How Health Reform would affect
Bernie & Elise: can’t start a business due to health coverage
Bernie, 35, would love to quit his construction job (income: $65,000) and start a home building business. But wife, Elise, has diabetes. Bernie fears they won’t get affordable health coverage on their own, so they’ve put off their dream to keep his employer-offered coverage.
Under the Proposed Health Reform Bills:
CHOICES
- Bernie and Elise could reconsider their dream due to new health coverage options. They can shop for insurance in a new "store" called the health insurance exchange where they would have a choice of plans.
- They couldn’t be denied coverage due to a pre-existing condition like diabetes. Insurers couldn’t charge higher premiums for such conditions.
- Policies offered in the exchange will cover diabetes tests, supplies and other treatments that Elise needs, with no unexpected gaps in covered benefits.
COSTS
- If Bernie and Elise start their own business, they may qualify for help paying for coverage (as individuals) through the exchange, depending on how much income they make.
- If they employ others, they also might qualify for new tax credits for small businesses who cover their employees (see below), but they wouldn’t be allowed to “double dip” and get both the individual and business credits.
- The couple may see annual premium increases moderate over time as insurance plans compete for customers in the exchange.
DIFFERENCES
House Bill (H.R. 3962, passed November 7, 2009):
- The new national exchange would feature a new public insurance plan option, in addition to private options.
- Small firms must have fewer than 25 employees and an average salary of under $40,000 to qualify for the new small business tax credits.
Senate Bill (H.R. 3590, passed December 24, 2009):
- The new state-based exchanges would feature new “multi-state” plan options – new, national private insurance plans regulated by a federal agency, at least one of which would be a non-profit plan.
- Small firms must have fewer than 25 employees and an average salary of under $50,000 to qualify for the new small business tax credits.