The ongoing debate over healthcare reform is as intense as ever, but nothing has been settled and there are still many compromises ahead before final bills are voted on in both the House and the Senate. Some of what the American public is hearing, however, has caused concern about how reform would affect them.
Here’s a guide to the facts–and some of the fiction:
What is the Individual Mandate?
The House Tri-Committee (Ways and Means, Energy and Commerce, and Energy and Labor) and the Senate Health Education Labor and Pensions Committee bills would require individuals to have health insurance and call for premium subsidies or cost-sharing credits for individuals and families with incomes up to 400% of the federal poverty level. Minimum coverage standards, such as preventive services with no cost-sharing, mental health services, and dental and vision for children, would be imposed. Exemptions may be granted for financial hardship.
What is the Employer Mandate?
Employers would be required to provide health insurance coverage for their employees or pay a payroll tax to help subsidize coverage in the exchange. Small businesses, whose employees on average earn low wages, would be exempt and those employees could access coverage through the exchange. Certain small businesses that over coverage may be eligible to receive tax credits.
Will reform make healthcare more affordable?
According to President Obama and House Democrats, reform will make healthcare more affordable because it will eliminate co-payments and deductibles for preventive care and rate increases based on preexisting conditions, gender, or occupation; provide individual access to group rates; offer a sliding scale affordability credits (see individual mandate); cap total out-of-pocket expenses; and prevent waste, fraud and abuse in Medicare and Medicaid. They say that without reform, healthcare costs for the average family will increase by $1,800 annually.
What’s the likelihood of reform being made into a law?
That’s the trillion-dollar question. Much will depend on whether lawmakers can compromise on controversial issues such as the public option, which Obama says is a “sliver†of reform. (And left-wing Democrats say there can be no reform–or bill—without it.) In addition, the president and lawmakers must convince the American public, most of whom are insured, why reform is good for them.
It is highly unlikely that any Republicans in either chamber will vote for healthcare reform. Democrats must also decide whether they have the courage to push a bill through via the controversial budget reconciliation process, which limits debate and requires only a simple majority to pass a bill.
What is the difference between a public option and a co-op plan?
A public option would be a government-run program, similar to Medicare or the Veterans healthcare system. To create a public option, Medicaid would be expanded to all individuals with incomes up to 133% (House) or 150% (Senate) of the federal poverty level. Like private insurers, the government would negotiate rates with providers. Supporters say a public option would force private insurers to be more competitive. Critics say this would put them out of business, making way for a government takeover of the entire insurance industry. They also argue that lower administrative costs and the ability to negotiate more favorable rates with physicians and other providers would give the government an unfair advantage.
A popular alternative to a public insurance option is the nonprofit health insurance cooperative
, which could be formed at the national, state, or local level. A cooperative, like a credit union, is member-owned by the patients it insures and they negotiate rates. The appeal to supporters is that it’s not a government run program. Details must still be worked out, but the conventional wisdom is that the government would fund the start up of co-ops and then turn them over to their members.Another idea being considered is a public option trigger. Private insurers would be given a series of benchmarks they must meet by a specific deadline. If they don’t, the government would be free to create a public insurance program. Senate Democrats and conservative House Blue Dog Democrats like the idea.
Under a new healthcare plan, would employers, including small businesses, be required to cover their workers?
A plan requiring businesses to provide insurance benefits for their employees will likely be included. That could mean that companies with more than 25 employees (or possibly 50) would have to provide insurance for their workers or pay a penalty. Smaller businesses would be exempted. A House bill would exempt firms with a payroll of less than $250,000 a year.
Will people lose their current coverage?
No. People will still have the choices they have today, and the government will work to expand the choice of doctors and plans for everyone. Medicare would remain a critical part of any reformed system, according to the Center for American Progress think tank.
Can you tell me more about the Health Insurance Exchange?
The exchange would enable individuals and businesses to choose from a variety of standard plans, including a public option, and benefit from the competitive rates given large businesses.
It is one-stop shopping that will enable you and your family to find a plan that is right for you, according to the government.
What are some of the Proposed Consumer Protection Reforms?
These reforms call for increased access to preventive services and screenings. Insurers would be prohibited from refusing coverage based on pre-existing conditions. Basing rates on gender, health status, occupation, or age would be prohibited.
Standard, out-of-pocket spending limits would be imposed to prevent bankruptcy due to medical expenses. There would be streamlining of administrative forms, billing codes, and other processes, and the programs that promote diversity in the healthcare workforce would be expanded.
Who pays for all of this — me, my employer, or the government?
Obama has said that he won’t sign a reform bill that would add to the already staggering deficit. The bill is anticipated to cost $1 trillion over a 10-year period, to be paid for through reduced spending or new taxes.
The government says the majority of the initiatives that would pay for reform will come from cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. Under the government’s plan, money that is already being spent on healthcare will be re-allocated toward reforms that lower costs and assure quality affordable healthcare.
HEALTHCARE REFORM MYTHS
Myth: Employers will drop coverage and force American workers into the public plan.
Fact: No one will be forced to enter a public option. The House estimates that one in 10 Americans will enter the Health Insurance Exchange on their own where they will be given a choice between a public option and a variety of private plans. If some companies, such as small businesses that are exempt from the employer mandate, provide insurance through the exchange the employees make that choice.
Myth: Government bureaucrats will be allowed to decide on the care and treatments available to patients, also known as rationing.
Fact: Currently there are no caps on costly treatments and insurance companies can decide to provide or refuse coverage. The government would create an independent committee of doctors, patient advocates, and other experts that would provide comparative effectiveness research to make recommendations about
Myth: The House bill will create a government panel to make end-of-life decisions for seniors or force them to make life-shortening decisions.
Fact: The House bill reimburses fees patients pay to voluntarily discuss their end-of life care preferences, so their wishes will be honored. In addition, there is no mandate to create a living will or advance care directive.
Myth: Your taxes will be raised to pay for healthcare reform.
Fact: The House bill calls for the wealthiest 1.2% of Americans to pay a surcharge on income exceeding $350,000 for joint filers.
Myth: Reform would force taxpayers to pay for abortion.
Fact: While private insurance companies will be able to offer this service, the House bill would not. A Commerce and Energy committee amendment states that no federal funds can be used to pay for abortions except in the case of rape, incest, or the life of the woman.
Myth: Reform will provide immigrants with free health insurance.
Fact: The House bill states that “individuals who are not lawfully present in the United States†won’t be allowed to receive subsidies.
Myth: Democrats want to socialize medicine so the federal government can control decisions about your healthcare.
Fact: Under socialized medicine, a government finances and directly provides healthcare services. House and Senate proposals preserve employer-based coverage, private insurance plans, and the freedom to choose your own doctors.