Understanding The Latest Health Care Changes

The six-month anniversary of the Obama administration's health care law ushered in a new set of rules that will have implications for many consumers. NPR Health Care Correspondent Julie Rovner explains the changes, and the fine print behind some of the new provisions.

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NEAL CONAN, host:

This is TALK OF THE NATION. Im Neal Conan in Washington.

Six months later, another round of President Obama's health care law took effect last week, and it's still the subject of debate. Democrats hope voters will like changes, like the provision that lets children stay on their parents' plans until they turn 26. Republicans believe they'll win votes with a promise to repeal and replace the health care law if they win majorities in Congress.

In this hour, NPR health policy correspondent Julie Rovner on what's changed, how insurance companies are responding, what's next and the continuing political debate.

What changes have you noticed? 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. Thats at npr.org. Click on TALK OF THE NATION.

Julie Rovner joins us here in Studio 3A. Always so delighted to have you on the program.

JULIE ROVNER: Always nice to be here.

CONAN: And we know that some things took effect as soon as the president's pen left the paper, but other things, a big round of effect - things took effect last week.

ROVNER: That's right. This was the so-called Patient's Bill of Rights. This was mostly what was kicking around in Congress in the late 1990s, early 2000s, that came this close to becoming law under President Bush just before 9/11, didn't quite make it over the finish line.

So basically they took most of that law, which was pretty bipartisan, and just folded it into the health law. And these are mostly protections from people against abuses by their insurance companies, if you will, things that people really hated during the era of managed care, which is mostly over, but not completely.

So these were things like ensuring that you can choose your own doctor, that women can go to an obstetrician/gynecologist without a referral; that if you're, if you've had something denied by your insurance company, that you could get an outside appeal; that you could - that insurers, if you went to an emergency room that was not in your network that they couldn't charge you an out-of-network fee. Those were all things, as I say, that have been kicking around for a while.

Some things that have come up more recently, things like rescinding people's insurance policies. What would happen is that people - this was mostly in the individual market - people would buy an insurance policy, things would go along, everything would be okay.

Then something bad would happen. They would have a car accident, they would get diagnosed with cancer, they would rack up a whole lot of insurance. They'd rack up a whole lot of medical bills, and the insurance company would go back and scrutinize the original application and find some very small omission and go back and say: oh, you lied on your application, we're going to rescind your insurance retroactively. So we're not going to pay all of these expensive medical bills.

That will no longer be legal. They will have to prove actual fraud in order to rescind your insurance policy.

And there will now be no more lifetime limits. This was something that about 100 million people have and probably don't know they had a lifetime limit of perhaps $1 million, $2 million, maybe even $4 million.

CONAN: Which sounds like oh, I'll never get that high.

ROVNER: Exactly, but, you know, if you have some serious form of cancer or the aforementioned car accident, or this often happened to people with really serious chronic conditions. A common one is hemophilia because the Factor 8, the blood-clotting factor that hemophiliacs take, costs about $100,000 a month. Well, that's, you know, over $1 million a year. You chew through a $2 million, $3 million lifetime limit real fast with something like that.

CONAN: And as we also as we mentioned, the ability to keep your kid on the parents' insurance policies until they, the kids, turn 26.

ROVNER: Absolutely. That one turned out to be really, really popular because a lot of people have kids who are graduating from college or have graduated already, gone off, found those first jobs, but those first jobs don't offer health insurance.

CONAN: Now, children can no longer be denied coverage for pre-existing conditions. Yet some insurance companies are saying, well, if that's the law, we're going to stop offering those policies.

ROVNER: And, you know, that's one of the problems with re-doing the health care system to rely on private insurers. And that's something that they were entitled to do.

Now, this was fairly small. It was it does not apply to that many people. There are not that many insurance companies that offer what they call child-only policies, and there's not that many families that need them.

If you think about it, most children are covered under their parents' policies, or they're covered under Medicaid or the state children's health insurance plan. So there's not that many kids who are going to need a policy just for the child.

But what the insurance companies were saying is that for this million-or-so kids who do need these policies, they're worried that if they can't really discriminate against kids who could, theoretically, wait until they were sick for their parents or grandparents in some cases or guardians to buy them insurance, that you are going to end up with a pool of just sick kids. It was going to get too expensive.

This goes to the same problem that there would be in the adult market. This is why there is this individual mandate for adults. This is why the pre-existing conditions for adults ban doesn't take effect until that mandate kicks in.

So that's what these insurance companies were saying, and these are some of the really big insurance companies - it's Aetna and CIGNA and Anthem Blue Cross -that says we were really afraid to do this. And there actually is some talking going on between the Department of Health and Human Services and these insurance companies to see if maybe there's some way they could charge a little extra to try to get them to come back into the market and offer these child-only policies, because for the kids who need them, they are important.

CONAN: This is NPR's health policy correspondent Julie Rovner. We'd like to hear what you have noticed about the health care. How has it changed? 800-989-8255. Email talk@npr.org. We'll start with Belinda(ph), Belinda with us from Rapid City, South Dakota.

BELINDA (Caller): Yes, sir. I have an employee-sponsored plan, and my question is whether or not this legislation is going to require companies to offer a better plan.

My specific plan, and I'll read two sentences off of this, it is considered a sickness and accident plan that covers everyday medical expenses. It is not a major medical plan and is not designed to cover major health problems like heart disease or cancer.

If I pay about $700 a year in premiums, I'll get excuse me about $2,000 a year in coverage. This is really pathetic coverage, and I choose not to pay for it.

CONAN: So it would cover a checkup, but again, that aforementioned car accident, you'd be on your own.

BELINDA: Exactly. And will the legislation compel my employer to offer something more viable?

CONAN: Julie?

ROVNER: It depends, is the short answer. And not yet is the longer answer. One of the things that took effect as part of this Patient's Bill of Rights is a phase-out of what they call annual limits, that you can't have, you know -there were these lifetime limits. There are also annual limits that a smaller number of plans would have.

They would say you could only, you know, have we would only cover $30,000 a year, or sometimes even $10,000 a year, in claims. In your case, it was, what, a couple of thousand dollars a year. These are limited-benefit - or these sickness plans.

But there was under this regulation that the administration put out to do this, there was some worry that there would be employers who would drop coverage completely if they you know, they said we're not going to have, we're not going to offer any benefits at all if we can't offer these limited -very limited - plans.

And so the employers could apply for a waiver. So in your case, your employer -depending on how large your employer is - could apply for a waiver to continue to offer this very limited plan. So they will be allowed.

Now, in 2014, everything changes. That's when employers, larger employers will have to either if they don't offer coverage, then they will be dunned if you end up buying your coverage from one of these exchanges.

If they're a smaller employer, then they will not have to offer coverage, but they'll get a tax credit if they do. But at that point, you'll be able to go into the exchange and buy your own coverage. And again, depending on the size of the employer, the employer will have to pay a penalty if you end up buying your coverage in the exchange.

CONAN: So basically, Belinda, I think what she's saying is drive carefully.

BELINDA: Right, until 2014.

ROVNER: Until 2014, yeah, when you'll have a change to buy...

(Soundbite of laughter)

CONAN: Then put the pedal to the metal.

ROVNER: Yeah, and hope it doesn't get repealed between now and then.

BELINDA: Right. Okay, thank you very much. I appreciate that.

CONAN: Thanks very much for the phone call, appreciate that. And that raises again the politics of this. As you said, the Democrats hoping that people will say, hey, hey, I can put my kid on my parents plan until 26, very popular, as you say. Republicans are pointing out, hey, your premiums are going up. So this is all getting back into the debate.

ROVNER: That's right. And that and even your premiums going up is more complicated than it seems because most of the actuarial analyses are not just done by the administration but done by - outside actuaries say that all of these benefits should add about one to two percent to premiums. And what's happening is that premiums are going up by nine to 10 percent.

Now actually, a friend of mines sent a letter to me from one of the insurance companies that explained why her premiums were going up, and it actually didn't blame the law. It blamed all the reasons that premiums are going up. And there was nothing in this law that was going to make premiums not go up, particularly not for the first couple of years.

Everything that might hold down health care cost doesn't happen for several more years, in some cases more than a decade. One of the reasons that Republicans said that they were going to vote, in lock-step, against this is that they knew that that would mean that Democrats would own the health care system and everything bad about it for the next several years because they knew there was nothing that was going to keep premiums from going up.

But insurance companies are, in fact, blaming the law for a lot more than they should in terms of the premiums going up.

CONAN: Last week in the House of Representatives, Republicans released their Pledge to America, which included provisions on the health care law.

Representative BILL CASSIDY (Republican, Louisiana): The American people have told us what they want is that we defund, repeal and replace.

CONAN: That's Congressman Bill Cassidy, Republican from Louisiana, and, well, defund, repeal and replace. Easier said than done. Nevertheless, this is a major tenet, a platform, if you will, of the Republican Party in this year's midterm elections.

ROVNER: Yes, indeed it is. As I mentioned, the Republicans were, you know, unanimously against this when it became law, and they remain unanimously against it.

Repealing would be difficult. They'd need to get two-thirds, obviously, in both the House and the Senate, which seems unlikely.

CONAN: If President Obama vetoed it, which...

ROVNER: Right, exactly, if President Obama vetoed it. But if they take over the House, which seems plausible, if not likely, defunding is a little bit easier because they will have the purse strings in the Appropriations Committee, and defunding it would be not so hard.

And, you know, they could pull out what the Department of Health and Human Services is doing to implement this, and that would make things really quite tricky. They could perform all kinds of mischief on implementation of this law, and they intend to.

CONAN: One of the ideas that they came up with in that Pledge to America about health care, this is just one of them, but this is again Congressman Cassidy.

Rep. CASSIDY: Lower cost for the purchaser of insurance by allowing Americans to buy insurance across state lines. Make these big insurance companies with market concentration compete against one another for the benefit of the small businesswoman or the individual purchaser of insurance.

CONAN: Now, this was one of those ideas that was debated. Republicans said why don't you incorporate this as one of them? Obviously, it's not in the bill.

ROVNER: No, it's not, and it's been actually, a piece of it is if the insurance if the state insurance commissioners would like to allow it, they could, but the insurance companies wouldn't be allowed to allow it.

And this has been very controversial. It's been so controversial it's never, in fact, been brought up even to the full House for a vote, and it's been kicking around for five or six years. So this is actually much more difficult to do than it sounds.

CONAN: Julie Rovner, stay with us, and we'd like to hear from you. What have you noticed in changes in health care, particularly in, well, I guess the last week or so, since six months after the provision was signed into law by President Obama, 800-989-8255. You can drop us an email, talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. Im Neal Conan from NPR News.

Six months after the health care law was signed, more than half of Americans are still confused about how it affects them. A poll from the Kaiser Family Foundation shows 53 percent say they are now confused. That's up eight points from last month and the highest since April.

At the same time, as some of the biggest protections take effect, more people say they have a favorable view of the law, 49 percent to 40.

Today we're talking with NPR health policy correspondent Julie Rovner about what's changed, how insurance companies are responding, what's next and the continuing political debate.

Tell us what you've noticed, 800-989-8255. What's different? Email us, talk@npr.org. You can join the conversation on our website, as well. Thats at npr.org. Click on TALK OF THE NATION.

And let's go next to Trish(ph), Trish with us from Nevada City in California.

TRISH (Caller): Hi, thanks for having me on.

CONAN: Sure.

TRISH: I we are, just like your friend, also received a letter in the mail last month that all of our premiums went up in our family. I have no idea why. I originally had signed up for individual plans. We have two kids, and then there's my husband and myself. We have individual plans with a really high deductable, and it went up by $84 a month just last week.

And, you know, so of course we're disappointed in that with all the talk of health care getting better. But our concern is, you know, we were discussing whether or not we should call to see if we could get some kind of better plan. And we're afraid of being dropped.

CONAN: Is the could she be dropped by her insurance company? I'm asking Julie here.

ROVNER: Yeah, well, if she the problem is that there she couldn't be dropped, but if she went to get a new plan, you're still subject to, you know, to the medical underwriting until 2014. That's the problem. There are still pre-existing conditions allowed for adults until 2014. So she's right. If she went to try to get a different plan.

Then there's all this question, and I'm sure she got this in her letter, about grandfathered plans, you know, whether her plan stays the same.

CONAN: That information came with a magnifying glass, right?

ROVNER: Well, no, actually, most of the letters are going they don't come with a magnifying glass. They come in 10-point type. It's just really complicated.

People I know. I've seen a lot of these letters because people send them to me and say can you explain this to me, and it's hard even for me, and I've read the regulation about what this says is that if the plans don't change, and if they don't substantially reduce benefits that they don't have to apply some of these new benefits.

They do have to apply some of them. They don't have to apply others of them. So some of these new rules apply to all plans regardless. Some of the other rules don't apply to plans that are quote-unquote grandfathered.

This goes back to this promise that the president made that says if you like the plan you have, you can keep it. That's the grandfathered plan. So it's a question of do you want to keep your plan knowing that you might not get some of the new benefits, but you also aren't going to get anything changed, or do you want to take the chance and switch to a new plan that might have better benefits but might also cost a little bit more.

And, you know, people keep that's the question that people keep coming to me, and my answer is I don't know.

(Soundbite of laughter)

CONAN: So it sounds like this is the health care casino.

ROVNER: Yeah, it really is. This year is pretty much it because this is when you have to decide: Are you going to stay in your grandfathered plan with the benefits, that, you know, you know and love, or are you going to go to the new plan with the new benefits, but you don't really know how much it's going to cost?

And as I said, these new benefits in particular shouldn't cost very much, but that's not stopping the insurance companies from claiming that they are.

CONAN: I see. And Trish, if I could ask a question, you said the insurance policies are going up $84 a month. Is that which is, what, about $1,000 a year. Is that per plan, or is that everybody?

TRISH: No, that's a total for all four of us. So it just went, you know, it wasn't - $20 here for the kids kind of a thing and then $30-something for each of us, around there, and it added up to $84. I forget the individual.

But I mean, it was a huge book. It wasn't a letter, to say the least. It was a huge book that, you know, page after page after page. It was stapled. And I guess I just was nervous about trying to get a better plan and some red flag coming up and then seeing that, you know, we had a prescription for, you know, penicillin and some pre-existing condition and to lose the existing one. But that can't happen.

CONAN: Okay, Trish, good luck.

TRISH: Okay, thanks so much.

CONAN: Thanks so much for the call. An email from Christine(ph) in Levittown, that's in Pennsylvania: Where can I write to call to get a list of covered preventive services I no longer have to pay a co-pay for? And can I call Medicare for this? P.S., when I call, the phone just disconnects right away.

(Soundbite of laughter)

ROVNER: Actually, yes, if you're on Medicare, you should be able, and you should also be able to get it on the Medicare website, medicare.gov. If you're not on Medicare and the Medicare preventive services I believe start at the first of the year, the Medicare services with no co-pay.

And we should point out that for everybody else, these new benefits kick in at different times. The rule is that they start on or after the next policy renewal date, as of last Thursday. So if you get a new plan, if you're buying a new plan now, it would start when you get the new plan. For everybody else, it's the next time your policy renews, so...

CONAN: For a lot of people, that's October 1.

ROVNER: Yeah, for a lot of people, it's October 1, some people November 1. For a lot of people, it's next January 1. So a lot of people won't see these new benefits until January 1. So it's not automatic as of that date. It's just the next time your policy renews you see these new things.

But for everyone else, actually it is on the Web, and that would be the best place to find it. Most of the new preventive benefits that you can get without paying a co-pay are those that are recommended by the U.S. Preventive Services Task Force.

But there are others. There are immunizations. There are some from the Health Resources and Services Administration. So there's a lot of preventive benefits that you'll now be able to get, including and someone pointed out, a very smart health blogger pointed out, that it includes mammograms for women between the ages of 40 and 50, which is not part of the recommendations from the U.S. Preventive Health Services Task Force, and that was more of a political decision than a medical decision. But that will be covered without co-pay.

CONAN: Let's go next to Frankie(ph), Frankie with us from Thompson's Station in Tennessee.

FRANKIE (Caller): Hi, my question is my son had graduated. He's 22. The thing is, though, he's still dependent on us. He's studying to go back to school. But they dropped him, and they said that there's going to be a lag time, which we have to buy COBRA, until November. I don't understand this.

ROVNER: That's right. That's what I was talking about before. It's whenever your policy renews. A lot of plans, and the president and the administration really urged plans to please put graduating seniors on, to not drop them and keep them on continuously. But they weren't required to do it under the law until, as I mentioned, the first policy renewal date after September 23.

So if your policy doesn't renew until November, they weren't required to put him back on. I assume that November is when your policy renews.

FRANKIE: Yes.

ROVNER: Yeah, see, that's all the law required. So that was correct. It wasn't very nice, but that was all the law required.

FRANKIE: Well, the thing is, he's still dependent on us.

ROVNER: It doesn't matter. The law prior to that was that he had to still be a full-time student. It didn't matter, the dependency didn't matter. It was when he ceased to be a full-time student, he was no longer eligible.

And in fact under the new law, he doesn't have to be dependent. He can be off, have a job, be married and still get, be on your insurance.

CONAN: He could be a billionaire.

ROVNER: Yes, he could be a billionaire, as long as he doesn't have health insurance.

(Soundbite of laughter)

CONAN: And in Frankie's dreams, he will be.

ROVNER: But yeah, the law, the way the law is written, they don't have to let you put him back on until the next time your policy renews, and that's obviously in November.

FRANKIE: Ouch.

ROVNER: Sorry.

CONAN: Yeah, swallow hard.

ROVNER: But at least you get him back on in November.

FRANKIE: Yeah, but in the meantime, ouch.

ROVNER: Yeah, sorry. I know, COBRA's expensive.

(Soundbite of laughter)

FRANKIE: Thank you.

CONAN: Bye, Frankie. Here's Concetta(ph) in Florida: My premiums went up and included an increase in the co-pay for specialist visits. The new legislation was supposed to make preventive care visits without having a deductible.

I called my insurance company to see if my preventive care visits were now classified under specialists were not without deductible. She said it wouldn't take effect until the next plan year - this is a big word, play year, phrase with is August, 2011. Is that true? So I guess I thought you were saying it took effect January 1.

ROVNER: No, it's the next time your policy renews after the next time your policy renews after September 23.

CONAN: So it could be August if the timing was very bad.

ROVNER: Yeah, if your policy renewed in August, you are out that's the worst-case scenario. I mean, no, I guess the worst-case scenario is if your policy renewed on September 22, you're going to have to wait 364 days, but...

CONAN: Let's go to Christine(ph) and Christine calling from Tucson.

CHRISTINE (Caller): Hi, I think my question was answered by one of the previous callers, but I'll ask anyway. Our son is 19. He just turned 19 in August. He was dropped by my husband's insurance. We got a letter in the mail. He was dropped at the end of August.

My husband was able to reinstate him because they didn't know he was in college. So we got him back on, but my question is: With the federal policy going into effect, I wonder if there is some kind of a cut-off date saying, well, this only applies to kids as of September 1 or something. I guess I'm worrying about something that might happen later just because of the timing when all of this went into effect.

CONAN: It sounds like since she's got her son back on her husband's plan, he's good until he turns 26 years old.

ROVNER: Yeah, you should be good until he reaches his 26th birthday. And then there's some there's some question about how long they get to stay on after their 26th birthday. That's still I think being determined by the Treasury Department.

CHRISTINE: So I guess my other question would be even if he chooses not to stay in school but, you know, goes and actually gets a full-time job, he'll still be covered.

ROVNER: Yup, that's the whole point of this.

CHRISTINE: That's the best. All right, thank you.

CONAN: Thanks very much. Let's go next to this is Susan(ph), Susan with us from Portland.

SUSAN (Caller): Hi, I'm actually calling because I haven't seen any changes, and I'm worried because I was unemployed for a long time, and I had to take two part-time jobs to get full-time work. Neither of them offered benefits. And I was just given the new employee handbook for one of them and it doesn't mention benefits for anyone under 21 hours. Will I be able to get any kind of benefits?

ROVNER: Probably not yet. People - these are mostly - these benefits are mostly for people who already have insurance. The benefits for people who don't yet have insurance don't kick in until 2014, largely. There's a high risk pool that began in July or, I guess, August, for people who have preexisting conditions and haven't had insurance but that's very expensive.

If you - those are - and you have to have demonstrated that you've not been able to get coverage elsewhere. So if you're healthy and you just don't have insurance, then there's really - you're going to pretty much have to wait until 2014. There are some - there is a small business tax credit that's now in effect to encourage more small businesses to offer coverage, but there's really not that much out there until 2014, when the exchanges start to allow just people who don't have insurance to go out and buy it.

SUSAN(ph): Ah, pretty discouraging.

(Soundbite of laughter)

ROVNER: Sorry.

SUSAN: Yeah. I have some health things that are coming up. I've been without health insurance for almost five years now.

CONAN: Ow. Well, I'm sorry about that, Susan.

SUSAN: And, yeah, I don't know where to turn. Okay. All right. Thank you very much.

CONAN: Sorry. Let's go next to - this is Becky(ph), Becky with us from Sacramento.

BECKY (Caller): Hi. Yeah, I have a 25-year-old son who does have health insurance through his employer but it's very, very poor health insurance. But does that, according to my understanding, makes him not eligible for...

CONAN: Being put back on your plan?

BECKY: Being back on my plan.

ROVNER: Okay, this is where it gets confusing. It has to do with whether the plan is grandfathered, and I'm trying to remember which is which. It does - at first, I thought that they were - if they had health - if they were offered health insurance, they couldn't do it. I think if they offered health insurance and you're in a - it depends whether your plan is grandfathered.

If your plan is grandfathered and he has health insurance, then he can't get back on. But if your plan is not grandfathered and he has health insurance, then he can. But if he's already 25, I'm not sure what the implications will be for him getting back on if he were to get back on your plan, and then when he turns 26, what would then happen.

BECKY: Right. My understanding is that he cannot get it now just because he has one offered to him at work, even though it pays only like 50 percent of, you know, that humongous number that no insurance company pays of cost.

ROVNER: Yeah, as I said, that has to do with the status of your plan, whether your plan is grandfathered or not.

CONAN: So check it for whiskers.

(Soundbite of laughter)

BECKY: Okay. And will the new plans - I mean, will he be able to buy exchange plans if we have a bad insurance plan offered through our employer?

ROVNER: Not necessarily. That's another big issue about who the exchanges will be open to. It depends, again, on the size of your insurer but most people will not actually be able - at least initially, the exchanges will not be open to people unless they're in small businesses.

CONAN: Becky, thank you. Good luck.

BECKY: Thank you very much.

CONAN: Bye-bye. We're talking with NPR health policy correspondent Julie Rovner. You're listening to TALK OF THE NATION from NPR News.

And here's an email question. This is from Diane(ph) in Spearfish, South Dakota. I am covered under my husband's plan at his work. He works for a global mining company. I understand his company's plan is considered self-insured; therefore, they do not have to offer coverage for children until the age of 26. Self-insured companies are not required to provide this feature under health reform?

ROVNER: Mm-mm. No, that's not true. I mean, that's just a self-insured ERISA plan, but this covers ERISA plans, they do have to abide by these rules. The ones - the people who got caught by this who didn't have to abide by this are the people in TRICARE, one of the military plans, who were so anxious to be excluded from all of this that they got themselves excluded from all of these new rules and then suddenly came clamoring back to complain because suddenly their kids who are age 22 to 26 weren't being covered.

CONAN: So, well, be careful what you ask for.

(Soundbite of laughter)

ROVNER: Exactly.

CONAN: Okay. Let's see if we can go next to - this is Barbara(ph), Barbara with us from Narragansett in Rhode Island.

BARBARA (Caller): Hi. Yes, my husband is a federal employee, and we received a letter last week from Blue Cross, which is probably the only insurer in the state that they were not going to provide coverage for federal employees. You know, we have to go to open season and then select some other program. Are companies doing this, dropping a whole bunch of people because they don't want to insure them?

ROVNER: You mean they're going to stop providing coverage in the state? Or...

BARBARA: For federal employees, correct.

ROVNER: Oh. I hadn't heard that. I mean, but company - I mean, companies do, although I don't know that - did they say it was because of the new law? Or...

BARBARA: They didn't say. They just say effective, you know, with open season, you must select another coverage. And Blue Cross/Blue Shield is practically the only insurer in the state. We'd have to go with a national plan, but I was surprised to see it because there's so many people - federal employees are covered by Blue Cross in the state.

ROVNER: Yeah, I had not heard that. I was...

BARBARA: Last week - the letter was out last week.

ROVNER: Yeah. I was not aware that they were leaving the...

BARBARA: We're a little state.

(Soundbite of laughter)

ROVNER: Yeah. That I know.

CONAN: The federal government is a large employer, though.

ROVNER: Yes, they are.

BARBARA: Yes, it is.

ROVNER: And there are many health plans in the federal benefits plan.

BARBARA: I wanted to pass that on as that's something that's happening.

ROVNER: I would look into that.

BARBARA: All right, thank you.

CONAN: Bye-bye.

BARBARA: Bye.

CONAN: And finally, Julie, we talked a little bit about the politics of this before. We mentioned some of those polls that have been done. One of them is about the general popularity of the health care reform. This could play a part in November as people consider that, and the numbers are pretty interesting.

ROVNER: Yes, they are. You know, well, one thing, it should bear saying that for all the focus on this this year, health care is not really up towards the top of people's voting issues. The economy is playing a much, much, much larger role.

But one of the interesting things, as much as the Republicans are trying to make hay out of the people's discontent with this law, you know, was this poll by the Associated Press over the weekend that found that four in 10 people who don't - four in 10 people say that they think this law didn't go far enough, which is twice as many people who think that the law went too far.

So there's actually a fair number of people who wish that the law had done more. So there really is a lot of very mixed opinion about what this does. And I think, really, what's important here is that the health care system is so complex - and I think we've seen that just from the questions. It affects everybody differently. People are still confused because it's inherently confusing.

CONAN: Julie Rovner, thanks very much for helping us lose a little bit of that confusion. Anyway, we appreciate your time.

ROVNER: We'll keep at it.

CONAN: NPR health policy correspondent Julie Rovner, with us here in Studio 3A. Coming up, the decline of the American dream. What does that phrase mean to you? 800-989-8255. Email us: talk@npr.org. Gregory Rodriguez will join us on the Opinion Page next. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

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