Friday, July 31, 2009
Efforts to Stall Health Care Reform Unreasonable
This week the Harris County Hospital District hosted Senator Kay Bailey Hutchison at a news conference asking Congress to delay reforming our broken health care system.
Some of the institutions represented at the press conference pointed out that many programs vital to our state's health care system are being short-changed. These are valid points with which I agree. As one of the people that President Obama has entrusted to achieve health care reform, I have scheduled meetings with the Harris County Hospital District, the Texas Medical Center, and others represented at the press conference to ensure they are heard.
Interestingly enough, the challenges discussed by the institutions were caused by policy decisions [HB 2292 by Arlene Wohlgemuth, aided by Talmadge Heflin and pushed by Governor Perry, David Dewhusrt and Tom Craddick] made at the state level in 2003.
Now, the Republican leadership is attempting to kill health care reform by using delay tactics that will prevent a vote on any bill. At a time when six million Texans, including 1.5 million children lack health insurance, failing to act on policy issues that will insure millions of Texans and Americans is not an option. Harris County alone has 1.1 million uninsured residents.
The dilemma began when the hospital district presented a double standard on policy which has harmed the people I represent. However, now we are moving forward to focus on the policy of the people rather than the politics of the moment.
Below I have included:
Houston Chronicle
Democrat questions health care news event
By TODD ACKERMAN
July 30, 2009, 8:26PM
State Rep. Garnet Coleman is calling out the Harris County Hospital District for hosting U.S. Sen. Kay Bailey Hutchison's news conference on health care reform Monday, 1½ years after it rejected his request to hold a similar event on the grounds that it was political.
Coleman said the Hutchison event, where many of the Texas Medical Center's top leaders urged Congress not to rush efforts to fix America's health care system, betrayed a "double standard" and may have lent a partisan meaning many of those leaders didn't intend.
"The Republican Party is trying to kill health care reform, and anyone in politics knows delay delay delay is one good way to do it," said Coleman, D-Houston, who is on President Barack Obama's 32-member team of State Legislators for Health Reform. "It's unfortunate the medical center was used to help that cause."
Republicans spoke
Medical Center leaders at the news conference emphasized they're strongly in favor of health care reform. But one contacted Thursday reiterated Congress needs to be as careful about its details as doctors are about treating patients.
In a statement, the hospital district said it hasn't taken a position on any legislation or policy and will work to ensure that appropriate reform strategies are implemented as quickly as possible. It said it agrees with its medical center peers that "a prudent review" of the current proposals is appropriate.
The news conference at Ben Taub Hospital was arranged by Hutchison, R-Texas, following phone calls of concern from the hospital district and other urban hospitals around the state about House legislation that would reduce reimbursement of uncompensated care.
Hutchison and U.S. Rep. Kevin Brady, R-The Woodlands, led off the news conference with criticism of a bill that House Speaker Nancy Pelosi last week said she wanted to pass before the August recess but now will have to wait until September.
Hutchison and Brady were followed in their remarks by many of the medical center's most influential people, virtually all of whom emphasized that Congress should proceed slowly, so as to ensure that reform not only fixes the problems but preserves the things American health care does well.
Welcomes forum
Dr. Kenneth Mattox, chief of staff at Ben Taub, said he knew little about the news conference when he was asked to attend. But he played down questions about its appropriateness, saying he welcomes any forum to talk about health care reform.
"Everybody indicated we must have a change in the health care delivery and the status quo," he said. "You didn't hear anyone there say anything about killing health reform."
Coleman responded that it's common political strategy to "kill bills without saying so."
The news conference Coleman had wanted to hold at the hospital district in late 2007 involved his push for the federal government to renew the Children's Health Insurance Program. Implying the rejection was a mistake, the hospital district said Thursday that Coleman is welcome "to hold an event at any of our facilities at any time to share his views on current health care reform initiatives."
todd.ackerman@chron.com
Houston Chronicle
Med Center leaders: Slow down on health reform
By TODD ACKERMAN
July 29, 2009, 7:17PM
In their first unified voice on the subject, Texas Medical Center leaders Monday sent a message to Congress as it tries to reform America's troubled health care system: slow down.
Appearing at a news conference sponsored by U.S. Sen. Kay Bailey Hutchison, R-Texas, many of the medical center's biggest names said the issue is too important to rush through legislation that could have unforeseen harmful consequences.
"This is a monumental piece of legislation that is going to impact people for many years, both the 253 million people who have insurance and the 47 million who don't," said Dan Wolterman, CEO of the Memorial Hermann Health Care System. "The priority should be, let's get it right, not let's get it done fast."
Afterward, some of the leaders acknowledged the time needed might extend past 2009 but said it's more important to pass a good bill than to meet an arbitrary timetable. Two said the process ought to take years, perhaps involving a series of bills.
Others said they were optimistic it can be done by the end of the year.
President Barack Obama originally had called for passage of a bill by the end of August but last week said the end of the year is fine, following the Senate Finance Committee's decision to hold off on the matter until after the August recess. The committee has not yet released the bill it has been negotiating, though details began leaking Monday.
But House Speaker Nancy Pelosi, D-Calif., is still vowing to pass health care reform before the break in the House. Pelosi said Monday that lawmakers were "moving closer" to agreement on the 1,000-page, $1 trillion measure that last week stalled in committees.
The bill has faced criticism from all sides about its cost, scope and funding, and Republicans have blasted it as a gateway to a government takeover of health care.
All back idea of reform
At the news conference at Ben Taub Hospital on Monday, Hutchison said "everything about the bill is counter intuitive," then turned over the podium to a who's who of medical center leaders that included Harris County Hospital District President and Chief Executive David Lopez, University of Texas Health Science Center at Houston President Dr. Larry Kaiser, Texas Heart Institute President Dr. James Willerson and Ben Taub Chief of Staff Ken Mattox. Every major medical center institution was represented.
Though each brought its own concerns, they were united that reform is necessary but that Congress needs to tread carefully to preserve the best of American health care while it tries to fix what's broken. They complained that Congress has done little to solicit input from the medical community.
"I applaud Congress' efforts, but now isn't the time to rush," Kaiser said. "I liken it to taking out a tumor. There's a time when there's an urge to get it done quickly, but that's when mistakes can be made. That's the time to take it slowly and carefully."
But Kaiser said he thinks Congress needs to act by the end of the year, or else it risks losing momentum on the issue. He said he thinks the American people want something and won't be content with no health care reform being accomplished this year.
Mattox said he'd like to see a Texas Medical Center document recommending the key principles of reform.
Medical center leaders' criticism of reform efforts include: no mechanism to pay for the expanded coverage by cutting waste, fraud and errors; no attention paid to the role of illegal immigrants on health care costs; and no emphasis on prevention and graduate medical education.
The unity extended to those not at the press conference, such as Texas Medical Center President Richard Wainerdi, who said the House bill "may have unintended consequences that could be catastrophic to providers and patients" and UT M.D. Anderson Cancer Center President Dr. John Mendelsohn, who said "Congress needs to focus on the whole package, not just access."
The New York Times
Health Care Reform and You
July 26, 2009
EDITORIAL
The health care reform bills moving through Congress look as though they would do a good job of providing coverage for millions of uninsured Americans. But what would they do for the far greater number of people who already have insurance? As President Obama noted in his news conference last week, many of them are wondering: "What's in this for me? How does my family stand to benefit from health insurance reform?"
Many crucial decisions on coverage and financing have yet to be made, but the general direction of the legislation is clear enough to make some educated guesses about the likely winners and losers.
WHAT ARE THE ELEMENTS OF REFORM? The House bill and a similar bill in the Senate would require virtually all Americans to carry health insurance with specified minimum benefits or pay a penalty. They would require all but the smallest businesses to provide and subsidize insurance that meets minimum standards for their workers or pay a fee for failing to do so.
The reforms would help the poorest of the uninsured by expanding Medicaid. Some middle-class Americans — earning up to three or four times the poverty level, or $66,000 to $88,000 for a family of four — would get subsidies to help them buy coverage through new health insurance exchanges, national or state, which would offer a menu of policies from different companies.
IS THERE HELP FOR THE INSURED? Many insured people need help almost as much as the uninsured. Premiums and out-of-pocket spending for health care have been rising far faster than wages. Millions of people are "underinsured" — their policies don't come close to covering their medical bills. Many postpone medical care or don't fill prescriptions because they can't afford to pay their share of the costs. And many declare personal bankruptcy because they are unable to pay big medical debts.
The reform effort should help ease the burdens of many of them, some more quickly than others. The legislation seems almost certain to include a new marketplace, the so-called health insurance exchange. Since there will be tens of millions of new subscribers, virtually all major insurers are expected to offer policies through an exchange. To participate, these companies would have to agree to provide a specified level of benefits, and they would set premiums at rates more comparable to group rates for big employers than to the exorbitant rates typically charged for individual coverage.
Under the House bill, the exchanges would start operating in 2013. They would be open initially to people who lack any insurance; to the 13 million people who have bought individual policies from insurance companies, which often charge them high rates for relatively skimpy coverage; and to employees of small businesses, who often pay high rates for their group policies, especially if a few of their co-workers have run up high medical bills. By the third year, larger businesses might be allowed to shift their workers to an exchange. All told, the Congressional Budget Office estimates that 36 million people would be covered by policies purchased on an exchange by 2019.
IS THERE MORE SECURITY FOR ALL? As part of health reform, all insurance companies would be more tightly regulated. For Americans who are never quite certain that their policies will come through for them when needed, that is very good news.
The House bill, for example, would require that all new policies sold on or off the exchanges must offer yet-to-be-determined "essential benefits." It would prohibit those policies from excluding or charging higher rates to people with pre-existing conditions and would bar the companies from rescinding policies after people come down with a serious illness. It would also prohibit insurers from setting annual or lifetime limits on what a policy would pay. All this would kick in immediately for all new policies. These rules would start in 2013 for policies purchased on the exchange, and, after a grace period, would apply to employer-provided plans as well.
WHO PAYS? Current estimates suggest that it would cost in the neighborhood of $1 trillion over 10 years to extend coverage to tens of millions of uninsured Americans. Under current plans, half or more of that would be covered by reducing payments to providers within the giant Medicare program, but the rest would require new taxes or revenue sources.
If President Obama and House Democratic leaders have their way, the entire tax burden would be dropped on families earning more than $250,000 or $350,000 or $1 million a year, depending on who's talking. There is strong opposition in the Senate, and it seems likely that at least some burden would fall on the less wealthy.
Many Americans reflexively reject the idea of any new taxes — especially to pay for others' health insurance. They should remember that if this reform effort fails, there is little hope of reining in the relentless rise of health care costs. That means their own premiums and out-of-pocket medical expenses will continue to soar faster than their wages. And they will end up paying higher taxes anyway, to cover a swelling federal deficit driven by escalating Medicare and Medicaid costs.
WHO WON'T BE HAPPY? Healthy young people who might prefer not to buy insurance at all will probably be forced to by a federal mandate. That is all to the good. When such people get into a bad accident or contract a serious illness, they often can't pay the cost of their care, and the rest of us bear their burden. Moreover, conscripting healthy people into the insured pool would help reduce the premiums for sicker people.
Less clear is what financial burden middle-income Americans would bear when forced to buy coverage. There are concerns that the subsidies ultimately approved by Congress might not be generous enough.
WHAT IF I HAVE GOOD GROUP COVERAGE? The main gain for these people is greater security. If they got laid off or chose to leave their jobs, they would no longer be faced with the exorbitant costs of individually bought insurance but could buy new policies through the insurance exchanges at affordable rates.
President Obama has also pledged that if you like your current insurance you can keep it.
Right now employers are free to change or even drop your coverage at any time. Under likely reforms, they would remain free to do so, provided they paid a penalty to help offset the cost for their workers who would then buy coverage through an exchange. Under the House reform bill, all employers would eventually be allowed to enroll their workers in insurance exchanges that would offer an array of policies to choose from, including a public plan whose premiums would almost certainly be lower than those of competing private plans.
Some employers might well conclude that it is a better deal — for them or for you — to subsidize your coverage on the exchange rather than in your current plan. If so, you might end up with better or cheaper coverage. You would probably also have a wider choice of plans, since most employers offer only one or two options.
WILL I PAY LESS? Two factors could help drive down the premiums for those who are insured.
In the short-term, if reform manages to cover most of the uninsured, that should greatly reduce the amount of charity care delivered by hospitals and eliminate the need for the hospitals to shift such costs to patients who have private insurance. One oft-cited study estimates that cost-shifting to cover care for the uninsured adds about $1,000 to a family's annual insurance premiums; other experts think it may be a few hundred dollars. In theory, eliminating most charity care should help hold down or even reduce the premiums charged for private insurance. When, if ever, that might happen is unclear.
In the long run, if reform efforts slow the growth of health care costs, then the increase in insurance costs should ease as well. And if the new health insurance exchanges — and possibly a new public plan — inject more competition into markets that are often dominated by one or two big private insurance companies, that, too, could help bring down premiums.
But these are big question marks, and the effects seem distant.
WILL MY CARE SUFFER? Critics have raised the specter that health care will be "rationed" to save money. The truth is that health care is already rationed. No insurance, public or private, covers everything at any cost. That will not change any time soon.
It is true that the long-term goal of health reform is to get rid of the fee-for-service system in which patients often get very expensive care but not necessarily the best care. Virtually all experts blame the system for runaway health care costs because it pays doctors and hospitals for each service they perform, thus providing a financial incentive to order excessive tests or treatments, some of which harm the patients.
An earlier wave of managed care plans concentrated on reining in costs and aroused a backlash among angry beneficiaries who were denied the care they wanted. The most expensive treatment is not always the best treatment. The reform bills call for research and pilot programs to find ways to both control costs and improve patients' care.
The bills would alter payment incentives in Medicare to reduce needless readmissions to hospitals. They would promote comparative effectiveness research to determine which treatments are best but would not force doctors to use them. And they call for pilot programs in Medicare to test the best ways for doctors to manage and coordinate a patient's total care.
Any changes in the organization of care would take time to percolate from Medicare throughout the health care system. They are unlikely to affect most people in the immediate future.
WHAT DOES IT MEAN FOR OLDER AMERICANS? People over 65 are already covered by Medicare and would seem to have little to gain. But many of the chronically ill elderly who use lots of drugs could save significant money. The drug industry has already agreed to provide 50 percent discounts on brand-name drugs to Medicare beneficiaries who have reached the so-called "doughnut hole" where they must pay the full cost of their medicines. The House reform bill would gradually phase out the doughnut hole entirely, thus making it less likely that beneficiaries will stop taking their drugs once they have to pay the whole cost.
Not everyone in Medicare will be happy. The prospective losers are likely to include many people enrolled in the private plans that participate in Medicare, known as Medicare Advantage plans. They are heavily subsidized, and to pay for reform, Congress is likely to reduce or do away with those subsidies. If so, many of these plans are apt to charge their clients more for their current policies or offer them fewer benefits. The subsidies are hard to justify when the care could be delivered more cheaply in traditional Medicare, and the subsidies force up the premiums for the beneficiaries in traditional Medicare to cover their cost.
Reformers are planning to finance universal coverage in large part by saving money in the traditional Medicare program, raising the question of whether all beneficiaries will face a reduction in benefits. President Obama insisted that benefits won't be reduced, they'll simply be delivered in more efficient ways, like better coordination of care, elimination of duplicate tests and reliance on treatments known to work best.
The AARP, the main lobby for older Americans, has praised the emerging bills and thrown its weight behind the cause. All of this suggests to us that the great majority of Americans — those with insurance and those without — would benefit from health care reform.
Some of the institutions represented at the press conference pointed out that many programs vital to our state's health care system are being short-changed. These are valid points with which I agree. As one of the people that President Obama has entrusted to achieve health care reform, I have scheduled meetings with the Harris County Hospital District, the Texas Medical Center, and others represented at the press conference to ensure they are heard.
Interestingly enough, the challenges discussed by the institutions were caused by policy decisions [HB 2292 by Arlene Wohlgemuth, aided by Talmadge Heflin and pushed by Governor Perry, David Dewhusrt and Tom Craddick] made at the state level in 2003.
Now, the Republican leadership is attempting to kill health care reform by using delay tactics that will prevent a vote on any bill. At a time when six million Texans, including 1.5 million children lack health insurance, failing to act on policy issues that will insure millions of Texans and Americans is not an option. Harris County alone has 1.1 million uninsured residents.
The dilemma began when the hospital district presented a double standard on policy which has harmed the people I represent. However, now we are moving forward to focus on the policy of the people rather than the politics of the moment.
Below I have included:
- A Houston Chronicle article describing an apparently partisan press conference hosted by the Harris County Hospital District at the request of Senator Hutchison.
- A Houston Chronicle article detailing Senator Hutchison's press conference and her wish to delay health care reform.
- A New York Times Sunday editorial that explains how federal health care reform legislation will affect you and your family.
Democrat questions health care news event
By TODD ACKERMAN
July 30, 2009, 8:26PM
State Rep. Garnet Coleman is calling out the Harris County Hospital District for hosting U.S. Sen. Kay Bailey Hutchison's news conference on health care reform Monday, 1½ years after it rejected his request to hold a similar event on the grounds that it was political.
Coleman said the Hutchison event, where many of the Texas Medical Center's top leaders urged Congress not to rush efforts to fix America's health care system, betrayed a "double standard" and may have lent a partisan meaning many of those leaders didn't intend.
"The Republican Party is trying to kill health care reform, and anyone in politics knows delay delay delay is one good way to do it," said Coleman, D-Houston, who is on President Barack Obama's 32-member team of State Legislators for Health Reform. "It's unfortunate the medical center was used to help that cause."
Republicans spoke
Medical Center leaders at the news conference emphasized they're strongly in favor of health care reform. But one contacted Thursday reiterated Congress needs to be as careful about its details as doctors are about treating patients.
In a statement, the hospital district said it hasn't taken a position on any legislation or policy and will work to ensure that appropriate reform strategies are implemented as quickly as possible. It said it agrees with its medical center peers that "a prudent review" of the current proposals is appropriate.
The news conference at Ben Taub Hospital was arranged by Hutchison, R-Texas, following phone calls of concern from the hospital district and other urban hospitals around the state about House legislation that would reduce reimbursement of uncompensated care.
Hutchison and U.S. Rep. Kevin Brady, R-The Woodlands, led off the news conference with criticism of a bill that House Speaker Nancy Pelosi last week said she wanted to pass before the August recess but now will have to wait until September.
Hutchison and Brady were followed in their remarks by many of the medical center's most influential people, virtually all of whom emphasized that Congress should proceed slowly, so as to ensure that reform not only fixes the problems but preserves the things American health care does well.
Welcomes forum
Dr. Kenneth Mattox, chief of staff at Ben Taub, said he knew little about the news conference when he was asked to attend. But he played down questions about its appropriateness, saying he welcomes any forum to talk about health care reform.
"Everybody indicated we must have a change in the health care delivery and the status quo," he said. "You didn't hear anyone there say anything about killing health reform."
Coleman responded that it's common political strategy to "kill bills without saying so."
The news conference Coleman had wanted to hold at the hospital district in late 2007 involved his push for the federal government to renew the Children's Health Insurance Program. Implying the rejection was a mistake, the hospital district said Thursday that Coleman is welcome "to hold an event at any of our facilities at any time to share his views on current health care reform initiatives."
todd.ackerman@chron.com
Med Center leaders: Slow down on health reform
By TODD ACKERMAN
July 29, 2009, 7:17PM
In their first unified voice on the subject, Texas Medical Center leaders Monday sent a message to Congress as it tries to reform America's troubled health care system: slow down.
Appearing at a news conference sponsored by U.S. Sen. Kay Bailey Hutchison, R-Texas, many of the medical center's biggest names said the issue is too important to rush through legislation that could have unforeseen harmful consequences.
"This is a monumental piece of legislation that is going to impact people for many years, both the 253 million people who have insurance and the 47 million who don't," said Dan Wolterman, CEO of the Memorial Hermann Health Care System. "The priority should be, let's get it right, not let's get it done fast."
Afterward, some of the leaders acknowledged the time needed might extend past 2009 but said it's more important to pass a good bill than to meet an arbitrary timetable. Two said the process ought to take years, perhaps involving a series of bills.
Others said they were optimistic it can be done by the end of the year.
President Barack Obama originally had called for passage of a bill by the end of August but last week said the end of the year is fine, following the Senate Finance Committee's decision to hold off on the matter until after the August recess. The committee has not yet released the bill it has been negotiating, though details began leaking Monday.
But House Speaker Nancy Pelosi, D-Calif., is still vowing to pass health care reform before the break in the House. Pelosi said Monday that lawmakers were "moving closer" to agreement on the 1,000-page, $1 trillion measure that last week stalled in committees.
The bill has faced criticism from all sides about its cost, scope and funding, and Republicans have blasted it as a gateway to a government takeover of health care.
All back idea of reform
At the news conference at Ben Taub Hospital on Monday, Hutchison said "everything about the bill is counter intuitive," then turned over the podium to a who's who of medical center leaders that included Harris County Hospital District President and Chief Executive David Lopez, University of Texas Health Science Center at Houston President Dr. Larry Kaiser, Texas Heart Institute President Dr. James Willerson and Ben Taub Chief of Staff Ken Mattox. Every major medical center institution was represented.
Though each brought its own concerns, they were united that reform is necessary but that Congress needs to tread carefully to preserve the best of American health care while it tries to fix what's broken. They complained that Congress has done little to solicit input from the medical community.
"I applaud Congress' efforts, but now isn't the time to rush," Kaiser said. "I liken it to taking out a tumor. There's a time when there's an urge to get it done quickly, but that's when mistakes can be made. That's the time to take it slowly and carefully."
But Kaiser said he thinks Congress needs to act by the end of the year, or else it risks losing momentum on the issue. He said he thinks the American people want something and won't be content with no health care reform being accomplished this year.
Mattox said he'd like to see a Texas Medical Center document recommending the key principles of reform.
Medical center leaders' criticism of reform efforts include: no mechanism to pay for the expanded coverage by cutting waste, fraud and errors; no attention paid to the role of illegal immigrants on health care costs; and no emphasis on prevention and graduate medical education.
The unity extended to those not at the press conference, such as Texas Medical Center President Richard Wainerdi, who said the House bill "may have unintended consequences that could be catastrophic to providers and patients" and UT M.D. Anderson Cancer Center President Dr. John Mendelsohn, who said "Congress needs to focus on the whole package, not just access."
The New York Times
Health Care Reform and You
July 26, 2009
EDITORIAL
The health care reform bills moving through Congress look as though they would do a good job of providing coverage for millions of uninsured Americans. But what would they do for the far greater number of people who already have insurance? As President Obama noted in his news conference last week, many of them are wondering: "What's in this for me? How does my family stand to benefit from health insurance reform?"
Many crucial decisions on coverage and financing have yet to be made, but the general direction of the legislation is clear enough to make some educated guesses about the likely winners and losers.
WHAT ARE THE ELEMENTS OF REFORM? The House bill and a similar bill in the Senate would require virtually all Americans to carry health insurance with specified minimum benefits or pay a penalty. They would require all but the smallest businesses to provide and subsidize insurance that meets minimum standards for their workers or pay a fee for failing to do so.
The reforms would help the poorest of the uninsured by expanding Medicaid. Some middle-class Americans — earning up to three or four times the poverty level, or $66,000 to $88,000 for a family of four — would get subsidies to help them buy coverage through new health insurance exchanges, national or state, which would offer a menu of policies from different companies.
IS THERE HELP FOR THE INSURED? Many insured people need help almost as much as the uninsured. Premiums and out-of-pocket spending for health care have been rising far faster than wages. Millions of people are "underinsured" — their policies don't come close to covering their medical bills. Many postpone medical care or don't fill prescriptions because they can't afford to pay their share of the costs. And many declare personal bankruptcy because they are unable to pay big medical debts.
The reform effort should help ease the burdens of many of them, some more quickly than others. The legislation seems almost certain to include a new marketplace, the so-called health insurance exchange. Since there will be tens of millions of new subscribers, virtually all major insurers are expected to offer policies through an exchange. To participate, these companies would have to agree to provide a specified level of benefits, and they would set premiums at rates more comparable to group rates for big employers than to the exorbitant rates typically charged for individual coverage.
Under the House bill, the exchanges would start operating in 2013. They would be open initially to people who lack any insurance; to the 13 million people who have bought individual policies from insurance companies, which often charge them high rates for relatively skimpy coverage; and to employees of small businesses, who often pay high rates for their group policies, especially if a few of their co-workers have run up high medical bills. By the third year, larger businesses might be allowed to shift their workers to an exchange. All told, the Congressional Budget Office estimates that 36 million people would be covered by policies purchased on an exchange by 2019.
IS THERE MORE SECURITY FOR ALL? As part of health reform, all insurance companies would be more tightly regulated. For Americans who are never quite certain that their policies will come through for them when needed, that is very good news.
The House bill, for example, would require that all new policies sold on or off the exchanges must offer yet-to-be-determined "essential benefits." It would prohibit those policies from excluding or charging higher rates to people with pre-existing conditions and would bar the companies from rescinding policies after people come down with a serious illness. It would also prohibit insurers from setting annual or lifetime limits on what a policy would pay. All this would kick in immediately for all new policies. These rules would start in 2013 for policies purchased on the exchange, and, after a grace period, would apply to employer-provided plans as well.
WHO PAYS? Current estimates suggest that it would cost in the neighborhood of $1 trillion over 10 years to extend coverage to tens of millions of uninsured Americans. Under current plans, half or more of that would be covered by reducing payments to providers within the giant Medicare program, but the rest would require new taxes or revenue sources.
If President Obama and House Democratic leaders have their way, the entire tax burden would be dropped on families earning more than $250,000 or $350,000 or $1 million a year, depending on who's talking. There is strong opposition in the Senate, and it seems likely that at least some burden would fall on the less wealthy.
Many Americans reflexively reject the idea of any new taxes — especially to pay for others' health insurance. They should remember that if this reform effort fails, there is little hope of reining in the relentless rise of health care costs. That means their own premiums and out-of-pocket medical expenses will continue to soar faster than their wages. And they will end up paying higher taxes anyway, to cover a swelling federal deficit driven by escalating Medicare and Medicaid costs.
WHO WON'T BE HAPPY? Healthy young people who might prefer not to buy insurance at all will probably be forced to by a federal mandate. That is all to the good. When such people get into a bad accident or contract a serious illness, they often can't pay the cost of their care, and the rest of us bear their burden. Moreover, conscripting healthy people into the insured pool would help reduce the premiums for sicker people.
Less clear is what financial burden middle-income Americans would bear when forced to buy coverage. There are concerns that the subsidies ultimately approved by Congress might not be generous enough.
WHAT IF I HAVE GOOD GROUP COVERAGE? The main gain for these people is greater security. If they got laid off or chose to leave their jobs, they would no longer be faced with the exorbitant costs of individually bought insurance but could buy new policies through the insurance exchanges at affordable rates.
President Obama has also pledged that if you like your current insurance you can keep it.
Right now employers are free to change or even drop your coverage at any time. Under likely reforms, they would remain free to do so, provided they paid a penalty to help offset the cost for their workers who would then buy coverage through an exchange. Under the House reform bill, all employers would eventually be allowed to enroll their workers in insurance exchanges that would offer an array of policies to choose from, including a public plan whose premiums would almost certainly be lower than those of competing private plans.
Some employers might well conclude that it is a better deal — for them or for you — to subsidize your coverage on the exchange rather than in your current plan. If so, you might end up with better or cheaper coverage. You would probably also have a wider choice of plans, since most employers offer only one or two options.
WILL I PAY LESS? Two factors could help drive down the premiums for those who are insured.
In the short-term, if reform manages to cover most of the uninsured, that should greatly reduce the amount of charity care delivered by hospitals and eliminate the need for the hospitals to shift such costs to patients who have private insurance. One oft-cited study estimates that cost-shifting to cover care for the uninsured adds about $1,000 to a family's annual insurance premiums; other experts think it may be a few hundred dollars. In theory, eliminating most charity care should help hold down or even reduce the premiums charged for private insurance. When, if ever, that might happen is unclear.
In the long run, if reform efforts slow the growth of health care costs, then the increase in insurance costs should ease as well. And if the new health insurance exchanges — and possibly a new public plan — inject more competition into markets that are often dominated by one or two big private insurance companies, that, too, could help bring down premiums.
But these are big question marks, and the effects seem distant.
WILL MY CARE SUFFER? Critics have raised the specter that health care will be "rationed" to save money. The truth is that health care is already rationed. No insurance, public or private, covers everything at any cost. That will not change any time soon.
It is true that the long-term goal of health reform is to get rid of the fee-for-service system in which patients often get very expensive care but not necessarily the best care. Virtually all experts blame the system for runaway health care costs because it pays doctors and hospitals for each service they perform, thus providing a financial incentive to order excessive tests or treatments, some of which harm the patients.
An earlier wave of managed care plans concentrated on reining in costs and aroused a backlash among angry beneficiaries who were denied the care they wanted. The most expensive treatment is not always the best treatment. The reform bills call for research and pilot programs to find ways to both control costs and improve patients' care.
The bills would alter payment incentives in Medicare to reduce needless readmissions to hospitals. They would promote comparative effectiveness research to determine which treatments are best but would not force doctors to use them. And they call for pilot programs in Medicare to test the best ways for doctors to manage and coordinate a patient's total care.
Any changes in the organization of care would take time to percolate from Medicare throughout the health care system. They are unlikely to affect most people in the immediate future.
WHAT DOES IT MEAN FOR OLDER AMERICANS? People over 65 are already covered by Medicare and would seem to have little to gain. But many of the chronically ill elderly who use lots of drugs could save significant money. The drug industry has already agreed to provide 50 percent discounts on brand-name drugs to Medicare beneficiaries who have reached the so-called "doughnut hole" where they must pay the full cost of their medicines. The House reform bill would gradually phase out the doughnut hole entirely, thus making it less likely that beneficiaries will stop taking their drugs once they have to pay the whole cost.
Not everyone in Medicare will be happy. The prospective losers are likely to include many people enrolled in the private plans that participate in Medicare, known as Medicare Advantage plans. They are heavily subsidized, and to pay for reform, Congress is likely to reduce or do away with those subsidies. If so, many of these plans are apt to charge their clients more for their current policies or offer them fewer benefits. The subsidies are hard to justify when the care could be delivered more cheaply in traditional Medicare, and the subsidies force up the premiums for the beneficiaries in traditional Medicare to cover their cost.
Reformers are planning to finance universal coverage in large part by saving money in the traditional Medicare program, raising the question of whether all beneficiaries will face a reduction in benefits. President Obama insisted that benefits won't be reduced, they'll simply be delivered in more efficient ways, like better coordination of care, elimination of duplicate tests and reliance on treatments known to work best.
The AARP, the main lobby for older Americans, has praised the emerging bills and thrown its weight behind the cause. All of this suggests to us that the great majority of Americans — those with insurance and those without — would benefit from health care reform.
posted by Rep. Garnet F. Coleman at
11:17 AM
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