No Health Care Overhaul Will Bring More Problems
From Associated Press (February 14, 2010)
WASHINGTON -- What could be worse for Americans than health care
overhaul? No health care overhaul.
It's anybody's guess whether President Barack Obama's health remake
will survive in Congress.
But there's no doubting the consequences if lawmakers fail to
address the problems of costs, coverage and quality: surging
insurance premiums, more working families without coverage, bigger
out-of-pocket bills, a prescription coverage gap for seniors that
grows wider and deeper, and government programs that pay when
people get sick but do little to keep them healthy.
"They complained, 'If you pass this bill, prices will go up,'" said
Sen. Maria Cantwell of Washington state, who helped shape the
Senate Democrats' bill. "Well, you don't pass it, and prices will
still go up."
For economist Douglas Holtz-Eakin, a top adviser to 2008 Republican
presidential nominee John McCain, "no one has the luxury of saying
we're not going to worry about this." While he's no fan of the
Democrats' approach, he said Republicans "are going to have to
deliver something at some point. The question is whether they do it
with this president leading or wait for a Republican
president."
Health care spending in the U.S. hit $2.5 trillion last year,
growing faster as a share of the economy than at any time in a half
century, yet with results that compare poorly with other advanced
countries spending less and offering universal coverage. Government
programs -- mainly Medicare for the elderly and Medicaid for the
poor -- will soon cover more than half the nation's health care
tab, a staggering burden for federal and state budgets.
For those with private insurance, the recently announced
double-digit premium increases for people purchasing their own
coverage with Anthem in California could be a harbinger. Medical
costs are rising in a weak economy, causing healthy people to drop
coverage and raising costs for those left behind, with no limit in
sight.
"We will see real changes in the way health care is delivered,
regardless," Holtz-Eakin said. "The question is whether they are
coordinated and done proactively or whether they are done on the
ground by providers, insurance companies and employers, reacting to
their costs and their risk pools."
A look at how some major groups would fare if the health care
overhaul collapses and present trends continue unchecked:
OLDER PEOPLE
Both Democratic bills would begin experiments aimed at providing
quality care at lower cost for Medicare recipients, particularly
those with chronic conditions such as heart failure and diabetes.
Copayments for preventive care would be eliminated. The House bill
gradually would close a gap in prescription drug coverage for
seniors, now growing wider and deeper because of inflation. Those
improvements would be lost.
On the plus side, private insurance plans in the Medicare Advantage
program, serving about one-fourth of seniors, would be spared cuts
proposed by Democrats. Still, insurers and other service providers
won't get a free pass. With Congress looking to cut the federal
deficit, Medicare will be on the chopping block again.
"The irony is that major interest groups -- hospitals and drug
makers -- had agreed to take reductions this time," said John
Rother, top political strategist for AARP, an advocacy group for
seniors, which supports the Democratic bills.
WORKERS
The divide between those who have health insurance and those who
don't will get deeper. Many more will find themselves with
inadequate coverage that leaves them with hefty bills if they get
seriously ill.
"More employers will drop coverage. More consumers will get
increased copayments and deductibles," said Oregon Democratic Sen.
Ron Wyden, a moderate who has not given up hope of a deal with
Republicans. "I believe that would be so corrosive for the country
that we would not let it be the outcome."
By 2019, the number of uninsured Americans would rise to 54
million, most of them low-income workers paying federal and state
taxes to support health care programs for older people and the
poor. The Democratic bills would expand Medicaid to pick up more
people near the poverty line, while providing subsidies for many
middle-class households to buy private coverage.
PEOPLE WITH HEALTH PROBLEMS
Insurers would be able to continue denying coverage to people with
medical problems, or charge them higher premiums. People who get
sick could face cancellation of their coverage in certain
circumstances.
People in their 50s and 60s, when many medical conditions emerge,
would face premiums up to six times or seven times higher than what
those in their 20s pay.
Conversely, 20-year-olds would continue to enjoy access to low-cost
health insurance. The Democratic bills would have forced them to
subsidize premiums for older generations. Still, young people would
not escape unscathed. The Democratic bills would have allowed
children to stay on their parent's coverage until their
mid-twenties, a particularly valuable benefit for those with health
problems.
EMPLOYERS
Big employers were hoping that the Medicare experiments would
provide a template for their own efforts to try to control costs
and maintain quality. Small employers were leery of the Democratic
bills, although some would have received subsidies to help them
provide coverage.
If nothing gets done, large employers will be the front line in
efforts to rein in health care spending. They will keep passing on
costs to employees through higher premiums and copayments. But
they're also expected to take a more aggressive approach to get
workers to shape up by quitting smoking, losing weight and making
other lifestyle changes. Employers won't just be insurance sponsors
any longer; they could start acting more like the health
police.
Small companies are likely to keep dropping coverage, as are
employers with lots of low-wage workers.
"The fact that we had a mandate from voters to do something, and
that a major effort to respond led to such a deep partisan divide
and gridlock is not positive," said AARP's Rother. "The gridlock
that's developed on health care is a very serious and negative omen
for our ability to tackle Social Security and deficits."
Posted: February 2010
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