Examining Health Care Coverage Fears

Karen Pollitz, a research professor at Georgetown University's Health Policy Institute, says as long as those people who obtain health insurance through their workplace remain employed they should feel comfortable about their plan. She adds that there is no requirement that anyone has to change their coverage.

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MELISSA BLOCK, host:

So should Dave Koenig be worried? To help answer that question, I'm joined by Karen Pollitz. She's a research professor at Georgetown University's Health Policy Institute.

Welcome to the program.

Professor KAREN POLLITZ (Research, Health Policy Institute, Georgetown University): Thank you very much.

BLOCK: And how typical would you say Mr. Koenig's situation is? He says he's paying about $300 a month for his family under Blue Cross, that's through his employer. And he calls it wonderful. He says he's never paid a dime for his multiple surgeries.

Prof. POLLITZ: Well, $300 a month is actually quite typical for what people pay for their share of employer coverage today. But a typical employer plan has a lot higher cost-sharing than what Dave reported. So my guess would be he's in an above-average plan and his employer is contributing more toward the cost of that, so that he doesn't have to pay high deductibles and co-pays whenever he needs to make claims.

BLOCK: And you heard him there say that he is worried that with a complete overhaul, that things might change; that tomorrow it could all change, he says. Should he be worried?

Prof. POLLITZ: I think not, actually. I think as long as Dave stays working with his employer, it sounds like it's a high-tech firm, a profitable firm, and I would hazard a guess that he has specialized skills. And so employers like his would be happy to have him. So given all of that, he should feel pretty comfortable; that as long as he can stay in that job, he'll be able to keep that insurance. And that shouldn't change.

BLOCK: But the fear that's been expressed by him and many others is that if there is a complete overhaul, that health insurance companies will change the way they do business in order to stay profitable.

Prof. POLLITZ: There is no requirement that Dave has to change his coverage. There is a requirement that everybody has to have coverage that meets minimum standards. And it sounds like Dave's coverage - and his sister Jane's coverage -already is well above that minimum standard. So it's not a constraint that's going to move him anywhere. It is generally the case, and has been for a long time, that health insurance coverage kind of declines over time. We've seen a steady erosion in what health insurance covers and a steady increase in what it costs, both for people who buy on their own and for people who get coverage at work. So I think there's no guarantee that Dave's employer won't change his coverage over time, just in response to rising health care costs.

But under health reform, no matter which bill passes, there will be a requirement that health insurance policies that you get at work, that you buy on your own cover a minimum number of services and have a maximum level of cost-sharing. So that, I think, should be helpful for everybody, and it shouldn't change. It shouldn't change what Dave has because it sounds like he's on the high end of coverage right now. And if his employer feels pressure over time if health care costs continue to increase, even after health reform, then it's possible that his employer might back down toward that minimum. But I think that would happen in the absence of reform as well.

BLOCK: How important do you think it is for proponents of a health- care overhaul to get people like Dave Koenig to buy into the process, to shed their fears? And how would they do that?

Prof. POLLITZ: Well, I think it is important, and that is the reason why the proponents of health reform have stressed that you're not going to be required to change your policy; if you like what you have, you can keep it. There's a long history, almost a hundred-year-long history of health-care reform efforts where the opponents of reform have tried to scare people into thinking that change will make them worse off. And I think that is absolutely what is at the heart of this insistence by the advocates of reform on saying - again and again and again - if you like what you have you can keep it.

BLOCK: Karen Pollitz is a research professor at Georgetown University's Health Policy Institute.

Karen, thank you very much.

Prof. POLLITZ: Thank you, Melissa.

BLOCK: Our series "Are You Covered?" is produced in partnership with Kaiser Health News, that's a nonprofit news service. And at npr.org, you can explore the health insurance situations of other Americans, from the uninsured to those who have the same plan as Congress.

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Holding On To Health Insurance That Works

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Dave Koenig gets private insurance through his employer and couldn't be happier. A conservative, he thinks private health care is the way to go, but he supports some changes to the insurance industry to protect patients from losing their coverage.

Dave Koenig is happy with his private insurance plan. i i

Dave Koenig, 49, is happy with his private insurance plan. Still, he worries he could be dropped or lose coverage if he loses his job. For these reasons, he supports some changes to the insurance industry. Heather Brand/Aurora Select for NPR hide caption

itoggle caption Heather Brand/Aurora Select for NPR
Dave Koenig is happy with his private insurance plan.

Dave Koenig, 49, is happy with his private insurance plan. Still, he worries he could be dropped or lose coverage if he loses his job. For these reasons, he supports some changes to the insurance industry.

Heather Brand/Aurora Select for NPR

Tall and with a buzz cut, Koenig, 49, works as a manager for a tech company, Hitachi Data Systems. He lives in a pristine suburb of Sacramento, Calif., with his wife and 8-year-old son. Their backyard has a pool, a foosball table, a shaded hammock, and fruit trees ripe with peaches, pears, oranges, apricots, cherries and plums.

"It's kind of a quiet, pretty expensive neighborhood. Guess we'd probably be considered middle- to upper-class," Koenig says.

Insurance That Does Its Job

And his high-paying job doesn't just mean a nice house. He also gets pretty decent health benefits. It's private insurance through Blue Cross — he pays a monthly premium of about $300 for his family's coverage.

A Follow Up, 3 Months Later

"My current insurance through my company is wonderful. I pay a copay for doctors' visits, I pay a co-pay for prescriptions. Through the six or seven surgeries I've had in the last five years, I've never paid a dime to a hospital, an anesthesiologist, blood work — it's all been covered, so I'm of course very happy with my insurance," he says.

Things weren't always that easy. In the early '90s, he was laid off and went without insurance for several months. He says it was an uncertain time, and he sympathizes with the millions of Americans who don't have coverage — or could be dropped at any time.

"I mean, you hear horror stories about people who have insurance, and then all the sudden get denied coverage down the line because they may have had a pre-existing condition," Koenig says. He, too, worries that he's one step away from being dropped from his plan, or losing his job and not being able to afford coverage.

Supports Changes, Not Overhaul

Are You Covered?

A look at Americans and health insurance

And that's why Koenig is on board with parts of the big push to change the health care system. But he says the focus should be on regulating the insurance industry, not a government takeover, which he believes President Obama is pushing for.

"I find that scary for me personally, because right now I've got what I feel is great coverage from my company. Tomorrow it could all change, I don't know," he says. "I don't want to see massive overhaul. I can see reform taking place in areas, but do I want the system overhauled? No. And I don't think the majority of the people in the country want it overhauled."

Koenig keeps returning to the fact that in his experience, health insurance has been great. And, he says, in the case of his younger sister, her health insurance paid for the care that saved her life.

Five years ago, his sister Jane was out on a jog when she collapsed and had a heart attack. "She got lucky that some neighborhood women were out for a walk, and they walked by and saw her on the ground gasping for air," Koenig says.

Scared To Lose What They Have

Like him, his sister has good employer-based health insurance — she gets it through her husband, who is a vice president of a credit union.

"She's 46 now. She was 41 when she had her heart attack, and 41 when she had her transplant. They ended up finding a genetic heart defect. She had full coverage, so I guess we didn't even think about it at the time, but thankful for it now."

Koenig and his sister are happy with their health insurance coverage. But Koenig worries that the benefits they enjoy could change under a complete overhaul.

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