Obama signs health bill today, but changes will come slowly

March 23, 2010 at 12:00a.m.

Associated Press

WASHINGTON

The first changes under the new health-care law will be easy to see and not long in coming: There’ll be $250 rebate checks for seniors in the Medicare drug coverage gap, and young adults moving from college to work will be able to stay on their parents’ plans until they turn 26.

But the peace of mind the president promised — the antidote for health-care insecurity, whether you favored or opposed his overhaul — is still a ways beyond the horizon, starting only in 2014. Insurers then will be barred from turning down people with medical problems, and the government will provide tax credits to help millions of working families buy coverage they can’t afford now.

Health-care overhaul will bring real change, but it’s going to happen slowly.

President Barack Obama plans to sign the main legislation today in the White House East Room after a bitterly divided House approved it Sunday night. That will cap a turbulent, yearlong quest by the president and congressional Democrats to remake the nation’s health-care system, fully one-sixth of the U.S. economy.

Obama’s signature will start the Senate considering a package of changes the House also has approved. But the main overhaul will already be officially on the books.

Still, if Obama wants to actually preside over the expansion of coverage to more than 30 million people, he’ll first have to persuade a majority of Americans to re-elect him in 2012.

“For people who have the greatest need, a number of things will start quickly and make a difference,” said DeAnn Friedholm of Consumers Union. For others, 2014 may seem like a long way away. “Some people may be frustrated that it’s going to be several years, but that is the reality of what it takes to make these significant changes,” she added.

The main reason that Obama’s plan phases in slowly boils down to cost. The Medicare cuts and tax increases to finance the bill start early; the subsidies to help people purchase coverage come later. That combination keeps the cost of the overhaul under $1 trillion in its first decade, as Obama promised.

Roughly a third of people in their 20s are uninsured, so allowing young adults to remain on their parents’ plans until 26 would be a significant new option for families.

Adult children would not be able to stay on a parental plan if they had access to employer coverage of their own. But they could get married and still be covered. (Grandchildren, however, would not qualify.) Regulations will clarify to what degree young adults have to be financially dependent on their parents.

Other reforms starting this year would prevent insurers from canceling the policies of people who get sick, from denying coverage to children with medical problems, and from putting lifetime dollar limits on a policy.

These changes will spread risks more broadly, but they’re also likely to nudge insurance premiums somewhat higher.