While Senators Speechify, We Answer More Listener Questions

Settle in for a long weekend of health care debate, folks. As promised, the Senate will keep turning health care on the legislative spit.

Friday afternoon was just a tune up, with jawboning and a few votes on topics like long-term care and Medicare cuts.

Majority Leader Harry Reid says Saturday will feature votes on amendment to limit pay for health insurance execs.

 

For now, the biggest issues—abortion and the public option—remain in the background.

While the Senate jaws on, you can get some straight talk from NPR's Julie Rovner, as she answers listeners' questions on Friday's All Things Considered.

The first listener asks if the health bill would stop insurance companies from denying people care based on pre-existing conditions. James Stoffer of Delafield, Wisconsin, asks if this means self-employed people won't have to disclose their health history anymore? And if not, would insurers just raise premiums instead of denying coverage?

Rovner replies: To answer the second question first, yes, hiking the premium to make it unaffordable is often tantamount to denying coverage. And no, insurers won't be able to do it anymore under the bill. Once the bill takes full effect — which isn't until 2014, by the way — self-employed people won't have to disclose their health history or go through the underwriting process to buy coverage.

Insurers will only be able to vary what they charge in premiums to people in the new marketplaces, called exchanges, for a couple of reasons: the size of your family, whether you're a smoker; your age, where in the country you live, and whether you participate in a wellness program.

Many listeners are confused by the cost of the bill. Richard Zimmerer of Charlotte, North Carolina, asks about what sounds like some fuzzy math: "First, that it will save $130 billion over ten years. Second, that it will cost $800 billion to $1 trillion over ten years. And third, that it will not add one dime to the federal deficit." Are all three of these claims true?

Rovner answers: Yes. All three of these statements are actually true at the same time, believe it or not. The Congressional Budget Office says the bill will cost, in fact $848 billion over ten years. Over that same period, the bill also raises $978 billion in new taxes and fees and reduced spending for Medicare, for a net reduction in the deficit of $130 billion. So, at least in that first decade, it adds not one dime to the federal deficit — in fact, takes a whole lot of dimes away.

Medicare saw lots of floor action today and with all of the bluster it's no wonder listener Evelyn Keerson of Boca Raton, Florida, wants to know how Medicare will change if a bill passes, especially with the addition of millions of "baby boomers" to the program?

Rovner answers: Well, the idea is to prevent adverse changes for seniors in Medicare, particularly with 78 million baby boomers set to join the program. The Medicare parts of the bill are actually aimed at giving doctors, hospitals, and other health care providers, incentives to provide better care, rather than just more care. The hope is to at least slow how fast spending grows, not to cut the program, so that Medicare can be sustained for those baby boomers.

Now one controversial item that is in the bill would undo something Republicans did in 2003 — which was to give big raises to the private plans called Medicare Advantage. Today these plans get about 14 percent more than it costs to care for each of those Medicare patients, and some of those payments go toward giving patients benefits Medicare doesn't otherwise cover, like eye and foot care.

Now if you take those overpayments away, like the bill proposes, the patients will still have all the benefits guaranteed by regular Medicare, but they could lose some of the extra benefits plans have been providing with those overpayments.