Monday, July 27, 2009
What Health Care Reform May Hold For Those Who Have Insurance
World Health Organization's 2000 World Health Report, rated 191 countries' medical systems. The United States placed 37th, behind even Morocco, Cyprus, and Costa Rica. Everyone is curious and deeply concerned about the health care reform bills moving through Congress. Current estimates suggest that it would cost close to $1 trillion over 10 years to extend coverage to tens of millions of uninsured Americans. Though costly, most agree that the reform would do a good job of providing coverage for uninsured Americans, but what about the effect of the reform on the far greater number of people who already have insurance? A recent editorial in the New York Times outlined some answers for the insured. Keep in mind, this is an editorial. Read as much as you can about the bills and decide the direction that benefits most. Labeling and stereotyping does nothing to help alleviate the current problems. Knowledge is the key to solving the health care dilemma of cost versus service. I have outlined some of the major points in the editorial for ease of delivery. Please read the entire article on site. ("Health Care Reform and You," July 25 2009, http://www.nytimes.com/2009/07/26/opinion/26sun1.html?pagewanted=1) 1. Expanding Medicaid would help the poorest of the uninsured. A family of four earning $66,000 to $88,000 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 agreeing to provide a specified level of benefits and set premiums at rates more comparable to group rates for big employers than to exorbitant rates charged for individual coverage. 2. A new marketplace, the so-called health insurance exchange would be born. With the creation of so many new subscribers, virtually all major insurers are expected to offer policies through an exchange. 3. All insurance companies would be more tightly regulated. For example, reform would prohibit policies from excluding or charging higher rates to people with pre-existing conditions, bar companies from rescinding policies after people come down with a serious illness, and prohibit insurers from setting annual or lifetime limits on what a policy would pay. 4. In President Obama's proposal, the entire tax burden would be dropped on families earning more than $250,000 or $350,000 or $1 million a year, depending on proposals. There is strong opposition in the Senate, so it seems likely that some burden would fall on the less wealthy. 5. Healthy young people who might prefer not to buy insurance at all will probably be forced to because of a federal mandate. 6. 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. 7. Greater security is the main gain for those enrolled in group coverage. When laid off or leaving a job, those people would no longer be faced with exorbitant costs of individually bought insurance; instead, they could buy new policies through the insurance exchanges at affordable rates. 8. President Obama has also pledged that if people like their current insurance, they can keep it. 9. Coverage for the uninsured 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. It is anticipated in the long run, if reform efforts slow the growth of health care costs, then the increase in insurance costs should ease as well. 10. The bills would alter payment incentives in Medicare to reduce needless re-admissions to hospitals. The bills should promote comparative effectiveness research to determine which treatments are best but would not force doctors to use them and call for pilot programs in Medicare to test the best ways for doctors to manage and coordinate a patient’s total care. 11. 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. 12. 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. 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. 13. The AARP, the main lobby for older Americans, has praised the emerging bills. This might suggests that the great majority of Americans — those with insurance and those without — would benefit from health care reform.