Questions On Health Care Legislation
MELISSA BLOCK, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.
MICHELE NORRIS, host:
And I'm Michele Norris.
On Capitol Hill, senators are continuing their health care debate. But we thought we'd provide a little explanation in plain spoken English of what they're actually talking about and what it might mean for you. Earlier this week, we asked you to submit your questions about the bill. Now we're going to get some answers with the help of NPR health policy correspondent Julie Rovner. Julie is here in the studio.
JULIE ROVNER: Thank you.
NORRIS: We had several questions from people who are self-employed and have to buy their own coverage. This one comes from James Stauffer(ph) of Delafield, Wisconsin. He says, there's a lot of talk in the current proposals about eliminating denial of coverage for pre-existing conditions. Does this mean that self-employed people will no longer have to disclose their health history or go through underwriting to buy coverage?
If this is not the case, what's to stop insurers from simply rating up applicants with health issues in lieu of denying coverage? Doubling or tripling the premium is the same as denial of coverage, isn't it?
ROVNER: Well, to answer the second question first: Yes, hiking up premium to make it unaffordable is often tantamount to denying coverage. And, no, insurers won't be able to do it anymore under the bill. And once the bill fully takes effect - which isn't until 2014, by the way - self-employed people won't have to disclose their health history or go through underwriting to buy coverage.
Insurers, in fact, will only be able to vary what they charge in premiums to people in the new marketplace called Exchanges for a couple of variables: how many people are in your family, whether you smoke, your age, where in the country you live and whether you participate in a wellness program.
NORRIS: All right, Julie, here's a math question. It comes from Richard Zimmer(ph) of Charlotte, North Carolina. Let's listen.
Mr. RICHARD ZIMMER: I'd like to be able to understand contradictions on three financial claims about the Senate health bill. First, that it will save $130 billion over 10 years. Second, that it will cost $800 billion to $1 trillion over 10 years. And third, that it will not add one dime to the federal deficit.
ROVNER: All three of those statements are true at the same time, believe it or not. The Congressional Budget Office says the bill will cost $848 billion over 10 years. Over that same period, the bill also raises $978 billion in new taxes and fees and reduce spending for Medicare, for a net reduction in the deficit of $130 billion. So at least in that first decade, it adds not one dime to the federal deficit; in fact, takes a whole lot of dimes away.
NORRIS: Okay. Now, here's a question on Medicare from Evelyn Kirsten(ph) of Boca Raton, Florida. She wants to know what adverse changes can seniors anticipate if health care legislation is passed, particularly with the addition of millions of baby boomers to Medicare.
ROVNER: Well, the idea, of course, is to prevent adverse changes for seniors in the program. The Medicare part to the bill are actually aimed at giving doctors and hospitals and other health care providers incentives to provide better care, rather than just more care, which is the way the system is set up now.
The hope is to at least slow how fast spending is growing, not really cut the program in actual terms, so Medicare can be sustained for those Baby Boomers.
Now, one controversial thing that is in the bill would undo something Republicans did in 2003, which was to give big raises to the private plans called Medicare Advantage. Today, those plans get about 14 percent more than it cost to care for each of those Medicare patients. And some of those payments do go towards giving patients benefits Medicare wouldn't otherwise cover, like eye care and foot care.
The patients will still have all the benefits guaranteed by regular Medicare but those people could lose some of the extra benefits that the plans have been providing with those overpayments.
NORRIS: Now, here's another question about insurance companies. This comes from Heidi Wayner(ph) of Moab, Utah. She says she has health insurance.
Ms. HEIDI WAYNER: But over the past five years, I've found that my insurance company regularly denies all claims over about a hundred dollars, even ones that they've pre-approved. It takes hours on the phone demanding to speak to supervisors for the insurance company to eventually pay. And to me, this seems like a breach of contract done in the hopes that people will not fight the fight and just pay.
Will either of the current bills in Congress do anything to stop this despicable practice?
NORRIS: Julie, I think we heard frustration in her voice. What's the answer to her question?
ROVNER: Yes. Of course, it's already illegal for insurance companies to deny coverage of things they are contractually obligated to pay for. But this is a pretty common complaint, so the bills don't have to make it illegal again. But I think the idea is that the competition, created by these new insurance exchanges, will make the companies better about customer service, that knowing people can switch plans every year might curb these kinds of abuses.
NORRIS: Thank you, Julie.
ROVNER: You're welcome, Michele.
NORRIS: That's NPR health policy correspondent Julie Rovner. And thanks also to our listeners for sending in their questions.
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