Q. What's happening with health-reform legislation?
A. There are two bills out there right now: the House Tri-Committee bill (H.R. 3200), which has been passed out of three committees of jurisdiction in the House, [and] also a bill in the Senate that came out of the Senate Health, Education, Labor, and Pensions (HELP) committee. There's a second committee in the Senate, the U.S. Senate Committee on Finance, that is also working on a bill that's likely to look very different from the other two. The problem is that when you start talking about health reform and what it will mean and the implications, it may mean one thing under the provisions in the House bill and a little bit different under provisions in the Senate HELP Committee bill, and then [it's] likely to look much, much different when we finally see a bill out of Finance.
Q. Tell us about the House bill.
[Ed. Note: This is the main bill in play right now.]
A. What the House bill does is establish a floor of coverage, what is referred to as an essential-benefits package, that specifies what benefits have to be covered and sets limits on the amount of money that people have to pay out of their own pockets for health care, in the form of either deductibles or copayments. Any employer plans that don't meet those minimum standards today will have five years to come into compliance.
Q. Will health reform affect people who have insurance through their employer?
A. People who have employer-based coverage are not likely to see much change after health reform.
Q. Will health reform affect people who have insurance through their employer?
A. People who have employer-based coverage are not likely to see much change after health reform.
Q. What about the public option?
A. The public option is part of this debate, but it's only one plan among many private plans that would be offered in this newly created health-insurance exchange. And this exchange, I like to think of it as a virtual marketplace—it's like Travelocity for health insurance. It's simply a place where people can go and compare plans on a number of different measures. [The exchange] will enable people to choose the plan that best meets their and their family's needs. This public option, if it does remain in the bill, will simply be one plan choice among many in this exchange. You will still have a choice of many different private plans.
Q. What is the debate over the public plan?
A. The advocates of the public-plan option would say that one of the goals of having the option in place is to spur competition, to provide people with additional choice of plans—particularly in areas where there may not be, right now, much choice. The supporters of the public plan would say the goal is not necessarily to drive out private coverage, but simply to spur competition among plans. Critics ... say that it's a kind of a step toward erosion of private coverage entirely, to the extent that the public plan can offer lower premiums than the private plans, which simply can't compete, and eventually everyone will choose that public-plan option because it's cheaper.
Q. Are health exchanges mainly for people who don't receive coverage from their employers?
A. If you have access to coverage through an employer, you could purchase coverage in the exchange, but you would have to pay the full cost of the premium, so it's not going to make much sense for you. If you have employer coverage and the family share of the premium exceeds 12 percent of [your] income, then [you] would be eligible to purchase coverage in the exchange. But the exchange really is designed for people who are uninsured or currently purchase coverage on their own through the individual market. An important component of the exchange is not only this choice of plans that will be available, but also the availability of federal subsidies for families making up to 400 percent of the federal poverty level, or about $88,000 for a family of four, to help them afford coverage.
Q. How will health reform expand coverage?
A. Reform extends Medicaid eligibility to families up to 133 [percent of the poverty level], and that's important, because now states have the ability to set eligibility levels in Medicaid. [There's broad coverage for children in Medicaid; many states cover children through either Medicaid or Children's Health Insurance Programs (CHIP) in families making up to 200 percent of the poverty level or above.] But there are many states that don't cover the parents even up to 50 percent of the federal poverty level. So while most children covered by Medicaid will remain covered by Medicaid, many more parents will become eligible for Medicaid under health reform.
Helpful Health-Care-Reform Resources:
•
Kaiser Health Reform Gateway
• "Your Handy Health Care Cheat Sheet,"
by Alec MacGillis, The Washington Post
• "Health Care Reform Cheat Sheet,"
by Jill Schlesinger, CBS MoneyWatch.com
