The debate over health-care reform has given one topic short shrift: How would reform affect consumers?

While some of the details are not yet decided (and may not be fully decided for months), a picture is emerging that could help you better understand how buying health insurance could change under the proposals.

The key issues for consumers fall into two broad categories -- market reforms and coverage guarantees, said Drew Altman, president and chief executive of the Kaiser Family Foundation.

Market reforms address how insurance companies can operate, and these changes are dramatic. Under existing law, insurers have the right to pick and choose their customers. They would not have that right under any of the reform proposals.

ACCESS

Insurance companies would be barred from refusing to cover "pre-existing medical conditions" and from denying coverage completely because of ailments that you already have or that run in your family.

In addition, the proposed laws would prevent companies from charging sick people so much for coverage that it would price them out of the market, Altman said.

"That's a sweeping change that touches everyone," Altman said. "You cannot get dropped or turned away if you lose your job or lose your insurance. And they cannot raise your rates to make it impossible for you to afford coverage."

MANDATES

The flip side of that coin: You would have to buy insurance, whether you want to or not.

All the proposals require that you buy health insurance or pay a penalty, usually in the form of a tax. The amount of the penalty is a moving target at the moment, but it would probably amount to some percentage of the cost of bare-bones coverage.

A lot of people have a teenage reaction to mandates -- they don't like being told what to do. But experts explain that mandates are necessary here because they would eliminate the inequity of today's system.

Under existing law, you can choose not to spend money on health insurance without worrying that you won't get care. Why? Federal law demands that you get treated, regardless of whether you are insured or can afford to pay, said John Desser, vice president of public policy at EHealthInsurance Services Inc. in Mountain View, Calif.

The Emergency Medical Treatment and Active Labor Act, passed in 1986, says that you cannot be refused treatment or transferred to another facility when you are in an unstable medical condition.

As a result, people who are not insured merely need to wait until their condition is bad enough. Then they can go to an emergency room and get treated free of charge -- or rather at a huge cost, but to taxpayers rather than themselves.

That law is also why debates about whether illegal immigrants would get health coverage under the law are spurious. Yes, they will. They get coverage now. It's a matter of whether they get coverage through an insurance program or through emergency rooms, as they do now. Continued...