Simplifying the Health Care Reform Act
By Mandy Kendall
I recently decided to immerse myself into finding out more about the Health Care Reform that comes into effect next year. Working on the premise that there is “no such thing as too much information” I decided to pass on the facts and recommendations that I discovered.
Here are some of the key points:
• Health insurance rates can no longer be based on risk, and can only be based on age, residency, and tobacco use.
• You cannot be denied coverage, have coverage excluded for a specific condition, or be charged higher premiums due to health history.
• Insurance companies will no longer be allowed to set lifetime limits on an individual’s medical bills so people will no longer get into debt when the coverage runs out.
As of Jan. 1, 2014, all individual and small business health plans must offer a comprehensive package of benefits that includes: emergency services, hospitalizations, laboratory services, maternity care, mental health and substance abuse treatment, outpatient care, pediatric care, prescription drugs, preventative care vision and dental care for children.
Some statistics:
• Nearly 50 percent of the 850,000 of U.S. physicians are over the age of 50.
• There are 51.8 percent fewer medical students going into primary care since 1997.
• There will be approximately $718 billion in cuts in reimbursement for Medicare.
• The Association of American Medical Colleges predicts a shortage of nearly 40,000 primary care physicians by 2020.
• 32 million Americans expected to be newly insured over the next decade.
• Medicare enrollment is growing at a rate of 10,000 per day.
• Result – Fewer Doctors + more patients = longer wait times.
Considerations — Thinking of canceling your insurance? Be aware that there will be penalties for not having insurance. “If someone can afford it, but doesn’t have health insurance coverage in 2014, they may have to pay a fee. They must also pay for all of their care.” (Healthcare.gov)
Recommendations — If you have a grandfathered plan, keep it. All plans purchased after March 23, 2010, are non-grandfathered plans and must change.
Agencies are advising people to act now to avoid reform related premium increases for as long as possible.
Lock in a new premium based upon current rates and members ages to keep through 2014
Subsidies will be available and you can determine if you are eligible online at the Kaiser Family Foundation (www.kff.org).
There are ways to offset increased costs through a Health Reimbursement Arrangement (HRA).
Contact a licensed insurance agent as soon as possible who can help navigate you through these very complicated new rules and regulations.
Look into telemedicine or concierge medical services to reduce wait times and increase your chance of getting an appointment with your doctor when you need it.
More information can be found online. This site provides useful information about insurance options available to you and changes created by health-care reform.
Kaiser Family Foundation has info online.
This site has in-depth information on key health policy issues, plus interactive tools to determine how health-care reform will impact you. It also provides information about the exchange in your state.
Consumer Reports offers a range of resources from understanding health insurance and reform to help navigating Medicaid and Medicare to advice on maximizing your insurance options.
Mandy Kendall operates Health Connective in South Lake Tahoe, which aligns wellness seekers with their ideal wellness provider. If you have questions, would like some advice, or would like to request some Qwik-e tips on any health and well-being topic, drop her an email at connect@healthconnective.com or keep an eye out on Lake Tahoe News for regular Qwik-e tips on how to make healthy changes one Quick and Easy step at a time.




I was under the impression that Kaiser was unavailable up here in Tahoe; outside the distance allowed. Did that change with obamacare too?
Yes, the insurance companies can’t charge more now based on people being higher risk. So consequently EVERYBODY must pay more to cover those high risk people. The insurance companies can’t lose money and survive. It’s basic economics. But government doesn’t understand basic economics, does it?
We had to do something about the completely failed healthcare system and the Affordable Care Act was the best we could do thanks to the idiot teabaggers obstruction. Hopefully we will have a few states successfully put single payer into play and we can eventually join the rest of the industrialized world with universal care. That’s the solution.
Dogula, Kaiser Family foundation is not the same as Kaiser Permante.
As for insurance company premiums the buyer always pays based on the risks of others. Ditto for when we buy from Wal-mart. We pay for those that steal. If we aren’t affected by crime then why should we pay for the police. If we have no enemies why do we pay for our military.
We all have selfish traits. But I would suggest we insured shouldn’t feel all smug about it. We quickly find out how good our insurance is when we get sick. Right now I suggest ‘Don’t get sick in America’. It isn’t pretty.
I used to live in Massachusetts and “Obamacare” has been working very well there for years and will in any other state that is willing. The cost of the “high risk” patients is offset by the “low risk” (young & healthy) being forced to buy into the program. This program is a blessing to hard working middle & lower class families. If you’re against it, you’re making that desisicon from a place of partisan ignorance. Get out of the way and time will prove me right.
If you believe it is just to FORCE people to purchase something they don’t want, or necessarily need, then bully for you.
I’ve been buying insurance for 25 years. It’s always been expensive, but it was less expensive and I had more options before government started legislating what the insurance companies must cover. We used to be able to pick and choose.
As for poor people not having been able to afford insurance in the past, well, there has been Medi-Cal and Medi-caid for years. There are some really good voluntary charities out there too. Yeah, it ain’t perfect. I don’t think this new system will be much of an improvement on the government programs. And a LOT of people who claim they couldn’t afford insurance before are full of it. I had friends who never bought it because they couldn’t afford it. But they managed to go on vacations to Mexico and Hawaii several times a year, and eat dinner out most nights. A LOT of what people can afford depends on priorities. When government takes from one person to give to another, it’s theft, no matter how you want to spin it.
But I really didn’t mean to go off on this tangent. My initial quest was an actual question, which was kindly answered by Don. As usual, lilpeter had to start with the animosity.
Thanks Mandy- good info. I look forward to looking into it more.
Dogula-If you believe that the majority of middle class Americans have animosity towards the teabaggers obstruction of healthcare reform and our recovery from the reagonomics recession you would be correct-for once.
Dogula, the issue is simple. Everyone in America has emergency health insurance. Nobody is getting left on the side of the road after an accident if they don’t have health insurance. Finally those people have to actually pay for the emergency health insurance they already receive for free. So saying they are paying for something they don’t want and don’t need completely misses the point. People that do not pay for health insurance are in fact receiving the service for free. That is theft.
Anyone that claims that going to the ER is proper healthcare for the poor, or that it is somehow free for those that can’t afford an insurance policy because of slave wages, are huge lies.
One trip to the ER can be economically devastating for a person’s credit and most bankruptcies are from med. bills such as these that can devastate people that actually work and have insurance.
Don’t believe any of the for profit funded BS about the ACA. Take the quiz about the healthcare act in the Kaiser link that Mandy has provided in this article to debunk some of their nonsense.