A user's guide to Health Reform 2010

Health reform, the biggest piece of social justice legislation in decades, has passed. It bears the signature of President Obama, who made health reform the top priority of his domestic agenda. Much has been made of the size of the legislation; some lawmakers opposed to it have dropped it dramatically onto a desk just for the satisfaction of making a loud noise.

But what exactly does health reform do? And when? And for whom?

Below is a short user's guide to the elements of health reform that kick in sooner rather than later. Tomorrow I will spell out what is scheduled to launch between 2010 and 2014. I give my thanks to a number of medical and consumer groups who were helpful to me in figuring out the immediate effects of the legislation; there's a reason so many Americans have been confused about the content of the bill. Here's how things will change in 2010:

* Insurers can't drop patients if they get sick. This is huge. We've all read those stories about people who paid their premiums on time, all the time, and then suddenly were dropped by their insurer because they developed a cancer, or some other expensive condition. By being dropped they were dealt a double-whammy: they no longer had insurance, and their illness now put them in the camp of "pre-existing conditions," which made it very difficult and expensive to get replacement insurance. This leads me to another big health reform change in 2010:

* Lifetime caps on benefits will be outlawed. One case of cancer or a transplant can eat up many lifetime maximum coverage caps. Under health reform, insurers can no longer impose lifetime caps.

* Children cannot be denied insurance coverage due to a pre-existing medical condition. This is a big relief for the parents of kids with asthma, or those who beat back childhood cancer. If they lived in a state that offered "medically needy," programs - Medicaid style programs for people who have catastrophic illnesses and can't afford insurance - their children could at least get essential prescriptions and services. But not everyone qualifies for those programs, and they are among the first things states tend to cut in tough budget times. Health reform fixes that.

* Health reform establishes a temporary national "high-risk pool" for adults with pre-existing medical conditions who can't get private insurance. It also gives financial subsidies to make premiums more affordable, until all insurers are required to cover people with pre-existing conditions in 2014. This is the one to watch. It will be interesting to see how much it costs to run a high-risk pool - and to see if insurance companies launch a fight to keep it instead of covering those patients in four years. You read it here: I predict a lot of maneuvering in 2013, including industry-funded studies lauding the benefits of a national high-risk pool.

* Young adults up to age 26 can remain as a dependent on their parents' private health insurance plan. This is good. Young people don't tend to use a lot of expensive drugs. Overall, they are among the healthiest of us. But they are also the most likely to get in accidents - which can require expensive surgeries and rehabilitation. Under health reform, young people don't have to worry about wrecking their financial life just as their adult life is beginning.

* Lastly, preventive services for women, such as mammograms, and vaccinations for children must be covered by insurers, who can't require co-payments or deductibles. This could go a long way toward keeping kids healthy, and in chipping away at the disparities between those who could afford preventative care and those who cannot.

Photo Credit: Beverly & Pack