“I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.” – President Barack Obama
President Obama left no stone unturned to reassure Americans that there will be additional benefits through the reform and they will be allowed to keep their existing health plans.
However, both the Senate and House Health Reform Bills seem to contain several restrictions and mandates that would change the health-care coverage.
The new health care platform would offer an expensive and highly subsidized coverage. This includes benefits people would never pay for with their own money, delivered through a restrictive, HMO-type plan that will ascertain the type of care and tests you can or cannot have.
If these bills go through, Americans may not have the freedom to choose. Read on to find out more …
The Type Of Plan
The bills in both the houses need Americans to purchase insurance through “qualified” plans that are offered by health-care exchanges set up in each state. The problem with this is that a minimum list of benefits that each plan “has to” offer will be imposed by the federal government.
Most of the states today require these standard benefits packages and this is the reason health-care costs are increasing. All groups of physicians vie with each other to get included in these packages. For example, in Connecticut, hair transplants, in vitro fertilization and hearing aids also require reimbursement.
For now, Americans will have no idea what is in their plans and what they would be paying for, either directly or indirectly, till such a time as these bills become law.
Community rating exists in many states. It means all the patients pay the same rates based on the coverage, irrespective of the medical condition or age. Although, it is said that community rating is a fair way to provide health care, this is not how it works. It forces younger people, who usually do not earn as much as the older people, to pay much higher than the actual cost, while the older people with far higher income get their health care at a lower cost. This is seen to be one of the major reasons why so many of them remain un-insured.
The bills also restrict insurers from charging higher premiums based on the health of their customers. This sort of a restriction is great for people with chronic illnesses but does not help people leading a healthy lifestyle. It’s almost the same as car insurance companies charging the same rates for drivers with a history of accidents as well as for safe drivers.
The bills also completely disregard consumers’ spending money from their pockets.
Many employers these days offer Health Savings Accounts to their employees. The employees deposit tax-free money in these accounts and it is matched with a contribution by their employer. These funds can be used by them to buy a high-deductible plan. There is reimbursement for preventive care but patients pay for all other regular visits to the physicians and tests with their own money from the HAS account. This makes the HAS user more cost-conscious than others who get a reimbursement for most of their health-care.
The bills do not cater to this segment of consumers. By insisting on minimum packages, they would be preventing patients from choosing plans that cover only major medical expenses.
Keeping The Existing Plan
This is something that President Obama keeps talking about and assuring people. But the bills do not speak the same language as the President.
Employees covered under the Employee Retirement Security Act (ERISA) can have any plan they want. ERISA regulates companies that are self-insured. Most of the big companies, like Time Warner, fall under this category. According to the House bill, these employers are not restricted to the standard packages and community rating and are allowed to reward their employees for healthy lifestyles in most states. But all this for just five years, which is the deadline for these companies to offer only approved plans with the rules being the same as the others.
For employees who are not under ERISA but get their own insurance or through small businesses, the scenario is worse. All insurers that currently offer a wide range of plans to such employees will have to restrict them to only “qualified” plans to new customers. The others with existing plans, can keep them, but if the plan changes, the employee has to get out and choose one of the qualified plans. Since most of these plans keep changing policies every year, many of these employees will be forced to get into the main stream sooner than later.
The Senate bill states that all Americans buying through these exchanges must get their care through “medical home,” which is similar to an HMO. A primary care doctor will be assigned and access to specialists will only be through this primary care physician. It is also the primary care physician that will decide on the diagnostic scans and MRIs that are needed for the patient, including whether a cardiologist or some other specialist should be consulted or not.
Overall, the ability to choose your own cardiologist under a company’s Preferred Provider Organization plan (PPO), reduced premiums rewarded by employers because of their employees healthy lifestyles, the Health Savings Account (HAS) that insures just for the essentials, or the freedom to spend your own money for a policy that covers the latest diagnostic tests and drugs – there is a possibility of losing all these things under the rules proposed in the two bills.
Many Americans believe that Obama’s health plan would worsen the quality of health care and do not approve of the way the President is handling it. We will just have to wait and see what the end result is going to be.