Late on Sunday night (later than I wanted to stay up, anyway) the House passed both the Senate healthcare reform legislation and the House bundle of fixes. The entire package is on its way to Obama’s desk for signature. So what now? Brace yourself …

… for a whole lot of very little. If you are in the largest group of un- or under-insured folks, you’ll find the result of the last year+ of healthcare drama to be pretty anticlimactic. Don’t get me wrong: the bill isn’t just the emperor’s new clothes. But for years to come it will resemble a very skimpy bikini. Until 2014, here is what different demographics can expect:

• Seniors: will notice their doughnut hole prescription drug bill decreasing, in the form of a $250 rebate this year and a 50% reduction in doughnut hole drug prices next year.
• The 26-and-Under Set: will be eligible to remain on their parents’ plan if their parents have one, although insurers can still reject them if they have pre-existing conditions they don’t want to cover.
• Those with Low $ Maximum Benefits: will find their benefit ceiling rise annually, and disappear on a lifetime basis.
• Those Racking up Expensive Claims on Individual Plans: will theoretically be protected from having their coverage rescinded. But remember, insurers can still use “fraud” as a valid excuse. As in: your doctor never told you he wrote “watch for hypertension” in your chart? Too bad, not reporting your unknown budding heart disease on your insurance application is fraud.
• The Uninsurable: can sign up for high-risk pools, if they have gone bare for 6 months, and if they want to pay for coverage  that will exclude the pre-existing conditions they need treated for 12 months. Then, 18 months later, some real coverage will kick in.
• Insurers Themselves: must now report their Medical Loss Ratio, i.e. how much premium money they actually spend on medical claims.
• Small Businesses: for those small businesses (<25 employees) still somehow affording the ridiculous cost of small group health coverage for their employees (average wages <$50k), they can qualify for a tax credit of up to 35% of the premium cost.

As you can see, there are a lot of “ifs” scattered throughout the immediately effective healthcare reform provisions. That’s a clue as to the degree of real reform in the bills. If none of the above apply to you, you’ll have to wait until 2014 to see more substance from the historic passage of US healthcare market reform. If we’re lucky, the next President will use it as a springboard to genuine healthcare reform, creating an effective US healthcare system. Stay tuned.

Photo credit: Crystl

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