Well, after all the excitement and the best efforts of the GOP to say “No” loud and long enough to make a difference, the President signed the healthcare reform into law. The partisans are now into the equally exciting game of trying to decide whether this is the greatest victory since Abraham Lincoln, with a little help from General Ulysses S. Grant, won the Civil War or the greatest disaster since Hurricane Katrina reminded us Nature can be devastating. Allowing for the fact this is a complicated piece of legislation, this is a little difficult to predict because so much of it is not designed to take effect for years. Calling for immediate repeal does not seem helpful when no one can say how the future will turn out. As time passes and we dig ourselves out of the recession, it is entirely possible this may turn out to have been a good “thing” on balance. If “things” do not look quite as good, a little tinkering may set matters to right. History has a way of judging “things” rather differently than we expect. This leaves us with the next twelve months during which there are elections and an opportunity for voters to have their say. What is due to happen and will this make the reform look good enough to keep?

1. There will be a payment of $250 to people in Medicare. This is designed to close the Part D donut hole. In 2011, there will be a 50% discount on the branded drugs in the hole with the hole closing by 2020.

2. Starting on January 1, 2011 there will be no co-payments for preventative medical care. This care will also be exempted when calculating the deductible.

3. Starting in three months, there will be a temporary re-insurance program for employers to cover retirees in the age range 55 to 64.

4. Starting in six months, insurers shall not cancel a policy if a claim is made nor discriminate against children with a pre-existing condition. There are also to be new controls to prevent insurers from imposing caps on coverage.

5. Before the reform, the majority of people were insured by their employers. Starting immediately, small businesses can claim, tax credits of 35% of premiums if they decide to buy a health plan. This rises to 50% in 2014. Up to now, small businesses have always claimed they were the victims of discrimination, priced out of the market by the insurance industry. With a government subsidy, this argument looks less real.

Whether this will be enough to sway public opinion is anyone’s guess. Health insurance has provoked some seriously extreme reactions and it will take time for people to take a more calm view of what the reforms offer. The reaction of the insurance companies is also difficult to predict. Some may react to the new controls by increasing their premiums. Insurers are, after all, for-profit organizations and they have never shown themselves slow in coming forward with premium hikes. This makes it even more important to get the maximum possible number of health insurance quotes before deciding on which policy or plan to buy. When midterm elections come in November 2012, 36 seats in the Senate and all the seats in the House are up for grabs. Experts predict the Democrats will lose seats. But, with President Obama in the White House, no repeal will be signed into law.

The lawmakers in Colorado are debating a change in the law to correct the gender discrimination currently requiring women to pay more than men to insure their health. The facts are discouraging. In some 90% of all private health plans, women have premium rates 60% higher than men. This is so even though the statistics show women enjoy better health than men, have less bad habits and make fewer claims. This is so even though the men used for comparative purposes are significantly older. And, if you feel you need any more confirmation of the basic unfairness, even men who smoke pay less than female non-smokers. As one of the women promoting the bill commented: insurers often refuse coverage because the applicant has a pre-existing condition. The way the premiums are loaded, it seems being a woman is a pre-existing condition.

The people who are paid to speak on behalf of the insurance industry usually fall back on the tried and trusted defense that women have medical needs specific to their gender. The most often quoted example is maternity and prenatal care. Ignoring the fact that men also have problems specific to their gender, such as erectile dysfunction, women are still quoted premiums 60% higher on policies excluding reproductive health needs. In other words, the discrimination persists even though the scope of the medical coverage is identical. So what’s going on? The answer, in this instance, is slightly complicated. If we start with auto insurance, it’s common knowledge that young men are statistically more likely than any other group of drivers to crash into another vehicle or some stationary object.

Thus, where the policy discriminates between different groups of drivers, young men pay significantly more than women who tend to drive more safely. Not all auto policies do discriminate. By spreading the risk among a big group of drivers, the good subsidize the bad. But, most auto insurers do set different premium rates for different groups of drivers distinguished by gender and age. In medicine, it’s a fact that men fall ill and die, whereas women tend to recover from illnesses. This is one of the reasons why women have a longer life expectancy than men. But it also explains why women cost more. They survive for longer with chronic problems requiring continuing treatment. Thus, if the premium is a reflection of the likely costs of treatment over a person’s lifetime, it may appear slightly more reasonable to charge women higher premiums. Except this ignores the general rule that private health insurance stops at 65 as Medicare kicks in. The major long-term costs tend to occur after 65.

Colorado looks as though it may join the one or two other states with equality provisions. There’s no evidence from these other states that men now have to pay significantly more. For now, insurers simply make less profit. As a woman, it’s particularly important to research exactly what the different companies offer. Because of this, searching for cheap health insurance is a greater challenge. Always refer to the websites of the companies making the best quotes to see if there are additional discounts available or special policies for women. If there seems to be no cheap health insurance available, talk directly with the insurers to see whether the difference between the male and female premium rates can be reduced. Not everyone is lucky enough to live in a state committed to equality. It is for you to protect yourself as best as possible.