HEALTH REFORM: Can I Get of Side of Reason With Those Hash Browns?
For me and millions of Americans, "if it's Sunday, it's Meet the Press." This Sunday I was cozied up with egg whites, everything bagels, and my morning caffeine when none other than Tom Brokaw conflated (incorrectly) the cost of health reform with the cost of a possible public health insurance option. This was disconcerting, both as a health policy analyst and a loyal fan of Tom Brokaw. I put down the veggie cream cheese and pondered: if Tom Brokaw -- one of the smartest and most trusted faces on TV -- has his wires crossed about the facts of reform, how far has the misinformation penetrated?
As we prepare for the President's Wednesday night prime-time address, it is worth reminding ourselves of a few things about the reforms being discussed in Congress.
- New marketplace. Reform would create a new marketplace (otherwise known as exchange, gateway, or connector) where people without access to insurance through a large employer could purchase coverage. This marketplace would make insurers follow certain rules. For example, it would prohibit insurers from denying people coverage, refusing to cover a pre-existing condition, or charging customers more because they are sick or have a risky family history. The marketplace or exchange would also help make signing up for insurance less confusing by providing easy-to-understand information for comparing plans.
- Choice of private coverage. Americans buying coverage through the new marketplace would choose from competing private insurers like Blue Cross, Aetna, Kaiser, Cigna and others. Some lawmakers would also like Americans to be able to choose a public health insurance option or a non-profit co-op as an alternative to private insurers. Either way, the goal is to give Americans choices and promote competition in the marketplace.
- Choice of public coverage...maybe. If a public health insurance option is included in reform legislation (and that is a big "if" right now), no one would be forced to enroll. No one (and I mean no one), would be forced, required, or otherwise cajoled to enroll in the public health insurance option. The public health insurance plan would compete on a level playing field with private insurers. It would be given no advantages over private plans. The public plan itself would not cost the government money because its operating costs would be financed by premium contributions -- just like private insurers.
- Subsidies. Subsidies -- financial assistance to help people afford insurance -- are why health reform costs so much. Reform proposals would help many hard-working Americans -- people who make too much money to qualify for programs like Medicaid but make too little to purchase coverage on their own -- buy quality health insurance. People eligible for subsidies would receive a tax credit to help them pay the premium for their choice of plans offered in the new marketplace or exchange. Again, individuals receiving subsidies would be able to take their subsidy dollars and choose the plan that is right for them -- either private or public (if a public plan is offered).
Tom Brokaw's small misstep is important to clarify, but it pales in comparison to the rhetoric showing up on news programs across the county. So this Sunday don't let the talk shows ruin your brunch. Just remember:
- If you get insurance through your large employer today nothing about how you get your coverage will change. Health reform will, however, make your premiums lower than they would otherwise have been over time and give you the security and stability of knowing you will always have access to quality, affordable health insurance even if you lose your job and even if you get sick.
- No one -- including people receiving subsidies -- will be forced into a public health insurance plan (if it is part of reform at all).
- The public plan and health reform are not the same. Likewise, the public plan and the exchange are not the same. The exchange is like a menu -- a public plan may be one option among many private options offered for people who do not have access to insurance through a large employer.
- The reason health reform costs so much is because so many hard-working Americans need help affording coverage. Health reform also means making investments in things like health information technology, preventive care, and primary care doctors that will save us money and improve our health over the long-term.