Debating Year One Of The Health Care Overhaul

A sweeping health care overhaul was signed into law a year ago, promising to make insurance companies more accountable, offer more health care choices and reduce costs for patients. But perceptions of the Patient Protection and Affordable Care Act have been mixed. Guest host Farai Chideya explores the broad impressions, including the public and political responses to the law, with Mary Agnes Carey, senior correspondent for Kaiser Health News.

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FARAI CHIDEYA, host:

And now for more on the first anniversary of the Patient Protection and Affordable Care Act, we turn to Mary Agnes Carey. She's a senior correspondent at Kaiser Health News. It's an independent nonprofit research program not affiliated with Kaiser Permanente Health Care. Mary Agnes, thanks for joining us in studio.

Ms. MARY AGNES CAREY (Senior Correspondent, Kaiser Health News): Thanks for having me.

CHIDEYA: So, lawmakers are not the only people questioning this. The Kaiser Family Foundation, part of the nonprofit that you are associated with says that more than half of Americans, 53 percent say they are, quote, "confused by the health care overhaul." What does that mean in terms of trying to have people understand and process this?

Ms. CAREY: Well, it's an incredibly complicated law. Some of the provisions that were just discussed, for example, keeping a child on your health insurance until they're age 26 or helping seniors close that donut hole Medicare gap of coverage, those things just came online. They started for plan years after September 23rd of last year. And for most of us, that's January 1st. So people are just beginning to learn and understand the law.

But some of the biggest provisions don't come into place until 2014. For example, you were just talking about the Medicaid expansion, the health insurance exchanges, the subsidies. So I think it's natural that people are extremely confused about what goes into effect now, what goes into effect later.

And let's not forget about what's happening on Capitol Hill. House Republicans and Senate Republicans are vehemently opposed to the bill. They're out there talking about it, passing measures in the House of Representatives to defund the law. That adds confusion to people. You've got all the lawsuits in states over the individual mandates. So I think it's natural that people are confused.

CHIDEYA: So, is one year too soon to evaluate the progress of this law, given everything you've just said?

Ms. CAREY: In some ways, yes. But in other ways you can see where there was great expectation among people because a year ago, there we all were at the White House, the signing ceremony. It was a culmination of two years of activity on Capitol Hill.

But then again, on the other hand, to change something as sweeping and comprehensive as the nation's health care system is going to take time and it's expensive. So they couldn't fund the exchanges immediately. They couldn't do the subsidies right away. They had to put that Medicaid expansion out to 2014.

CHIDEYA: Now, some Republicans have been threatening to repeal the Patient Protection and Affordable Care Act since the day it was signed. Could that actually happen? And if so, what would need to happen for the repeal to happen?

Ms. CAREY: It's a pretty big task to do that now and probably won't happen with the current Congress because the Republicans control the House of Representatives. They do not control the Senate. And, of course, President Obama is defending the law and said he would sign any measure to repeal it. And there aren't enough Republicans in the chamber to override it.

But the show now here really shifts to 2012. If in the midterm, I beg your pardon, the presidential year of 2012, if Republicans took the Senate, if they took the White House, then the health law could really be in trouble. I'm on saying that's going to happen, but that's kind of the political showdown that's ahead.

CHIDEYA: So, what have you heard from individuals? I mean, have you been able to talk to real people and find out what they think?

Ms. CAREY: If people have benefited from the law personally, the one provision I've heard a lot about are from parents whose child just got out of college, their son or daughter doesn't have a job, they don't have health insurance, perhaps they have a chronic medical condition, they can keep that child on their policy until age 26. People like that.

People like the idea that their health insurance plan isn't charging a co-pay or deductible, a cost-sharing for preventive services. Seniors like the help with their prescription drug cost. But I also hear a lot about some people who seem very concerned about the individual mandate. There's some confusion. They think it means, for example, if they're covered by health insurance now, some people think they have to go out and buy something different in 2014. That's not the case. If you have health insurance through your employer, you've got it on your own, you're covered with the mandate requirement.

CHIDEYA: And just briefly, do you have a sense of how many states are considering opting out that whole idea that if you create your own better plan that still provides what the law requires, the state can enforce its own plan?

Ms. CAREY: That is a difficult hurdle to meet because on one hand it is flexibility. But on the other, you have to still hit the requirements of the law, the coverage requirements, the affordability requirements, the scope of everything that must be in that benefit package. And governors that dislike the law are saying it isn't that we want to find a different way to meet the requirements of the law, we just don't want to have to meet the requirements of the law.

CHIDEYA: Well, we're going to take a short break and when we return, we'll continue our conversation about the Affordable Care Act with Mary Agnes Carey of Kaiser Health News.

Stay with us on TELL ME MORE from NPR News. I'm Farai Chideya.

(Soundbite of music)

I'm Farai Chideya, and this is TELL ME MORE from NPR News. Michel Martin is away.

Coming up, we'll talk about our pursuit if clean, safe energy from a scientific and community standpoint.

But first, I'm back with Mary Agnes Carey. She's a senior correspondent at Kaiser Health News, which does research on health care policy and we're continuing our discussion on the first anniversary of the Patient Protection and Affordable Care Act. It was signed into law by President Obama exactly one year ago today. And it was a contentious fight.

Do you think that eventually people on both sides of the aisle will settle into this bill? I mean, what do you, like, looking ahead, do you think it will still be contentious or that we'll find a middle ground?

Ms. CAREY: I think a lot of the arguments, the political wrangling and so on will intensify through 2012. A key year here is if the law is not repealed, or major provisions aren't stricken, once 2014 comes, then everyone, no matter what their view of the law can see it how it unfolds. And that's been one of the most difficult things for proponents of the law to talk about because people have to wait for 2014.

I read someone talking about I wish 2014 was tomorrow - one of the proponents. So I think that until that time, that's the greatest opportunity for opponents to kill the law. But at 2014, when major provisions get phased in, then people might give it a second look.

CHIDEYA: Now, let's talk specifically about seniors. The health care law made brand name drugs much more affordable for some people covered by Medicare, which is, you know, for individuals 65 and over. And you report that 48,000 people have used discounts provided by the law, resulting in $38 million in total savings for Medicare beneficiaries. That's an average of $800 per person. That's a significant amount of money.

But a poll by the Kaiser Family Foundation shows that more than half of senior citizens oppose the Patient Protection and Affordable Care Act. Why do you think that is?

Ms. CAREY: There's a lot of concern about changes to Medicare in the law and Republicans have really focused on this, talking about the law. Cuts Medicare, it's going to cut your Medicare benefits. What happened is that there were several changes in the Medicare program. They were spending reductions and they were spending increases, new additions. The donut hole coverage and phasing out the donut hole, for example, is a new benefit.

The law looked at these private health insurers called Medicare Advantage. They are paid considerably more than on a per beneficiary basis and (unintelligible) fee for service. They felt that that was a place where they could trim some savings. Hospitals agreed to some reductions in their Medicare payments because as the number of insured increase, their number of what's called uncompensated care will decrease.

So there's a lot more to the Medicare changes in the law, but that constant mantra of opponents that Medicare's been cut by 500 billion is very frightening to seniors.

CHIDEYA: And, finally, when you think about the provisions over preexisting conditions which have plagued so many people, what year did those go into effect?

Ms. CAREY: For children, immediately you could not discriminate based on a preexisting condition. For adults and for the rest of the population, it wouldn't go in till 2014 because that's when the requirement that most Americans purchase coverage goes into place or you have to pay a fine. So that's when the - for everyone it applies in 2014.

CHIDEYA: I think a lot of people are keeping an eye on that. And Mary Agnes Carey, senior correspondent at Kaiser Health News. Thank you so much for joining us.

Ms. CAREY: Thanks for having me.

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