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Health care policy expert explains reform law

Thursday, April 29, 2010 | 12:01 a.m. CDT

COLUMBIA — A health care policy expert said health care reform will create winners and losers, and some people will be in both columns.

"There will be changes, mark my words," said Karen Edison, director of the non-partisan MU Center for Health Policy. "And there will be unintended consequences.

"The devil's in the details," Edison said repeatedly during a presentation to roughly 100 health care professionals at the MU School of Medicine on Wednesday. Edison is also the chair of the Dermatology Department.

Everyone is still seeking clarity on the law's implications. Most major changes won't begin taking effect until 2014 because the stakeholders need time to adjust to such a major overhaul, she said.

"Crafting programs, expanding programs — it's going to take a while," she said. 

Edison noted these changes will begin within the next year:

  • Children will no longer be denied coverage based on pre-existing conditions
  • Young adults can stay on their parents' insurance plan until they turn 26
  • Temporary insurance will be set up for high-risk people who are denied coverage because of health issues
  • Senior citizens will get a $250 rebate to counter a gap in prescription drug coverage
  • Tax credits will be given to small companies offering coverage
  • Insurance companies will no longer be able to cancel or limit coverage arbitrarily
  • Insurers will be required to put more dollars from premiums into benefits instead of profits

Among the changes in 2014:

  • No one will be denied coverage based on pre-existing conditions
  • 32 million people who are currently uninsured will be covered
  • Medicaid coverage will be expanded 
  • State-based exchanges will begin operating

Edison talked about the winners and losers of the reform. Some people, such as young adults and insurers, she put in both categories because they'll be able to stay on their parents' policies until age 26, but be required to purchase insurance at a time when they're typically young and healthy. 

Private insurers are another good example. They stand to gain 32 million more customers, but they'll have to offer insurance to everyone, even those with pre-existing conditions.

The reform will have a major impact on how businesses offer coverage. There are three categories for businesses under the new law:

  • Large — more than 50 full-time employees
  • Mid-sized — 26 to 50 full-time employees
  • Small — fewer than 26 full-time employees

Beginning in 2014, only large businesses are required to provide coverage for their employees or face a $2,000 fine per uninsured employee, except for the first 30 uninsured people. Edison hinted that businesses might hire more part-time employees to counter this requirement. Tax credits will be given to small businesses that cover at least half of their employees' premiums. Mid-sized businesses won't face any penalties for not providing coverage to their employees, but they won't receive credits for offering coverage, either. 

An audience member asked how the health profession will handle the large increase in those seeking primary care. Edison, who discussed the current shortage of health care workers earlier in the presentation, said it was a concern.

"There's not a major workforce effort (in the bill)," she said. "It's one of the things people say was left out of the bill."

The entire 81-minute presentation is available online.


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