Jen Cannistra from the White House Office of Health reform has a post up at the White House Blog that takes an interesting approach to assessing the current health care reform effort. She reminds us of something the Obama Team did during the transition.
…in December 2008, we invited Americans across the country to host and participate in Health Care Community Discussions to talk about the problems they faced with the health care system and proposed solutions. Over 9,000 Americans in all 50 states and the District of Columbia signed up during the holiday season to host a Health Care Community Discussion, coming from every walk of life – patients, doctors, nurses, religious leaders, first responders, and small business owners.
She then breaks down what they learned into discreet categories and says what the current bills do to address the problems.
Lacking Insurance Security
Health Insurance Reform Solution: Reform will ensure that Americans always have guaranteed choices of quality, affordable health insurance whether you lose your job, switch jobs, move, or get sick. With the new health insurance exchange, Americans can easily compare insurance plans, prices, and performance to decide which quality affordable insurance option is the right one.
Problems with Insurance Companies
Health Insurance Reform Solution: Reform will end insurer abuses, lower premiums, and hold insurance companies accountable. Insurance market reforms will prohibit abuses such as denying coverage for pre-existing conditions; charging exorbitant premiums based on gender, age, or health status; dropping coverage when people are sick; and imposing annual or lifetime limits on benefits. Insurers will be held accountable for excessive overhead costs fueled by unreasonable executive compensation and profits. And consumer rights will be enhanced by requiring all insurers to provide effective appeals procedures including outside, independent review of appeals.
Denied Coverage because of a Pre-Existing Condition
Health Insurance Reform Solution: Insurance companies will no longer be able to deny or water down coverage because of a pre-existing condition. Affordable insurance coverage options will also be made immediately available through a high-risk pool for Americans who are uninsured and have a pre-existing condition. In the Senate bill, insurers will be prohibited from denying coverage to kids with pre-existing conditions six months after enactment.
Charged More Because of Illness
Health Insurance Reform Solution: Reform will end insurance discrimination that charges individuals more if they currently face or previously had any illness.
Overwhelmed by Out-of-Pocket Expenses
Health Insurance Reform Solution: Reform will save families from financial ruin by placing a cap on what insurance companies can force individuals to pay in out-of-pocket expenses. As well, Americans will no longer face annual or lifetime benefit limits so that Americans can have the peace of mind that treatments they need will be provided.
Lacking Access to Health Care
Health Insurance Reform Solution:Reform will give insurance coverage to over 30 million previously uninsured Americans and will provide refundable tax credits to make sure Americans can afford quality coverage. For those receiving this premium assistance, the Congressional Budget Office estimates that average premiums under reform will be significantly less than what they would have paid without reform.
Caught by the “Donut Hole”
Health Insurance Reform Solution: Reform will close the coverage gap, or “donut hole,” in the Medicare Prescription Drug Program, dramatically lowering the cost of drugs for millions of seniors.
Expensive Early Retiree Premiums
Health Insurance Reform Solution: Employers and their retirees between 55 and 64 years of age will have lower premiums from new financial assistance to employer health plans that cover early retirees, bringing down premiums by as much as $1,200 per family per year for some plans.
Small Business Burdens
Health Insurance Reform Solution: Small businesses pay three times the administrative costs of large businesses for health insurance. Health reform will create a health insurance exchange that will reduce administrative costs, enabling small businesses to easily and simply compare the prices, benefits, and performance of health plans. Reform will also provide tax credits to help small businesses provide health insurance for their employees, making health care significantly more affordable for small businesses and their workers.
Struggling with Rising Health Care Costs
Health Insurance Reform Solution: There are numerous ways that reform will lower costs for Americans. Reform will create an “exchange” or marketplace for insurance competition that will lower administrative costs. The Congressional Budget Office estimates that such reforms will lower premiums of a comparable plan in the individual market by 7 to 10 percent – which means more money in the pockets of Americans, and the security of having high quality coverage. Reform will also lower health care costs by streamlining the health care system through reforms such as improving care coordination, reducing medical errors, and encouraging more efficient health plans. A recent Council of Economic Advisers report (pdf) estimates that these provisions could reduce the growth of health care costs by one percent, generating 320,000 jobs nationwide and raising median family income by $6,800 by 2030. And a recent Business Roundtable study found that with reform, health care costs could be reduced by as much as $3,000 per employee by 2019.
Concerns about Fragmentation in the Health Care System
Health Insurance Reform Solution: Health insurance reform will invest in innovative models of care such as “patient-centered medical homes” and “accountable care organizations” that rely on teams of primary care doctors, specialists, and nurses working together to coordinate and monitor a patient’s care more effectively. These models are intended to encourage health care providers to better coordinate a patient’s care, track prescriptions, avoid duplication of treatments or tests, and follow a patient’s health progress. This will help improve quality of care, prevent medical complications, and reduce costs by keeping people healthier and out of the hospital, especially important for those with chronic medical conditions.
Concerns about Medical Malpractice
Health Insurance Reform Solution: In September, President Obama issued a Presidential Memorandum directing the Secretary of HHS to move forward with an initiative to give states and health systems the opportunity to apply for medical liability demonstration grants that put patient safety first and work to reduce preventable injuries; foster better communication between doctors and their patients; ensure that patients are compensated in a fair and timely manner for medical injuries, while also reducing the incidence of frivolous lawsuits; and reduce liability premiums. To encourage states to develop alternatives to traditional malpractice litigation, the House bill includes a voluntary state incentive grants program and the Senate bill includes state demonstration grants.
Inadequate Emphasis on Prevention
Health Insurance Reform Solution: Reform will require insurance plans to provide free preventive services and will create a system that manages illness and disease instead of just treating it when it’s too late.
Primary Care Physician Shortages
Health Insurance Reform Solution: Reform will increase funding for grants, scholarships and loan repayments for physicians, nurses, dentists, mental health providers, and others. Reform will also provide loan repayment programs to encourage more nurse faculty to address the educational bottleneck in nursing, support programs to increase diversity in our workforce, invest in better workforce analysis so we know where more resources and providers are necessary, and provide payment bonuses to primary care providers practicing in underserved areas.
You can drill down and get more detail as well as read real-world testimonies at the original link.
How do these concerns line up with your experiences? What do you think of the “reform solutions”?
I was recently denied coverage because of a pre-existing condition because I got pregnant within three months of being added to my new husbands insurance plan. So, I am happy to see the bill dealt with this issue. But we still don’t have a cost control mechanism so they can charge people with pre-existing condition much more.
The WH has realized how disappointed their base is and they are fighting back by listing what they’ve accomplished. I don’t know if it will work because people are livid and rightly so.
Charged More Because of Illness
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Well, if that’s the case then why is there so much backlash? All the stuff you listed sounds too good to be true. What gives? I just don’t trust politicians nor the industry. They will find a way to penalize those with pre-existing condition. I want to be happy about this bill but I am not. Unless we have legitimate competition, the industry will come out on top again.
The straight answer: because it was tantalizingly close to being even better, and because the reasons it didn’t get to be better are illogical (it’s too expensive!) and/or spiteful (if liberals like something too much, it must be bad).
The snarky answer: because too many people have too much of their self-image invested in never being satisfied, always being disappointed, or in flashing their leftier-than-thou cred. If you’re not outraged, you’re not paying attention, right? So by being outraged, you prove that you’re paying attention, that you’re nobody’s patsy, and that you’re straight-up hardcore. Also, if it turns out badly, it wasn’t your fault, because they shoulda done it your way anyway.
There is so much backlash because the article Booman links to does not go into what insurance companies will be able to do to deny insurance for pre-existing conditions under the Senate Bill. To start with they can double your premium, then they can cut you by claiming fraud, which they will do. If you are over 54 they can triple your premium, if you smoke they can increase it 1.5 times. The Senate bill gives them even more tools to deny coverage than before. There are many other items they can use to screw you, and they will.
Booman, I thought this bill allowed the Insurancecos to charge up to triple for pre-existing, but not to deny. This implies that they cannot be denied or charged more. Which is right?
That’s the impression that I was given as well? The House bill 2x, the Senate bill 3x; both equally horrendous, and take away the entire purpose of insurance.
Today’s flip-out is over a provision that will tax the so-called “cadillac” group health plans.
What people don’t seem to realize is that this type of tax is very common in other countries. In Canada, group plans at work that cover dental care and eyeglasses are considered as “taxable benefits” and I pay more income tax because my employer offers this plan. There is actually nothing unusual about this.
Except given how our system is constructed .. the tax on “Cadillac” plans will hurt the middle class .. especially unions
Yes, I didn’t hear anyone complain that they are charged too little or their plan covered too much.
I would be willing to pay the 40% tax on my vision and dental benefits, but their premium is trivial compared to the medical benefits. Besides, what’s Canada’s big gripe against medical and dental benefits? after all, I already pay 100% of the premiums. Why does that make me evil?
There’s nothing “evil” about this — its just that if you get an extra benefit from your workplace, like dental care or eyeglasses, it should be considered as ab additional part of your compensation and thus it is taxable.
Do I like it? Of course not, nobody likes taxes, but I understand why they are charging it. The Canadian income tax system has operated this way for two decades at least, and I assume every other country considers employment perks as taxable benefits too.
How is it part of my compensation when I pay 100% of the premium?
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My God – I had no idea!
I did. My daughter lives in Alabama. Of course, now she will be fined for not buying the health insurance that she literally cannot afford, i.e. cost is over 100% of her income.
Surreal!
Is that true if she now qualifies for Medicaid?
Nope.
She doesn’t qualify for Medicaid, she is not handicapped.
I thought Medicaid was the program for the poor (no physical disability required), while Medicare is the program covers the elderly and some of the disabled.
I’m sorry, it just makes no sense that someone would be required to spend more than their annual earnings on health insurance. Maybe I’m misunderstanding something.
Medicaid used to be that way until Clinton changed “welfare as we know it”. Now to receive Medicaid you must be poor and either old or handicapped. A revived (and totally federalized) Medicaid and age-lowered Medicare could become the core of a new single-payer system. That’s what Howard Dean wanted.
However, the disabled, like my hearing-impaired grandson, get Medicaid, not Medicare. Poor seniors can get both.
The Republicans like to link Medicare and Medicaid because that feeds their meme that Medicare is welfare.
Another argument for why Medicaid needs to be federalized. It ends an unfunded mandate. It keeps Medicaid from being held hostage every year to balancing state budgets. It equalizes benefits.
If this bill really does all that’s claimed, we should all be out celebrating. It will be a true breakthrough reform that will deeply change the way healthcare works in the US. The devil will be in the details, of course.
Crucial initiatives yet to be accomplished:
–Total delinking of insurance/employment.
–Bringing nonprofit organizations into the provider market.
–Financing healthcare almost entirely through sharply graduated personal and corporate taxes.
–Making malpractice trials the last, not the first, resort in settling genuine cases of error, incompetence, or indifference on the part of doctors and hospitals.
–Making Medicare opt-in part of the exchange offerings, or better yet, making Medicare and Medicaid unnecessary at all.
Seems to me the bill, as described, takes the US out of its own private healthcare hell and places it into line with at least the worst of the developed world — a giant step forward. It also appears to have the potential to add on further achievements like those mentioned above. Overall, it’s time to quit bitching, start cheering, and begin working to make the thing much better and much sooner.
What I think of the reform solutions?
The devil is in the details. And I have a hard time mapping the bills as documented in their thousands of pages (Yes, I have slogged through them.) with the statements of reform presented in your diary. Plus there are any number of provisions in the bills that if interpreted in one way could vitiate a lot of the reforms that precede them. And no matter what the bill authorizes DHHS to do, the real devil is in the details of the regulations that DHHS creates, the systems it creates, and the operational rules that implement the legislation. All of those are reviewable by the public when they get drafted after the bill is enacted.
The one that I find troubling is the reform of the Medicare Part D donut hole and the existing Social Security-Medicare donut hole (Social Security can be claimed at 62, Medicare only at 65). The closing of the Medicare donut hole can best be summarized for most Medicare recipients as “it will be closed after you are dead.” And most folks who go on Social Security before they are 65 do so for medical reasons.
having waded thru both bills, the house and senate versions, l think your misgivings are well placed. there appears to be a substantial amount of the old adage: the large print giveth, the small print taketh away.
l’m withholding final judgement until l can see the actual bill that comes out of conference, or whatever procedure they decide to use, but there are some very large holes, as it were, in both versions to date.
an aside, re: your point that “most folks who go on Social Security before they are 65 do so for medical reasons.”…l would posit that it’s more likely that the early enrollers, especially today, are doing it for financial reasons.
The table of contents giveth.
The definitions of terms taketh away.
Well those who are unemployed most likely are. I have not seen an age breakdown of the layoffs over the last year, but I bet it is skewed toward 45+ and has a high proportion over 55. And for those in the 62-65 range, they are not just unemployed but for all practical purposes unemployable (in the eyes of potential employers, not in fact).