Atlanta Man Sees Hope In Health Care Plan

Many Americans are trying to figure out how and if the new health care law will affect them. Among them is a 63-year-old man Atlanta man who lost his job and his insurance. For months he has been trying to figure out how to get free or low-cost care. Now the overhaul may put him squarely in line for a subsidy and an affordable plan in an exchange.

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RENEE MONTAGNE, host:

Politics aside, the health care bill is now law, and many Americans are trying to figure out how and if the new law will affect them.

NPR's Joanne Silberner has this profile of one middle-aged man who might benefit.

JOANNE SILBERNER: James Schwarzlose has a part-time job teaching English as a Second Language at DeKalb Technical College in Atlanta.

Mr. JAMES SCHWARZLOSE (Faculty, English as a Second Language): Come on in. Come on in. Come on in.

SILBERNER: His students are from Somalia, Nepal, Haiti, Bhutan.

Mr. SCHWARZLOSE: Im going to give you something just to work on to start with...

SILBERNER: It's raining on this day. Many of the students have walked here and they're straggling in. The lesson plan includes medical terms, and he picks the word, cardiologist.

Mr. SCHWARZLOSE: Everyone, because you need to know this, because if I fall down and suddenly on the floor, you're going to have to tell them, call a cardiologist. So everyone say, cardiologist.

STUDENTS: Cardiologist.

SILBERNER: Schwarzlose is 63 years old. He's got congestive heart failure. He's been turned down for insurance everywhere he's looked, and there's a limit to what he could afford - he makes $18,000 a year.

He's interested in whatever the health law has to offer. Chatting on his porch the day after the bill was signed, he says he's not exactly sure what that is.

Mr. SCHWARZLOSE: It is like a massive onion and there are so many layers to be peeled back before you can ever discover what it is.

SILBERNER: There are layers that will help other people: an expansion of the Medicaid program, but that's not until 2014; better drug benefits and Medicare, but he's not on Medicare yet.

There is one thing that will help Schwarzlose and other sick people who can't buy insurance until a permanent program is put into place in 2014. Karen Pollitz, a professor with Georgetown University's Health Policy Institute, explains.

Professor KAREN POLLITZ (Health Policy Institute, Georgetown University): The first thing that happens, probably later this summer, the federal government is to establish a temporary high-risk health insurance pool program.

SILBERNER: With his congestive heart failure, Schwarzlose is likely to qualify. Some states already have high-risk insurance plans, but they can be pricey. Pollitz says one of those might cost him $1,000 a month - two-thirds of his income. The new law puts $5 billion into the pot and the insurance policies are more likely to be affordable, says Pollitz.

Prof. POLLITZ: The law specifies that the premiums charged for this would reflect standard rates that would be charged for comparable coverage by private insurers in the individual market today.

SILBERNER: What's not specified, though, is what the benefits package will be, which can greatly affect rates. And the law says premiums can be set by age, with as much as a four-to-one difference between the lowest rates and the highest. At 63, Schwarzlose would pay the highest rate. So, what exactly will that be?

Secretary KATHLEEN SEBELIUS (Department of Health and Human Services): I think we're going to find out pretty soon.

SILBERNER: The secretary of Health and Human Services has 88 days, now, to design the program. Schwarzlose could always stay with what he has, but he doesn't like it very much. He's got the only thing he could find: a card that gives him a discount at a local public hospital, Grady Memorial. The 50 percent discount he qualifies for is off the full rate, not the discounted rate Grady allows health insurers. Schwarzlose recently got a $400 bill for his first doctor visit. That's a lot more than he ever paid when he had private insurance. And it leaves him worried about having an accident or doing anything that would require medical services.

The Grady card has other limits. He can only get care in the Atlanta area. The new plan is likely to be more flexible.

Mr. SCHWARZLOSE: It certainly would free me up greatly to do things in a lot more relaxed way - travel, go see my kids, even garden.

SILBERNER: James Schwarzlose says if the new plan comes in at $500, which it could, he'd pay it gladly.

In the meantime, for the Atlanta teacher and neighbors like him, there's the hospital discount card, and the hospital isn't about to yank it, says Grady Marketing Director Matt Gove.

Mr. MATT GOVE (Marketing Director, Grady Memorial Hospital): I believe we'll always have a financial assistance program for those patients who fall through the cracks.

SILBERNER: And there are people who will fall through the cracks. The new law may leave as many as 23 million people uninsured.

Joanne Silberner, NPR News, Atlanta.

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