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We've been understandably focused on the details of health reform legislation: Will our benefits get taxed? Will there be a public option? What will premiums be? Who will be eligible for coverage? Of course, we need to think about these questions - it's important to get health reform right. But it's also worth remembering why we need health reform in the first place.
Rashidam Shakirova waited for an insurance company to approve her enrollment - and while she was waiting, delayed treatment for a lump she felt in her breast. Finally, after several months she hired a lawyer, and the insurer began coverage. By then, however, the cancer has spread, and although she received treatment, doctors think she has less than five years to live, the New York Times reported.
"If I had gotten it when I was supposed to, I would have gone back to work and felt fine and my life would not have been broken," she told the Times. "I'm paying taxes. I'm not here for charity. I want to work; I want to contribute and be functional in society."
For other people, the problem isn't getting coverage from an insurance company. The problem is keeping the coverage they have.
Jennifer Latham, a Colorado preschool teacher, suffered a brain injury and multiple fractures when her car was slammed by a suspect fleeing police. She spent a month in the hospital and a month in a rehab center. But soon after she got home, she received a letter from her insurance company, saying they had cancelled her claim and wouldn't pay her $185,000 in medical bills, according to an article in the Boulder Daily Camera.
The insurer said it was justified in cancelling because when she applied for the insurance, she hadn't told the company about a previous emergency room treatment for shortness of breath.
Coverage denied, coverage delayed, coverage withdrawn - all part of our broken system.
How could health reform help? Although they differ in details, bills passed by the House and Senate would:
- Prohibit insurance companies from denying coverage based on pre-existing medical conditions.
- Prohibit insurance companies from cancelling policies when people get sick.
- In addition, the Senate bill would penalize employers who require a waiting period for coverage of more than 60 days - a provision that would have gotten Rashidam Shakirova coverage about the time she first felt the lump in her breast.
Getting rid of denying coverage for pre-existing conditions is popular; Republicans as well as Democrats say they support it. Some have suggested, given the political complexity of passing comprehensive reform legislation, just passing a law requiring insurance companies to sell policies to anyone who wants one. But passing small, popular pieces of reform without a comprehensive package creates more problems.
In this case, simply preventing insurers from denying coverage would mean that people could go uninsured until they get sick, then quickly buy a policy. Like selling homeowners insurance to people whose houses are already on fire, that would drive up premiums for everyone. So the comprehensive reform bills say everyone has to buy health insurance.
What about people who can't afford the full cost of coverage? To make it possible for everyone to buy coverage, the comprehensive bills set up a system of sliding-scale subsidies for moderate-income people.
– 02/08/10
We've been understandably focused on the details of health reform legislation: Will our benefits get taxed? Will there be a public option? What will premiums be? Who will be eligible for coverage? Of course, we need to think about these questions - it's important to get health reform right. But it's also worth remembering why we need health reform in the first place.
We've got two fresh reminders of how out-of-control health costs are stretching the resources of working families, employers and government.
- Health insurance costs are primed for another double-digit increase, according to a recent survey of insurers by a benefits adviser, Buck Consultants. In responses from more than 100 insurers and HMOs covering 78 million people, Buck projects increases in premiums for 2010 of 11.1% for PPOs and 10.3% for HMOs. "The double-digit cost increases that Buck Consultants expect are over twice the rate of general inflation in the U.S. expected in 2010. Thus, the marketplace isn't nearly moderating health costs on its own without the influence of health reform," writes health blogger Jane Sarasohn-Kahn. And cost escalation isn't exactly news. From 1999 to 2009, the average cost of employer-provided family coverage has jumped from $5,701 to $13,375, according to the Kaiser Family Foundation. And the share of that premium paid by workers has more than doubled as well - from $1,543 to $3,515.
- Governments and the economy in general are feeling the pain, just as families and employers are. A new report by Medicare's Office of the Actuary, released today, finds that health spending grew to consume a record 17.3% of the economy last year, up from 16.2% in 2008. A nearly half of that $2.5 billion in health spending comes from the federal government. "The report appears likely to fuel further debate about the health bills now stalled in Congress," the Los Angeles Times said. "In the absence of change, the report raises a grim prospect for the country - a healthcare system consuming an ever greater and potentially unsustainable share of the economy even as private health coverage lags." And with the federal deficit ballooning, "the big drivers are mandatory spending on Medicare and Medicaid - huge, rapidly growing costs that are outside the purview of Obama's (or any president's) annual recommendations for discretionary spending," the Wall Street Journal's Health Blog commented.
How could health reform help? Although they differ in details (such as subsidy levels), bills passed by the House and Senate would:
- Help moderate-income families buying their own insurance with premium subsidies.
- Help small employers, who often can't afford coverage, with tax credits if they buy health insurance for workers.
- Allow those buying their own insurance to join in an exchange, bringing down average costs by pooling risk.
- Bring down government costs by phasing down subsidies to insurance companies providing Medicare coverage and by slowing future growth of payments to hospitals, medical equipments companies and providers. This would save hundreds of millions of dollars, but would not change Medicare benefits or reduce payments to doctors.
- Develop new payment models to control future costs by experimenting with recognizing "accountable care organizations" that provide good quality at reduced cost and "bundled payments" to hospitals and doctors which would reward lower-cost care.
- Since Medicare has been a leader in developing new payment models in the past, private insurers are likely to follow suit with any changes that help control costs. This would help control costs for companies and those who get insurance from employers.
- The Senate bill would create an independent board to take stronger action to control costs in Medicare.
- The House bill would require the government to negotiate lower drug prices.
– 02/04/10
Posted by: Bill Salganik |
Quiet talks continue in Washington on how to move health reform forward, as the Los Angeles Times reported.
"We're still inside the five-yard line," White House spokesman Robert Gibbs said Sunday, as reported by the Wall Street Journal.
Similarly, CWA and its allies are deciding how best to make reform a reality. Medical and consumer groups also are working to find a way to fix the health system.
On Capitol Hill, "behind the scenes party leaders have nearly settled on a strategy to salvage the massive legislation," the L.A. Times said. "They are meeting almost daily to plot legislative moves while gently persuading skittish rank-and-file lawmakers to back a sweeping bill."
Over the next few weeks, the newspaper said, Democratic leaders may put together a plan to have the House of Representatives pass the Senate's version of the health reform bill, and, more or less simultaneously, have both Houses agree on a series of fixes to the Senate bill.
CWA was among the backers of a new Coalition of Health Care Coalitions announced last week. Other participants include Health Care for America Now, the American College of Cardiology and Families USA. CWA and its partners will continue to seek meaningful reform of the health system without a tax and benefits which would punish working families.
– 02/01/10
Supporters of the tax on high-premium health benefits said it would lower health costs. Here's how it's supposed to work, they said: Employers will cut benefits to avoid the tax, meaning higher out-of-pocket costs for workers; to avoid paying those costs, the workers would cut out unnecessary doctor visits, saving costs for the system.
A new study in this week's New England Journal of Medicine adds more evidence that the theory of cost savings through higher out-of-pocket costs isn't true.
The study tracks Medicare health plans, such as HMOs, that increased the co-pay for doctor visits. It compared records of more than 800,000 patients - some in health plans that raised co-pays, some in similar plans that kept co-pays level. Those facing higher co-pays did, in fact, make fewer doctor visits - but they ended up needing more hospital care, driving overall costs up.
By raising co-payments, the study estimated, health insurers collected an additional $5,950 in co-pays from each 100 patients, and fewer doctor visits saved another $1,200 for the insurance company, for a total apparent saving of $7,150. But those 100 patients, on average, generated an extra two hospital admissions and 13 days of hospital care, for an added cost of $24,000 - more than three times as much as was "saved."
The results are consistent with other research showing that higher co-payments can lead to more hospitalizations when patients defer needed preventive care.
Why does this matter? As Congress considers how to move forward with health reform, the Senate's health reform bill would tax high-premium benefits, the House's bill wouldn't. Some are suggesting the House should pass the Senate's bill. CWA thinks that's the wrong way to go because the benefits tax is misguided policy.
– 01/29/10
"Don't walk away from reform," President Barack Obama told Congress last night in his State of the Union address. While the politics have become more difficult, the need for health reform remains, he said. Here, from the official transcript, is the section of his speech dealing with health reform:
"And it is precisely to relieve the burden on middle-class families that we still need health insurance reform. (Applause.) Yes, we do. (Applause.) "Now, let's clear a few things up. (Laughter.) I didn't choose to tackle this issue to get some legislative victory under my belt. And by now it should be fairly obvious that I didn't take on health care because it was good politics. (Laughter.) I took on health care because of the stories I've heard from Americans with preexisting conditions whose lives depend on getting coverage; patients who've been denied coverage; families -- even those with insurance -- who are just one illness away from financial ruin.
"After nearly a century of trying -- Democratic administrations, Republican administrations -- we are closer than ever to bringing more security to the lives of so many Americans. The approach we've taken would protect every American from the worst practices of the insurance industry. It would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market. It would require every insurance plan to cover preventive care.
"And by the way, I want to acknowledge our First Lady, Michelle Obama, who this year is creating a national movement to tackle the epidemic of childhood obesity and make kids healthier. (Applause.) Thank you. She gets embarrassed. (Laughter.)
"Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan. It would reduce costs and premiums for millions of families and businesses. And according to the Congressional Budget Office -- the independent organization that both parties have cited as the official scorekeeper for Congress -- our approach would bring down the deficit by as much as $1 trillion over the next two decades. (Applause.)
"Still, this is a complex issue, and the longer it was debated, the more skeptical people became. I take my share of the blame for not explaining it more clearly to the American people. And I know that with all the lobbying and horse-trading, the process left most Americans wondering, 'What's in it for me?' "But I also know this problem is not going away. By the time I'm finished speaking tonight, more Americans will have lost their health insurance. Millions will lose it this year. Our deficit will grow. Premiums will go up. Patients will be denied the care they need. Small business owners will continue to drop coverage altogether. I will not walk away from these Americans, and neither should the people in this chamber. (Applause.)
"So, as temperatures cool, I want everyone to take another look at the plan we've proposed. There's a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. (Applause.) Let me know. Let me know. (Applause.) I'm eager to see it.
"Here's what I ask Congress, though: Don't walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people. (Applause.) Let's get it done. Let's get it done. (Applause.)"
– 01/28/10
Health insurers quietly funneled millions of dollars to the Chamber of Commerce to pay for ads attacking health reform, National Journal reported recently.
The insurance industry's trade association and lobbying arm, America's Health Insurance Plans (AHIP) hit up the largest for-profit insurers to chip in to the Chamber's efforts to help sink reform, according to the report. And the big insurance companies - Aetna, Cigna, Humana, UnitedHealth and WellPoint - each ponied up a seven-figure contribution.
At the same time it was collecting millions to block reform legislation, AHIP was saying publicly that it supported reform. AHIP disguised its own role in funding the ads, passing the money through the Chamber of Commerce, to avoid backlash, one lobbying source told National Journal.
Apart from the millions they've been quietly slipping to the Chamber of Commerce, the insurers have also been lavishing big bucks on lobbying - including $4.7 million last year by WellPoint and $4.5 million by United Health, according to The Hill.
All this serves as a reminder of who benefits from the status quo - and it isn't ordinary consumers and patients.
– 01/26/10
While Americans remain closely divided over health reform, people are not sure what's in the current bills. And when they learn more about elements of the reform bills, their support increases, according to a new poll by the Kaiser Family Foundation.
Overall, 42 percent of people polled said they supported the current legislation, while 41 percent said they were opposed. But when told about specific elements of the proposals - tax credits to help small business, health insurance exchanges, insurance companies not being able to deny coverage because of pre-existing conditions - they said that made them more supportive.
"It's one thing to talk about the public's perception of health care reform legislation, which right now is in some ways negative, but it's another to tell people what's actually in the bill, and when you do that people are more positive," said Drew Altman, president and CEO of the Kaiser Foundation.
Other examples of the-more-they-know-the-better-people-like-it cited in Kaiser's report: "Among the least known elements of the bills, those with the biggest potential to change minds include the fact that the Congressional Budget Office has said health reform would reduce the deficit (only 15% expect the legislation to reduce the deficit, but 56% said hearing that makes them more supportive) and that the legislation would stop insurers from charging women more than men (37% are aware that the legislation would do this, but 50% said this provision makes them more supportive)."
Seniors were one group that trended strongly against the reform proposals, but became much more supportive when they learned that the legislation would close the Medicare prescription "donut hole," reducing the costs of medications for seniors.
– 01/25/10
CWA and its allies are assessing strategy for health reform in light of the Republican win in the Massachusetts Senate election. The win denies Democrats enough votes to block a filibuster in the Senate, making it nearly certain that Republicans can block action on the current health reform bill.
"Over the next several days, CWA will continue to work with our coalition partners, other labor unions, and our friends in the House of Representatives to determine the best path for moving forward on any legislation," CWA leaders said in a statement. "CWA remains opposed to the Senate bill as it currently stands and will continue the work we have been engaged in over the past several weeks to ensure that any legislation addresses our members concerns. Until we determine the best course of action, our many grassroots programs around the issue have been put on hold."
CWA remains committed to fixing a broken health care system with a system that provides secure and affordable coverage for all Americans, is financed fairly, controls cost escalation, curbs abusive practices by insurance companies, and improves quality.
– 01/22/10
A Republican win in the special Senate election to replace Ted Kennedy in Massachusetts leaves an uncertain road for health reform. Without 60 votes in the Senate, the Democrats can't stop a filibuster, which could block action on a Senate-House compromise reform bill now taking shape.
It's unclear at this point how the Democrats will proceed. One suggestion is that the House could approve the version of the health bill already passed by the Senate, thus avoiding another Senate vote, then fix problems in the Senate bill later. That's a scary prospect for us, since the Senate bill contained a number of serious flaws, including the tax on high-premium health benefits.
We don't want to see the Senate bill passed with only a vague hope of fixing its problems.
Another suggestion is that the Democrats back off, on the belief that the Massachusetts results show the public doesn't want health reform. That's not good, either, and would represent a misreading of the vote.
The winning Republican, Scott Brown, supported the health reform bill which passed several years ago in Massachusetts, and which was similar to the bill being considered in Washington. What Brown argued during the campaign is that national reform wouldn't help Massachusetts, since the state reforms already meant less than 3 percent of the population there was uninsured.
Exiting polling by Rasmussen Reports doesn't support the idea that Brown's win was a referendum on health reform. While 56% of voters told Rasmussen that health reform was the most important issue in the election, Democrat Martha Coakley won among those health voters. Brown built his margin among voters who said the most important issues were the economy, taxes and national security.
Moreover, the Massachusetts election doesn't change the facts that make health reform necessary: Escalating costs. A system that leaves all of us a layoff from being uninsured. Medical bankruptcies when people – even insured people – get sick. Insurance companies that can deny coverage to people who need it. The highest health costs in the world, without the best results. Tens of millions without coverage.
"In the wake of Mr. Brown’s victory, the decision facing Democrats is not whether to start with a blank slate and try to write a bill based on both liberal health care ideas and conservative ones. They’ve already tried that," writes New York Times columnist David Leonhardt. "The decision is whether to expand insurance and try to control costs, despite the political risks, or whether that project will once again be put off until another day."
– 01/20/10
After many hours of negotiations with the White House and Congressional leaders - and continued pressure from our members - CWA President Larry Cohen and other labor leaders have been able to negotiate significant improvements in the proposed tax on high-cost health benefits.
"This is not the plan we would have written if we were the sole author, but just like contract negotiations there is another side to the table. And in this case there are three other sides: the House, the Senate and the White House," CWA leadership said in a statement. "We are proud that the improvements we negotiated protect both union members and members of the public. Labor unions have a long history of protecting all workers and this is another great example.
"More than any other union, CWA's leadership has really pushed this issue in the mainstream and online media, on Capitol Hill, and in building coalitions to help deliver the message that there's a better way to finance health care reform," the statement continued. "Our members mobilized. We made tens of thousands of calls and visits to the House and Senate. We should all be proud of what we have accomplished here."
The job, however, isn't finished. We need to see the agreement into final legislative language, which must be passed by both the House and Senate.
Improvements include:
- A delay until 2018 on applying the tax to collectively-bargained plans, allowing time to bargain for changes in benefits and wages.
- A higher premium level before the tax kicks in ($24,000 for family coverage, compared to $23,000 in the Senate bill).
- Exemption of dental and vision benefits, effectively raising the threshold by another $1,500.
- Agreement that the threshold will be pushed up further if health costs rise faster than expected.
- Adjusting the threshold for plans with large numbers of women and older workers - people for whom premiums are higher because they use more care. Also, the agreement preserves Senate-passed protections for plans that cover workers in high-risk occupations and for plans that cover retirees between the ages of 55 and 65 - two other groups with higher-than-average premiums.
– 01/15/10
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