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Susan Dentzer Answers Your Questions about Health Reform

Over the past week, we’ve noticed many questions in the comments section of the Rundown about how the new health care reform law will affect people’s lives and their health care.

We posed some of those questions to Susan Dentzer, former NewsHour health correspondent and current editor of the journal Health Affairs. She’s been helping us explain the ins and outs of the bill on the show this week. Read Susan’s answers to a few of your questions below, and then catch up on any videos you might have missed.

Does the law change the rules about health savings accounts? Has there been any analysis from experts about whether, under the new law, insurance companies will likely continue to offer the high-deductible, low (relatively) premium HSA-compatible plans on the individual market? — yingchen

Susan Dentzer: The final version of the legislation does allow for high-deductible plans to be offered through the exchanges. What we don’t know is how the federal government is going to write regulations for those plans — what contours they’ll set, if any, for what the HSA plans have to look like. But it is the case that the exchanges will be able to offer HSA plans.

Also, the law says that any plans currently in existence through employers get grandfathered in — and that would include any HSA plans.

And, insurers are allowed to sell products outside the exchanges.

So the answer is that yes, HSAs will continue, and in fact there will likely be HSA plans available in the exchanges.

How long until my 23- and 24-year-old kids will be covered under my wife’s union health plan? — SteveBI

Susan Dentzer: Well, the answer is: It all depends. The language says that [the rule permitting young adults to stay on their parents’ plans] takes effect six months after enactment. But what it really means is that this has to take effect in the next plan year.

Now with a union plan, it may also be subject to the union contract. It looks like the strict reading of this would be that it’s going to apply for the next collectively bargained contract. However, some unions may be inclined to do this sooner rather than later. The experts I’ve talked to generally think plans will try to do this sooner rather than later. But it really depends what benefits were negotiated with the employer, and when.

What you need to do is call the union health plan to find out the specifics for your plan.

Under the health reform bill will larger companies be required to provide health insurance for all of their employees — including part-time employees?

Susan Dentzer: No, large companies do not have to provide coverage to part-time employees. The rules for employer responsibility apply only to full-time employees. But that’s defined as anyone who works 30 hours or more per week. So if you’re working 30 hours rather than 45, then you have to be covered.

And if you’re working 30 hours a week or more and the employer doesn’t provide you with coverage, they have to pay a $2000-per-employee fee. So there are some pretty big sticks that essentially require employers to provide coverage for full-time employees.

What effect will the health care bill have on military retiree’s health care benefits? — Artis Harrel

Susan Dentzer: There’s no effect — nothing in this will change your benefits.

I would like to know what happens to people who are in Medicare Advantage Plans? Will the plan close and then they must purchase insurance? — Joseph Gotsens

Susan Dentzer: For Medicare Advantage, it’s not possible to answer at the moment what’s going to happen to specific plans. It all depends on what plan you’re in, and what part of the country you’re in, because these changes will affect the plans in different ways.

There are a number of reasons for that. The changes to Medicare Advantage payments phase in — the payments to the plans get frozen in 2011, and then the serious payment changes begin to kick in in 2012 and last for next seven years. So it all depends on how plans decide to respond to those payment changes.

The changes will reward plans that produce high-quality results, so some of these plans will get bonuses. So if you’re in a plan that’s doing a good job and might be eligible for bonuses, you shouldn’t worry about it.

There’s nothing that automatically makes the plans close, though some may decide to close as a business decision. But it’s highly likely that the good plans will stay in business. I was just talking to the executive vice president at Geisinger Health System the other day — they’re rated one of the best in America — and they’re gearing up to stay in the game of Medicare Advantage and win these bonus payments.

So you might want to make sure that you’re in a plan that’s gotten good reviews and is working on things, like coordinating patient care, that will be rewarded. Medicare ranks plans on a five-star quality rating scale. There is a Medicare database where you can find out how your plan is ranked. The Kaiser Family Foundation has also done an analysis of those quality rankings.


On Monday night, Susan discussed how the bill will change the private insurance market in the United States:

And on Tuesday, she explained what it will mean for the uninsured:

On Thursday, NPR health policy correspondent Julie Rovner discussed the changes in store for Medicare:

Watch next week for more explanation and analysis of the new law.

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