SCOTT SIMON, HOST:
Going to open up our reporter hotline now. That's where we take your questions about election year issues and put them to our correspondents. This week, our focus is health care and we're joined by NPR's Julie Rovner, NPR's health policy correspondent. Julie, thanks so much for being with us.
JULIE ROVNER, BYLINE: Nice to be here.
SIMON: And let's start with a question that in many ways gets to the heart of this debate over health insurance.
BOB DUNNE: My name is Bob Dunne and I'm from Cedar Park, Texas. Why do you have to work to maintain your health insurance? In other words, I know many people who won't quit their jobs because they're not working for the salary, they're working for the health insurance.
ROVNER: Well, you have to go back to World War II. The U.S. had wage and price controls, but also a labor shortage because so many men were part of the war effort. So one of the ways employers started to differentiate themselves was by boosting benefits, and health insurance was one of those benefits they started offering.
By the time health care got so expense that insurance was a real necessity rather than something that was just a nice fringe benefit, which was around the 1970s, really we, as a country, were sort of settled into the idea of having that employer-based system. In fact, it was President Richard Nixon who first proposed the idea of getting everyone covered by requiring all employers to provide health insurance to their workers.
That came in response to the Democrats' proposal of that same era to have a tax-funded insurance plan for everyone. Later on, the Democrats would pick up Nixon's idea and propose that so-called employer mandate. In response, Republicans came up with the idea of requiring individuals to have their own coverage, which is of course what ended up passing first in Massachusetts under then-Governor Mitt Romney, and then in the Affordable Care Act, which we have today.
SIMON: Let's go to another question, this one from Majal Perry in Monterey, Kentucky.
MAJAL PERRY: I really want to know what each candidate's health care solution would specifically mean for me and other women like me, who are in their mid-20s, working, but low to lower mid-income and without insurance. How would their plans cover me should I ever choose to have children?
ROVNER: Well, you're one of those people who would likely face a very stark difference between the two candidates' plans. Under the Affordable Care Act, starting in 2014, you'll likely be able to afford your own insurance through one of the health care exchanges, and you'll probably qualify for a subsidy. Insurance companies also won't be able to charge you more because you're a woman of child-bearing age, and they will have to cover maternity benefits. None of those things are true now.
Governor Romney hasn't told us enough about what he would do to replace the Affordable Care Act, which he wants to repeal, to know if he'd offer any of those same protections. He does have some proposals he said would improve competition and potentially lower prices for insurance for people like you, though.
SIMON: A last question now.
PATRISHA THOMSON: My name is Patrisha Thomson. I live in Los Angeles. A social worker I know who works in the medical field was telling me that many doctors are not accepting Medicare patients because they're not receiving the amount of money that really makes it a reasonable income. I would be interested to know how prevalent that is. And if that's true, what has changed?
ROVNER: Well, you know, there's a continuing standoff in Congress about the way doctors are paid under Medicare. This predates the health law. This goes back to the late-1990s, and actually, if Congress doesn't do anything, doctors are going to see their pay cut by 27 percent more. So we are hearing more anecdotal evidence, at least, about doctors not taking new Medicare patients in particular.
This is something that's going to come up again in the context of this fiscal cliff at the end of the year, something Congress has to deal with, along with these expiring tax cuts and the potential for big budget cuts. And it is something that is definitely on policymakers' radar screens.
SIMON: Let me understand this complaint. Are doctors saying they're not getting reimbursed for the full value of the service they render?
ROVNER: Mostly it's that they've not had any kind of real inflation increase really in a decade now. So they're getting less and less in the way of Medicare reimbursement compared to how much their cost of providing the care is going up. To be fair, most doctors continue to accept Medicare patients, to take Medicare, but it's getting more and more difficult for a lot of doctors to do that.
SIMON: Julie Rovner is health policy correspondent for NPR. Thanks very much for being with us.
ROVNER: Thank you.
SIMON: Next week, we're going to tackle your questions on two subjects: veterans and defense spending. If you're wondering the candidates stand and how their policies differ, you can send your questions to ReporterHotline@npr.org. Please include your full name and a phone number where we can reach you. That's ReporterHotline, all one word, @npr.org.
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