Q & A: Health care reform

Posted: 12:00am on Oct 6, 2009; Modified: 7:24am on Oct 6, 2009

  • Key health care terms

    Employer health care tax credit: An incentive mechanism designed to encourage employers, usually small employers, to offer health insurance to their employees. The tax credit enables employers to deduct an amount, usually a percentage of the contribution they make toward their employees' premiums, from the federal taxes they owe.

    Entitlement program: Federal programs, such as Medicare and Medicaid, for which people who meet eligibility criteria have a federal right to benefits. Changes to eligibility criteria and benefits require legislation.

    Medicaid: A federal entitlement program that provides health and long-term care coverage to certain categories of low-income Americans. States design their own Medicaid programs within broad federal guidelines.

    Medicare: A federal entitlement program that provides health insurance coverage to 45 million people, including people 65 and older, and younger people with permanent disabilities, end-stage renal disease and Lou Gehrig's disease.

    Medicare Advantage: A health plan option under the Medicare program that allows participants to choose Medicare health maintenance organizations, preferred provider organizations, private fee-for-service plans or Medicare special-needs plans provided through private insurers.

    Pre-existing condition exclusions: An illness or medical condition diagnosed or treated within a specified period of time before a person became insured. Health care providers can exclude benefits for a defined period of time for the treatment of medical conditions that they determine to have existed before the beginning of coverage.

    Public plan option: A proposal to create a new insurance plan administered and funded by federal or state government that would be offered along with private plans in a newly created health insurance exchange.

    Kaiser Family Foundation (www.kff.org), www.medicare.gov

  • What one survey says

    According to 2009 reports from the Kaiser Family Foundation:

    32% of Americans report that their families have had problems paying medical bills in the past year, and 18 percent report bills in excess of $1,000.

    53% of Americans say their households cut back on health care because of cost concerns in the past 12 months.

    11% of Americans used up all or most of their savings in the past 12 months because of medical bills.

    66% of Americans are very worried or somewhat worried about not being able to afford the health care services they think they need.

Will your insurance premiums go up? Will your taxes? Will your Medicare coverage stay the same?

Probably not, maybe and probably not.

But really, who knows? Nothing is all that clear as Congress and the White House struggle to overhaul the nation's health care system, a task likely to take most of this year, if it succeeds at all.

Such potentially huge changes are provoking important questions, but the legislative process has a long road ahead.

The Senate Finance Committee wrapped up work on its bill last week, and after evaluation by the Congressional Budget Office, the chamber will vote on a bill and begin the work of blending it with a measure that passes the House.

But even when there's legislation to examine, respected analysts disagree on its meaning.

So with the asterisk that nothing is certain until President Barack Obama signs a bill — if that ever happens — and that the nation's best financial and health care minds often disagree, here's the consensus on key questions:

Q: Will there be a new government-run health care program?

Probably not. The "public option" that Obama and a lot of congressional Democrats are seeking — which would offer coverage to those who generally can't get it from the private sector — looks unlikely to muster the votes it needs. Senate Finance Committee Chairman Max Baucus, D-Mont., is offering co-ops as an alternative.

Q: Are health care co-ops likely?

Maybe. Baucus' plan would create non-profit co-ops on a state, local or national basis that would be run and owned by members. The government would provide $6 billion in start-up money and to help maintain solvency, but co-ops must be self-supporting. Supporters say co-ops could negotiate with doctors and hospitals for lower rates.

Q: Can I keep the coverage I now have?

Absolutely, the president says. Employers are expected to continue coverage — or face penalties. Some critics say that if government-run plans or co-ops are created, employers might be motivated to limit or change coverage.

Q: Will my Medicare benefits be cut?

There's no talk of that — although some lawmakers worry that benefits could be reduced — but chances are slim because the program is so popular. In fact, consumers could get an extra benefit because the House of Representatives bill wants to eventually close the "doughnut hole" in prescription drug coverage. Currently, once beneficiaries have received $2,700 a year in aid, they have to pay out of pocket until that figure reaches $6,100, when government help again kicks in.

Q: Will Medicare Advantage change?

Probably. About 22 percent of seniors get Medicare benefits from private insurers rather than traditional Medicare. A lot of Democrats say the private companies are too costly, and they would change the system so payments are more equal. The White House argues that no one would lose benefits, but some analysts say the 10.5 million people getting private coverage could see premium increases or cuts to the extra benefits that Advantage plans provide.

Q: But the president talks about billions in Medicare "savings." Won't that affect my coverage?

Democrats insist that the savings will come from making the system more efficient and eliminating waste, fraud and abuse. But a lot of financial analysts disagree, noting that savings are hard to predict — because changes in patient and provider behavior are hard to predict.

Q: Will legislation be deficit-neutral?

The White House and congressional Democrats insist it will be. But a lot of respected independent analysts say it's going to be hard. Obama says "most" of the savings in his plan would come from making Medicare and Medicaid more efficient, but the non-partisan Congressional Budget Office estimates that only about $230 billion of his $900 billion plan can be paid that way. And the CBO estimates that the House bill adds $239 billion to the deficit over 10 years. The Baucus measure, it says, would cut the deficit by $21 billion.

Q: Will my taxes go up?

Hard to say. House Democrats want to impose a surcharge on adjusted gross incomes of $280,000 for singles and $350,000 for couples. Senators are less enthusiastic, and Baucus proposes a 40 percent excise tax on insurers' policies above $8,000 for singles and $21,000 for families. The threshold for most retirees and people with high-risk jobs would be $8,750 for singles and $23,000 for families.

Q: Will insurers be able to reject people with pre-existing conditions?

Almost everyone agrees that this practice must stop. All major legislation will include provisions barring insurers from denying coverage because of pre-existing medical conditions or canceling of coverage when people get very ill.

Q: Will small businesses find themselves saddled with new burdens?

Probably not. Thanks to strong lobbying from conservative Democrats, under the House plan, small businesses with payrolls of less than $500,000 would not have to offer coverage. Under the Baucus plan, smaller companies would be exempt.

Q: Will I have to buy insurance?

There's a general consensus among Democrats that you'll have to buy an insurance plan or pay a penalty, unless you can demonstrate financial hardship.

Q: Will Republicans have any say in all this?

Possibly in the Senate. In the House, Republican proposals have been largely defeated in committees. In the Senate, at least two moderate Republicans, Maine's Susan Collins and Olympia Snowe, have indicated they would be willing to find common ground.

Q: Can the Senate pass legislation without Republican votes?

Yes. It usually takes 60 votes to cut off debate, and the Senate has 59 Democrats. But a rule change adopted earlier this year would allow certain health care changes to pass with 51 votes after Oct. 15.

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