allow 30 days between your calls. guest: a high risk pools -- folks who are medically uninsured, they will be able to presumably by coverage once they are set up. they are supposed to do that within 90 days. host: uninsured people who have a medical condition that kept them from getting coverage. bonn -- some are closed and have restrictions. only 200,000 people in this country are currently in a high risk pool. this will set aside $5 billion to create these pools everywhere. host: how many people do they think could potentially be in these polls? guest: that is hard to say. i really don't know. it could be several million people. i think a lot of these things happening in the first couple of years of fact -- i don't want to say a narrow swath, but not everybody. certainly the donut hall, 4

million people hit that every year according to statistics. high risk pool, there are certainly a lot of people were rejected -- that is the second big change. a third change is the tax credits for small businesses that offer coverage. if you have 25 or fewer employees, and they earn an average of $50,000 a year or less, you could qualify -- and you offer insurance now -- you can qualify for up to 35% subsidy to help you buy the coverage for your workers. host: what if you are a small business that does not offer insurance? guest: you don't get the credit. if you start, you could probably get the credit. the president was speaking about this yesterday and he was hitting on this, the small business and go. so -- there are a number of changes to the insurance. they go into effect six months after enactment. after the day your policy renews

six month after enactment. for some people in their jobs, it will happen this year -- you know when you sign up for insurance coverage it is usually january through the end of the year, or for some people, middle of the year, open enrollment. for a lot of people these changes may not happen until january 1, 2011. no more lifetime caps. this is where -- you might have an insurance policy and it says, we will cover up to a million dollars or $2 million, and that's it. those are going to be gone. they are more common, i think, in insurance that people by themselves in individual market rather than what employers often. but some employer plans to have the caps. in fact, i was looking at a survey the other day by the kaiser family foundation, employer survey, and something like 43% of covered workers, those who have insurance, have a cap of $2 million or more. those will be gone.

there will be restrictions on its annual dollar limits. some insurance plans -- we will only spend x and not a year on chemotherapy or this or that. the hhs secretary is going to draw up a list of what are the essential benefits that have to be in a package and then say where those annual limits can be said. so there is a lot of work for the secretary. a lot of these will happen with regulations. host: is that how the legislation is written, as the hhs secretary will determine -- guest: essential benefits package -- package and what restrictions on a dollar limit. host: gary, democrat, dallas, texas. you are on with julie appleby from kaiser health news. caller: how are you? good. c-span, this is a great show today. you need to have more people on like this.

i don't want to be cut off, because this is very important. let me ask you a question. i don't have insurance on my job. my wife works for a large medical firm, they have like 600 physicians there. she can't afford their insurance. we also have our own business, a small business. so, we don't have insurance within that. my point is that, does this affect how her company would price her policy for her at her job since it was so expensive to most of the employees there? also, with our business, we have 12 employees. would we be able to afford coverage if we decide to buy a policy? host: julie appleby, do you have

any questions from what he said? guest: do you know if your wife's insurance plan, how much of a percentage of income? you don't have to answer that on the air. but under the law -- an excellent this will not take effect until 2014 -- she made a bold -- may be able to buy insurance on the exchange but it has to being as buying the policy through her employer would cost more than, i believe, at 8% or 9% of income. it is more than a certain percentage of the income she may be able to go on the exchange. and may qualify for subsidies. if not, she does have to stick with her employer policy. for you, it sounds like a of a small business so you might want to look like how much this would cost and whether the tax credit will help you. that starts this year. guest: how -- the line caller: how will i find out? guest: the president said within a month it will put out information on how to apply for the credit. if you need to look at the company right now and look at restrictions. you have 12 employees, so you

will have to look at the 12 employees and with average salaries are and have the below $50,000. you have to pay at least -- i think half the cost of insurance policy for your workers. caller: do you know if they have to be full-time employees? they are contract. guest: that i don't know. i am not at that level of detail. host: why don't you offer health insurance? caller: it is a new business. we open did about 30 days ago. most of these people -- i don't know if you know much about the beauty industry, but they are mostly contractor people. they work commission. they are not hourly employees. host: have you looked at the cost of health insurance and how much it would cost you as an employer? caller: i called blue cross blue shield, cigna, it was so high that i just disconnected the phone call. guest: that is an issue.

all the time, we have to see what happens with premiums. but that is one of the things that has driven the whole debate, how will slow the growth of premiums, especially for small businesses like yours. host: here is an employer who did look into it but saw that it was economically not feasible. 2014, you say the exchanges began, or the subsidies. .

the reason for this is the medicare advantage plans,

currently on average, pay about 14% more than traditional medicare. with the additional payments, the insurers often offer additional benefits that are not required by the law. things like vision care, dental care, free gym membership, low or premiums, or zero premiums. some parts of california, some folks don't pay premiums at all. some of that may change. you may see your premium, if you don't have a premium, you receive premium. you may see option of benefits but they can't cut your required medicare benefits. so, we will see. i don't know if you remember back in the late 1990's and early 2000's there were cuts to medicare and at that time that it ravenna's plans were called medicare plus choice. there were a number of insurers who pulled back or dropped out of certain areas and some raise premiums. .

she just wet and medicare. -- went on medicare. host: what exactly was your question? caller: how can we get prescriptions paid for? host: thank you. let us sit in definite answers. >> she could sign up for part "d"would cover prescriptions. for you, there are some programs through some of the drug companies that can help with free or low-cost prescription drugs. you can apply for those. it tends to be a lot of paperwork.

there are some programs like that. you may be able to qualify for health insurance when it changes in 2014. you may want to try some of those things. host: what is the relationship between kaiser permanente and kaiser health? guest: there really is none. we are a program of the family foundation. host: the next call from florida. caller: this is my first call

and i am a little nervous. i am a construction worker. i own my own business. i have catastrophic health-care coverage. i go to the doctor once a year to get checked out. i pay for all of it myself. that is how i have decided to live my life. the question i have is will it change now? will i be forced to buy health care coverage? i am a male. i probably will never get ovarian cancer. will i have to buy that type of coverage that i do not need or do not want? host: a couple of questions. how old are you and how much you pay for your catastrophic? 36 caller: 36 years old and about 230. i have employees. five of them.

host: to you offer them catastrophic health insurance? caller: i do not. i pay them well enough. i feel that if they wanted, they can go out and get it themselves. stay on the line in case she has any questions. guest: what is your deductible? caller: i am not sure. guest: if you want to keep your plan, you can keep it. the plan is not going to change. caller: will i be forced to buy a health care? i have catastrophic health care. i do not have anything that covers going to the doctor. a little over a couple of years ago, i got a bit of mercer in my leg. i went to the immediate care center. it cost me a little over $200

and another $200 for the lab. it came back, and they gave me an antibiotic. it ended up costing $800 because i am allergic to keflex. and in other antibiotic. the pharmacist found something for me that was cheaper. i do not want to pay for a health insurance that covers ovarian cancer, which is something i will not get. it does not cost more in the long run? guest: overtime you may want a different policy. you may go to the exchange and bought a policy. after 2014, you may have to buy a policy that will cover more than what you have now. the policies that will be available on the exchange, the minimum coverage will cover 60%

of your average medical costs. you would pay the rest. it may be more generous than the plan you have now. it may cost a bit more as a result. you may choose to buy it. here is what will change for you in 2014. if you get sick between now and then -- if you get a disease or herself on the job. insurance cannot reject you. you would be able to change plans. that is not true today. if you were to get ill and try to change plans, they could reject you today. that is one of the big changes happening in 2014. if you decided you did not like the current plan or wanted a different type of coverage, you could change it. you will not be forced to buy something you do not want. insurance is a risk pool. you are paying in case something

happens to you. it cannot be ovarian cancer, but it may be something else. nobody knows what is going to happen. that is the idea behind insurance. host: why did the pre-existing get delayed until 2014? guest: a lot of the economists say to make that work and to say to insurance companies, you have to cover everybody and you have to require everyone have insurance. people may wait until they are sick to buy insurance and that would raise the cost for everybody. that is why we are seeing that happen together. given all that has happened, it would be really hard. that is why they're waiting until 2014. host: is getting hit by a truck a pre-existing condition after

2014? guest: you could get insurance if you wanted to change plans. host: staten island. caller: my comments to the host. -- complement to the host. [unintelligible] you have been so clear and concise in providing information. you should be in congress. my question, real quick. as far as the health insurance companies are concerned, is there any information on the breakdown as far as what they get and the services they provide? you have answered most of my questions.

guest: i think your question is what of the insurance companies. to be required to do and pay. there are a number of things that affect them. they will not be able to reject you anymore in 2014. this year, they cannot cancel your policy which is a fairly rare occurrence it can be a big deal if you are in that 1%. that is going to be a change. they have to report how much they are spending on direct medical care such as administrative costs. some of it is disease management. there are salaries and profits. they will have to tell this secretary how much they are spending on each of those things.

starting next year, if they do not reach a certain targets, they have to give some of that money back to consumers. if you are in a small group plan or individual plant next year, 80% of the revenue must be spent on medical care. that is if you are with a small group plan. a 5% if you are with a large group plan. and that is immediate. -- 85 cent% if you are with a le group plan. and that is immediate. caller: my question is about medicaid. i was disabled. already under our governor's things he did, i am

experiencing loss mostly in prescriptions and restrictions. it seems to make no sense that basically it is treating people as well we are all cookie cutter people. everybody gets the same thing. host: thank you. what about at the state level? guest: in medicaid, there are moneys that are available to health basic health preventative. for people that make too much to qualify for traditional medicaid but not enough for private coverage -- there will be held for states with those programs. i think they can start applying for that this year.

in 2014, it expands to cover more people. if you do not have children, you are not eligible for that matter how little money you make. that will change. they would expand medicaid for that whether or not they have kids. the states will start paying their share in some years. they are concerned. we will see many more people covered by medicaid. host: how much money is being spent? guest: i do not know what the number is this year, the cost is

going to be $9.8 billion over the 10 years. it will reduce the deficit by $124 billion over 10 years. those estimates that far out in 20 years are uncertain. taxes this year, there is a fee this year. if the good to a tanning salon, a 10% additional tax. that goes to help pay for some of those programs. there will be a tax on drug makers. those happen further out. the taxes are likely to be

passed onto consumers. it will happen after the exchange's get going. host: republican, st. petersburg, florida. caller: c-span need an alternative viewpoint. kaiser is following the obama talking points. they are a big cheerleader. they did not find anything wrong with the plan. everything she is describing is going to increase the cost of health insurance. the silver plan which is 7% will cost about $19,000 -- 70% will cost about $19,000.

you save money with an unsustainable and hot mud from the government that as a $38 trillion medicare liability. host: you have a question? caller: i am a doctor. i will be penalized if i go over budget for my patients. they will say, you cann-h spenda certain amount for spine surgery. if he spent over it, we will cut 5% and call you a bad name in the newspaper. patients coming to the doctors will not be able to trust the doctors, because they will get more if they spend less on their patients. why should we ration care that way using government power? host: stay on the line in case she has questions for you. we did not invite her to be an advocate for an opponent. she is an analyst. that is what we are doing today. talking about the immediate

effect. what immediately goes into effect for you as a doctor? caller: i am a brain and spine surgeons. they say some programs save money. but they hurt people. people that get circuit aborted by their doctors because they are afraid of getting a bad report card. guest: some of these things are occurring through insurance companies doing different things in trying to determine which are the most efficient doctors and practices. they are kind to steer patients to use high-quality doctors and whatever they want to label them or call them. he made a couple of points that may or may not be correct. they talked about what will happen in the premiums. some will go up. there are going to go up anyway.

they were going up on average 8% a year already. the hope is that this legislation will slow that premium growth over time. in 2016 when a lot of this is fully implemented, premiums for large employer plans will be about they would if this law had not changed. premiums for small businesses may go down or make up by 1%. premiums for individual policies may go up 10% or 15%, because of these changes. for half of the people, there would be subsidies to offset the cost. doctors are concerned about this. it depends