Opinion: What's in Health Insurance Reform for You

(March 29) -- In a letter to President Barack Obama before he died, Sen. Ted Kennedy wrote that access to health care was "the great unfinished business of our society." It was, until now.

The House and the Senate have joined the president in taking historic action on health care. The new law ensures affordability for the middle class, accessibility for 32 million more people and accountability for the insurance industry, ending discrimination based on pre-existing conditions or illness and the capping limits on what they will cover. It puts American families and small-business owners -- not the insurance companies -- in control of their own health care.

And on Tuesday, the president will sign the "reconciliation" fixes into law, making health care more affordable. The law will have more equity for the states by removing the Nebraska arrangement. It holds insurance companies more accountable by improving the reforms that were in the original legislation, makes the bill more fair to the middle class and closes the prescription drug "donut hole" for seniors.

So what's in it for you? While it will take time to implement all the reforms in the legislation and establish the health exchanges where you can buy your own insurance in a competitive marketplace, here are just some of the ways the bill will help you this year:

If you are a small-business owner, you are likely to get a tax credit of up to 35 percent of the employer contribution toward premiums if you choose to cover your employees (this scales up to 50 percent in 2014).

If you are a senior and hit the prescription drug "donut hole," you will get a $250 rebate check this year. You will also receive free preventive and wellness visits to your doctors. And, as the AARP said in its letter of support for our bill, the legislation "improves efforts to crack down on fraud and waste in Medicare, strengthening the program for today's seniors and future generations."

If you have private health insurance, you will no longer have lifetime limits on what insurance companies will pay, and annual limits will be tightly regulated. You can't be dropped from coverage if you get sick, you'll have free preventive care under new plans, you can't be discriminated against based on your salary and your children can't be denied coverage for having a pre-existing condition.

In addition, a new independent appeals process will be set up, ensuring that consumers in new plans will have access to an effective internal and external appeals process to challenge decisions by the insurance companies. And starting on Jan. 1, 2011, health plans will have to put more of your premium dollars into your care and less into profits and CEO pay (80 percent to 85 percent of your premium dollars must be spent on medical services, and if your insurer doesn't meet that threshold, you'll get a rebate).

If you don't have health insurance and can't get it because you have a pre-existing condition, in less than three months you'll have access to a high-risk pool with affordable premiums until the exchanges are up and running, when all health plans will be banned from discriminating against people with pre-existing conditions.

If you are a young American, you can now stay on your parents' insurance policy until your 26th birthday, unless you're offered coverage through your job.

The present system of health care in America was unsustainable. I have heard from families who had to choose between buying groceries or seeing a doctor, and from those who were refused coverage because their child had a pre-existing condition.

I met with a senior in Michigan whose wife had been sick for 16 years. He didn't know how he would pay the medical bills, and he worried he might lose his house because of the cost of care.

Americans shouldn't face financial ruin because a loved one is sick. And no American should lose a loved one because they don't have health insurance. Yet every year, 45,000 families have. Those days are over.

Failure to act would have meant continued double-digit premium increases for American families and huge increases in the federal deficit. Instead, health care reform strengthens America's family budgets and the federal budget, saving the taxpayer $1.3 trillion over the next 20 years.

Health care is about opportunity. We will soon realize an economy where Americans have more freedom to follow their talents and their aspirations; we will have an economy that encourages an entrepreneurial spirit. Americans will be able to change jobs or start a small business without worrying about health insurance. And this legislation will create 4 million jobs over the life of the bill, hundreds of thousands almost immediately.

Health care reform marks a remarkable step forward for our nation. Others who came before us gave our nation Social Security and Medicare. Now, we have added health care as a right, not a privilege. And when we did, we not only made history, we made progress for the American people.

Nancy Pelosi, D-Calif., is the speaker of the House of Representatives.
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ANOTHER VIEW: We need to repeal this jobs-killing government takeover of health care and enact real reforms that will lower health care costs and help small businesses get back to creating jobs, says House Republican leader John Boehner, R-Ohio.

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