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Questions about new health care law answered

Understanding the impact of the more than 2,000-page federal health care overhaul that completed its last legislative hurdle Thursday is daunting.

Federal and state governments and health insurers must still figure out how some programs - such as insurance exchanges - will be set up. Many requirements are being phased in over a period of years.

And some may not affect New Yorkers, because the state already has similar laws on the books. For instance, the new federal legislation bars insurers from excluding people from getting health insurance because of pre-existing conditions, but that has been banned in New York since the early 1990s.

"These issues need to be sorted out," said state Insurance Department spokesman Ron Klug. "We're studying it and we need to look at the regulations the federal government is going to hand down."

Here are a few answers to questions Newsday readers called in or e-mailed to us.

Will insurance premiums go up in New York?

Health insurers said yes. Robert Zirkelbach of America's Health Insurance Plans, a national trade group, predicted they will go up but not as much as in other states.

Leslie Moran of the New York Health Plan Association, a state trade group, said that New Yorkers might even fare worse than other states. "It's all a big question mark - and a concern," she said.

Nationally, the Congressional Budget Office predicted premiums for those who buy individual health plans will go up 10 percent to 13 percent by 2016 because of the legislation. For employer-based plans, which about 60 percent of Americans have, premiums will go up much less - or even down - as a result of the new law, the CBO predicted.

In New York, premiums are already high. That's because the state already requires health insurers to allow anyone to get health insurance regardless of pre-existing conditions. Yet it hasn't required everyone - including healthy people - to have health insurance. That is what the federal law now will do, and that is what it is hoped will help push premiums down.

But Zirkelbach and Moran said increased medical costs and taxes on insurers will keep premiums in New York from actually going down and might push them even higher.

I don't have health insurance. Where do I sign up?

In 2014, the states will open up health insurance exchanges for individuals and small businesses that will let people comparison shop for insurance.

What happens to the uninsured with health problems until 2014?

Within three months, the government will set up a temporary national high-risk pool for people with pre-existing medical conditions who have been uninsured for at least six months. This year, the maximum cost of the insurance will be $5,950 for an individual and $11,900 for a family.

To put that into perspective: According to the Kaiser Family Foundation, the average annual premiums for employer-sponsored health insurance in 2009 was $4,824 for single coverage and $13,375 for family coverage.

What if I am uninsured and healthy?

You can buy private health insurance or wait until 2014 when state-based insurance marketplaces will be set up.

What if I can't afford a health plan?

Medicaid, government health insurance for the low income and disabled, is being expanded beginning in 2014. Adults would be eligible if their incomes don't exceed $14,404 for individuals and $29,326 for a family of four.

What happens if I don't buy health insurance? Will I go to jail?

By 2014, most Americans have to have insurance or pay a fine. The penalty would start at $95 for an individual or $285 for a family, up to 1 percent of income, whichever is greater. By 2016, that would rise to $695 for an individual, $2,085 for a family, or up to 2.5 percent of income. Jail is not an option. The law prohibits the IRS from confiscating assets, using liens or levies or imposing criminal penalties because of no coverage.

What if I don't qualify for Medicaid but still can't afford a private plan?

You could be eligible for a government subsidy. Subsidies would be available for individuals with incomes ranging from $14,404 to $43,320 and $29,326 to $88,200 for a family of four.

The subsidies will be on a sliding scale. For instance a family of four earning $33,075 a year would have to pay no more than 4 percent, or $1,323, a year on premiums. For a family earning $88,200, the cost of coverage would be 9.5 percent of income, or $8,379.

I have a small business. Do I have to offer insurance?

If you have fewer than 50 employees, you face no penalties. This year, employers with fewer than 25 employees and average annual wages of less than $50,000 who offer health insurance coverage to their workers can get a tax credit up to 35 percent of the cost of the premiums. That will reach 50 percent by 2014.

What about businesses with 50 or more employees?

By 2014, big businesses that don't offer coverage to their employees will pay a fine.

What about the new federal law that says parents can keep their uninsured, unmarried children on their health plan until age 26?

New York already has a law that allows them to stay on until age 29. While several experts said the state law would take precedence over the federal, the state insurance department said that is unclear. "We're trying to sort out the situation," Klug said. "We don't know the specifics yet."

Will Medicare be more expensive for me?

It should cost less. The legislation gradually closes the "doughnut hole," the coverage gap in Medicare's prescription drug benefit. This year seniors will get a $250 rebate if they hit the hole. Next year they will get a 50 percent discount for brand-name drugs if they fall into the gap. By 2020, the hole will be completely filled. Next year, seniors will get free annual exams and other preventive care.

When does the new Medicare tax on unearned income, capital gains and dividends kick in?

Jan. 1, 2013. Then an individual earning more than $200,000 or a married couple earning more than $250,000 will be taxed an increase of 0.9 percent. They will also pay a 3.8 percent tax on investment income.

It's already hard to find a doctor who will take Medicaid. Will it get harder?

In 2013 and 2014, primary-care doctors will be reimbursed for Medicaid at the same rate as Medicare, which pays better. "This should help encourage physicians to participate," said Joan Alker, co-executive director of the Georgetown Center for Children and Families. Starting next year, $11 billion over five years will be spent for community health centers, which focus on lower income patients.

Where do I go for more information?

The Kaiser Family Foundation,, has summaries of the legislation on an interactive tool. The House Ways and Means, Energy and Commerce, and Education and Labor committees have put out a series of papers on the impact of the overhaul on different groups and a timeline. Follow the links at


Much of the health care legislation is being phased in over 10 years. Here are some key dates and key changes:


  • Establishes high risk insurance pool.
  • Extends coverage for uninsured, unmarried children to age 26.
  • Bans health insurers from denying children health coverage because of pre-existing conditions.
  • Gives tax credit of up to 35 percent for small businesses with health plans.

  • 2011

    • Offers Medicare recipients free annual wellness visits.
    • Provides 50 percent discount on brand-name drugs for seniors in the doughnut hole.

    • 2013

      • Taxes individual earning more than $200,000 or a married couple earning more than $250,000 on investment income.

      • 2014

        • Sets up health insurance exchanges.
        • Prohibits insurers from denying adults coverage because of pre-existing conditions.
        • Fines people who do not buy insurance.

        • 2018

          • Taxes so-called Cadillac health plans.
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