HELENA - Now that Congress has passed a health-reform bill and President Barack Obama prepares to sign it, Americans no doubt are wondering what it (and companion bills) actually do.

Here's a look at the highlights:

Mandates to buy health insurance: Starting in 2014, all Americans will be required to have health insurance, or pay a tax penalty that starts at $95 and rises to $695 by 2016. Some exceptions exist for low-income people.

Subsidies to help you pay for insurance: These also take effect in 2014, for those buying on the individual market. Households earning up to 400 percent of the federal poverty level ($43,300 for a single person; $88,200 for a family of four) can get subsidies, with higher subsidies for those with lower income.

Employer requirements on offering health coverage: The bill has no direct requirement. But as of 2014, employers with more than 50 workers and that don't offer health insurance may get hit with an annual penalty of $2,000 per full-time worker (if any of their full-time workers get government subsidies to buy his/her own insurance).

Small business tax breaks for health insurance: These take effect this year, for businesses with 25 or fewer workers, whose average salary is less than $50,000. The credit is up to 35 percent of the employer's cost of providing health insurance to employees - if the employer covers at least half the overall insurance costs.

New taxes: Starting in 2012, families earning more than $250,000 a year ($200,000 for singles) will pay 0.9 percent higher Medicare payroll tax on their earned income, and a 3.8 percent tax on "unearned" (investment) income. Starting in 2018, a 40 percent tax will be levied on so-called "Cadillac" insurance plans. And, indoor tanning services will pay a 10 percent tax.

Medicaid expansion: Medicaid is the state-federal program that covers medical bills for the poor. Starting in 2014, Medicaid will be open to everyone earning up to 133 percent of the federal poverty level, or $29,300 for a family of four.

In Montana, this change would extend this coverage to anywhere from 50,000 to 100,000 additional people.

Also, primary-care physicians who treat Medicaid patients get a boost in reimbursement, starting in 2013. The payments will be increased to Medicare levels, which are about 20 percent higher than Medicaid.

High-risk pool for the uninsured: This year, the federal government will create a high-risk insurance pool for those who have a pre-existing health condition and been uninsured for at least six months. The cost would be limited to $5,950 for an individual buying into the coverage.

Health-insurance reforms: Many things here, both now and in the future. Within months, dependent children up to 26 must be allowed coverage on a family policy. Also this year, health-insurance plans must pay at least 80 percent of their revenue in benefits (85 percent for large-group plans), or, if they don't, give rebates to customers starting in 2011.

Limits on annual and lifetime coverage amounts will be banned this year, and coverage for children won't be able to be denied because of a pre-existing medical condition. The ban on pre-existing condition denial doesn't apply to adults until 2014.

Changes in Medicare: Changes for this government program covering people 65 and older include wide-ranging cuts in some payments to providers and cuts in funds for Medicare Advantage plans. On prescription drugs, it expands coverage to gradually close the "doughnut hole" that now forces seniors to pay full price on some drugs purchases.

Cost savings/preventive health: The bill includes experimental medical programs to attempt to reduce costs, requirements to standardize insurance forms, initiatives to increase the number of primary-care physicians, and increased payments for preventive care. Also, a new commission is created to examine Medicare and make recommendations on payments, with the goal of "reducing excess cost growth and improving quality of care."


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