Guest Post: Would Health Care Reform Help You?

This is guest post from Barbara O’Brien (aka Maha from the excellent The Mahablog) outlining some of the reasons why passing the health care reform bill would help out a whole bunch of people.

Many obstacles and stumbling blocks remain in the way of health care reform. The House and Senate bills will have to be merged, and then the House and Senate both will vote on the final bill. We don’t yet know what will be in the final bill, or if the final bill will be passed into law. Passage will be especially difficult in the Senate, where it will need 60 votes to pass. It is still possible that after all this angst, just one grandstanding senator could kill the whole thing.

But just for fun, let’s look at what conventional wisdom says will be in the final bill and see if there is anything in it that will be an immediate benefit to people with mesothelioma and other asbestos-related disease.

It is likely that the final bill will provide additional funding for state high-risk insurance pools. Currently more than 30 states run such pools, which are nonprofit, state-sponsored health insurance plans for people who can’t buy insurance because of pre-existing conditions. The biggest problem with such pools is that, often, the insurance they offer is too expensive for many who might need it. Both the Senate and House bills provide $5 billion in subsidies for state high-risk pools to make the insurance more affordable.

Under the Senate bill, beginning in 2014, private companies would no longer be able to deny coverage to adults with pre-existing conditions, nor could they charge higher premiums for people with pre-existing conditions. Until then, the state high-risk pools could provide some help.

Closing the Medicare Part D coverage gap — also called the “doughnut hole” — is another potential provision that could help some patients with asbestos-related disease. The “doughnut hole” is the gap between the coverage for yearly out-of-pocket expenses provided by Medicare Part D and Medicare’s “catastrophic coverage” threshold.

For example, in 2009 Medicare Part D paid at least 75 percent of what patients paid for prescription drugs up to $2,700. After that, patients must pay for all of their prescription medications until what they have paid exceeds $6,154. At that point, the catastrophic coverage takes over, and Medicare pays for all but 5 percent of the patient’s drug bills. The final health care reform bill probably will provide for paying at least 50 percent of out-of-pocket costs in the doughnut hole.

You may have heard the bills include budget cuts to the Medicare program, and this has been a big concern to many people. Proponents of the bill insist that savings can be found to pay for the cuts, and that people who depend on Medicare won’t face reduced services. But this is a complex issue that I want to address in a later post.

The long-term provisions probably will include many other provisions that would benefit patients with asbestos-related disease, including increased funding for medical research. Although there are many complaints about the bill coming from all parts of the political spectrum, on the whole it would be a huge benefit to many people.

— Barbara O’Brien
March 9, 2010

Posted by Kevin K. on 03/11/10 at 09:16 AM • Permalink

Categories: Politics • Health Care •

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First, a shout out to Barbara. I recall meeting you at the 2005 Take Back America on blogger’s row. It’s strange to recall that just a few short years ago the progressive blogosphere was united in its dislike of the Bush administration.

While much has been discussed about the Public Option, the most important issue for those of us who have insurance is the denial of benefits because of pre-existing conditions. For that reason the Senate bill is very attractive.

There’s been some not-so-progressive bloggers that are making the claim that companies will react to the Senate bill by opting for low-cost high-deductible policies, thus eliminating the “cadillac tax.” I asked our HR person about this, and she emphatically stated this is not the case, and went to on say that the current Senate bill would not change anything with my company’s current health insurance.

Comment by AltHippo on 03/11/10 at 10:31 AM

Denial of coverage because of pre-existing conditions is the major thing for me. Both my sisters have them—they lose their jobs, they’re screwed. That is so much more important to me than a watered-down public option (as in the House bill) that is largely a symbolic fuck-you to the corporations. Ideally, I would love to see a strong public option—hell, I want single-payer. But we’re not there yet and may not be for a while. And we won’t get there at all in the next twenty years if this bill goes down, I fear. (But of course, that just means we’ll “heighten the contradictions” and all those sick broke people who can’t get coverage will somehow wreak revolution against the insurance companies. Or something.)

I think some people who have had the luxury of being covered by their employers (versus trying to get an individual plan, worrying about being denied because of some minor pre-existing condition, and then paying through the nose for it if you DO get a policy—and NOT with pre-tax dollars) don’t fully understand how easy it is to be denied coverage.

It’s not just older people, either. Have allergies? I know freelancers much younger than me who have been denied coverage for that reason. Really—think about any health condition you’ve reported to a doctor in the last several years under your group plan. Then think about going through a vetting process to get a crappier plan with much higher premiums—and being denied because of what seems to you to be a pretty minor condition, or having to pay a hell of a lot more than you did as an employee.

I really wish that we could stop making this false dichotomy about “we need jobs, not healthcare reform.” Help small businesses get more affordable insurance, and that helps employment figures. Expand the number of people who have access to insurance and can do routine preventative care, and more jobs will be created WITHIN the healthcare sector—not just doctors and nurses, but administrative staff as well—that stuff can’t be outsourced easily. They are intimately connected issues.

Comment by Oblomova on 03/11/10 at 10:58 AM

false dichotomy about “we need jobs, not healthcare reform.”

False dichotomies are the meat and potatos of American political misdirection.

Add to the number of people who can’t leave their jobs, people who are covered through their spouse’s insurance, and who couldn’t otherwise get coverage, and you have a gigantic number of people to whom this bill, even stripped of the public option and battered by Blue Dogs, makes all the difference.

Comment by Mrs. Polly on 03/11/10 at 11:11 AM

Mrs. Polly, isn’t it ironic (don’t you think?) that the people who trumpet the virtues of entrepreneurial spirit the loudest are the very ones who stand in the way of the one thing that would make it easier for people to strike out on their own? Why, it’s almost as if the corporate parties WANT to keep employees fearful of losing their health benefits so they can cow them into submission, force them to work longer hours for less pay, etc.—all with the stick of “no healthcare for you and your family.”