Benefits Of Health Care Overhaul To Take Time

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A public option looks likely to be included in both the House and Senate versions of health care bills expected to be brought to their respective floors early next month. But even if lawmakers can get a bill passed and signed by President Obama, they are faced with a potential public relations problem: Most of the benefits don't actually take effect for three years or more.

ROBERT SIEGEL, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel in Washington.

MELISSA BLOCK, host:

And I'm Melissa Block at NPR West in California.

Democratic leaders in the House and Senate are putting the finishing touches on the health care bills they plan to bring to their respective floors early next month. This afternoon, Senate Majority Leader Harry Reid made this announcement about what is in the bill he's crafting.

Senator HARRY REID (Democrat, Nevada; Senate Majority Leader): I believe that a public option can achieve the goal of bringing meaningful reform to our broken system. It will protect consumers, keep insurers honest and ensure competition. And that's why we intend to include it in the bill that will be submitted to the Senate.

BLOCK: So, a public option for both the Senate and the House bills. But in the Senate, states will be allowed to opt out.

SIEGEL: Urgent is a term often associated with this legislation. But even if lawmakers can get a bill passed and signed by President Obama, they're faced with a potential public relations problem: most of the benefits don't actually take effect for three years or more.

NPR's Julie Rovner joins us now to discuss what that might mean politically and practically, and what lawmakers are trying to do to address that problem. Julie, why such a long delay between passing a bill and having it actually take effect?

JULIE ROVNER: Well, you know, this may be a bit of an overused analogy, but it's really true. The nation's health care system is like a huge ocean liner, and you just can't turn it very fast. It will literally take several years to build the new infrastructure to get people covered who aren't covered now. You can't require people to buy insurance until there's a place for them to go to buy it. And until you have everyone buying insurance, you can't require insurance companies to accept people with preexisting health conditions because otherwise only the sick people will sign up.

So, all that has to happen at the same time, and experts say it will take at least that couple of years. Now, I should add that a lag time like this isn't anything new. When Congress passed the Medicare Prescription Drug Law in 2003, it didn't take effect until 2006, and that was a much smaller program to get up and running.

SIEGEL: But Democrats are worried about the delay. Why?

ROVNER: Well, the main reason Democrats are worried is that some costs for the bill would start to take effect right away, things like fees on insurance companies and drug makers. Those fees are likely to get passed on to consumers. So, there's a real worry about consumers seeing pain and no gain. And remember, there are two elections between now and the year 2013, when most of this starts to take effect. There's also a worry this may come as something of a rude surprise to voters. There was a poll last week from the Kaiser Family Foundation, found about half the public thinks that many of those key benefits would start within a year of the bill's passage.

SIEGEL: So they would be very disappointed in that case, and yet the higher premiums, you're saying, could hit right away in the first year. What are lawmakers doing to try to fix this?

ROVNER: Well, they can't really speed up the big changes in the bills for the reasons I've talked about. It just takes that long to set things up. But they are trying to put in some smaller fixes to make sure there are some benefits that go out quickly. So, for example, there's likely to be new high-risk pools, people without insurance, but with preexisting conditions can get into, until the new rules on preexisting conditions take effect. And there's a whole lot of new benefits, for instance, aimed at seniors on Medicare.

Just last Friday, House Speaker Nancy Pelosi described how, in the latest version of the bill, there's more money to speed up help for seniors who fall into Medicare's notorious donut hole, where they have to pay for all their drugs themselves.

Representative NANCY PELOSI (Democrat, California; Speaker of the House): The first bill was good, this is much better. These changes mean that 1.1 million seniors will avoid falling into the donut hole in 2010.

SIEGEL: But over 1.1 million seniors would mean spending more money, no?

ROVNER: Yes, it probably would mean spending a little more money. But I think in this case, lawmakers seem to be making the calculation they'd rather spend a little bit more money than reap a whirlwind of an unhappy public.

SIEGEL: Thank you, Julie.

ROVNER: You're very welcome.

SIEGEL: That's NPR's health policy correspondent, Julie Rovner.

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