New rules governing insurance companies will prevent insurers from denying coverage to persons with pre-existing conditions. Other rules will also make it more difficult for insurers to cancel policies once a covered individual actually gets sick. Children will benefit from the new protections within six months of the law's enactment, with adults added in 2014.
The 33 million Americans currently without health insurance will get it through a series of expansions and additions, including expansion of Medicaid eligibility and the creation of state-based insurance exchanges where individuals and small businesses can shop for coverage.
Subsidies will enable Americans making between 1.33 and four times the Federal poverty-level income of $22,050 for a family of four to afford insurance coverage.
The bill will close the "donut hole" in Medicare Part D (prescription drug) coverage by 2020. Seniors who fall into the hole starting this year will receive a $250 rebate of their prescription drug costs.
Employees of companies that offer extremely generous health care plans may find their benefits cut once a 40 percent excise tax on so-called "Cadillac" insurance plans -- those with a value of $10,200 or more for an individual and $27,500 for a family -- kicks in starting in 2018.
Starting in 2014, those who do not purchase health insurance will pay a $695 fine each year, with a few exceptions for low-income individuals. One problem: Unless premiums fall or are heavily subsidized, the fine may not be steep enough to encourage healthy young individuals to purchase insurance - and without their participation, the cost of providing insurance to the rest of the population could soar -- or some companies might simply stop writing new insurance policies altogether.
Employers with 50 or more employees will also face fines if they do not offer insurance -- $2000 per worker per year for every worker who gets Federal subsidies to buy insurance.
The more affluent will pick up a larger chunk of the tab for insuring everyone through expansion of the Medicare payroll tax to unearned income -- i.e., income from investments. The new tax will apply to individuals making more than $200,000 per year and families making more than $250,000 per year.
Critics of the bill charge that doctors will quit their practices rather than accept reduced reimbursements from Medicare and new regulations contained in the bill.
Other critics charge that employers will similarly face bottom-line pressure that will lead them to drop their insurance plans and force employees into the state insurance exchanges. The Obama Administration vigorously denies this charge.
Written by Sandy Smith