Doctors, Consumer Prep For Health Care Changes
MICHEL MARTIN, host:
I'm Michel Martin, and this is TELL ME MORE from NPR News.
Coming up, what are some of the best companies for working mothers? We'll ask Working Mother magazine about that in just a few minutes.
But first, it's been six months since Congress passed the historic health care reform bill. Today, a new set of provisions go into effect, including one that allows parents to keep their children covered under their insurance up to the age of 26.
Additionally, insurance companies can no longer put a lifetime dollar limit on coverage, and children cannot be denied coverage because of preexisting conditions.
These provisions and President Obama's health care overhaul has provoked strong reactions both in favor of against, and a group of states is suing the federal government over the adoption of these new policies.
To get a sense of what goes into effect today and the debate over health care reform as it stands now, we've called on three guests whom we've spoken with before, first Jane Delgado. She is the president and CEO of the National Alliance for Hispanic Health. She holds a doctorate in psychology and clinical psychology.
Also with us, Dr. Leslie Walker. She's the chief of adolescent medicine at Seattle Children's Hospital. And finally, Michael Cannon, he's director of health policy studies at the CATO Institute. He's been a strong and consistent critic of the health care reform measures as they've gone forward, and he continues with that stance. And we'll hear from why in just a few minutes. But I welcome you all. Thank you all so much for joining us once again.
Mr. MICHAEL CANNON (Director of Health Policy Studies, Cato Institute): Great to be here.
Dr. JANE DELGADO (President and CEO, National Alliance for Hispanic Health): Nice to be here.
Dr. LESLIE WALKER (Chief of Adolescent Medicine, Seattle Children's Hospital): Nice to be here.
MARTIN: So, Jane Delgado, I'll start with you. What do you think are some of the most important provisions going into effect now, particularly as it relates to underserved populations, people who haven't had access to health insurance before?
Dr. DELGADO: Well, I think the most important thing is that we're finally tackling this for our country. And the most important thing right now is small things but important steps, for example, the idea that if you have a child that they can stay under your policy until they're age 26.
MARTIN: And why does that matter?
Dr. DELGADO: Because for a lot of kids, they lose their coverage as soon as they either graduate from college or as soon as they age out, and they can't get coverage. It's very hard and very expensive. And this way, they can still be covered and have the coverage they need to maintain their health, so they can be productive parts of our society.
MARTIN: Anything else?
Dr. DELGADO: Well, the other thing that is also helpful is the idea that now children cannot be denied coverage. But, you know, one of the things that concerns me is how all this is being interpreted by the states and by the insurance companies and also by the HR people who are controlling a lot of what the companies are doing.
MARTIN: Okay, we can talk more about what your concerns are in a minute. But I want to hear first from Dr. Walker. Dr. Walker, based on your practice, based on the families that you see, what are you most happy about at this point? And are you concerned about anything as the new law goes into effect?
Dr. WALKER: Well, I think the new health care law is actually a great beginning and especially for people of color. Not being able to get kids off of insurance plans with preexisting conditions is really important.
I see kids all the time that are dealing with asthma, transplant, mental health disease, obesity. And, you know, once they have one of these conditions, they may need chronic medical care. And when they try to continue to access that care, they hit limits. They hit a place where, while they're in the middle of their care, they have to drop out for a time.
And that just, that ends up costing us more because then when they get back into care, they're sicker, they need more health care, and they need more attention.
MARTIN: Is there anything you're worried about?
Dr. WALKER: Well, I think that, you know, companies that are trying to find a way around covering, keep continuing to cover the kids with preexisting, is concerning. I'm hoping that people will react to that by choice and moving to different plans and employers looking at plans that actually cover their kids, their employees' kids because if a person has a kid who's sick and can't get to the doctor, they're not going to be at work. You know, it's important to keep kids in good health care and especially kids with chronic medical conditions.
MARTIN: And Dr. Walker, can I ask you, are the families with whom you are in touch, are they aware of the law going into effect, and is it having, you know, Dr. Delgado talked about the kind of the psychological effect of just the peace of mind, a feeling that, you know, it may be a small step, but at least it is a step.
And then President Obama talked about the peace-of-mind effect. Are you seeing the peace-of-mind effect at all among your patients and your families?
Dr. WALKER: I'm seeing some hopefulness. You know, I think that the peace of mind will come when they actually see, you know, today, you know, it takes effect, you know, tomorrow when their child turns 18 or 19, they won't get a lot of letters from the insurance company saying they're being discontinued.
I think that's when we'll see the real peace of mind. But it's a beginning. And I think some of my patients are hopeful, but they're waiting to see how the insurance companies react to some of the health care law provisions.
MARTIN: Well, needless to say, not everybody is jumping for joy here today. Some 20 states are suing the federal government in a case that is likely to move forward. They contend that the government does not have the authority to require participation in health insurance.
So, Michael Cannon, first I'm going to ask you what's the basis for these states' opposition and whether or not you share it. And then tell me your own.
Mr. CANNON: Well, the basis for those lawsuits is that the federal government, under the Constitution, does not have the authority to require Americans to purchase a private product.
And if this law is deemed constitutional, then there's really nothing to stop Congress from requiring you to purchase any private product. If they decide that we have to prop up GM in order to save the economy, they can require people to purchase GM cars.
But today being the six-month anniversary of the signing of this law, it's important to look at to remember that there was wide bipartisan opposition to this law while it was being debated. There's still bipartisan opposition right now, the American public pretty consistently in polls say they disapprove of this law. And we're starting to see why there's been such widespread opposition to this law.
The president promised that this law would contain consumer protections. In fact, what it's doing is making a lot of consumers more vulnerable and blocking access to coverage and care.
MARTIN: Give an example.
Mr. CANNON: The requirement that insurers provide coverage for children with preexisting conditions is a perfect example. This is a government price control where the government says to insurance companies: Even if it costs $25,000 to cover this child, you can't charge them any more than, say, $10,000.
The problem there is the same problem you run into if the government says that you can't charge more than 50 cents for apples when it costs a dollar to produce an apple.
That creates shortages. Producers can't producers flee the market. And so that's what's happening with child-only health insurance. We've had at least six I'm sorry six insurance companies across the country saying that they're not going to write these policies anymore.
Now as a result of this law, a lot of parents are not going to be able to insure their children, where they would've been able to do so before. That makes people more vulnerable.
President Obama also promised that this would make, this law would make insurance more affordable. But insurance companies are reporting that the requirements, the mandates that take effect today are going to be increasing premiums by as much as 30 percent.
Now back in February, when private insurance companies were increasing premiums that much, President Obama called those increases jaw-dropping. And his secretary of Health and Human Services said that those would threaten coverage for people, premium increases of that magnitude. So exactly what they were trying to save us from, they have wrought through this law.
MARTIN: Jane Delgado, do you want to respond to that?
Dr. DELGADO: Well, I think part of it is, remember, this is health insurance reform. Health insurance is a major industry in the U.S., and we're going through a shift in it.
Part of what the law does is it also says that there's a limit to how much you can put in your administrative costs and really make most of the dollars that you earn go towards patient care.
The insurance industry is fighting this, trying to defy it in all sorts of ways. This is a major battle for the health of Americans. Insurance is core to how many people get their health care, and we have to change the way that happens.
And I think that some of Michael's points shows how the industry, rather than being proactive and trying to fix the situation, is finding ways, new ways to cut people out, and cutting out children who really need this kind of insurance.
MARTIN: If you're just joining us, you're listening to TELL ME MORE from NPR News. I'm Michel Martin. And we're talking about the new provisions of the health care law that take effect today.
We're joined by Jane Delgado of the National Alliance for Hispanic Health, she's the CEO. She is also a clinical psychologist. She holds a doctorate in that field. Michael Cannon of the Cato Institute; and Dr. Leslie Walker from Seattle Children's Hospital, she's a pediatrician.
And well, Michael Cannon, I mean, to Jane Delgado's point, I mean, isn't some of the opposition, wasn't it based on deliberate falsehoods like the whole death-panels argument, which would have compensated doctors for advising patients on end-of-life care, and this was deliberately manipulated and distorted. I think you would agree with that, (unintelligible) opposition.
Mr. CANNON: There are a lot of falsehoods coming from both sides in this debate. I think the one about death panels actually had some truth to it, even though it was deemed a lie by a lot of people. And I could discuss that in great length if you are interested.
But I don't think that it's fair to say that it's the insurance companies are just being greedy and trying to find ways to cut people out of the system. Look, if you tell, you know, apple growers that they can't sell an apple for a dollar when that's how much it costs to produce an apple, they're not going to do it.
And if you tell insurance companies you cannot charge an actuarially fair premium for these people, you're going to take a loss if you insure these people, they're going to flee the marketplace. That's what people who oppose these sort of - these price controls predicted before the law was enacted, and that's exactly what happened as a result of the law.
MARTIN: I take your point. The only question I would have for you is on the - aren't - isn't health insurance a different commodity than apples, where you can't necessarily predict how many apples you wish to consume, number one? And part of it, isn't it, that the savings arise when everybody buys in. That's the logic of requiring everyone to buy in, because that's the only way savings can be achieved, when healthy people, as well as not-healthy people are also paying into the same pool in some form or another, so that the savings cannot possibly be realized unless everybody is herded in.
Mr. CANNON: Well, you raised two important points. And the first one is that health insurance is different from other products, but it's still subject to the laws of economics. So if you try to force people to do things where they're going to suffer financially, they're going to resist, and it's a predictable response. That's what the insurance companies. Now, the government does a lot of things to try to mitigate those perverse incentives that it creates with those price controls, and one of them takes effect in 2014, which is going to require all of us to purchase health insurance.
But remember that even on - even once the government does that, every insurance company has an incentive to avoid each individual sick patient because they'll be taking maybe a $15,000 loss on each of them. And so we're going to see more of this in 2014. This problem is going to become much worse. It's going to become much harder for the state to actually (unintelligible).
MARTIN: Let me let Dr. Walker in on this, and Jane Delgado. I'll come back to you. Dr. Walker?
Dr. WALKER: Yes. One of the things that I think is still being overlooked is that a lot of people, especially people -disproportionately, people of color, are already out of the system. I mean, I have patients who - they're not worried about how much, you know, they're going to have to pay. And they can't even get the point of finding a way to have health insurance. Their kids are sick. They have chronic illness. They're walking around, and they're not able to work because they're in the hospital so much with their kid. This - some of these provisions are a good beginning to be - finally have equality and get close to equality for people of color having access to health care.
MARTIN: Dr. Walker...
Dr. WALKER: The health care's disparities are so great, and this will only help. It cannot hurt. Most of the people that I deal with, people of color, they're not even in the system.
MARTIN: Can I ask you, though, within your practice, Dr. Walker - I take your point, first of all, that a lot of the people you've seen don't have access to the system now, except - or perhaps very sparingly through existing government programs. But are you seeing, in your practice, for example, some of your major insurers alerting you that they're going to be making changes in who they cover or what they cover in advance of the law going into effect?
Dr. WALKER: I think one of the most dramatic ones so far has been in medications, and what insurance companies are beginning to approve. I have kids who are in school today and being productive kids. I have a patient who, you know, was not in school. And she now has medication to deal with her mental health issues, who now the insurance said we will no longer cover that medication. You have to use this one. Well, the other medications don't really work. So what happened is she then loses some of her ability to go to school. She's now - we would have to start all over again. So, you know, I have seen that, you know, some of the medication changes.
MARTIN: And Jane Delgado?
Dr. DELGADO: Well, just let me go back to something that Michael said. Apples are apples. Health care is not a commodity. Health insurance is not a commodity. It's very personal to each person, because it's a matter of your life and death. So the same economic principles do not apply, because when your life is threatened, you take it to another step. And when your child's life is threatened, it's more important for the government to be involved and be helpful and move us as a country to where we should be.
MARTIN: Well, Jane, though, let's just take the point that insurance -or health care, at least - is a social good, as well as a commodity, OK? What do you think accounts for the fact that there is this ongoing resistance to this law? Do you think it is on economic grounds, as Michael Cannon suggested the economics of it simply don't and that people know that? Or do you think that there is something else behind it?
Dr. DELGADO: Well...
MARTIN: Because the fact is, is that everybody knows that there's a problem with large gaps of people who aren't covered. But yet there is this ongoing and intense resistance to it. What do you think that's about?
Dr. DELGADO: Well, that's very easy to explain, because what happens is because health is so personal, and most people actually like their health care providers, they're saying what's in it for me? And really, this is a matter of the greater good, because you may be healthy today, but in a few months, you will not be healthy and you will need the extra benefits that are provided. You will need to have access to more medicines. And right now, what some of the insurance companies are doing is thinking that because a lot of these new provisions apply to new plans, they want to make sure that the current plan is grandfathered in, so they have a few more years before they have to have all these provisions cover all the people.
So there's some gaming going on, and what we have to make sure is, as consumers, to see what our plans are doing and that we'll get the coverage that we need and we have earned.
MARTIN: Michael Cannon, the - you made the point earlier that the - part of the opposition to this, just - it's on philosophical grounds, is that people simply feel that the core values of this country do not permit the government to tell you to buy something, however beneficial it may be. Do you think there are other reasons why this - the law is still being resisted? I'm asking you, I guess, to sort of prime out(ph), to get a little - look out a little bit further and tell us a little bit about why you think there are ongoing resistances there. And what do you think happens next?
Mr. CANNON: Well, I think that there's resistance to this law on philosophical grounds, on constitutional grounds, on economic grounds, and also on - I don't know, what you might call political grounds. Because I think a lot of people resent how this law was pushed through Congress, the shady deals that went into getting all the votes that they needed, how it was cobbled together behind closed doors.
But more broadly, I think that the philosophical and the economic arguments work in tandem this way: For the past seven decades or more, the federal and state governments have been heaping more government mandates, more government price controls, more government subsidies on our health care sector. And those are the factors that are making health care less affordable, that are holding back quality, that are leaving more families in these situations where they cannot get their child the health care they need. And what this law does is it just pours more fuel on that fire.
MARTIN: Well, I gave Jane the first word, I'm going to give you the last word. So what's your better idea? And I know you write about this every day, so it's hard to encapsulate in one minute, but I'm going to ask you to try. What's your better idea?
Mr. CANNON: Well, probably, the most important thing that Congress can do to protect consumers right now would be to repeal this law. And beyond that, Congress should enact some pretty sweeping reforms that let consumers control their health care dollars and that deregulate the health care sector so that consumers will have more choices, and there will more competition.
MARTIN: Is that going happen?
Mr. CANNON: Within our lifetimes? I'm hopeful.
MARTIN: Jane? I'm going to switch up, here. Yes or no: Is that going to happen?
Dr. DELGADO: That we're going to have health care reform?
MARTIN: That the law's going to be repealed. Yes or no.
Dr. DELGADO: No. I hope not. I hope we're more responsible.
MARTIN: Jane Delgado is president and CEO of the National Alliance for Hispanic Health. She was here with me in a our Washington, D.C. studio, along with Michael Cannon, director of health policy studies at the Cato Institute. He writes widely about this. And we'll link to his site so you can see what he's had to say about it.
Also with us, Dr. Leslie Walker's the chief of adolescent medicine at Seattle Children's Hospital, and she joined us from her office. I thank you all so much for speaking with us. To be continued.
Mr. CANNON: Thanks so much.
Dr. DELGADO: Thank you.
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