Health-care reform: What’s left if the public option is gone? A lot.
Dec 15, 2009 2:58 PM
Groundbreaking health-care reform travels on a long and winding road. And it’s made all the more curvy by one Senator Joe Lieberman (I-Conn).
Just months after the Senator told a Connecticut newspaper editorial board he’d like to see the “public option” replaced with a plan for older adults aged 55 and up to buy into Medicare, he appears to have successfully negotiated the death of both the public option, and what seemed its likely replacement, the Medicare buy-in—even before an analysis from the Congressional Budget Office on the cost of the latest proposal is available.
What replaces these plans? We’ll have to wait and see. But reports indicate that will largely be up to Lieberman.
The public option became the lightening rod of reform, as revered on one side as it was reviled on the other. Proponents, including Consumers Union, saw it as a great equalizer: an insurance program run by the government that competes on the open market with private insurance. If private companies fail to control costs and make their plans affordable, Americans would have another option—providing a strong, market-based incentive for private insurers to focus on providing value to consumers. But opponents claimed that private companies could not successfully compete with the government in the health care arena.
Public plan advocates and lawmakers who support the proposal are no doubt working to save it—if not now than in the future—but the opponents appear to have won the day. But while the public option has dominated the ink on health reform, it is actually a small part of a bill that will transform our nation’s health care system. Senator Jay Rockefeller (D-WV), a strong public plan supporter, said after a meeting with Lieberman and Senate Majority Leader Harry Reid (D-Nev) last night, “We’re not going to get all that we want, but we’re going to get so much more than we have.”
While some public plan proponents may now oppose the entire health care bill, the White House says it’s now or never for reform: “If President Obama doesn't pass health reform, it’s hard to imagine another president ever taking on this Herculean task. For those whose life's work is reforming health care, this may be the last train leaving the station,” White House Communications Director Dan Pfeiffer told Politico.
So if you’re asking yourself what’s left in the reform proposal for you, here are some of the major changes to the health care system in the Senate plan that consumers can look forward to if it becomes law:
Consumer Protection Reforms
- End of preexisting conditions: The all-too-common experience of being turned down for health insurance coverage due to preexisting conditions will be a thing of the past. As soon as the bill becomes law, consumers currently locked out of the health-care system will have access to high-risk pools that will give them basic health-care coverage. Then, when the health insurance exchange is set up (in 2014 under the Senate bill and 2013 in the House version), they will have a choice of plans, none of which will be allowed to discriminate because of health conditions, or gender.
- Guaranteed coverage: Insurance companies would also be banned from cancelling your policy because you get sick. That practice is called rescission, and it happens all the time when insurance companies take advantage of loopholes in the fine print that allow them to terminate a policy when the policyholder files an expensive claim. The bill would outlaw this practice.
- End of misleading “junk-insurance” policies: Once the health insurance exchanges are set up, all the policies available through them will have to meet new clearly defined terms—including standard minimum benefits, transparency, and disclosure of out-of-pocket costs. You’ll know how much coverage you’re paying for, and what you’ll actually pay for it.
- Comparison shopping: The reforms create various quality reporting and customer satisfaction tools to help you compare and choose plans on an apple-to-apple basis.
- Subsidies: Individuals and families earning less than 400 percent of the federal poverty level—that’s about $43,000 for an individual and about $88,000 for a family of four in 2009—would qualify for help paying for insurance from the exchange. Those who get insurance through their employer would get help if their share of the premiums exceed about 10 percent of their income.
- Expansion of coverage for younger adults: Starting in 2010, adult children would be able to stay on their parents’ health insurance plans until they reach the age of 26.
- Expansion of low-income assistance: Anyone who makes up to 133 percent of the federal poverty level—about $14,000 for an individual and about $29,000 for a family of four—would be eligible for Medicaid, a low cost government insurance plan. Far more than are eligible now. In many states, it’s now nearly impossible for an adult without children to qualify for Medicaid.
- Shrinks or eliminates the Medicare donut hole: Seniors who use the Medicare Part D prescription drug coverage would see the donut hole—the portion of coverage for which they have to pay for 100 percent of the cost of their prescriptions—shrunk to $500, the way the Senate bill is currently written. But the House bill eliminates the donut hole, and Senator Reid has reportedly pledged to AARP that the final Senate version will do away with it as well. And they’d get a 50 percent discount on brand name drugs in the donut hole while it is phased out.
—Kevin McCarthy, associate editor
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