Public boggled over when health law kicks in

Insurers, care providers, human resources departments flooded with questions

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WASHINGTON -- Two weeks after President Barack Obama signed the big health care overhaul into law, Americans are struggling to understand how -- and when -- the sweeping measure will affect them.

Questions reflecting confusion have flooded insurance companies, doctors' offices, human resources departments and business groups.

"They're saying, 'Where do we get the free Obama care, and how do I sign up for that?' " said Carrie McLean, a licensed agent for eHealthInsurance.com. The California-based company sells coverage from 185 health insurance carriers in 50 states.

Ms. McLean said the call center had been inundated by uninsured consumers hoping that the overhaul would translate into instant, affordable coverage. That widespread misconception may have originated in part from distorted rhetoric about the legislation bubbling up from the hyper-partisan debate about it in Washington and on some media outlets, such as when opponents denounced it as socialism.

"We tell them it's not free, that there are going to be things in place that help people who are low-income, but that ultimately most of that is not going to be taking place until 2014," she said.

Adults with pre-existing conditions are frustrated to learn that insurers won't have to cover them until 2014 (although those under 18 will be protected in late September); then they become both hopeful and confused upon learning that a federal high-risk pool for them will be established in the next few months. "Health insurance is so confusing. You add this on top of it, and it makes it even more confusing," Ms. McLean said.

The Obama administration is embarking on a years-long public education campaign on the overhaul, including a Web component.

But much of the guidance will depend on Department of Health and Human Services regulations that are still being developed.

Parents of young adults, including those who are preparing to graduate from college this spring, have heard that the overhaul will let them keep their children on their insurance plans until they reach age 26. That starts in September, however; they have to determine how to cover them until then.

A new wave of inquiries could come next month, as federal COBRA subsidies for laid-off workers dry up.

Ann Wooten of Austin, Texas, a breast cancer survivor, said she didn't understand whether the health insurance overhaul law meant that she should try to access private coverage again someday. She was diagnosed with breast cancer in 2008, after she lost her insurance in a divorce, and soon after, she lost her job at a convenience store as a result of the economic crisis.

Medicaid has covered her treatments, but she must apply regularly to renew the coverage. She went back to school to learn hotel management and is seeking a good-paying job with benefits. She doesn't know how the health overhaul will affect her options, and hasn't yet found the time or energy to investigate.

Americans who already have good coverage aren't so worried about the immediate implications, but some admit that they're plenty confused. "Why does it take so long for certain health care things to take effect?" said Sandra Preston, a state employee in Paterson, N.J.

Ben Wiesen, a software engineer who works for a small firm in Tarrytown, N.Y., said he had read up on the overhaul, but remained concerned about the unknowns. "The timelines have been pretty clearly stated," he said. "It's the execution and the details: How are they really going to roll out the changes, and who ultimately will be the arbiter and decision-maker?"

Many small-business owners are nervous about requirements being phased in. "Members are still trying to wrap their head around everything that's in this law," said Michelle Dimarob, manager of legislative affairs for the National Federation of Independent Business, the small-business lobby.

Ms. Dimarob said the lobby's primary concern was that its costs would rise over the next four years as a result of fees, taxes and coverage mandates related to the overhaul. "The next question that comes out of their mouths is: 'What do I have to do right now?'

"They need to start talking with their accountant, depending on how they're organized, what industry they're in and whether they're offering insurance now, and what kind they're offering. We're suggesting they talk to their agent or broker."

Tanning salons face a new excise tax starting in July as part of the overhaul.

Other business owners are trying to understand new Internal Revenue Service reporting requirements related to business-to-business transactions that will kick in as a result of the new law. Others are looking ahead to coverage mandates for 2014 and calculating how many part-time versus full-time employees they should have to best contain costs.

While Mr. Obama has been touting a tax credit for small businesses that offer employees health coverage, Ms. Dimarob said many small businesses wouldn't be able to participate. First, they must do research to see whether they qualify. "It requires them to understand the intricacies," she said.

The president has begun traveling the country to talk about the new law to ordinary Americans. In Maine last week, he explained many highlights of the four-year phase-in. But Mr. Obama's remarks were laced with enough political rhetoric to dilute his policy message.

Many organizations have produced timelines explaining when provisions are to be phased in. Still, it's confusing for consumers, and until the administration issues more regulations, many details can't be pinned down.

"The first meeting the president held with the team post-passage was on implementation," White House press secretary Robert Gibbs said. "Obviously this is a big task, and a campaign to ensure that people understand what benefits are coming online when obviously will be tremendously important."



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