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Much of the economic stimulus bill that'sworking its way through Congress involves cutting taxes or adding money for existing programs. But when it comes to health care, the bill includes at least one brand new concept - providing government subsidies for people to keep their health insurance when they lose their jobs. NPR's Julie Rovner reports.
JULIE ROVNER: Way back in 1985 during consideration of a huge budget bill, lawmakers decided to add a tiny provision aimed at helping people who lose their jobs keep the health insurance that came with that job for 18 months, as long as they paid the entire premium themselves.
Over the years, that one provision has come to be known by the name of the entire bill COBRA. COBRA can literally be a life saver, says Karen Pollitz, an insurance expert at Georgetown University.
Ms. KAREN POLLITZ (Project Director, Health Policy Institute, Georgetown University): Because it is a continuation, right? Your coverage doesn't stop, you don't have to start a new annual deductible, you don't have to change doctors in a different network. All of your benefits are the same.
ROVNER: But there is a big problem with COBRA, says Pollitz. Having to pay the full premium is simply more than most people can handle.
Ms. POLLITZ: The combination of losing that employer subsidy and losing your job usually means the sticker price for COBRA is too much.
ROVNER: That's exactly what happened to Bernadette Hicks of Warren, Rhode Island. She and her husband are the parents of nine children, two of their own and seven adopted foster children. Her husband is self-employed. He runs a driveway ceiling and repair business. So until two years ago, the entire family was covered through her job as an administrator at a nursing home.
Ms. BERNADETTE HICKS: Unfortunately, the nursing home owners decided to close the nursing home. It would have cost us a little over $800 a month for the COBRA insurance to kick in for us to keep this insurance. And there are just - there was no way we could come up with that kind of money.
ROVNER: The children were eligible for Medicaid, but Bernadette and her husband were not. They gambled that they wouldn't need expensive medical care, and they lost. Bill Hicks, who has diabetes, suffered a cerebral hemorrhage last February.
Ms. HICKS: Spent five days in the hospital, three days in intensive care and it was only five days in the hospital because I talked them into letting him come home because we had no coverage.
ROVNER: After they were unable to get Bill timely follow up care, he later had another stroke. And now, the couple has a hundred thousand dollars in medical debt and still no insurance. Looking back, Bernadette Hicks says if the COBRA coverage had been much less expensive when she lost her job, say, $300 dollars a month, she would have jumped at it.
Ms. HICKS: Three hundred dollars is so much better than $800. Eight hundred dollars to a family like mine is like a national debt. But bringing it down to 300, you can manage that so much better.
ROVNER: That's pretty much what the House and Senate stimulus bills envision - a 65 percent subsidy for COBRA premiums for laid-off workers for between nine and 12 months. And it would be retroactive, so people who had lost their jobs as long ago as last September could qualify.
The business community has been cautiously supportive of the short-term subsidies. Helen Darling of the National Business Group on Health which represents Fortune 500 companies says, as a stop gap measure, it's not too bad.
Ms. HELEN DARLING (President, National Business Group on Health): It is something that works and people are familiar with. And as often happens in a crisis, you want to find mechanisms that are easy to execute.
ROVNER: But not everyone is sold on the idea. Tom Miller of the conservative American Enterprise Institute says it may not be wise to help people stay with their very expensive employer plans, when a more bare-bones policy might be more appropriate.
Mr. TOM MILLER (Resident Fellow, American Enterprise Institute): People are moving out of houses they can't afford. They're taking jobs they otherwise would prefer not to take. It's a necessity. In the same way, every single dollar we have can't go to health insurance first over other competing needs.
ROVNER: Even with the subsidies, COBRA will remain too expensive for many who are losing their jobs and their health coverage, which will lead to Congress' next fight over a health-care overhaul. Julie Rovner, NPR News, Washington.
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