Tuesday, November 3, 2009


I finally made it through all 1990 pages. I could live with this bill, although it won't be the final result after conference with the Senate. And there are flaws.

According to today's NY Times:

Under the House bill, the budget office said, a family of four with income of $78,000 in 2016 would pay, on average, an annual premium of $8,800 and co-payments of $5,000, for a total of $13,800, equivalent to 18 percent of the family’s income.

A family of four with income of $90,100 could also receive subsidies. It would pay $11,100 in premiums and $5,500 in cost-sharing, for a total of $16,600, or 18 percent of family income, the budget office said.

For lower-income people, the subsidies would be more generous. A family of four with income of $66,000 would pay premiums of $6,300 and cost-sharing of $3,700, for a total of $10,000, or 15 percent of its income in 2016, the budget office said.

That worries me a lot. Don't forget that I think that's gross income compared to actual costs, so actually the families would pay a much higher percentage of take-home pay. It's better than it is today -- a $5000 cap on out-of-pocket costs is better than catastrophic losses people suffer today with hundreds of thousands of dollars out of pocket for long hospitalizations, stays in intensive care, and expensive infusion drugs. But still -- this is a huge amount of money to expect people to pay every year, year after year.

And this is why we need a less expensive public option. Because with prices like these, we are not making insurance affordable enough. People will still have to go without insurance.

Now, to answer Rabbit's questions from yesterday's post -- I'm answering them here rather than in a comment because they're particularly good questions that others probably have, too:

There's no info about whether the House's high risk pool would be priced like state high risk pools, which tend to be very expensive. The national high risk pool would be temporary, just to find a way to cover people with pre-existing conditions until the exchange gets up and running. There's very little detail about the plan, though.

The rules about pre-existing conditions will be the same no matter how many pre-existing conditions you have. Between 2010 and 2013, the existing rules, which require states to offer a guaranteed issue option if you've had insurance and you don't have more than a 63 day break in coverage, you'll be able to get insurance. And there will be the national high risk pool, as well. After 2013, when the exchanges go up, there will be no more pre-existing condition exclusions -- period. One condition or many, the rules will be the same.

I'm worried about letting states opt-out of the public option, too. We have to hope that political pressure and federal funding stop that from happening. And the new Medicaid rules, which will cover single adults with no children up to 133 or 150% of the federal poverty level (depending on whether we get the House or the Senate version), will apply in every state -- no opt-out allowed. So that's going to be a very big and welcome change.

And what's a medical home? It's a proposal for chronic care management which has a primary care doctor or physician's assistant as the person who coordinates care and is the point of contact for the patient. In the House version, it can be a specialist, too. That person coordinates care among all the specialists and makes sure that all of the patient's needs are met. The idea is that the patient will have one-stop-doctoring at the medical home, which will also hold all of the patient's medical records, make sure there are no medication interactions, etc., etc. For those of us with chronic illnesses, the medical home should simplify our lives. My problem with most medical home models is that they focus on doctors and coordinating care, all revolving around a single doctor when they should revolve around the patient. But that may come as more of this pilot projects get under way.

And finally Rabbit wants to know how I'm doing. I've been talking about myself less lately, mostly because it's so important to get accurate info about health care reform out there. But I've lost 12 pounds. I have one more trip -- DC next week -- and then hernia surgery on November 20. It's pathetic, but I'm looking forward to it because it will give me an excuse to take some time off, and the week of Thanksgiving should be slow anyway.

And that's the scoop. If anybody has more questions, let me know and I'll try my best to answer them. Jennifer

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