The experts weigh in

Many of you have sent in questions about how the new health care law will affect you and your family. We’ve compiled some answers from our experts to help you navigate changes to the health care system. If you’d like to submit your own question, please click here.

Member from Montclair, NJ

Will health reform require new health care plans to cover pregnancy care and delivery by midwifes? Will lactation consultants’ services be covered?

Under health reform, health plans will cover standardized, comprehensive benefit packages. The law sets out general categories of benefits that must be covered, and these categories include maternity and newborn care. The details of the specific services that will be covered under each category will be determined by future regulations from the Secretary of Health and Human Services. The law specifically requires the Secretary to consider the health care needs of women when determining the services that the benefits package will include. There will also be a public input process for people to express which benefits they believe are necessary for the Secretary to include in the required benefits package.

Member from Hackensack, NJ

I have been unemployed since December 2008, and my husband works for a very small company with 5-6 employees that does not offer healthcare. Will health reform mandate all employers, regardless of size, to provide healthcare?

Health reform does not mandate that small employers offer coverage to their workers. However, it does make it easier for small employers to offer coverage. Health reform provides employers with up to 25 workers with tax credits to make coverage more affordable—increasing the likelihood that they will offer coverage. Starting this year, small employers can get tax credits for up to 35 percent of their share of the premiums for their workers’ health coverage. In 2014, they will be eligible for credits of up to 50 percent of the premiums they pay.

In addition, starting in 2014, small employers will have a new marketplace (also referred to as an “exchange”) in which they can shop for coverage for their workers. In the new health insurance exchanges, insurers will provide small employers with clear, comparable information on the costs and benefits of different health plans, which will help small employers find quality coverage that meets their workers’ needs.

If your husband’s employer decides not to offer coverage to his/her workers, you and your family will still be able to get coverage starting in 2014 through the new health insurance exchange. Moreover, many low- and middle-income workers will get significant help affording coverage through a new tax credit subsidy.

Member from Cresskill, NJ

I work in a small business. We just learned that our premium is going up 33% so we will need to go with a different, less expensive plan with less generous benefits. Will the Department of Health and Human Services ever be looking to scrutinize these types of rate hikes to see if these rate hikes are justified?

Under reform, insurers will have to submit transparent information to regulators on how they calculate their premium rates, justifying any rates that seem unreasonable. Health reform also provides new funding for states to implement or enhance oversight of health insurers’ proposed rate increases. And, plans that impose unreasonable rate hikes in the next few years may be prohibited from participating in the new health insurance exchanges once they’re up and running in 2014.