Q&A on Healthcare reform

August 11, 2009 6:25:25 PM PDT
There are many claims and counter claims surrounding President Obama's healthcare reform plan. Action News asked an expert, David Grande, Ph.D., a professor of health policy in the Leonard Davis Institute, at the University of Pennsylvania, for help answering some common questions.

Here is a transcript of Dr. Grande's interview with Action News producer Dawn Heefner:

Q: Will everyone have health insurance?

A: There'll be a certain small slice of the population that always does fall down through the cracks. But what the legislation really does is create a mechanism for people who are in small businesses, who are self-employed, who struggle to get health insurance in that marketplace, to open up a new regulated marketplace for them, where they can purchase health insurance.

And then it would impose some requirements on companies to offer health insurance for their employees as well.

Q: How many Americans will be covered?

A: Through a variety of mechanisms, there will substantially increase the number of americans covered with health insurance. The estimates are on the order of 95 per cent of the people would have health insurance coverage.

Q: How will the plan affect small business owners?

A: Small businesses will be eligible to buy insurance for their employees through something called the Health Insurance Exchange, which would be a regulated marketplace for private health insurance, as well as a public health insurance option that would be available through the government.

But they could also continue on their own to buy health insurance just as they do today, or instances of small businesses who don't provide insurance for their workers today, they could be eligible for tax credits to help pay for that insurance. There are exemptions for small businesses below a certain size. And that has been a moving target in some of the debates. I think the last cut off I saw come out of the commerce and energy committee was half a million dollars. So businesses with a payroll of less than a half a million dollars would not be required to cover the employees, nor would they pay a penalty if they did not.

There's not a specific cutoff on the number of employees, as much as how big the payroll is for the small business.

Q: Will you be able to keep your plan?

A: Most people who have health insurance in this country receive it through a large employer, or a medium-sized employer. there's really nothing in the legislation that would change that. and so people would continue to get insurance exactly how they do today. And so the health insurance exchange that would be set up, isn't even a place where large employers are eligible to purchase insurance. So really, at the end of the day, large employers, where many people do have their private insurance today, would remain unchanged.

Q. How will self-employed American get insurance?

A: If you are self-employed, or you are just someone who wants to purchase insurance on your own, you can open up the phone book, go online and purchase insurance that way, if someone's willing to sell you the policy. The price you will pay for that policy depends on many things - including youtr age, your gender, any pre=existing medical conditions you've had., you medical history. All of that will affect how much you pay for health insurance. The Health Insurance Exchange is essentially setting up a new reguilated marketplace, where private insurance could come to sell their insurance

Q: Will there be standards for the policies?

A: They could all sell insurance in that marketplace, if they all agree to a certain existing set of ground rules. And some of the ground rules to sell insurance there would include not being able to deny coverage for any pre-existing conditions. So if you have diabetes, and you purchase a plan, your diabetes would be covered. You're not allowed to turn down people for coverage altogether, which of course can happens today. and insurance plans will be required to allow you to renew your plan every year, so they couldn't throw you out of the plan either.

Q: What about those who don't earn much money?

A: People would be eligible for subsidies, depending on their income. And so the idea with having the affordable options available, is, depending on your income, the government would kick in a certain amount of your money towards the price of that premium.

Q: Would I be forced into the government insurance?

A: If you work for a large employer, and that employer is not eligible because of its size, to participate in the Insurance Exchange, then you wouldn't even be able to purchase the government plan.

The public health insurance option is only available to the same population of people who are eligible to purchase insurance in the Exchange - people who are self-employed, people who are unemployed - those are all the people who would be purchasing their insurance through the exchange.

Q: Will there be variations in coverage for the plans in the Health Insurance Exchange?

A: Everybody who decides to purchase insurance through the health insurance exchange will have the same menu of plans they can choose from, depending where they live. if somebody's below a certain income level, they may qualify for some subsidies from the government to purchase a plan. With that subsidy, they could either choose to purchase a private plan, or choose to purchase a public plan, from the government.

Q: What about Americans with low incomes?

A: You would have more people eligible for medicaid, than under current rules.

Nobody would be forced into a government plan. they would have the option to purchase it from the Health Insurance Exchange, or they could then enroll in Medicaid. But Medicaid would be for those who are truly at very low income levels.

Q: We've heard a lot about "comparative effectiveness." Many people are worried the government will force my doctor to decide on treatment based on cost?

A: It's interesting there's so much controversy around this area. Comparative effectiveness research is something that's been going on for a very long time, and I think many people in health policy have been clamoring for more of this research to be done, so we could understand more about medical treatments that are available, and help doctors make decisions with their patients.

Right now, all of the proposals are about funding research, and setting up mechanisms to decide what research to fund - what are the big priorities in healthcare right now?

It (the legislation introduced in the House) would prohibit coverage decisions from being made on the basis of cost from comparative effectiveness research.

Q: Can insurers decide what treatments they will cover, like they do now?

A: Insurers would continue to decide what to offer above and beyond the basics, and there may be some plans that decide to offer some drugs, and not others. and other plans that differ in some ways. that's a part of the system that is likely to persist.

Q: Why is this such a volatile issue?

A: Healthcare is very personal - we all live it every dayin our lives in some way. so any discussion of healthcare reform, becomes, i think, more personal than other issues.

President obama has staked his reputation, to some extent, in this first year in office, on the issue of healthcare. he's clearly put it front & center of his domestic agenda.

It's become a broader fight over the Obama presidency. so i think a lot of people who are opposing healthcare reform right now are in some sense, they're shouting and yelling at the president as much as they're shouting & yelling about healthcare.

If President Obama had staked his first year in office on another issue, we'd probably be seeing a fight over that issue instead of healthcare.

Q: What happens next?

A: The next few months are going to be a true test of the president's leadership abilities, and communication skills in communicating with the public in helping them understand what's in healthcare reform for them.

He has a lot of people on his side in this debate that other president haven't had. The provider community - the physicians and nurses - are largely behind him, which is different from what we saw in those previous fights.

There's a lot more constant, 24-hour coverage around the political debate than we had in the past.

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