Health Care


Of course, the conversation on health care in this country continues to come back to coverage. Yesterday, we heard about a debate over the constitutionality of requiring Americans to buy health insurance. And theres another debate over the individual mandate. Its about affordability. NPRs Julie Rovner looks at what it would cost the average family.

JULIE ROVNER: Ron Pollack, of the consumer group Families USA, says he thinks how affordable newly mandated insurance is will determine whether the entire health overhaul effort is a public relations success or failure.

Mr. RON POLLACK (Families USA): I think the way the American public is going to view health reform is on a personal pocketbook test. If they feel that coverage is affordable, that care is affordable, then theyre really going to be very happy with health reform.

ROVNER: And if they feel care is not affordable - well, thats something lawmakers simply can't allow to happen, says Illinois Democratic congresswoman Jan Schakowsky.

Representative JAN SCHAKOWSKY (Democrat, Illinois): As Charlie Rangel, the chairman of Ways and Means, said: If they can't buy it, we can't sell it. There are no words, there are no messages that will cover up for that. And so we absolutely have to; its an imperative to adjust the affordability issues.

ROVNER: Schakowsky says adjust because theres a big difference between how affordable insurance would be in the House bill compared to the Senate bill. The House bill has much larger subsidies to help people who earn under two-and-half times the poverty line - about $55,000 a year for a family of four - buy insurance. Several religious and antipoverty groups highlighted those differences at a meeting held last week in a crowded hearing room on Capitol Hill.

Ms. GLORIA COOPER (San Diego Organizing Project): What is the key to health-care reform?

Unidentified Group: Affordability.

ROVNER: Heres how Gloria Cooper, of the San Diego Organizing Project,described whats at stake in the House-Senate negotiations.

Ms. COOPER: What they decide could mean the difference between a family with a sick child paying $5,000 a year for health care...

ROVNER: As they might under the Senate bill.

Ms. COOPER: ...or $1,800 per year.

ROVNER: The lower number they could end up paying under the House bill.

Ms. COOPER: Let me tell you, to a family that is struggling to get by, the difference really means a difference.

ROVNER: Among the people telling stories about being unable to afford care at the summit was a member of Congress, Maryland Democrat Donna Edwards. Seventeen years ago, said Edwards, she was a young mother without health insurance when she slipped and fell in the produce section of the grocery store. She was taken by ambulance to the local hospital.

Representative DONNA EDWARDS (Democrat, Maryland): They didn't say, do you have health-care insurance? They didn't say, wheres your card? They treated me. And it cost me thousands of dollars, nearly bankrupt me, put me in debt, just like millions of Americans across this country. Affordability is accessibility.

ROVNER: House members have been agitating for the Senate to take their more generous subsidy structure. They say thats more important than ever because the final bill is almost certain to drop the House-passed government-sponsored public option. That was supposed to be one way to put pressure on insurance companies to keep premiums low.

But Pollack, of Families USA, says that unlike some other differences between the bills, getting the Senate to do something about the affordability issue probably won't be all that difficult.

Mr. POLLACK: Theres no question that the House leadership wants to make this a top priority and have the Senate move closer to the House provisions. But I have to tell you, I think that the leaders in the Senate, they, too, want to improve affordability, and the White House wants to see this improve. So I believe from all three key sources - the House, the Senate, the White House -this is going to be a top priority.

ROVNER: Of course, making the bill more generous for those with moderate incomes will boost the measures bottom-line cost. And that means negotiators will have to raise that money somewhere else, which could set off a whole round of other problems.

Julie Rovner, NPR News, Washington.

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