How Health Reform would affect
Frank: high-deductible insurance through his job
Frank, 57, has insurance but struggles to get care for his high cholesterol. Every year he must pay out-of-pocket until he meets his $1,500 deductible, and he has difficulty finding doctors who will take his coverage. Income: $35,000.
Under the Proposed Health Reform Bills:
CHOICES
- Frank could keep his coverage through his job. Frank’s employer is likely to continue offering health coverage to employees and contribute toward his premium.
- Or, Frank could get coverage on his own through a new health insurance “store” or exchange with a variety of choices -- an important safety net should Frank lose his employer coverage.
- Reforms include provisions to increase the number of primary care providers, which could make it easier for Frank to find a doctor.
COSTS
- If Frank continues insurance from his job, his costs may stay about the same.
- As long as his job offers him qualified coverage, Frank won’t qualify for premium credits to buy coverage in the exchange – making exchange coverage more expensive than the coverage through his employer. (Frank’s employer pays a large portion of the premium, so Frank’s share is far less than the total cost of the coverage.)
DIFFERENCES
House bill (H.R. 3962, passed November 7, 2009):
- All but the smallest employers would be required to offer health coverage to employees and contribute a certain amount towards the premium, or pay a penalty. This minimum contribution is set at 72.5% of the premium for single coverage, and 65% for family coverage.
- Eventually employers must offer coverage that meets minimum standards. However, high-deductible plans such as Frank’s could meet that standard.
Senate Bill (H.R. 3590, passed December 24, 2009):
- As is the case today, employers are not required to offer coverage to workers. However, if they have workers who purchase health insurance using the new premium credits, then the employer will have to pay into a fund that helps finance those tax credits. If they have workers who enroll in Medicaid coverage, no employer fee is assessed.
- No coverage standards are imposed on large employers, although if their plan they offer falls below a certain standard, their employees may become eligible for tax credits in the exchange and the employer may be liable for the resulting penalty.