. This coverage would be more comprehensive than the Medicare he is waiting for.
- Under the other bill (where he is ineligible for Medicaid), Brian could buy coverage in the new health insurance exchange. This coverage may be more comprehensive than the coverage he is waiting to get in Medicare. Once eligible for Medicare, however, Brian will no longer be eligible for coverage in the exchange. Brian also has the option of buying health insurance outside the exchange but he won’t get any premium credits to purchase it.
- Insurers may not deny coverage to people with pre-existing conditions or charge them a different amount, even for policies sold outside the exchange.
- Brian must have coverage unless he can show he can’t afford it.
COSTS
- With Medicaid coverage, Brian would have no or only small co-pays for drugs and doctor visits. He'd likely pay little to no premium. Medicaid would be cheaper than the coverage he’s waiting for under Medicare.
- Under the other proposal, Brian would get substantial help paying for his coverage in the exchange. He would be expected to pay less than 4% of his income for his premium (less than $300 a year). His costs for medical services would also be affordable.
DIFFERENCES
House bill (H.R. 3962, passed November 7, 2009):
- Brian would now qualify for Medicaid because he makes less than $16,250 per year. (Larger families can make more and still qualify.) Because he is eligible for Medicaid, Brian doesn't qualify for premium credits to buy coverage in the exchange.
- Individuals couldn't buy coverage outside the insurance exchange.
Senate bill(H.R. 3590, passed December 24, 2009):
- Brian wouldn't qualify for Medicaid because individuals can make no more than $14,500 per year.
- At his income, Brian would qualify for premium credits to help purchase coverage in the exchange.
- Brian would have the option of buying a policy outside of the exchange. He could not get premium credits to help pay for this coverage.