Convener: Timothy Jost
Attendees: About 50
These notes are actually the “outline form” of Professor Jost’s PowerPoint presentation. The presentation and conversation was more detailed and expansive of what is covered here. The information is also current as of August 29, 2009.
The Problem
o Nearly 50 million uninsured
o 2007 -2008, 87 million uninsured, one third of under 65 adults
o Another 25 million underinsured
o Harrisonburg, at 28.5 %, highest rate in state
o 9500 uninsured
o Rockingham County, almost 12,000, 19.1%
o 22,000 deaths nationwide from lack of insurance
Who are the Uninsured?
o 80% are employed
o 2/3 earn less than 200% of poverty
o 79% US citizens (and many of the rest legal immigrants)
o 20% are children
o Half are over 30
o ¾ have been uninsured for more than a year
o Tend to be in worse health than the insured
Cost
o 2.5 trillion dollars
o $8,160 per resident
o 17.6% of GDP
o Grows at about 6% a year
o ¼ of GDP by about 2030, half by 2080
o Over twice as much per person as average developed nation
Quality
o Best health care system in the world?
o Very good at some things, five year cancer survival rates high
o Not so good at other things, last among 19 nations in preventable deaths
o In fact, about average
What is Congress up to?
o Three House committees have passed a version of HR 3200, slightly different amendments
o Kennedy committee, Health, Education, Labor, and Pensions has passed a bill
o Waiting for Senate Finance
o Then House and Senate will vote on bills, which will be combined in conference committee.
Very big bills, 1000 pages
o But big bills common in Congress
o What this legislation does is really not that complicated
o Lots of details that need to be attended to
What bill does
o Reforms health insurance:
+ no preexisting conditions exclusions
+ no discrimination on health status
+ caps deductibles and coinsurance (at high levels)
+ No lifetime or annual limits
+ Must cover essential benefits
What bill does
o Establishes “exchanges”, markets in which you can compare policies and find the one best for you
o Requires larger employers to cover their employees or pay penalty
+ Most Americans get insurance through their jobs
+ This would continue, but with some additional protections for workers
+ Small employers excepted, but would get subsidies
What bill Does
o Individual mandate—people who can afford health insurance must buy it (religious exemption)
o But affordability premiums to help uninsured people up to 400% of poverty buy insurance ($88,000 for a family of four)
o Expand Medicaid to up to 133 or 150% of poverty, eliminate categorical eligibility
The Public plan
o Current legislation includes a public plan
o Idea is to create competition for private health insurance
o Most US markets dominated by a handful of insurers, Harrisonburg, Anthem has 86% of market
o Give Americans a choice
o It would have lower administrative costs, could pay lower rates, could charge lower prices
o CBO estimates 9 to 10 million Americans would choose
How much will this cost?
o $700 billion to 1 trillion plus over 10 years
o We currently are slated to spend $35 to $40 trillion over next 10 years, this adds 3%
o By comparison, $1.7 trillion, Bush tax cuts so far ($4.4 trillion if made permanent), $700 billion, Iraq war; $700 billion, bank bailout; $300 billion 5 year farm bill
o In the long run, it should save government money
o Would save money for private individuals
What will it do to our other public plan, Medicare?
o Bill looks to Medicare program for some savings
+ Some money currently built into Medicare for paying for the uninsured, this can be reduced
+ Money paid to Medicare Advantage plans, private insurance plans that provide care to beneficiaries for 14% more than traditional Medicare, will be cut
+ Reduces growth in some provider payments (already accepted by provider groups)
Medicare
o But more money for preventive care
o start to close donut hole
o Limit cost sharing under Medicare Advantage plans
o More assistance for low income beneficiaries
o And more money for doctors and rural health care
What the bill doesn’t do
o Create death panels
+ Bill contained bipartisan provisions to pay for end-of-life counseling, bizarrely twisted by misinformation campaign
o Pay for abortion (except, as Medicaid does now, for rape, incest, and life endangerment)
o Cover illegal aliens
Not a “government takeover of our healthcare system”
o The government already pays for 45% of healthcare, covers seniors and the poor, they are pretty happy with it. Don’t see many seniors asking for Medicare to be abolished, most want to see it protected
o Insurance already regulated, this legislation would increase consumer protection
o Would increase funding to make sure lower and middle income Americans can afford health insurance, but
No government takeover
o Would leave most Americans, 185 million, in private health insurance
o Would not significantly affect America’s private health care delivery system, except to keep it from going bankrupt
What you can do to help
o Call, fax, or email your senators and representative
o Mark Warner
+ Warner.senate.gov
+ TOLL FREE: 1-877-676-2759 [VA residents only]
Phone: 202-224-2023
Fax: 202-224-6295
Contact your representatives
o Jim Webb
+ Webb.senate.gov
+ Phone: 202-224-4024
Fax: 202-228-6363
+ Toll Free Number 1-866-507-1570
o Bob Goodlatte
+ Goodlatte.house.gov
+ Phone: (202) 225-5431
Fax: (202) 225-9681
Other actions
o Attend Bob Goodlatte’s Town Hall Meeting Saturday, Sept. 5, 10-12, TA High School
Be polite, but ask him what his plan is to insure Harrisonburg and Rockingham County’s uninsured
o Write to the DNR
o Talk to your friends and neighbors, take the fact sheets and pass them around
More resources
o Healthcareforamericanow.org
o www.ourfuture.org
o www.kff.org
o http://www.commonwealthfund.org/
o Timothy.jost [at] gmail.com
