10 Awesome Things That Would Happen If Health Reform Passes

[Joanne98]

By Joshua Holland, AlterNet
Posted on August 14, 2009, Printed on August 14, 2009
http://www.alternet.org/story/141916/

Unable to win the debate on the merits of their arguments, opponents of health care reform have resorted to a dizzying array of outright falsehoods to terrify Americans into opposing a process that might deliver real benefits to their families.

They've falsely claimed that the government would "take over" the health system, put private insurers out of business and let pasty bureaucrats decide what treatment Americans would receive.

They've spun wild tales of federal agents coming into Americans' homes for lifestyle checks and faceless government officials making end-of-life decisions for patients.

They've falsely claimed that the legislation being considered by Congress would cover undocumented immigrants, and they sent around elaborate-but-wholly-fake "analyses" of the supposed bill, with references to made-up page numbers and all.

All of these serve the same ends: using the politics of distortion and distraction to capitalize on people's natural fear of change and compelling them to fight noisily against their own interests. And it can be somewhat effective -- that's clear from the raw, populist anger unleashed into the health-care debate in recent weeks by well-heeled corporate-lobbyists bent on derailing the democratic process.

The industry-approved fog-and-monsters strategy has another benefit: It puts advocates of reform in the position of batting down a series of nonsensical arguments based on an endless string of health-policy straw men when they could be explaining why getting something decent done would in fact be good for the country.

So let's get past the fearmongering and look at some of the highlights of what's really in the more progressive legislation working its way through Congress. The proposals aren't perfect. As I've written before, in their current form, the bills fail the test of having a truly "robust" public insurance option, and as such has limited potential for cost savings.

But they are also substantial reforms that would go quite a way toward beefing up the health and economic security of a lot of American families if enacted.

The following breakdown is based on the legislation developed by three committees in the House of Representatives (HR 3200) and the Senate Health, Education, Labor and Pensions (HELP) Committee. A third piece of legislation is yet to emerge from the Senate Finance Committee. Reports suggest that the legislation coming out of Finance will be much more accommodating to the insurance industry and other corporate stakeholders.

Much of the real legislative fight will come when the two Senate bills are combined and then, later, when the final Senate and House bills are reconciled.

1: The First Thing That Will Happen Is Absolutely Nothing

At least that's the case for a lot of people who now have quality health insurance.

If you have a decent health plan through your job, nothing will change for you in terms of your insurance.

In fact, if you work for a large or medium-sized company and have decent coverage at a price you can afford, then nothing can change for you -- you'll be ineligible to enroll in the public insurance option (which is discussed below).

If you have already have government-run health care -- if you're a vet, or are on Medicare or Medicaid or have a child in the State Children's Health Insurance Program, nothing will change for you in terms of your coverage. (One exception: Under the House bill, eligible children would be shifted from S-CHIP to a new public insurance program in 2013).

The only thing that would change for you in these circumstances would be this: your current insurance company would have a harder time screwing you over if you get sick. That's because, although your policy wouldn't change, it would be governed by new public-interest regulations for the entire health insurance industry. (See next item.)

2. New Protections for Consumers

Regardless of your place of employment or the kind of coverage you have now, new regulations would take effect in 2010 that would go a long way toward curtailing the insurance companies' worst abuses.

Insurance companies could no longer deny coverage to people because they've had health problems in the past, nor could they charge hugely different rates for different groups of people (premiums could only vary by age, geography, tobacco use and family size).
The House bill bans recissions -- the insurance industry's habitual practice of collecting premiums until someone gets sick, and then digging through their histories for an excuse to cancel coverage.
Insurers wouldn't be allowed to cancel an individual's coverage for reasons other than failing to pay the premium.
Insurers would no longer be permitted to impose annual or lifetime caps on benefits.
Insurers that sell insufficient, cheapo plans that leave people vulnerable to medical crises would be required to disclose that fact to their customers.
All insurers would be required to disclose how much of their spending is on health care and how much goes to costs like overhead, advertising, etc.
The legislation (especially the Senate HELP bill) creates new tools for fighting insurance fraud and abuse.
3. Medical Bankruptcies Would Plummet

One of the most significant of these regulations is in the House bill: a cap on out-of-pocket expenses. If the measure passes, individuals would face a maximum of $5,000 in out-of-pocket expenses a year, and families no more than $10,000. For poorer families, the limits would be much lower: $500 per year, for example, for a family making less than 1.33 times the poverty rate.

In 2007, Harvard researchers studied thousands of bankruptcy filings and found that medical causes played a role in more than 6 in 10.

4. People Who Could Never Get Decent Coverage Will Finally Be Able To

So far, one of the great victories for the anti-reform movement has been convincing many small-business owners that health reform will put them under.

The reality is that small-business people, their employees, independent contractors, freelancers, entrepreneurs, part-timers and the "marginally employed" would be the biggest winners from the legislation if it passed as currently drafted. Small business owners and their employees -- as well as those other groups -- would, for the first time, be able to get decent coverage at a fair price, and if eligible, both employer and worker would be able to get extra help paying for it.

Under the current system, most of the largest employers in the country self-insure -- they pay their employees' claims directly and cut out the middleman.

Big firms that don't self-insure buy insurance on the large-group market, where risk is spread out over a large pool. Large-group plans tend to be more or less comprehensive and, relatively speaking, affordable.

But those forced to purchase coverage on the individual or small-group markets have little buying power and are routinely forced to pay budget-busting premiums for the worst possible coverage -- plans with high deductibles, caps on benefits and strict limits on what is and isn't covered.

This gets to the heart of the "public insurance option" -- the most contentious point of debate in the reform battle. It would work like this: The government would establish regional exchanges, or "gateways," that would be open to those who would otherwise be forced into the individual and small-group markets. These gateways would have relatively large insurance pools just like large employers -- and public programs like Medicare -- have now.

Within these large purchasing pools, people would be able to choose from among different insurance plans -- one a government-run "public option" and the rest offered by private insurers.

In order for private insurers to sell plans through the exchanges, they would be required to offer a standard set of benefits (which the public option would have to offer as well). They'd also be permitted to offer plans with more bells and whistles at a premium price.

For those enrolled in the public exchanges, the process would be quite similar to what employees in many large companies experience -- they would simply choose from among a variety of plans, with slightly different levels of coverage and costs.

Compared to the plans now available in the individual and small-group markets, they would pay a lot less for significantly better insurance (which, in reality, is what those "teabaggers" are protesting).

Because of pressure from Republicans and conservative Blue Dog Democrats, the public exchanges will phase in slowly, over a period of four to six years.

5. (Almost) Everyone Gets Covered

continued>>>
http://www.alternet.org/healthwellness/141916/10_awesome_things_that_would_happen_if_health_reform_passes/