CNN 2010-03-23

So let's say health care reform passes. And you're one of the millions of Americans needing insurance. Think you'll be covered immediately? Well, think again. Our chief medical correspondent 1 Dr. Sanjay Gupta is here to break it all down for us.

So, Sanjay, if the bill were to pass, when would we actually see any changes?

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Well, you know, some of those changes are going to come about pretty quickly. But, you know, it's important to sort of keep a couple of things in mind.

First, we don't know what the final shape of this thing ultimately 2 is going to be. And two is that not everything is going to happen at once. So it's not going to be a magic wand being waved and all of a sudden the system completely changing.

So let's take a look at a couple of the important things that might make a difference earlier on. First of all, I don't know if you have -- if you can see those or not, but this idea that there won't be any annual caps anymore.

So, say you've had some sort of illness. Sometimes the insurance company will say there's a yearly cap or a lifetime cap. Those are going to disappear, so insurance companies will continue to pay the medical expenses for people who have that.

Pre-existing conditions. Something we've been talking about for more than a year. If you've had some sort of pre-existing condition, it can be very difficult to get health insurance.

They're going to set up these high risk insurance pools around the country so that people who have some sort of pre-existing illness can get insurance through those pools and those are going to be subsidized.

Young adults covered to age 26. That's exactly what it means. If you have -- after college but before your first job, you can still get health care insurance. Drug discounts for seniors as well. This idea of the doughnut hole.

Fred, we've talked a lot about this. Think of a doughnut. It's got a hole in the middle. The way that these insurance works, these drugs is that they pay as you eat through the first part of the doughnut, but there's no coverage 3 in the middle of that doughnut.

And you don't start getting -- as far as coverage goes until you get to the other part of the doughnut. Shrinking that doughnut hole so that you have a shorter period of time where you're not covered. That's sort of the goal there.

So those are some of the things, if this passes, within 2010 we'll probably see.

WHITFIELD: And if you're uninsured and you desperately 4 want to be covered will you be covered immediately if this bill were to pass?

GUPTA: It depends who you are and exactly why you're not covered. So some people who have simply not bought health care insurance because they can't afford it, there may be some benefits here.

People who have not bought health insurance because it's been too expensive, because they've had some sort of pre-existing condition, they may get some benefit. But take a look at sort of what 2014 would look like. That's an important year as far as when this gets more widely implemented 5.

First of all there would be mandates 6. People are going to have to buy health care insurance or buy fines. The way that they're going to do this is through a health insurance exchange. Think about those as supermarkets. So private plans that you can select from. If you can't afford it, you get tax credits to help defray some of those costs.

Again, no discrimination based on pre-existing conditions. Those tax credits to help pay for it. And finally this idea that, you know, expand Medicaid, part of this bill as well. So for childless adults living near poverty, they would qualify 7 for Medicaid expansion and possibly get some health savings 8 as well.

But, again, that's four years down the line, Fred, for -- you know a vast majority of Americans who are waiting for this to happen.

WHITFIELD: Wow. So in some cases immediately, almost immediately, in other cases you've got to wait at least four years. All this predicated on whether it passes at all.

GUPTA: That's right. Lots of layers. And we don't know how it's all going to look.

WHITFIELD: All right, Dr. Sanjay Gupta. Thanks so much.