STEVE INSKEEP, Host:
It's MORNING EDITION from NPR News. Good morning. I'm Steve Inskeep.
Here are some scenes from a presidency during a holiday week. On Monday the president met with his war cabinet to plan strategy for Afghanistan. On Tuesday Mr. Obama and his wife hosted the prime minister of India at a state dinner. On Wednesday the president pardoned a turkey. And while all this went on, the White House is still pushing for a health care overhaul. Much of the debate centers on what the bill will cost the government, but polls show Americans worry more about what they have to pay.
NPR's Julie Rovner has our report.
JULIE ROVNER: The extent to which people will be able to afford the coverage they're likely going to be required to purchase has been largely overlooked in the current debate. That's a big mistake, says MIT economist Jonathan Gruber.
JONATHAN GRUBER: I think it's the - let's put it this way, it is 10 times as important as the public option and has received one one-hundredth of the coverage.
ROVNER: That's because, in the end, whether or not health care is affordable may have a bigger impact on the bill's political popularity than whether the final price tag exceeds a trillion dollars. Joan Alker heads the Georgetown University's Center for Children and Families. Her group commissioned a survey of what voters want most in a health overhaul bill.
JOAN ALKER: We found, by a two-to-one margin, the priority of voters was to make health coverage more affordable for families, rather than making sure health reform doesn't cost the country too much money.
ROVNER: Defining what's affordable is tricky, says economist Gruber. One thing economists look at is disposable income.
GRUBER: Do people have enough income left after they spend money on other things we think they have to have? That is, we think no one should have to go without food or shelter to get their health insurance.
ROVNER: Another test is whether people would buy something voluntarily.
GRUBER: And if they would, then clearly it's affordable.
ROVNER: But Gruber points out that there is a third test, and it's that affordability is in the eye of the beholder. And for a lot of beholders in the real world, health insurance costs are quickly becoming unaffordable. Take Eric and Cynthia Cathcart. They're self-employed musicians from Silver Spring, Maryland. They have two kids and two cats. They have been buying their own coverage for 14 years. But with costs going up every year, and the complications of some pre-existing conditions, they now pay a $1,000 a month for two separate plans. Cynthia Cathcart says she is not sure how much longer the family will be able to continue.
CYNTHIA CATHCART: I've got two deductibles. If Eric and I are in a common accident, he's got to meet his deductible and I've got to meet mine. We're looking at an $8,000 deductible.
ROVNER: So, how would the bill help families like the Cathcart's? In both the bill that passed the House and the one now before the Senate, people would be required to buy insurance if they don't already have it. But they'd get government help to pay for plans if they earn up to four times the poverty level. That's about $88,000 for a family of four. Plus, no family would have to spend more than 10 percent of their income on health insurance premiums, poor families wouldn't have to spend more than two percent on premiums. But premiums are only the start of what people spend on health insurance. There's also deductibles, co-payments and other out-of-pocket costs. And Gruber says that when it comes to that sort of spending, the House bill is far more generous than the Senate bill. For example: for someone making two times the poverty level, or about $22,000 a year in the House bill...
GRUBER: That means, you know, something like a $500 deductible plan. On the other hand, in that same range in the Senate, now we're talking like a $2,500 deductible plan.
ROVNER: And that says Gruber might stretch the bounds of what people consider affordable.
GRUBER: I'm a big believer that people need to pay more for their health care. You know, I'm a believer in consumer's skin in the game, but a $2,500 deductible is a lot to ask of someone making $22,000 a year.
ROVNER: And it brings Gruber to the ultimate test of affordability, which he says...
GRUBER: It is a political test, which is, do people revolt if you say, I'm going to mandate you to pay this much?
ROVNER: That revolt hasn't materialized in Massachusetts, the only state that currently requires everyone to have health insurance and where Gruber serves on the board that oversees that plan. But Gruber concedes that Massachusetts was a lot less divided about imposing the requirement in 2006 than the rest of the country is today.
Julie Rovner, NPR News, Washington.
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