For the majority of Americans -- those with health insurance --
the changes to come from the most ambitious overhaul of the social
safety net in a generation turn out to be relatively modest, experts
say. The effect on the pocketbooks of most New Jerseyans is expected
to be slight.
Medical costs will not plummet. Premiums will still rise, albeit at a slightly slower rate. Some insurance policies will change, but for most, that will mean better value for the premium dollar.
"The dirty little secret, despite all the politics, is this is basically a very incremental law," said Alan Weil, executive director of the National Academy for State Health Policy. "The average citizen, despite the controversy over the law, will not see fundamental changes."
The most important -- and popular -- provisions for those with insurance have largely been implemented already. They include the consumer protections that bar lifetime caps on benefits, prohibit denial of coverage to people with pre-existing conditions, and make insurers account for how they spend premium dollars and how much they raise rates. They also extend coverage to children up to age 26 on their parents' policies, a provision through which 69,000 young people in New Jersey now are insured.
In terms of dollars and cents, however, the impact of the law on individual families is complicated. It must be seen through the prism of their current insurance status and income, analysts say. The complexity of this overhaul of the insurance marketplace, and the intricate ways in which each part of the reform interacts with the others, make a bottom-line prediction difficult.
The net effect of the law's mandate that almost everyone have health insurance will help hold down the upward pressure on premiums, said Joel Cantor, director of the Rutgers Center for State Health Policy. Now when premiums rise, it will be by a slightly lower percentage than if the law had not been passed, he said.
"I don't think the day this goes into effect, we'll see $1,000 off on our health insurance premiums," Cantor said, but it will mean "one less cost pressure."
In broad strokes, here's what to expect:
* Those with private insurance -- 5.3 million New Jerseyans or 61 percent of the population -- can expect to see the slowing of premium hikes. As millions of uninsured people are added to insurance rolls starting in 2014, there will be less cost-shifting by health providers to cover the costs of the uninsured.
Rebate checks also will be sent this summer to 45,000 New Jerseyans with private insurance, either directly or to their employers, from enforcement of the law's 80/20 rule. That requires insurers to spend 80 cents of the premium dollar on health care, not administration or salaries. The biggest rebates, averaging $359 apiece, will go to employees of large companies, where insurers have a higher bar to meet: 85 percent of premiums must be spent on health- related costs. In sum, New Jerseyans will receive $7.7 million.
* People with Medicare -- 1.1 million New Jerseyans or 12 percent of the population -- who have high prescription costs will pay less for their medication. The law gradually closes the so-called "doughnut hole," or gap in coverage under Medicare Part D, reached by those who spend more than $2,930 out of pocket on their medications.
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