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What You Should Know About Health Care Reform: Two Views

What do people need to know about how this health reform bill will — and won’t — affect them? What should people be thinking about now?

Gail Wilensky

Senior Fellow, Project HOPE Foundation; Former Director of Medicare and Medicaid during the George H.W. Bush administration

Many people who are uninsured report believing that they will get coverage within the next year. Unfortunately for them, most will not until 2014 when the Mediciaid expansion goes into effect as well as the subsidies to purchase insurance in the state-run health insurance exchanges.

While there are some benefits that will be available in the interim, such as no pre-existing condition exclusions for children, dependent coverage offered to unmarried working individuals under the age of 26 and the elimination of rescissions (except for fraud) and lifetime limits, these provisions will only affect a relatively small percentage of the under-65 population.

Furthermore, most of what occurs in the insurance reforms will only increase costs — particularly in the short run — as will the various excise taxes on pharmaceuticals, medical devices and insurance companies. This will also come as an unpleasant surprise and could lead to calls for yet more regulation — which may not bother some in the Congress that are inclined in this direction.

The high-risk pool is a real short-term benefit for people who are not able to get insurance because of a major medical problem. The $5 billion is not nearly enough to last until early 2014 but will be an important help to those who qualify.

Those who do get Medicaid when it is expanded may find it exceedingly difficult to get access to physicians. Medicaid is already reporting increased access problems. Opening up the program to an additional 16 million will make this more problematic — even with the increase in payments to Medicare rates for primary care physicians.

Finally, it would be worth noting that there will surely be many unintended consequences. It is impossible for that not to have happen in legislation that is as complex as the health care reform legislation. We are at best at health care reform, version 1.0.

Karen Davis

President, The Commonwealth Fund

There’s no question that the historic action by the House of Representatives in passing comprehensive health reform legislation will usher in a new era in American health care — one in which all Americans will be able get the care they need, without incurring financial hardship, and no American will be denied health insurance coverage simply because they have a pre-existing medical condition.

The real question is why it has taken this nation so long to reach this moment. Health reform will cover an additional 32 million people, ensure essential benefits for all, and make both medical bills and health insurance premiums affordable for working families. It will increase access to needed care for uninsured and underinsured people, improve prescription drug benefits and preventive care for Medicare beneficiaries, and help workers finance long-term care should they become disabled or frail. And it will do so in a way that does not add to the federal budget deficit or accelerate the growth in health care spending.

The Congressional Budget Office estimates that health reform, as passed by the House of Representatives, will reduce the federal deficit by $143 billion over 2010-2019. Congress is making the tough choices to both achieve savings of about $500 billion in the current federal budget over the next 10 years, and raise the revenues needed to finance the balance of the federal budget cost of this important reform.

Commonwealth Fund estimates indicate that total health spending will slow under this reform — from a 6.6 percent annual rate of increase to less than 6 percent. Employers and workers will also realize savings. Health insurance premiums will be reviewed — preventing increases of 20 to 40 percent that have recently been proposed by insurance companies. Reform will save the average American family $2,500 in 2019.

Most importantly, the legislation will put the U.S. health system on a path to high performance, by providing for the testing of new ways of paying doctors and hospitals to reward results rather than fees based on the volume of services delivered and for the development of strategies to promote prevention and improve quality. An Independent Payment Advisory Board will be established and charged with issuing recommendations to achieve federal health spending targets, as well as non-binding recommendations for private payers to harmonize private and public payment and achieve system-wide savings.

The U.S. will now join all other major industrialized countries with a system for ensuring access to essential health care, and lay the foundation for a high performance health system that yields access to care for all, improved quality, and greater efficiency. It is a victory for all Americans who deserve the finest health system in the world.