Lexington, VA • Monday, August 24, 2009
This commentary appeared originally in the Roanoke Times on August 24, 2009.
The media have made much in recent days of polls indicating that support for President Obama's health care reform initiatives is slipping. Misinformation campaigns claiming falsely that the legislation promotes euthanasia or mandates rationing are having an effect. But the most important factor in declining support seems to be that ordinary Americans, most of whom are insured through their jobs or through Medicare, are not convinced that reform will actually help them. Indeed, many are worried that reform will negatively affect the cost, quality or accessibility of their health care.
Americans understand that the legislation is intended to cover America's 50 million uninsured. The Congressional Budget Office estimates that 97 percent of those legally present in the United States will be covered under the House legislation in six years. But reform is also designed to help insured Americans.
Most importantly, the reform legislation offers insured Americans health security. At this moment, tens of thousands of working Americans are losing their health insurance every month. Under current law, if you lose your job, you will usually lose your employment-related health insurance as well. The reform legislation will assure you affordable coverage no matter what happens to your job.
If you are an employee and not covered by a collective bargaining agreement, current law leaves you totally dependent on your employer for your health benefits. Employers can increase your share of the premium, cut your benefits, increase your cost-sharing, or even wholly abandon benefits at will. Between 2000 and 2008, the percentage of firms offering health insurance dropped from 69 percent to 63 percent, while just between 2007 and 2008 the average deductible for family coverage for employee plans with a deductible climbed almost 30 percent.
Under reform legislation introduced in the House, employees will for the first time have the right to secure, comprehensive and affordable coverage. If you are satisfied with your employee benefits, you will be able to keep them. Indeed, reform may well improve them.
Once the House legislation is fully in effect, your employer will be required either to provide you a "qualified health benefits plan," pay to enroll you in a plan through an insurance exchange or face a penalty. Plans must cover essential services, cannot have annual or lifetime coverage limits, cannot impose cost-sharing on preventive care or above specified limits on other care and cannot limit coverage unless clinically appropriate.
Employers will not be able to require employees to pay more than a fixed percentage of the premium cost. Insurers will no longer be able to impose unaffordable premium increases on small businesses just because an employee gets sick. Federal subsidies will be available to small businesses to help cover the cost of coverage. The CBO projects that the number of Americans covered by employment-related insurance will actually grow by 16 million under the House bill over the next four years.
If you do lose your job, comprehensive affordable health insurance will be available and affordable to you, no matter where you live, how much you earn or whether you have a serious pre-existing condition. Even if your wife has cancer or your child has chronic asthma, you cannot be denied coverage. Families with incomes under $88,000 will have help paying their premiums and out-of-pocket health care costs. Public plan choice will offer you an affordable alternative to private insurance if you want it.
Polls show that many of America's 44 million Medicare beneficiaries are anxious because of all of the talk of cutting Medicare costs to help finance reform. But if you are a Medicare beneficiary, reform will also help you.
The House legislation will expand Medicare coverage for preventive services, limit cost-sharing under Medicare Advantage plans, gradually close the doughnut hole for prescription drug coverage, and increase assistance for low-income people with Medicare. Savings from the Medicare program will come from trimming wasteful payments to providers and private insurers, not from cutting benefits.
The battle over reform will be intense. The health insurance industry understandably prefers the status quo or changes in the law that would give them more business without demanding accountability. Conservative politicians see the defeat of reform as a chance to "break" a popular president. But the choice is ours.
Whether you are insured through your job, through Medicare, through the nongroup market, or not insured at all, reform offers you secure, stable, high-quality health care, no matter what your future otherwise holds.