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Who might, or might not be, covered under the healthcare bills

Q&A

Low-income people could get federal assistance, but even a public option may leave out some individuals.

October 26, 2009|James Oliphant and Kim Geiger

WASHINGTON — Some reader questions on the national healthcare debate:

I keep hearing that none of the Democratic healthcare bills would cover everyone. Who won't be covered?

Under the most recent Senate version of the bill, people who don't earn as much as four times the federal poverty level -- amounting to $43,320 for an individual or $88,200 for a family of four -- would be offered government assistance to buy insurance. But there would be no assistance for people who earn slightly more, though they could apply for an exemption from the insurance requirement if they can prove that the most inexpensive policy they could buy would exceed 8% of their income. That's why experts have estimated that 3% to 6% of those eligible would remain uninsured.

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Would a "public option" make it possible for everyone to be covered?

A so-called public option could make affordable insurance more accessible to those whose incomes are above the subsidy limit, but it is not likely that everyone would be covered.

The House bill, which does contain a public option, is estimated to cover about 97% of those eligible, more people than the Senate Finance Committee bill, which does not include a public option and would cover 94% of the population.

It is also possible that a public option would include a "firewall" that would prevent some people from enrolling -- specifically those who work at a company that already offers coverage, even if that policy is not affordable for the employee.

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I work at a small business, and my employer doesn't offer health benefits. Will healthcare reform require my employer to cover me?

It depends on the size of the business, but many small businesses are exempt in the House and Senate bills. The final Senate bill is likely to exempt businesses with fewer than 50 employees from a mandate to offer coverage. The House bill exempts or reduces the requirement for businesses that have yearly payrolls of less than $400,000.

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I have been denied health insurance because of a preexisting condition. Will any of these bills guarantee that I can buy insurance?

The bills appear to explicitly prohibit an insurer in the individual marketplace from denying you coverage because of your health status, regardless of whether you have been denied coverage in the past.

Of course, the bills do not guarantee you will be able to find an affordable policy.

And under the bills as they stand now, insurers will still be able to price policies based on your age or past tobacco use.

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joliphant@latimes.com

kgeiger@latimes.com

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