By admin | April 15, 2010
FOR IMMEDIATE RELEASE
Tuesday, April 6, 2010
Contact: HHS Press Office
(202) 690-6343
Secretary Sebelius Announces Five New HHS Regional Directors
HHS Secretary Kathleen Sebelius today announced the appointment of five new regional directors of the U.S. Department of Health and Human Services.
* Christie Hager, Region I - Boston (CT, ME, MA, NH, RI, VT)
* Jaime R. Torres, Region II - New York City (NY NJ, NY, PR, VI)
* Joanne Grossi, Region III - Philadelphia (PA DE, DC, MD, PA, VA, WV)
* Marguerite Salazar, Region VIII - Denver (CO, MT, ND, SD, UT, WY)
* Herb K. Schultz, Region IX - San Francisco (AZ, CA, HI, NV, Guam, PI, AS)
“I am very pleased to welcome Christie, Jaime, Joanne, Marguerite, and Herb to HHS,” said Secretary Sebelius. “They will play a vital role in our department’s effort to effectively implement the Patient Protection and Affordable Care Act. I look forward to working with them in the months and years ahead to achieve HHS’s mission to protect the health of all Americans and provide essential human services.”
As HHS regional directors, they will serve as key representatives of Secretary Sebelius in working with federal, state, local, and tribal officials on a wide range of health and social service issues.
Biographies:
Christie Hager, JD, MPH is currently an Adjunct Lecturer on Health Policy at the Harvard School of Public Health. Her research and teaching focus on state regulation of health care and public health, health care access, and the legislative process. From 2004-2009, she served on the staff of the Massachusetts House of Representatives, as Chief Health Counsel in the Office of the Speaker during the development, enactment and first three years of implementation of the health reform law passed in 2006. She previously served as Deputy Director of the Division of Public Health Practice at the Harvard School of Public Health. She was appointed Senior Fellow at the Schneider Institute for Health Policy at Brandeis University’s Heller School, where she served as Director and Principal Investigator at the Massachusetts Health Policy Forum, from 1999-2002. She also previously worked on the editorial staff of the New England Journal of Medicine. Ms. Hager received an AB from Smith College, a MPH from the Boston University School of Public Health, and a JD from the University of Connecticut School of Law.
Jaime R. Torres, DPM, MS, is currently Associate Director of Consultative Services at Coler-Goldwater Specialty Hospital, part of New York City’s Health and Hospital Corporation–the nation’s largest public hospital system. He is the founder and President of Latinos for National Health Insurance, a national coalition working for equality in healthcare. He is on the Board of Directors of the National Hispanic Council on Aging and served on the Advisory Board of the National Hispanic Medical Association (NHMA) from 2000-2006. For eight years he represented the NHMA in the National Diabetes Education Program (NDEP), which is sponsored by the National Institutes of Health and the Centers for Disease Control. As vice-chair of NDEP’s Hispanic/Latino Work Group, he was instrumental in creating bilingual health campaigns for people with diabetes. In 2006, he was a spokesperson for the American Podiatric Medical Association’s campaign “Descubras sus pies” (Discover Your Feet) which educated the Latino community on how to prevent foot ailments related to diabetes. Dr. Torres received his Doctorate of Podiatric Medicine from the New York College of Podiatric Medicine and a master’s degree in Community Health from Long Island University.
For the past seven years, Joanne Grossi has served in the administration of Governor Edward G. Rendell, first as Deputy Secretary of Health and later as the first- ever Director of the Office of Women’s Services. During her five-year tenure as Deputy Secretary for Health Promotion and Disease Prevention at the Pennsylvania Department of Health from 2003 to 2008, Ms. Grossi oversaw all the public health programs for the Commonwealth, including tobacco cessation and prevention; obesity prevention; drug and alcohol programs; and maternal and child health programs. As Director of the Office of Women’s Services at the Pennsylvania Department of Public Welfare from 2008 to 2010, Ms. Grossi administered statewide programs that provide assistance to women, including family planning/reproductive health; domestic violence; sexual violence; and the breast and cervical cancer treatment program.Before joining the Governor’s Administration, Ms. Grossi served for 13 years as a Senior Technical Advisor in the Bureau of Global Health at the United States Agency for International Development, where she oversaw international health programs in developing countries.Earlier in her career, Ms. Grossi served on the staffs of Congressman Peter Kostmayer and Ambassador Millicent H. Fenwick at the American Embassy in Rome, Italy. Ms. Grossi earned her master’s degree in International Public Policy at the Johns Hopkins University’s School of Advanced International Studies and completed additional graduate education at the Johns Hopkins University’s School of Public Health and Hygiene. She earned her B.A. in journalism at Temple University.
Marguerite Salazar has served as President/CEO of Valley Wide Health Services, Inc. (VWHS) since 1989. VWHS is one of the largest rural Community Health Centers in the country, providing primary care to over 40,000 residents of the San Luis, Lower Arkansas and Upper Arkansas Valleys in Southern Colorado. VWHS is recognized for exceptional outcomes with prenatal care and reducing ER utilization through Convenient Care in some of the poorest areas of Colorado. Previously, Ms. Salazar directed Access Social Work Service, a firm that contracted with local public health departments, hospitals and nursing homes to provide social work services. Ms. Salazar is a Fellow in the National Hispana Leadership Institute as well as a Livingston Fellow in the Bonfil Stanton Foundation, a Trustee for the Temple Hoyne Buell Foundation and was appointed by Governor Bill Ritter, Jr. to the Board of Governors for Colorado State University. She was appointed by Governor Bill Owens to serve as a Policy Board Member for the Colorado Children’s Basic Health Plan. In 1999, she was awarded the Bernie Valdez Award for Excellence in Health from the Latin American Research and Service Agency (LARASA). She holds a Master’s degree in counseling psychology from Adams State College in Colorado.
Herb K. Schultz, MPP, is currently Senior Advisor to Governor Arnold Schwarzenegger, and since January of this year, also the Director of the California Recovery Task Force. In this role, he is responsible for the oversight and implementation of the American Recovery and Reinvestment Act of 2009. As Senior Advisor to the Governor from 2008-2010, he represented the Governor on major domestic policy issues, which included serving as a principal advisor on health care reform. Previously, he served as the Senior Health Policy Advisor to the Governor during California’s 2006-2008 state debate on comprehensive health care reform. From 2005-2006, he served as Vice President of Government Programs for McKesson Health Solutions, where he oversaw the company’s disease management and nurse advice programs for Medicaid and Medicare beneficiaries. During the first year of Governor Schwarzenegger’s Administration, Mr. Schultz served as Acting Director of the California Employment Development Department. He also previously served as a member of former Governor Gray Davis’ Cabinet as Acting Secretary for the Labor and Workforce Development Agency. He served as the Agency’s Undersecretary before his Cabinet-Level appointment, and remained in both roles until the end of the Davis Administration. Prior to that, he was Deputy Director of External Affairs for the California Department of Managed Health Care, and served as Director of the Advisory Committee on Managed Health Care. Mr. Schultz received his BA in Political Science and International Studies from The American University in Washington, DC and has a Masters Degree in Public Policy from Georgetown University, also in Washington, DC.
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Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.
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By admin | April 3, 2010
El Nuevo Herald
Publicado el lunes 22 de marzo del 2010
IVONNE GOMEZ
El Congreso votó el domingo para dar luz verde a un paquete de reformas de salud que se espera traiga alivio a millones de personas en Estados Unidos.
Este es sólo el comienzo de un plan que tomará varios años en implementarse. Aunque muchos están optimistas en cuanto a las reformas, todavía existe confusión de cómo la medida los favorecerá o afectará directamente.
Algunos expertos que trabajan en el ámbito de la salud explican cómo conciben que la ley cambiará diferentes aspectos de la atención médica.
Doctor Olveen Carrasquillo, director de Medicina General en la Escuela de Medicina en la Universidad de Miami y vicepresidente de Latinos por un Seguro Medico Nacional:
ENH: ¿Qué significa esta reforma para el Jackson Memorial Hospital que atraviesa problemas financieros y para los pacientes que acuden allí sin seguro médico?
R: En este momento no significa nada para el hospital porque todo se va a ver a largo plazo y las soluciones que requiere el hospital son inmediatas.
Aunque para los pacientes los resultados se van a ver a largo plazo, definitivamente la reforma es una victoria.
ENH: ¿Cuáles son los casos crónicos más comunes que atiende de pacientes sin seguro médico?
R: Generalmente casos de pacientes con diabetes que se internan porque el azúcar se les sube a 600, una medida extrema que los hace sentir muy mal; los estabilizamos, pero el problema es que vuelven a sus casas y no tienen para pagar las medicinas y los monitoreos que requiere la enfermedad.
ENH: ¿En que medida la reforma ayudará a esos pacientes?
R: La reforma significa que más gente de bajos recursos va a poder calificar para la ayuda de Medicaid, un sistema restringido para niños y pacientes deshabilitados. Se van a hacer más flexibles los requisitos para que adultos de ingresos mínimos puedan beneficiarse de este sistema.
ENH: ¿En qué medida se beneficiará a la clase media?
R: El gobierno va a pagar una porción de su seguro médico de acuerdo a los ingresos. La gente de recursos altos deberá pagar un seguro médico obligatoriamente o de lo contrario tendrá que pagar una multa.
Yolanda Rodríguez, miembro del consejo ejecutivo de AARP para la Florida, una asociación que trabaja por mejorar la calidad de vida de personas mayores de 50 años.
ENH: ¿Qué significa la reforma para personas que ya han pasado de los 65 años y en la actualidad tienen acceso a Medicare?
R: Para muchas personas mayores de 65 años, es tal el costo de sus medicinas que tienen que elegir entre hacer sus compras en el mercado o estar al día con sus medicinas. El gobierno paga el costo de las medicinas hasta cierto tope, el resto queda por cuenta del paciente y se crea un vacío. La reforma promete un seguro para esas medicinas.
ENH: Que significa la reforma para personas entre los 50 y los 64 que aún no tienen acceso al Medicare?
R: Para las personas mayores de 50 que por alguna razon pierden su seguro, es difícil que una compañía los asegure de nuevo o los costos son demasiado altos. Más de 600,000 personas en la Florida caen en esta categoría. Con la reforma se abre la posibilidad de un seguro a nivel nacional que puedan pagar.
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By admin | April 3, 2010
New York Times
March 30, 2010
WASHINGTON — Under pressure from the White House, health insurance companies said Tuesday that they would comply with rules to be issued soon by the Obama administration requiring them to cover children with pre-existing medical problems.
“Health plans recognize the significant hardship that a family faces when they are unable to obtain coverage for a child with a pre-existing condition,” said Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group. Accordingly, she said, “we await and will fully comply with” the rules.
Ms. Ignagni made the commitment in a letter to Kathleen Sebelius, the secretary of health and human services, who had said she feared that some insurers might exploit a possible ambiguity in the new health care law to deny coverage to some sick children.
The White House immediately claimed victory.
In a Twitter message, Robert Gibbs, the White House press secretary, scored the tug of war as “Kids 1, insurance 0.”
Major provisions of the law take effect in 2014. Some, including a ban on “pre-existing condition exclusions” for children under 19, take effect in September. The law does not explicitly say that insurers must sell insurance to families with such children this year, but Democratic Congressional leaders and White House officials said that was their intent.
To eliminate any ambiguity, Ms. Sebelius said, she will issue rules defining the scope of the new law.
Under these rules, Ms. Sebelius said, “children with pre-existing conditions may not be denied access to their parents’ health insurance plan,” and “insurance companies will no longer be allowed to insure a child but exclude treatments for that child’s pre-existing condition.”
In response to a question, Nick Papas, a spokesman for the Department of Health and Human Services, said the rules would require insurers to offer coverage to children with pre-existing conditions, including those who have never had health insurance.
Ms. Sebelius said she was pleased that “insurance companies plan to do the right thing.”
It was not immediately clear whether the rules would allow insurers to charge higher premiums to families with children with pre-existing conditions. Administration officials said they would be monitoring any rate increases.
Some Democrats in Congress want Mr. Obama to take a tough line. If insurers could raise premiums without limits, they would, in effect, be denying coverage, Democrats say.
Some insurers said they were unclear about the language of the law, based on differing accounts, and looked forward to detailed guidance from the government.
“There has been some confusion regarding the elimination of pre-existing condition evaluation for children in the health care bill,” said Kristin E. Binns, a spokeswoman for WellPoint, one of the largest insurers. She said the company would “follow the law on this and all matters.”
Insurers said they would accept the administration’s reading of the law, even if they did not fully agree with it, because they wanted to avoid a showdown over the politically explosive issue of health insurance for sick children.
Several lawyers said Congress could easily clear up any confusion by revising the law. “The real solution here is a legislative fix so all players in the industry can act according to a clear set of rules,” said William G. Schiffbauer, a Washington lawyer whose clients include employers and insurance companies.
Representative Allyson Y. Schwartz, Democrat of Pennsylvania, who helped write a similar provision in an earlier version of the legislation, said the new law “requires that all insurers issue insurance to children regardless of health status, and cover all of their ailments,” starting in September.
Jeff Smokler, a spokesman for the Blue Cross and Blue Shield Association, said its member companies were “fully committed to complying with the new law” and accepted the principles set forth by Ms. Sebelius.
Gail K. Boudreaux, executive vice president of the UnitedHealth Group, said she supported the administration’s effort to clarify the law “to ensure that no child will be denied access to health insurance because of a pre-existing condition.”
“We expect that the new regulations will eliminate any uncertainty about the law’s intent,” Ms. Boudreaux said.
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By admin | April 3, 2010
New York Times
March 23, 2010
For all the political and economic uncertainties about health reform, at least one thing seems clear: The bill that President Obama signed on Tuesday is the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago.
Over most of that period, government policy and market forces have been moving in the same direction, both increasing inequality. The pretax incomes of the wealthy have soared since the late 1970s, while their tax rates have fallen more than rates for the middle class and poor.
Nearly every major aspect of the health bill pushes in the other direction. This fact helps explain why Mr. Obama was willing to spend so much political capital on the issue, even though it did not appear to be his top priority as a presidential candidate. Beyond the health reform’s effect on the medical system, it is the centerpiece of his deliberate effort to end what historians have called the age of Reagan.
Speaking to an ebullient audience of Democratic legislators and White House aides at the bill-signing ceremony on Tuesday, Mr. Obama claimed that health reform would “mark a new season in America.” He added, “We have now just enshrined, as soon as I sign this bill, the core principle that everybody should have some basic security when it comes to their health care.”
The bill is the most sweeping piece of federal legislation since Medicare was passed in 1965. It aims to smooth out one of the roughest edges in American society — the inability of many people to afford medical care after they lose a job or get sick. And it would do so in large measure by taxing the rich.
A big chunk of the money to pay for the bill comes from lifting payroll taxes on households making more than $250,000. On average, the annual tax bill for households making more than $1 million a year will rise by $46,000 in 2013, according to the Tax Policy Center, a Washington research group. Another major piece of financing would cut Medicare subsidies for private insurers, ultimately affecting their executives and shareholders.
The benefits, meanwhile, flow mostly to households making less than four times the poverty level — $88,200 for a family of four people. Those without insurance in this group will become eligible to receive subsidies or to join Medicaid. (Many of the poor are already covered by Medicaid.) Insurance costs are also likely to drop for higher-income workers at small companies.
Finally, the bill will also reduce a different kind of inequality. In the broadest sense, insurance is meant to spread the costs of an individual’s misfortune — illness, death, fire, flood — across society. Since the late 1970s, though, the share of Americans with health insurance has shrunk. As a result, the gap between the economic well-being of the sick and the healthy has been growing, at virtually every level of the income distribution.
The health reform bill will reverse that trend. By 2019, 95 percent of people are projected to be covered, up from 85 percent today (and about 90 percent in the late 1970s). Even affluent families ineligible for subsidies will benefit if they lose their insurance, by being able to buy a plan that can no longer charge more for pre-existing conditions. In effect, healthy families will be picking up most of the bill — and their insurance will be somewhat more expensive than it otherwise would have been.
Much about health reform remains unknown. Maybe it will deliver Congress to the Republicans this fall, or maybe it will help the Democrats keep power. Maybe the bill’s attempts to hold down the recent growth of medical costs will prove a big success, or maybe the results will be modest and inadequate. But the ways in which the bill attacks the inequality of the Reagan era — whether you love them or hate them — will probably be around for a long time.
“Legislative majorities come and go,” David Frum, a former speechwriter for President George W. Bush, lamented on Sunday. “This health care bill is forever.”
•
Since Mr. Obama began his presidential campaign in 2007, he has had a complicated relationship with the Reagan legacy. He has been more willing than many other Democrats to praise President Reagan. “Reagan’s central insight — that the liberal welfare state had grown complacent and overly bureaucratic,” Mr. Obama wrote in his second book, “contained a good deal of truth.” Most notably, he praised Mr. Reagan as a president who “changed the trajectory of America.”
But Mr. Obama also argued that the Reagan administration had gone too far, and that if elected, he would try to put the country on a new trajectory. “The project of the next president,” he said in an interview during the campaign, “is figuring out how you create bottom-up economic growth, as opposed to the trickle-down economic growth.”
Since 1980, median real household income has risen less than 15 percent. The only period of strong middle-class income growth during this time came in the mid- and late 1990s, which by coincidence was also the one time when taxes on the affluent were rising.
For most of the last three decades, tax rates for the wealthy have been falling, while their pretax pay has been rising rapidly. Real incomes at the 99.99th percentile have jumped more than 300 percent since 1980. At the 99th percentile — about $300,000 today — real pay has roughly doubled.
The laissez-faire revolution that Mr. Reagan started did not cause these trends. But its policies — tax cuts, light regulation, a patchwork safety net — have contributed to them.
Health reform hardly solves all of the American economy’s problems. Economic growth over the last decade was slower than in any decade since World War II. The tax cuts of the last 30 years, the two current wars, the Great Recession, the stimulus program and the looming retirement of the baby boomers have created huge deficits. Educational gains have slowed, and the planet is getting hotter.
Above all, the central question that both the Reagan and Obama administrations have tried to answer — what is the proper balance between the market and the government? — remains unresolved. But the bill signed on Tuesday certainly shifts our place on that spectrum.
Before he became Mr. Obama’s top economic adviser, Lawrence Summers told me a story about helping his daughter study for her Advanced Placement exam in American history. While doing so, Mr. Summers realized that the federal government had not passed major social legislation in decades. There was the frenzy of the New Deal, followed by the G.I. Bill, the Interstate Highway System, civil rights and Medicare — and then nothing worth its own section in the history books.
Now there is.
E-mail: leonhardt@nytimes.com
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By admin | April 3, 2010
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NEWS RELEASE
FOR IMMEDIATE DISTRIBUTION
March 24, 2010
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CONTACT:
Vanesa Ramirez, vramirez@rabengroup.com , (213) 236-3751
Estuardo Rodriguez estuardo@rabengroup.com , (202) 631-2892
Lizette Olmos, ljolmos@lulac.org, (202) 365-4553
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CIVIL RIGHTS AND ADVOCACY ORGANIZATIONS TURN TO SENATE FOR IMMEDIATE ACTION ON HISTORIC HEALTH REFORM ‘FIX-IT’ BILL
Latino leaders sent a letter today to the Senate urging a “no” vote on any amendments and to move quickly to vote “yes” for the reconciliation health care bill
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WASHINGTON, DC – Today, the National Hispanic Leadership Agenda (NHLA) and Latinos United for Healthcare (LUH), a coalition of national Latino civil rights and advocacy organizations, national and community leaders sent a letter to the full Senate today. (See Attached) The letter urges Senators to vote for the passage of H.R. 4872, the Health Care & Education Affordability Reconciliation Act of 2010 and oppose any points of order or amendments that would derail it.
“While no compromise is perfect, the Latino community won important improvements in the reconciliation bill, including more help for lower-income Latinos to purchase health insurance and added resources for Puerto Rico so that more of its residents will have access to healthcare,” stated Lillian Rodriguez-Lopez, Chair of NHLA and President of Hispanic Federation. “Today we look to the Senate to complete the work on healthcare reform, vote against any amendments that would delay the process and pass H.R. 4872.”
H.R. 4872 includes the following key improvements to H.R. 3590:
- More generous affordability credits that put health coverage within reach for low-income citizen and immigrant families who purchase insurance through an exchange.
- $6.3 billion in new Medicaid funding for the territories as well as new flexibility for Puerto Rico to determine how best to use this funding to expand coverage and improve services.
- Authorization for Puerto Rico to establish a Health Care Exchange and $1 billion for subsidies to individuals and families of modest means who participate in the exchange.
“This week we have witnessed the realization of Senator Ted Kennedy’s dream, healthcare reform which is inclusive of all Americans,” stated Brent Wilkes, Executive Director, LULAC. “We are one step away from making the necessary improvements to the newly enacted law and we cannot afford to get further caught up in partisan gamesmanship which only put the health and well-being of hardworking Americans at risk. The Senate must move forward and pass H.R. 4872 immediately.”
“There is much at stake for Latinos in healthcare reform and our families in every state and every city across the nation are counting on it,” said Dr. Jaime Torres, President of Latinos for National Health Insurance. “Senators need to stay focused and get the job done. This means voting down any amendments or procedural roadblocks that are intended to do nothing less than delay the health care that our community so desperately needs.”
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Established in 1991, The National Hispanic Leadership Agenda (NHLA) brings together Hispanic leaders to establish policy priorities that address, and raise public awareness of the major issues affecting the Latino community and the nation as a whole. For more information, please visit www.nationalhispanicleadership.org .
Latinos United for Healthcare (LUH) is a nonpartisan coalition of national, state and local Hispanic leaders and organizations that support the passage of significant healthcare reform that increases access to affordable, quality health coverage for all. For further information, please visit www.latinosunitedforhealthcare.org .
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By admin | December 18, 2009
Prepared by La Fe Policy Research and Education Center
ucation Center
Small businesses which the U.S. Small Business Administration defines as firms with less than 500 employees are critically important to the American economy.[1] They represent 99.7% of all employer firms; generate one-half of America’s Gross Domestic Product (GDP), and two-thirds of new jobs every year. Smaller firms with fewer than 20 employees accounted for approximately 18 percent of private sector jobs in 2006, but nearly 25 percent of net employment growth from 1992 to 2005.[2] These businesses account for a large majority of jobs in start-up and are a key source of innovation and economic growth.
The competitiveness of U.S. businesses continues to be negatively impacted by the rising costs of health care and a concurrent rise in the number of uninsured and underinsured workers.[3] There is a substantial competitiveness gap between the United States and numerous other industrialized countries in the global economy, including the loss of jobs to competitor countries.[4] Small businesses with less than 50 employees are particularly challenged to both thrive and compete.[5] The magnitude has lead some to suggest that employer-sponsored health insurance (ESI) as currently structured has outlived its usefulness.[6]
Indeed, health care costs are a barrier toward greater economic success for the small business owners and their employees, as well as contributing to income disparities.[7] Addressing how the cost of health care impacts small business is a major policy issue in the current health care reform legislation under consideration in both the Congressional House and Senate.[8] While there are identifiable business organizations lobbying on the purported behalf of small business, a major survey of small business owners indicates that they are not adequately being represented.[9]
The rise in health care costs and how it is leading to the growth in uninsured workers is a major salient issue in Texas because the state has the highest percentage (25%) of uninsured U.S. residents, a majority of whom works full-time. In 2006, there were 386,422 small business employers in Texas who accounted for 98.7% of all employers, and 46% of the state’s private-sector employment.[10] Small businesses with fewer than 50 employees accounted for 72% of Texas businesses. About 2 million or 24% of private sector employees worked in these firms in 2005, and over one-half of these private-sector small firms have fewer than ten employees. Of these businesses, 33.6% and 25.9% offered health insurance for firms with less than 50 and 10 employees respectively. [11]
The bienestar (well-being) and health of the Latino population in Texas is intertwined with the economic growth of small businesses and with the current national legislative proposal to reform the U.S. health care delivery system. More specifically, reform policies directed at addressing disparities[12] in health care access greatly affect Latinos in Texas. Many Latinos are very worried about health insecurity and strongly support current national health reform initiatives.[13] The long-term implications are clear in light of Hispanic population growth and the projected impact on the states’ education system, the labor force, the health system, and overall economy.[14]
Another important aspect of this debate is the concurrent underlying disproportionate negative impacts of these issues on the bienestar and health of uninsured Latino workers[15]because among Latino workers, the majority is employed in small businesses, many of whom are also small business owners.[16] In fact, Latino small business owners are growing at three-times above the average of non-Latino owned small businesses.[17] However, most Latino small business workers are low-wage earners whose overall bienestar is at risk because of health disparities (e.g., being uninsured and/or in poor health) that impact them.[18] Only 40% of Latinos had employer-based health insurance in 2008 compared to 62% for non-Latino Whites.
Latinos are the most uninsured population in the nation and in Texas, a trend that has existed for well over a decade. During the 1996-1998 period, the Latino uninsured rate (ages 19-64) in Texas was 38%; ten years later in 2008 it was 39%.[19] Their uninsured rate is still twice that of non-Latinos after excluding non-citizens (documented and undocumented U.S. Latino residents). Reasons cited for this severe health insurance disparity include:
· Lower education and income levels;
· High levels of employment in small businesses which do not offer health insurance coverage;
· Work in service and other occupations with the least access to affordable health insurance coverage; and
· Unaffordable premium-share when health insurance coverage is offered given their lower wages.
It is also worth noting that the health insurance disparity for Latinos persists when compared to the same level of education for Non-Latinos.[20]
Texas Uninsured by Race/Ethnicity and Educational Attainment
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Education
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Texas
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White
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Latino
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African American
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No high school diploma
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42%
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22%
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36%
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28%
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High school or equivalent
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30%
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19%
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41%
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36%
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Some college, less than 4-yr degree
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20%
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13%
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29%
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23%
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Bachelor’s degree or higher
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9%
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5%
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16%
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15%
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Source: US Census Bureau: Community Population Survey 2007
Note: Percentages reflect individual racial/ethnic and educational attainment sub groups and will not add up to 100%
For Latino small businesses and low-wage workers, affordability is increasingly challenged by the cumulative changes in health insurance premiums, inflation, and workers’ earnings. The trend has a direct impact on the question of what is affordable, and if disparities will be addressed. In Texas, severe affordability issues are exemplified by the following:[21]
· Health insurance premiums for working families increased by 86.8% from 2000 to 2007, while the median earnings of Texas’ workers increased by only 15% ($23,032 to $26,484). Health insurance premiums rose 5.8 times faster than median earnings.
· Family health coverage (employer and worker share of premiums combined) rose from $6,638 to $12,403.
· Family health coverage for the employer’s portion rose from $4,879 to $9,191, while the worker’s portion rose from $1,759 to $3,212.
· Individual health coverage (employer and worker share of premiums combined) rose from $2,627 to $4,385.
· Individual health coverage for the employer’s portion rose from $2,220 to $3,613 while the worker’s portion rose from $407 to $772.
For small business employers and their employees the challenges include:[22]
· Less than half of employees working in firms work for an employer offering coverage, compared to 93% in large firms. There are fewer in Texas than nationally.
· Of the 1.9 million employees working in small firms, less than 800,000 (42%) are eligible for coverage and less than 650,000 (32%) are enrolled.
· Texas families pay a higher share of premiums, deductibles, and out-of-pocket expenses for health insurance than nationally.
· The majority of small business employers who do not offer coverage report that they can only pay $100.00 or less per employee per month for health insurance.
A recent Institute of Medicine report notes, “Businesses must realize there are real bottom-line costs associated with health disparities. Employers cannot afford to continue shouldering the costs and consequences (illnesses, disabilities, premature death) of unnecessary or unequal health care particularly in light of a more diverse workforce.”[23] Racial and ethnicity minorities will comprise the majority of the U.S. population by 2042, and over 50% of the working-age population (30% Latino, 15% Black, and 9.6% Asian) by 2039, up from 34% in 2008. Latinos are projected to represent over 53% of the Texas population in 2040 compared to 32% and 10% for Anglos and African Americans respectively.[24]
Documented research demonstrates that high risks pools, health saving accounts, and the like have had limited impact in helping small businesses acquire affordable health insurance coverage.[25] Further, research shows that tax credits and subsidies must be well-developed and targeted to either the small business and/or individual employees to improve their chance of success.[26] In Texas, legislative efforts have had limited success in helping small businesses or low-wage workers to successfully purchase affordable health insurance coverage through high risks pools or tax credits.[27]
In summary, research repeatedly demonstrates the disadvantaged position of small businesses, as exemplified by the following issues:[28]
· A decade-old trend of rising premium cost;
· Higher premium cost disparities between small and large businesses;
· More limited health plan choices and less comprehensive health benefits;
· Disproportionately higher operating costs for small businesses;
· Health insurance access disparities between higher and lower-wage workers within small and large firms;
· A more severe decline in their ability to offer affordable health insurance compared to larger businesses;
· A lack of access to affordable health insurance coverage in private health insurance market for individuals or their families.
The current health reform proposals contain policies directed at addressing the negative impacts that health care costs are having on business, particularly policies that will assist small businesses to have access to affordable health insurance coverage.[29] According to proponents, 233,000 small businesses in Texas could be helped, and they would also be exempt from any employer responsibility provisions. Several important means are identified for providing access to affordable coverage: 1) a health insurance exchange that pools small businesses and their employees with millions of other Americans to increase purchasing power and competition in the insurance market: 2) tax credit for small businesses (with less than 50 employees); 3) termination of the ‘hidden tax’ on small businesses that provide health insurance, 4) prevention of arbitrary premium hikes; and 5) prevention of denial of coverage or high costs because of pre-existing health conditions.
There is, of course, heated debate about the impact that current health care reform proposals will have, and whether a final bill will either help or hurt small business regarding access to affordable health insurance coverage, as well as whether it will strengthen their long-term competitive growth and development. The strongest opposition has been from the U.S. Chamber of Commerce and National Federation of Independent Businesses, with some beginning support from the Business Roundtable. Whereas other business groups such as the Small Business Majority, Main Street Alliance, and National Minority Business Council have indicated strong support for the proposed reforms.
The importance of meaningful health care reform for small businesses and the disproportionate large number of uninsured Latinos is evident. As such, affordable health insurance expansion for small businesses and Latinos must consider:
Health Disparities - Over the next decade, the prevalence of disease will shift from White non-Latinos to Latinos who are primarily young and of working age. Therefore, socio-economic conditions coupled with existing health disparities and environmental circumstances of uninsured Latinos must be considered in order to successfully develop and implement effective policy solutions.
Affordability - Latinos are most likely to have lower education attainment, to live in poverty, have less disposable income, and be uninsured, and work in small businesses. Improvements to the system must include significantly reduced costs.
Accessibility - It is vital to healthy outcomes that services be accessible. Texas Latinos are not only the most uninsured, but are also more likely to reside in medically and health professions underserved areas.
National data indicate that over the next 10 years, Latino-owned businesses will have a growth rate of 8%–3 times the rate of U.S. firms overall, and their revenue and worker growth is also expected to be higher.[30] The most recent business data (2002) indicated that 18.4% (319,340) of all (1,694,485) Texas business owners were Latino, which represented a 32.8% increase from 1997. According to the State Comptroller, Latinos help propel the Texas economy. Latinos contributed more than 171 billion in 2008, and expected to rise to 252 billion by 2013 (47% increase), plus significant growth is expected in Latino-owned businesses.[31]
While all small businesses may share common concerns, it is imperative to determine if the experiences and perspectives of Latino small businesses are truly known and are accurately and adequately represented in the health reform debate. The disproportionate negative impacts are probably greater on Latino small businesses, their employees and families. While Latinos continue to grow in population, labor force, and entrepreneurship, access to healthcare and prevention are negatively impacting Latinos, hence the economic well-being of Texas. Latino small business opportunities are more limited regarding maintaining affordable and comprehensive health insurance benefits for their employees, while continuing to prosper in size and profits.
In summary, of 23 million Texans, one in three is Latino (36.5%), and their projected growth and economic contributions combined with improved health care access can further ensure our state’s productivity. Health insurance coverage increases the likelihood for regular access to a medical home for preventive primary care and access in the event of an unanticipated health care need. In short, access should provide the opportunity to maintain good health and not add to the risk of financial health care debt. Further, the coverage cost should not be a barrier to parents to pursue and retain individual and family financial security and self-sufficiency. The objective should be to reduce disparities, not increase them. Provided with affordable opportunities to access coverage for themselves and their employees, small businesses can increase their growth and make significant contributions to reducing the number of uninsured Latinos while improving their overall health status. All of Texas and all of its residents will benefit, thereby insuring the economic growth and prosperity of the state for decades to come.
[1] The Small Business Economy, A Report to the Presidents, Small Business Administration, Office of Advocacy, 2009, and Frequently Asked Questions, U.S. Small Business Administration, Office of Advocacy, Updated September 2009.
[2] Key Finding from Quantitative and Qualitative Research Among America’s Small Business Owners, The Robert Wood Johnson Foundation – Small Business Research, 2008.
[3] An International Comparison of Small Business Employment, Center for Economic and Policy Research, August 2009.
[4] Health Care Value Comparability Study, The Business Roundtable, Executive Summary, 2009.
[5] The High Cost of Small business Health Insurance: Limited Options, Limited Coverage, Hearing before Committee on Energy and Commerce, Subcommittee on Oversight and Investigation, U.S. House of Representatives, Statement of Linda J. Blumberg, Senior Fellow, The Urban Institute, October 20, 2009.
[6] The Future of Employment-Based Health Benefits: Have Employers Reached a Tipping Point?, Employee Benefit research Institute, Issue Brief No. 312, December 2007, and Quality, Affordable health Care for All: Moving Beyond the Employer-Based Health Insurance System, Committee for Economic Development, 2007.
[7] How health care costs contribute to income disparity in the United States, McKinsey Global Institute, The McKinsey Quarterly, March 2009.
[8] Out of Options: Why So Many Workers in Small Businesses Lack affordable Health Insurance, and How Health Care Reform Can Help, The Commonwealth Fund, Issues Brief September 2009.
[9] The Small Business Dilemma: How Rising Health Care Costs Are Tough On Small Business, U.S., PIRG Education Fund, July 2009; and The Employers Health Care Burden, New America Foundation, Issue Brief, May 2008.
[10] Texas Small Business Profile, U.S. Small Business Administration, Office of Advocacy, October 2009.
[11] Revitalizing the Small Employer Group Health Insurance Market in Texas, Mayors Office, City of Houston, August 2008. Data references can be accessed at http://www.meps.ahrq.gov/mepsweb/
[12] Disparities in “health care” and in “health” are not the same. A health care disparity refers to differences in coverage, access, or quality of care that is not due to health needs. A health disparity refers to a higher burden of illness, injury, disability, or mortality experienced by one population group in relation to another. The two concepts are related in that disparities in health care can contribute to health disparities, and the goal of the use of health services is to maintain and improve a population’s health.
[13] Health Care Insecurity Greatest Among Hispanics, Economic Policy Institute, Snapshot, February 20, 2008; and , New Survey Shows Overwhelming Support among Latinos for Health Care Reform That Includes Public Option, Latino Decisions, the Robert Wood Johnson Foundation Center for Health Policy at the University of New Mexico (UNM-RWJF Center), and impreMedia, Latino Decisions New Release, December 3, 2009.
[14] Population Change in Texas: Implication for Human and Socioeconomic Resources in the 21st Century, Steve H. Murdock, Institute for Demographic and Socioeconomic Research, University of Texas at San Antonio, 2006.
[15] The U.S. Economy and Changes In health Insurance Coverage, 2000 – 2006, Health Affairs, 27, No.2, February 20, 2008; and Employer Sponsored Health Insurance: Already Poor Access Further Dwindles for Working Latino Families, National Council de la Raza, Fact Sheet, 2008.
[16] Employment status of the civilian non-institutional population by age, sex, and race (Table 3) and Employment status of the Hispanic or Latino population by age and sex (Table 3), U.S. Department of Labor, Bureau of Labor Statistics, Current Population Survey, Annual Averages 2006. Available at http://www.bls.gov/cps/cpsa2006.pdf; and The Characteristic of Small-Business Employees, Monthly Labor Review, April 2000.
[17] Minorities in Business: A Demographic Review of Minority Business Ownership, Small Business Administration, Office of Advocacy, April 10, 2007; and Latino-Business Barometer United State, RDA Global, May 1, 2005.
[18] National Health Care Disparities Report, Agency for Healthcare Research and Quality, December 2009; and How Non-Group Health Coverage Varies with Income, The Henry J. Kaiser Family Foundation, February 2008.
[19] Texas Blue Ribbon Task Force on The Uninsured, Report to the 77th Legislature, February 2001; and U.S. Census Bureau Current Population Surveys, 2002 - 2008.
[20] Texas Medicaid Waiver: Implications for Health Care Reform, La Fe Policy Research and Education Center, March 2009. See Table 9; and The Challenges of Health Insurance for Small Businesses in Texas: Profiles and Trends, LBJ School of Public Affairs, Center for Health and Social Policy, October 2008.
[21] Premiums Versus Paychecks: A Growing Burden for Texas’s Workers, Families USA, October 2008.
[22] Texas Small Employer Health Insurance Survey Results 2009, Texas Department of Insurance, May 2009; and Healthy Texas Phase 1 Report, Senate Bill 20, Section 25, 80th Legislature, Regular Session 2007, November 2008.
[23] Challenges and Successes in Reducing Health Disparities: Workshop Summary, Institute of Medicine, Washington D.C., The National Academies Press, 2008.
[24] Population 2000 and Projected Population 2005-2040 by Race/Ethnicity and Mirgration Scenarios for State of Texas, Texas State Data Center 2005.
[25] What price universal health coverage? For many small employers, any price is too high, Mercer, Survey, October 2008.
[26] Health Tax Incentives: Healthy Choices or Bad Medicine, National Council de la Raza, Issue Brief, No. 18, 2009; and Target Subsidies: Employers Versus Individual, Urban Institute, October 2008.
[27] Analysis of Reinsurance and High-Risk Pool Options for Health Insurance in Texas, LBJ School of Public Affairs: Center for Health and Social Policy, December 2008; Code Red: The Critical Condition of Health Care in Texas, 2006, See Chapter V, State Regulations of Health Insurance; and Expanding Health Insurance Coverage with the Texas Health Insurance Risk Pool, Working Paper from the Policy Research Project on Expanding Health Care Coverage for the Uninsured 2002, The Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin.
[28] Wages and Benefits: A Long-Term View, The Henry J. Kaiser Family Foundation, Snapshots, November 2009; The Widen Health Care Gap Between High and Low-Wage Workers, The Commonwealth Fund, Issues Brief, May 2008; and The Fraying Link Between Work and Health Insurance: Trends in Employer-Sponsored Insurance for Employees, 2000-2007, The Kaiser Commission on Medicaid and the Uninsured, November 2008.
[29] The Economic Effects of Health Care Reform on Small Businesses and Their Employees, Executive Office Of The President Council Of Economic Advisers, July 25, 2009.
[30] Latino-Business Barometer United State, RDA Global, May 1, 2005.
[31] Combs Says Hispanics Help Propel the Texas Economy, Window on State government, New Release, October 1, 2009.
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By admin | November 1, 2009
By Ricardo Alonso-Zaldivar, Associated Press Writer
WASHINGTON — What’s all the fuss about? After all the noise over Democrats’ push for a government insurance plan to compete with private carriers, coverage numbers are finally in: Two percent.
That’s the estimated share of Americans younger than 65 who’d sign up for the public option plan under the health care bill that Speaker Nancy Pelosi, D-Calif., is steering toward House approval.
The underwhelming statistic is raising questions about whether the government plan will be the iron-fisted competitor that private insurers warn will shut them down or a niche operator that becomes a haven for patients with health insurance horror stories.
Some experts are wondering if lawmakers have wasted too much time arguing about the public plan, giving short shrift to basics such as ensuring that new coverage will be affordable.
“The public option is a significant issue, but its place in the debate is completely out of proportion to its actual importance to consumers,” said Drew Altman, president of the nonpartisan Kaiser Family Foundation. “It has sucked all the oxygen out of the room and diverted attention from bread-and-butter consumer issues, such as affordable coverage and comprehensive benefits.”
The Democratic health care bills would extend coverage to the uninsured by providing government help with premiums and prohibiting insurers from excluding people in poor health or charging them more. But to keep from piling more on the federal deficit, most of the uninsured will have to wait until 2013 for help. Even then, many will have to pay a significant share of their own health care costs.
The latest look at the public option comes from the Congressional Budget Office, the nonpartisan economic analysts for lawmakers.
It found that the scaled back government plan in the House bill wouldn’t overtake private health insurance. To the contrary, it might help the insurers a little.
The budget office estimated that about 6 million people would sign up for the public option in 2019, when the House bill is fully phased in. That represents about 2 percent of a total of 282 million Americans under age 65. (Older people are covered through Medicare.)
The overwhelming majority of the population would remain in private health insurance plans sponsored by employers. Others, mainly low-income people, would be covered through an expanded Medicaid program.
To be fair, most people would not have access to the new public plan. Under the House bill, it would be offered through new insurance exchanges open only to those who buy coverage on their own or work for small companies. Yet even within that pool of 30 million people, only 1-in-5 would take the public option.
Who’s likely to sign up?
The budget office said “a less healthy pool of enrollees” would probably be attracted to the public option, drawn by the prospect of looser rules on access to specialists and medical services.
As a result, premiums in the public plan would be higher than the average for private plans. That could nudge healthy middle-class workers and their families to sign up for private plans.
“The concern was that the public option would destabilize the bulk of private insurance, but in fact what Congress has fashioned is very targeted,” said economist Karen Davis, president of the Commonwealth Fund. “It’s not going to be taking away the insurance industry’s core business.”
It’s unclear whether there are enough votes in the Senate for a public plan. The version that Majority Leader Harry Reid, D-Nev., has offered would let states opt out, probably leaving a smaller plan that the House would want.
Insurers aren’t buying the budget office analysis. Asked if it might soften that opposition, industry spokesman Robert Zirkelbach of America’s Health Insurance Plans responded with a curt “No.”
While a government plan might start out modestly, insurers fear that Congress could change the rules later, opening it up to all people and setting take-it-or-leave payments for hospitals and medical providers, instead of negotiating, as the House bill calls for.
For the same reason, employer groups also remain wary. Big companies don’t want to lose control of their health care budgets and instead have the government send them a tax bill.
“That cost is going to come back to you one way or another … and it’s coming back in the way of taxes and liabilities,” said Eastman Kodak’s chief executive, Antonio M. Perez, speaking for the Business Roundtable. “We just don’t believe that there are miracles out there.”
If Congress passes a public plan that’s not much of a sensation, Democrats might have reason to regret all the time and energy they invested in it.
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By admin | November 1, 2009
latimes.com
HEALTHCARE Q & A
How Nancy Pelosi’s healthcare bill would affect taxes, Medicare prescription drug benefits, and more.
By Kim Geiger and James Oliphant
November 1, 2009
Reporting from Washington
Some reader questions on the national healthcare debate, focusing on the House bill unveiled Thursday by Speaker Nancy Pelosi (D-San Francisco):
Would the House Democrats’ bill raise my taxes more than the other bills making their way through Congress?
It depends on your income. The House bill would impose a surcharge on individuals who make more than $500,000 and couples who make more than $1 million. The previous House bill would have imposed the surcharge on individuals who make $280,000 and families that make $350,000. The current bill also would impose a tax of 2.5% of income for those who make more than $250,000 and fail to purchase health insurance.
How would the bill affect my prescription drug benefits under Medicare?
The bill would speed the closing of the Medicare Part D “doughnut hole” — the coverage gap that occurs when a patient’s prescription costs exceed a certain yearly amount. Over time, this bill would create a 50% discount for prescription drugs bought in the doughnut hole. That process would be completed in 2019 — five years earlier than proposed in the original House bill. The bill also would require the Health and Human Services secretary to negotiate for Medicare drug prices.
Why do insurers say this bill would raise healthcare costs?
Insurers are not happy that the bill includes a “public option,” a government-run plan that would be funded through an increased payroll tax for those who choose it. The public option would compete with private options in a regulated insurance exchange. Insurers say the public option will disrupt the healthcare market and could force some companies out of business. The bill also ends insurers’ exemption from antitrust laws that prohibit price-fixing, another element that they say could drive up costs.
How would the bill affect small businesses?
It would exempt more small businesses from a requirement to provide insurance benefits to employees. Employers with yearly payroll costs of less than $250,000, compared with $500,000 under the previous House bill, would be exempt from the requirement.
What parts of the bill would take effect as soon as it became law?
The bill would immediately eliminate lifetime coverage limits and rescission, the process an insurer uses to cancel a policy because the policyholder failed to disclose a preexisting condition.
In addition:
* People could keep their COBRA plans until the insurance exchange designed to offer affordable options is in place.
* Young people could stay on their parents’ insurance plans until they turn 27.
* Co-pays and deductibles for preventive services to Medicare patients would be eliminated.
* It would create a temporary insurance program for people who have been uninsured or denied coverage due to a preexisting condition.
I keep hearing that none of the Democratic healthcare bills would cover everyone. Who won’t be covered?
Under the most recent Senate version of the bill, people who don’t earn as much as four times the federal poverty level — amounting to $43,320 for an individual or $88,200 for a family of four — would be offered government assistance to buy insurance. But there would be no assistance for people who earn slightly more, though they could apply for an exemption from the insurance requirement if they can prove that the most inexpensive policy they could buy would exceed 8% of their income. That’s why experts have estimated that 3% to 6% of those eligible would remain uninsured.
Would a “public option” make it possible for everyone to be covered?
A so-called public option could make affordable insurance more accessible to those whose incomes are above the subsidy limit, but it is not likely that everyone would be covered.
The House bill, which does contain a public option, is estimated to cover about 97% of those eligible, more people than the Senate Finance Committee bill, which does not include a public option and would cover 94% of the population.
It is also possible that a public option would include a “firewall” that would prevent some people from enrolling — specifically those who work at a company that already offers coverage, even if that policy is not affordable for the employee.
I work at a small business, and my employer doesn’t offer health benefits. Will healthcare reform require my employer to cover me?
It depends on the size of the business, but many small businesses are exempt in the House and Senate bills. The final Senate bill is likely to exempt businesses with fewer than 50 employees from a mandate to offer coverage. The House bill exempts or reduces the requirement for businesses that have yearly payrolls of less than $400,000.
I have been denied health insurance because of a preexisting condition. Will any of these bills guarantee that I can buy insurance?
The bills appear to explicitly prohibit an insurer in the individual marketplace from denying you coverage because of your health status, regardless of whether you have been denied coverage in the past.
Of course, the bills do not guarantee you will be able to find an affordable policy.
And under the bills as they stand now, insurers will still be able to price policies based on your age or past tobacco use.
Some Democrats have proposed ending the insurance industry’s antitrust exemption. What exactly is that?
A 1945 law prevented the federal government from regulating all forms of insurance, leaving that duty to the states. As a result, the law also shielded insurers from federal antitrust laws that prohibit price-fixing and collusion. This is seen as a problem for residents in many areas where only one or two health insurers operate. Rather than go to a neighboring state where another insurer might be offering a better deal, residents are forced to choose between the insurers that are regulated by their state government. Some Democrats are proposing to repeal a portion of the law that relates to health insurers specifically.
Some Republicans have proposed allowing insurers to sell plans across state lines. Can’t they do that already?
A proposal to allow this was part of the bill that passed in the Democrat-controlled Senate Finance Committee last week. Republicans, however, have been the ones arguing the loudest in support of the idea. Currently, a resident in one state cannot buy a policy offered in another state because it would not meet state requirements and there would be no government regulator to ensure that the policy was honored. If the law were changed to allow interstate sales of health insurance, this could open the industry to federal antitrust laws because an interstate insurance regime would have to be regulated by the federal government.
What are some other proposals for increasing competition?
The one that draws the most attention is the “public option” — a government-run health insurer. Proponents say such an entity could offer cheaper insurance rates because it could deliver healthcare services in a more cost-effective way, particularly if it paid doctors at the same rate, or slightly higher, than Medicare does. Some members of Congress favor private, member-owned cooperatives that they say would compete with insurers without government involvement. And some believe that simply requiring all residents to buy insurance will give insurers enough incentive to compete for those new customers.
What about allowing national insurance plans?
That’s another proposal that proponents say would give consumers more choices and drive down premium costs. A provision in the Senate Finance Committee healthcare bill would allow insurers to offer national plans that would compete with state-based ones. Critics say such plans would evade tougher state regulations. The bill does allow states to opt out of the national plans, but some question whether states would be willing to do so if it meant preventing residents from buying less expensive plans that don’t meet state standards.
How can we be sure that there will be no rationing of healthcare or pharmaceuticals under the bills being considered in Congress?
Democrats argue that there is rationing in the current healthcare system, in part because insurance companies can rate consumers on the basis of preexisting medical conditions or drop them if they get sick. Those practices would be outlawed as part of the current legislation. As for pharmaceutical coverage, it’s possible that some consumers could end up with more coverage for prescription drugs than they have now.
Why is that?
It is likely that private companies seeking to participate in the new insurance exchanges — which would be created to help lower-income consumers — would have to offer prescription drug coverage as part of their essential benefits package. That could mean new coverage options for people who right now can’t afford such plans. At the same time, some consumers who obtained insurance through the exchanges might have to buy drug coverage they did not want or need — if they had other options for buying low-cost drugs, for example.
Will I have to pay more for my pharmaceuticals if I buy insurance through an exchange?
That would depend on what level of plan you chose. Under a less expensive plan, you would probably have to cover the cost of your prescription drugs until you reached a set deductible, something like $100 or $250. (This is separate from your overall insurance deductible.) At that point, your insurance would cover some or most of the cost. If you purchased a higher-priced plan, it’s likely there would be no deductible, and perhaps no co-pays either.
What about prescriptions under Medicare?
The overhaul proposals in Congress improve the drug benefit by reducing the so-called coverage gap or doughnut hole that exists for recipients of Medicare Part D, which affects about 4 million seniors each year. Under the $80-billion deal struck with the pharmaceutical industry, the prices of drugs that fall within the gap would be slashed by 50%.
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By admin | October 31, 2009
latimes.com
He suggests that those here illegally be kept from taking part in an insurance exchange set up by the government. Some on the left say that’s bad policy that panders to the likes of Joe Wilson.
By Peter Wallsten
September 16, 2009
Reporting from Washington
Trying to quell a conservative uproar over his healthcare agenda, President Obama has proposed barring illegal immigrants from a possible government-arranged health insurance marketplace — even if the immigrants pay with their own money.
The move has surprised some of Obama’s fellow Democrats and infuriated immigrant advocates, who on Tuesday attacked the position as political pandering and bad policy.
The White House revealed its stance Friday, after a renewed debate over illegal immigration that was triggered when Rep. Joe Wilson (R-S.C.) heckled Obama on the issue during the president’s televised address to Congress.
Wilson yelled out, “You lie!” when Obama said that illegal immigrants would receive no benefit from his healthcare proposals.
But some on the political left say that the White House — wary of more damaging battles with the right — has given in to Wilson and other conservatives.
Wilson “acted like a buffoon, and everybody criticized him — but then at the end of the day he sort of got his way,” said Brent A. Wilkes, national executive director of the League of United Latin American Citizens.
“It rewards bullying in a way that begets more bullying,” said Frank Sharry, who directs the pro-immigrant group America’s Voice and has been advising the White House and congressional Democrats on broader immigration issues.
After a sharply partisan debate Tuesday, the House voted 240 to 179 to formally rebuke Wilson for his outburst.
A White House official said that Obama’s stance barring undocumented immigrants from participating in the insurance marketplace did not reflect a change of heart after Wilson’s outburst — only that the specific question had just come up in recent days.
“The president has been clear since the campaign that he does not intend for health insurance reform to cover undocumented immigrants,” said the official, who spoke on the condition of anonymity while discussing official White House policy.
But several White House allies said Tuesday that the policy was a shift designed to position Obama to the right of his critics.
Rep. Luis V. Gutierrez (D-Ill.), an early Obama ally, said Tuesday that members of the Congressional Hispanic Caucus were reevaluating their support for the healthcare overhaul.
Wilson’s outburst, Gutierrez said, was “said in a mean, ugly way. And what the president did was create an even meaner, uglier public policy to accompany it.”
Congress is working on plans to give low- and moderate-income people subsidies to buy health insurance in an effort to reduce the number of uninsured in the country.
None of the measures would allow illegal immigrants to receive subsidies.
Obama’s proposal, circulated in an e-mail to reporters, would go further, barring undocumented immigrants from an insurance marketplace designed to make it easier for consumers to find coverage.
As they can today, undocumented immigrants still could buy insurance in the private market. But the White House e-mail noted that if the Democratic legislation passed, private insurers could be expected to sell more insurance through the so-called exchange and less coverage outside of it, leaving the private market to shrink over time.
The White House also has embraced a verification system to validate that people buying insurance were in the country legally. That idea had been rejected by House Democrats, who cited studies showing that such systems were costly and prone to mistakes.
The White House has not, however, proposed changing the law that requires emergency rooms to treat people who need care, including illegal immigrants.
Immigrant advocates said Tuesday that the insurance issue could be a political headache for the White House if members of the Congressional Hispanic Caucus, after hearing from their constituents, felt pressured to vote against the healthcare legislation.
Some said they intended to organize activists in the coming days to push the White House and Democratic leaders to make the bill more favorable to illegal immigrants.
Obama’s policy statement, some activists said, was motivated by politics — an effort to build credibility with conservatives and defuse criticism that the president was soft on illegal immigration.
Latino leaders and immigrant advocates aired their concerns during a meeting Monday at the White House. Administration officials said that the insurance coverage restriction was needed for the sake of clarity, according to several meeting participants.
One official, White House Deputy Chief of Staff Jim Messina, assured the group that Obama supported allowing legal immigrants to participate in the insurance exchange. Advocates said they presumed that meant legal immigrants would be eligible for subsidies.
Conservative critics have said that allowing illegal immigrants to participate in a government-run system rewarded lawbreakers. Moreover, they said, any ban on subsidies to illegal immigrants would be ineffective without an enforcement mechanism, such as requiring consumers to show that they were in the country legally.
But others have argued that imposing hurdles on illegal immigrants who want to buy insurance forces those people to hospital emergency rooms and raises taxpayer costs. And because illegal immigrants tend to be younger and more fit, some say their participation in insurance risk pools could actually drive down costs.
Leighton Ku, a health policy professor at George Washington University, said that immigrants’ healthcare costs about half as much as citizens’ care.
“They’re low-risk people,” Ku said. “It’s advantageous to have low-risk people in insurance pools.”
It was unclear how the policy would affect families in which parents were in the country illegally and the children were citizens, or how it would affect illegal immigrants who get their insurance through their employers, if the employers choose to participate in the new insurance exchange.
Experts said Tuesday that the dust-up over immigration amid the broader healthcare fight underscored the political challenges that await the White House later this fall and next year, when Obama has said he hoped to overhaul the immigration system.
Obama has said he supports creating a pathway to citizenship for the estimated 12 million illegal immigrants in the U.S. But some say that his new restrictive policy violates the spirit of that old pledge.
“It’s a contradiction in terms,” Gutierrez said, “to say that people live in the shadows, that they live in a constant state of exploitation — and then to push public policy that simply pushes them further into the shadows, further onto the periphery of society.”
peter.wallsten@latimes.com
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By admin | October 31, 2009
By Mark Schmitt, The American Prospect
Posted on October 31, 2009, Printed on October 31, 2009
http://www.alternet.org/story/143575/
American presidents have tried seven times to bring us into the community of nations that provide health care to all citizens. Seven times the effort failed. More accurately, it was blocked. In the 1940s, the anti-reform movement was led by doctors, through the American Medical Association. In the 1990s, it was led by the insurance and small-business lobbies.
This time everything has been different. The town hall meetings and right-wing distortions of this summer drew attention away from a far more significant fact: Most of the traditional enemies of reform have been quiet, absent, or divided. Many — including the conservative American Medical Association — are almost supportive of reform. Large and small businesses understand that reducing their health-care costs and making them predictable will be good for their bottom line, and the chief lobbyist for the U.S. Chamber of Commerce, Bruce Josten, has said, “The reality with the business community is that we want reform.” Even the National Federation of Independent Business, which took the lead in opposing reform in the Clinton years, now participates in some pro-reform coalitions. And while insurance companies have much to lose from legislation that includes a public option and tight regulations, many large insurers know that they can survive and thrive when every American purchases insurance.
Still, new obstacles emerged to take their place. Some, like the traditional opponents, fought the legislative battle, using public fear and political manipulation to try to stop the bill from passing or to influence it so it fails to achieve the goal of universal coverage. Other obstacles will not fully emerge until a health-reform bill becomes law. The bill that is coming together as of this writing is a product of delicate and complex maneuvering around not only the outright opponents of reform but also around the fallout from choices made earlier in the game by supporters of reform. The course taken around those obstacles will define the legislation and its ultimate direction. Will it lead to universal coverage? Will it reduce costs and bring insurance companies under control? Or will it do too little and create the wrong incentives? Worst of all, will it lead to a public backlash, like the one that led to the abrupt repeal of catastrophic care for seniors in 1989?
Those questions won’t be answered on the day that President Barack Obama signs a bill. His signing ceremony will be just one momentous step along the road to universal coverage. The forces that seek to undercut the promise of reform will still have plenty of room to maneuver. And the choices made by reformers will still define the path of what’s possible, for better or worse.
Unhinged Republicans
Before the 1994 health-care battle, William Kristol wrote a legendary memo advising Republicans to block everything that had to do with reform — but not everyone stayed on message. Moderate Republicans participated in the process because they did not want to be seen as obstructing a popular reform, and a bipartisan group of senators came surprisingly close to agreeing on a bill.
In the current episode, however, Republican legislators have been almost unanimous in taking Kristol’s advice. Claims from critics like the long-discredited Betsy McCaughey that the legislation would create “death panels” moved smoothly into the GOP bloodstream and became arguments not just to delete the elusive offending provision but to kill the entire bill. Even the small-business and insurance lobbyists have been more cooperative than the party they bankroll. The result of opting out of the legislative process is that Republicans have sacrificed the opportunity to craft the bill, and if they fail to block it, they have one option: Incite a backlash.
And that is not a far-fetched option. One of the great advantages of broadly bipartisan legislation is that, with both parties invested in it, neither can exploit a backlash. But if there is even a single moment of hesitation about the costs, slow implementation, or some unintended consequence, the GOP will aggressively remind voters of the “Democrat bill.” While the conventional wisdom — assumed by the Kristol strategy — is that health reform will be a lasting political victory for Democrats, there is still potential for trouble after the initial glow wears off.
Diffident Democrats
While Republicans bowed out of the health-reform game, the fear they stoked infected key Democrats, most notably Senate Finance Committee Chair Max Baucus of Montana. Baucus and his colleagues like Bill Nelson of Florida or Blanche Lincoln of Arkansas have never needed an excuse to avoid all political risk (even though they won their last elections with an average of 63 percent of the vote), but the Republican fear campaign about Medicare cuts, “death panels,” and government takeover sent Baucus and his ilk fluttering to safety, opposing strong versions of the public option and weakening the bill in other ways. Some of these Democrats are conservative “Blue Dogs,” but more often they seem driven less by ideology than by a conditioned response to the Reagan-Gingrich years and have resumed old patterns of learned helplessness.
Even that may be giving them too much credit. While the Republicans are actually doing few favors for their lobbyist allies, the Democrats causing the most difficulty often seem to be the most deeply embedded in the culture of influence. A recent study by the Sunlight Foundation, for example, found five former Baucus staffers lobbying for 27 different companies with interests in the bill.
Deficit Hawks
The recession and the urgent need for fiscal stimulus created a brief moment when we genuinely didn’t have to worry about the federal budget deficit. The Obama administration embraced the view, promulgated by Peter Orszag when he was head of the Congressional Budget Office, that the fiscal problem is a health-care problem and that over-hauling the entire system is the only way to bring the costs of Medicare and Medicaid (the entitlement programs driving the long-term deficit) under control.
By late summer, both ideas seemed to be fading away. The economic stimulus and other costs had set us on a path toward annual deficits in the trillion-dollar range that even most liberals recognize as unsustainable, and Orszag’s successor at the CBO, Doug Elmendorf, in his critical role of “scoring” the legislative proposals, was much more hesitant to embrace the idea that health reform creates savings. Meanwhile, the well-funded fiscal-responsibility lobby has been insistent that health reform not add to the deficit. There are savings possible in Medicare without reducing services, but the mere mention of changing Medicare created an opening for Republicans to stoke fear among the elderly.
As a result, the political obligation to satisfy deficit hawks like Sen. Kent Conrad, together with the diffident Democrats’ fear of even painless Medicare cuts, forced the legislation through the eye of a very small needle.
Deal-Makers
As George W. Bush loved to say, “I’m not going to negotiate with myself.” Long before the health-reform debate began, progressives began to make a series of negotiations with ourselves and with interest groups. The deals were probably necessary, and some were brilliant, but each came at a cost.
The first and savviest deal, embraced by all the major Democratic presidential candidates in 2008 and the main pro-reform coalition, Health Care for America Now, was to push not for single-payer health care but for a “public option” in a system of regulated private insurance. Candidate John Edwards promised that a well-designed public option might eventually become the main source of health insurance for Americans, a de facto single-payer system. That hope drew most of the single-payer constituency to the public option, even though the vision of a public plan that covers most Americans has long been abandoned.
What if single-payer advocates had stuck to their guns and then fallen back on the public option as a compromise? That’s a question progressives have been asking themselves all year. The answer is probably that the single-payer advocates would have been marginalized and left without much leverage, as was the case in 1993. This deal may have been necessary for reform, but it nonetheless limits the possibilities.
Other deals cut by the White House helped placate the pharmaceutical companies, hospitals, and doctors. Each compromise with lobbyists limited Congress’ freedom to craft a bill that might be more appealing to voters or expand coverage at a lower cost. The deals did successfully keep the old enemies of reform at bay. But as health reform moves toward implementation, the cost of making these deals will be undeniable.
Historians
Although a child born during the last health-reform fight would now be preparing for her SATs, the lessons of 1993 and 1994 loom over the current debate. Don’t write the bill in the White House. Don’t be too complicated. And above all, don’t mess with what people already have. Not surprisingly, it was Hillary Clinton, as a candidate in 2007, who set the tone — if you like the plan you have, you’ll get to keep it. Obama and the other candidates followed suit, and that promise — nothing will change, and you have nothing to fear if you are already insured — has become the one pillar of reform.
Like the deals, that assurance was probably necessary. Health-policy wonks often forget how closely fear is associated with health care and insurance. And as behavioral economics shows, people’s fear of losing what they have, even if it’s inadequate, outweighs the value they place on getting something better. But the promise that nothing will change creates a perception that reform benefits only the uninsured — it’s a program for “them,” not “us.” Members of the insured majority, then, bear the cost but see no benefit. The assurance that nothing will change excluded some of the most promising approaches to reform, notably those that would end employer-based health insurance completely.
It’s also a false promise. Any major change in health-insurance markets is likely to ripple through the entire system. And insurance changes in dramatic ways of its own accord — within a few years after the failure of the Clinton plan, the HMO revolution had achieved much of the cost reduction proposed in that plan. If voters take the promise that “nothing will change” too seriously, there is further risk of a backlash, because things will change.
A Caveat: Some things are just difficult! While some of the obstacles to reform can be given names and faces, probably the biggest barrier to a better health-care system is a bit more mundane: Reform is just inherently difficult. Implementation will take years and during that time, may be derailed by economic or political shifts. The quest to provide every American with decent health care will continue for years, if not decades, even if 2009 turns out to be the turning point in this long history.
Mark Schmitt is the executive editor of The American Prospect.
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