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Q&A - WHAT YOU NEED TO KNOW ABOUT HEALTH CARE REFORM

Washington Post

Here's a look at some ideas being considered to reform health care and the impact they might have.

If I don't have insurance now, how will reform affect me?

Under the proposals being considered, people without insurance will be required to get it. They can buy coverage on a new "exchange," a marketplace in which private insurers will offer plans (possibly alongside a government-run option or a nonprofit cooperative). The government will subsidize the cost of plans, on a sliding scale, up to a certain income: Liberal Democrats want help extended to families earning as much as four times the poverty level ($88,000 for a family of four); conservative Democrats want to limit help to families earning $66,000 or less. Meanwhile, the poorest among the uninsured will probably be covered by expanded Medicaid eligibility.

If I currently have health insurance, how will reform affect me?

Not that much, at least initially. The legislation is intended to preserve the existing employer-based insurance system - at first, only small businesses and people who aren't covered through their jobs will be allowed to buy plans on the new exchange. Over time, access may be broadened.

How much will reform cost?

The price tag for covering the uninsured comes in around $1 trillion over the first 10 years, just under double what the new Medicare drug benefit was expected to cost. The proposals would pay for about half of this by squeezing money out of Medicare and Medicaid, including the subsidies that now go to private insurers that offer Medicare Advantage plans and the Medicaid payments that go to hospitals caring for a disproportionate share of the uninsured - the hope is that more of these hospitals' patients would be covered after reform. Much of the remainder would be paid for through new tax revenue. House Democrats want an income tax surcharge on those earning more than $1 million, President Obama wants to reduce the itemized deductions for wealthy taxpayers, and moderate Senate Democrats have talked about taxing the most costly of employer-provided health plans.

How much does the federal government now spend on health care?

U.S. health care costs are paid with both private and public money. The federal government foots the bill for about a third.

In 2007, national health care spending totaled $2.3 trillion; of that, the federal government paid $754 billion. The bulk of federal dollars went to Medicare ($431 billion) and Medicaid ($186 billion).

What is likely to happen to my Medicare coverage under current proposals?

The vast majority of benefits provided by Medicare to 45 million senior citizens and people with disabilities would not be changed.

Under the House bills, premiums for Medicare prescription drug coverage, known as Part D, would increase slightly. That increase would be offset by deep discounts on medications bought in the coverage gap known as the "doughnut hole."

Overall, the result would be lower out-of-pocket costs on prescription drugs for most seniors, according to the Congressional Budget Office.

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