Two and a half weeks after President Barack Obama signed health care reform into law, there are more questions than answers.

“Nobody knows what’s going to come of all of this … but it’s now the law of the land” said Tupelo family physician Dr. Ed Hill, who is a former president of the American Medical Association. “Level heads need to mold it to get the best of health care at the most efficient cost.”

The best estimates are that the new law will provide coverage for 32 million of the 54 million uninsured, covering some 94 percent of legal U.S. residents by 2019, said economist Sara Collins, vice president for Affordable Health Insurance at the Commonwealth Fund.

“I think the law has, at heart, the interests of low- and moderate-income families,” Collins said.

Immediately, the law helps young adults by giving them access to insurance through their parents. In 2014, the big expansion arrives with the health care exchanges, expanded Medicaid, insurance mandates and penalties.

There are significant concerns about funding an expansion of Medicaid, which in 2014 would cover all adults and children who are at 133 percent of the federal poverty line – $29,327 for a family of four and $14,404 for an individual. Currently only poor children, pregnant women and disabled adults are covered under Medicaid.

“We struggle to fund our very conservative Medicaid program,” said state Rep. Steve Holland, D-Plantersville, who as chairman of the House Public Health Committee considers health care an essential right, just like police protection. “We likely would need a stable funding source for Medicaid.”

Hill, who is not a fan of the dysfunctional public debate process and is particularly concerned about Medicare’s stability, says many of the provisions have widespread support – like eliminating insurance companies being able to exclude pre-existing conditions from coverage.

“There’s a lot of good stuff in there,” Hill said. “The status quo was not acceptable” because of the rapidly escalating health care costs and the erosion of employer-provided insurance.

Len Nichols, professor of health care policy at George Mason University, thinks that employer-based coverage might improve under the health care law.

“This bill should – on balance – reduce the biggest cost shift, the uninsured,” who are subsidized by the people with public and private insurance, Nichols said.

However, people buying individual insurance plans could see increases of 10 to 13 percent; however, the plans will be much more comprehensive. The increases will be offset by federal subsidies for about half of the people who buy their own coverage, according to estimates from the Congressional Budget Office.

Here’s some basic information on provisions for consumers from The Commonwealth Fund and Kaiser Family Foundation.

People who buy their own insurance and small businesses would have access to qualified health plans through state health care exchanges:

- The federal government will set the standards and provide subsidies for low- to moderate-income families who don’t have access to employer-based health insurance. Private health insurance companies will provide the insurance policies.

- Plans must include an essential benefits package including emergency services; hospitalizations; maternity and newborn care; mental health and substance use disorder services, including behavioral health; prescription drugs; rehabilitative services and devices; laboratory services; preventive services, including services recommended by the Task Force on Clinical Preventive Services and vaccines recommended by the director of the Centers for Disease Control and Prevention; and chronic disease management. In addition, the plans must cover pediatric services, including vision and oral care.

- Based on premiums and out-of-pocket expenses, the plans will be sorted into different levels – bronze, silver, gold and platinum. There also will be a catastrophic cover policy open to young adults under 30. Companies will be required to offer plans at silver and gold levels to participate in the exchanges.

- Qualified health plans can be sold outside the exchange but the insurance issuer must charge the same premium for qualified plans sold within or outside the exchanges.

- Insurance companies will have to submit justification for premium increases to be certified as qualified health plans to state exchanges.

Subsidies

Premium subsidies for qualified health plans purchased through the exchange will be available for individuals and families earning between 133 percent – $29,327 for a family of four – and 400 percent of poverty – $88,200 for a family of four.

The subsidies – based on the second-lowest cost silver plan in their area – will limit how much of their income the families would put into premiums – from 2 percent for those closest to the poverty line to no more than 9.5 percent for those at 400 percent.

n Starting in 2015, the subsidies will be adjusted to reflect the excess of the rate of premium growth. Starting in 2019, the legislation will constrain the growth in subsidies if premiums are growing faster than the consumer price index. For families and individuals with incomes under 400 percent of poverty, premium increases will not exceed $400.

- Starting in 2014, all individuals will be required to have some kind of health insurance under the new law. People who cannot demonstrate on a tax form that they have such coverage will be required to pay a penalty equal to the greater of $95 or 1 percent of taxable income in 2014, $325 or 2 percent of taxable income in 2015, and $695 or 2.5 percent of taxable income in 2016, up to a cap of the national average bronze plan premium. Families will pay a penalty of half the amount for children up to a cap of $2,085 per family.

Contact Michaela Gibson Morris at (662)678-1599 or michaela.morris@djournal.com.