If you're feeling bewildered by the health care overhaul, you're not the only one.
As the dust settles over the controversial law, local insurance agents are busy figuring out what it means for them and their clients.
Wheaton-based insurance agent Karla Rockwell described the new health care law simply: "There's so many weeds, we can't see the crops," she said.That doesn't mean there aren't changes in the roughly 2,400-page Patient Protection and Affordable Care Bill and its companion bill, passed last week, she does like.
"I am in favor of mandates, of coverage for pre-existing conditions," she said. She favors the stricter rules concerning when an insurance company can rescind a policy, events she called "devastating."
What the complex changes do mean is that most insurance agents aren't entirely prepared to answer all your questions just yet. Rockwell and other members of her trade organization, the National Association of Health Underwriters, are getting constant updates on the new legislation. The complexity of the bills mean there's still room for interpretation before the laws are fully implemented, and, according to one Naperville insurance agent, a lot of "loopholes" that need closing.
"A lot of it is really detailed stuff," said Robert Slayton, of Robert Slayton & Associates. "Nobody's really read through the plan and is able to understand it."
Slayton said he's now spending more and more of his time with clients explaining what he knows so far.
"They're asking what's going to happen. The answer is, you're going to pay more money," said Slayton. Proponents of the plan say that while mandates may drive up insurance premiums, various tax credits are down the pipeline. And for those who are currently uninsurable, even a high premium will likely mean less money spent overall on health care costs. But there is one thing every agent in the industry can agree on."Companies will have more paperwork," Slayton said.
Employers will need to document how much is spent on health insurance, which will be included on an employee's W-2 forms each year. So even if it's unclear how the new laws will affect insurance agencies, accountants, both agents said, will be busier in the short term.
Aside from more complex record keeping, the biggest changes Naperville's small businesses will see are still a few years off. The so-called Cadillac Tax on high-cost plans begins in 2013. It's still unclear how many local people have these high-cost plans, but Rockwell said they're in demand in Naperville. "They have the money, they want those kinds of plans," she said. Many union plans, like those at nearby Caterpillar, also will be subject to Cadillac taxes.
But the biggest questions will come in 2014, when mandates for employers and individuals begin, and when state-run exchanges, Web-based marketplaces designed to help consumers shop for and buy policies, go online.
Until very recently, the exchanges were a concern for insurance agents, who only recently confirmed they would have access to the exchanges and would be able to purchase insurance for their clients on them. While it's unclear if fee structures for agents would change, both agents said they were sure their services will be in more demand as the laws get more complex. For most small business owners, health care costs determine how much a business can afford to grow.
"My biggest concern about moving forward is how it's going to affect the bottom line," said Mike Bakker, of Naperville-based Dutchman Heating and Cooling, one of Slayton's clients. His business is expanding and Bakker said he's planning to hire four new full-time employees, but said that if health care costs change dramatically, he "may hire more or less." As laws change, he said he'd be relying on Slayton for advice."As complexity gets higher, that's what people need more," Slayton said.
What you'll see this year
Most of the biggest changes to the nation's
health care system, including employer and individual
mandates, won't go into effect until 2014, but some changes
will begin throughout 2010.
Tax credits for small employers
Small businesses
with 25 or fewer employees will earn a tax credit, up to 50
percent of premiums paid for employee health insurance plans,
for two years, if the employer pays at least 50 percent of the
premium cost.
State insurance ombudsman programs
Federal grants
will pay for states to create or expand health insurance
ombudsman offices, where consumers can ask questions and file
complaints.
Therapeutic discovery tax credit
Businesses with 250
or fewer employees that make investments in disease research
in 2009 or 2010 can earn a tax credit.
High-risk pools
Within 90 days of the bill's enactment, people who cannot
buy individual insurance because of pre-existing conditions
will be able to purchase insurance through a national program
of high-risk pools.
Standardized state Web sites
States will be required
to develop Web sites for residents to find information on
sources of affordable insurance coverage, including Medicaid,
Children's Health Insurance Program, and the high-risk pool
program.
Tanning taxes
Customers at indoor tanning salons
will be charged a 10 percent excise tax.
Limits to salary-based coverage
Companies will be
prohibited from discriminating in favor of highly paid
employees in group health care plans.
Elimination of lifetime benefit limits
Insurance
companies will no longer be able to impose lifetime limits on
the dollar amount of benefits.
Changes to annual benefit limits
Insurance companies
can no longer place annual limits on essential benefits.
Nonessential benefits, defined by the Department of Health and
Human Services, are still subject to annual limits.
Increased dependent coverage
The age of dependents
will be increased to 26, beginning in September.
Limits on rescinding policies
Insurance companies
will no longer be able to retroactively rescind health care
coverage, except in cases of fraud. Companies are now required
to provide notice prior to canceling policies.
Preventative care coverage
Plans will be required to include preventative care,
including immunizations and screenings for childhood diseases
and breast cancer, without a co-pay for the service. It is
unclear if associated doctor visits would still be subject to
a co-pay.
Appeals processes
Plans will be required to have an
appeals process for claims.
Coverage for children with pre-existing conditions
Beginning in September, health plans will be required to cover
pre-existing conditions for children 19 and younger.
Grants for employer wellness programs
Federal
funding will pay for $200 million in grants to small
employer-based wellness programs.