Health care promises resolved

With the stroke of multiple pens on March 23, 2010, President Barack Obama signed into law an historic health care reform bill that will radically reshape the health care system.

That brings resolution to many of the dozens of health care-related promises Obama made during the campaign. Some of the provisions are years away from being fully implemented, and Republicans have vowed to try to repeal the law before much of it kicks in (not to mention the legal challenges being made), but unless or until the bill is overturned, it is the law. We think that provides enough finality to rate Obama's success in keeping the promises (or not), though we obviously reserve the right to revisit them if things should change.

So we'll be updating all of the promises touched by the 2,400-page bill. For now, here are some of the biggies.

The Kept Promises:

• No. 51: Require insurance companies to cover pre-existing conditions. This was one of the cornerstones of the health care reform bill.  The requirement to cover people with pre-existing conditions doesn't fully kick in until 2014. Until then, a new high-risk pool will offer coverage to uninsured people with pre-existing medical problems.

• No. 53: Give tax credits to those who need help to pay health premiums. One of the most controversial, and certainly the most expensive, provisions of the health care bill is the plan to extend government subsidies through tax credits to help middle- and lower-income people pay for health insurance, if they don't get it through an employer. Cost-sharing tax credits will be offered on an income-based sliding scale for people making between 133 percent and 400 percent of the poverty level ($88,200 for a family of four).

• No. 48: Close the "doughnut hole" in Medicare prescription drug plan. Under current law, prescription expenses between $2,830 and $4,550 are an out-of-pocket expense for Medicare enrollees. That's what's known as the doughnut hole. The hole won't be closed immediately, but the bill will phase it out over the next 10 years.

• No. 57: Expand eligibility for Medicaid. Under the new law, eligibility for Medicaid will be expanded to all individuals under age 65 with incomes up to 133 percent of the federal poverty level, beginning in 2014.

• No. 56: Require children to have health insurance coverage. One of the changes that goes into effect in 2010 is allowing young adults to continue on their parents policies. The law allows dependents up to age 26 to remain on plans. The bill also requires all includes an "individual mandate" that requires all individuals (not just children) to obtain insurance. That's scheduled to take effect in 2014.

The Compromises:

• No. 52: Create a National Health Insurance Exchange. The law calls for the creation of state-based health insurance exchanges, which are virtual marketplaces where people can go to buy health insurance. But during the campaign, Obama, promised to create one national exchange, a significant difference.

• No. 54: Create a small business tax credit to help with health premiums. In his remarks at the signing of the bill, Obama touted new small business tax credits as one of the immediate benefits of the bill. And the bill would, in fact, phase up to Obama's promise of a tax credit of up to 50 percent on premiums paid by small businesses on behalf of their employees by 2014. But there's one key difference between Obama's promise and what the bill delivers: The tax credit is not refundable -- so if the business' tax liability is less than zero, the government will not be sending a check.
 
The Promise Broken:

• No. 518: Create a public option health plan for a new National Health Insurance Exchange. Remember all of the debate over a public option, a government-run insurance plan on the exchange? It didn't make it into the final bill.