Understanding the health care overhaul

Associated Press | 12/2/2009, 2:25 a.m.

“The people who are going to do best are older people with a problematic medical history,” said health policy expert Paul Ginsburg, of the Center for Studying Health System Change.

Q: These bills are going to ban pre-existing conditions, right?

A: Yes, but not immediately.

Both bills would forbid insurers from denying coverage to people in poor health or charging them more. That would happen in 2013 under the House bill, and 2014 in the Senate’s.

The reason for the delay is that it would be unfair to require insurers to take all applicants right away. The sick would sign up, but healthy people would probably wait until they faced the threat of government fines. Such a situation could raise premiums for everyone.

Q: So if I have a health care problem, I might still have to wait three years to four years for coverage?

A: At Obama’s request, lawmakers tried to take care of that by setting aside $5 billion for temporary “high-risk” insurance pools to provide affordable coverage for people whose health is frail.

But there’s a problem with the patch.

According to the Congressional Budget Office, the money would run out in 2011 unless Congress pumps in more cash.

Q: Older people are concerned about what’s going to happen to Medicare. Should they be?

A: Even though cuts in Medicare payments to hospitals and other providers are paying for much of the cost of covering the uninsured, benefits under traditional Medicare aren’t reduced.

But those who’ve signed up for private insurance plans through Medicare Advantage could lose valuable extra benefits, according to the budget office.

For years, the government has been paying the private plans more than it costs traditional Medicare to deliver similar services. The plans used the money to provide extra benefits _ mainly lower copayments and deductibles.

Both bills offer cheaper prescription drugs to those who fall into the “doughnut hole,” the Medicare coverage gap. The House bill gradually would eliminate the gap. Both bills also provide better coverage for preventive care.

(Associated Press)