How Health Reform would affect
Mia: laid-off, can’t afford COBRA coverage
Mia, 56, is unemployed and uninsured. She couldn’t afford the COBRA premium after her layoff. Income: $20,000 from temp work. Her high blood pressure is a pre-existing condition, making it difficult to find an affordable policy.
Under the Proposed Health Reform Bills:
CHOICES
- Mia will be guaranteed access to an affordable policy through a new "store" called the health insurance exchange, which would offer a variety of plans including a public insurance plan option.
- Depending on the proposal, she could also buy coverage outside the exchange but without help to pay for 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.
- Mia would have to get coverage unless she can show she can’t afford it.
COSTS
- Because she makes far less than 400 percent of the Federal Poverty Level, Mia would get help paying for coverage purchased through the exchange. At her income, she would be expected to pay between 3% and 4.6% of her income for the premium (up to $900 a year).
- Mia's share of costs for medical services (co-pays and deductibles) would vary, depending on the proposal.
DIFFERENCES
House bill (H.R. 3962, passed November 7, 2009):
- Individuals couldn’t buy coverage outside the insurance exchange.
- The new national exchange would feature a new public insurance plan option, in addition to private options.
Senate bill (H.R. 3590, passed December 24, 2009):
- Mia would have the option of buying a policy outside of the exchange, but if she did, she could not get help (credits) paying for this coverage.
- 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.