Truth2 About Reform2 22 10

The Truth About Health Reform: It’s Up To Us Ellen R. Shaffer PhD MPH Joe Brenner MA EQUAL/Center for Policy Analysis www.centerforpolicyanalysis.org 415-922-6204 [email_address] February, 2010 February, 2010 EQUAL/ Center for Policy Analysis

Table of Contents
Introduction: We Need Reform; It’s Up To Us!
Health Care Costs
Lack of Insurance
We Have to Cover Everyone to Control Costs!
Politics of Reform
Obstacles to Reform
Reform Proposals: What’s On the Table
Single Payer: Keep Fighting
Keep Fighting: For Affordability, Abortion, Access

Countdown to Health Reform
Congress is closer to passing substantial health reform than at any time since 1965
Pending proposals take important incremental steps to expand coverage, improve quality, and begin to control costs
President Obama will debate Republicans on Feb. 25
February, 2010 EQUAL/ Center for Policy Analysis

Congress and the Public Stalemated
Many have legitimate reservations about the bills
These provisions can and must be fixed
The health insurance industry and their political allies want to stop reform
They can and must be opposed

Many are Misinformed Many are Uninformed February, 2010 EQUAL/ Center for Policy Analysis

The Public Must Step Up
The House and Senate disagree
The White House has not galvanized a movement
Everyone agrees someone should do something
It’s up to the public to step up

The Truth About Health Reform
The Problems
Cost, Access, Quality
Financing, Organization, Delivery
Health Care and Health
Why Insurance Doesn’t Work
The Politics of Reform
The Proposals: House and Senate
Keep Fighting for Single Payer
Fix It and Pass It!

What Is EQUAL? February, 2010 EQUAL/ Center for Policy Analysis

EQUAL Partners
E quitable, Q uality, U niversal, A ffordab l e health care
Center for Policy Analysis, anchor organization
Rekindling Reform, NY
California Public Health Association-North
California Women’s Agenda
Older Women’s League
Links:
Unitarian Universalist Legislative Ministry of Calif.
American Medical Women’s Association
National Women’s Health Network/Raising Women’s Voices
Congressional Progressive Caucus Inside-Outside Group

Activities
Forum, Oct. 2008
Policy Statements 2009
First 100 Days Health Agenda
Women’s Health
APHA Policy – Medical Care, CHPPD
Presentations
Conference calls
Radio Series - KPFA

The Truth About Health Reform Executive Summary February, 2010 EQUAL/ Center for Policy Analysis

Crisis in Costs, Access, Quality
$2.5 trillion a year
Health care inflation growing faster than economy
45 million uninsured
Outcomes in U.S. worse than countries with universal coverage
U.S. companies and workers: constraint on competitiveness

Health Care in the U.S.
Progress
Advances in science and technology
Social change: inclusion of women, people of color, patients’ perspectives
Financing, Delivery system, have not kept pace
Role of Government - controversial

The Problems: Financing, Organization, Delivery
Fragmented financing
Maze of public and private payment systems
No guarantee of coverage for most people
Profit motive for a public good
Drives fragmented delivery system
Complex, hierarchical
Too much acute care, not enough primary care
Little coordination among health care providers
No match between where health care needed and where available

Losing Primary Care: February, 2010 EQUAL/ Center for Policy Analysis Shortages in pediatrics, internal medicine and family medicine. Decreased access to geriatricians and gynecologists.

Focus on Health Care vs. Health
Money is concentrated on health care vs. public health
Improvements in health, increased life span in 20 th Century, related to
Environment – clean air, water, housing
Social and economic equality
Education
Economic wellbeing
Democratic participation, control over life circumstances

Structural Obstacles to Health
Social and economic inequalities undermine individual/community health
Economic policies
Low income, unstable economy, multiple jobs/unemployment
Suburban sprawl and design discourage exercise
Food & agriculture policies encourage poor diets
Reduced social spending, education
Reduced democratic participation, community
Health Consequences
Stress, incidence and poor management of chronic diseases, tobacco use, violence

Private Vs. Social Insurance
We have to cover everyone to save money.
Private insurance has failed as a mechanism to assure coverage for health care or to control costs.
Social insurance programs through the government are much more successful.

Politics of Reform
Entrenched interests and appeals to ideology have successfully blocked reform for decades.
The incremental proposals on the table are a step forward but not a final solution.

Health Care Costs Too Much February, 2010 EQUAL/ Center for Policy Analysis

Health Care is Big Business $2.5 Trillion A Year February, 2010 EQUAL/ Center for Policy Analysis

Distribution of National Health Expenditures, by Type of Service, 2008 February, 2010 EQUAL/ Center for Policy Analysis Note: Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc. Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http:// www.cms.hhs.gov/NationalHealthExpendData / (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).

Relative Contributions of Different Types of Health Services to Total Growth in National Health Expenditures, 1998-2008 February, 2010 EQUAL/ Center for Policy Analysis Notes: Percentages may not total 100% due to rounding. Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc. Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http:// www.cms.hhs.gov/NationalHealthExpendData / (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).

Total Health Expenditures Per Capita, U.S. and Selected Countries, 2003 February, 2010 EQUAL/ Center for Policy Analysis

* 2008 and 2009 NHE projections. .Source: K. Davis, Why Health Reform Must Counter the Rising Costs of Health Insurance Premiums, (New York: The Commonwealth Fund, Aug. 2009). Insurance Premiums Rising Faster Than Workers’ Earnings 2000–2009 Percent 108% 32% 24%

Premium as % of Median Family Income, 2008–2020 February, 2010 EQUAL/ Center for Policy Analysis Percent Projected

Health and Welfare Expenditures, General Fund, All K-12 Districts and County Offices of Education, California 1999 – 2008 February, 2010 EQUAL/ Center for Policy Analysis

February, 2010 EQUAL/ Center for Policy Analysis Notes: Percentages may not total 100% due to rounding. Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http:// www.cms.hhs.gov/NationalHealthExpendData / (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip). Distribution of National Prescription Drug Expenditures by Source of Payment, 1998-2008 Private Insurance Consumer Out-of-Pocket Payments Public Funds

Private Health Insurance Administrative Costs per Person Covered, 1986-2008 February, 2010 EQUAL/ Center for Policy Analysis Notes: These data show the net cost of private health insurance per private enrollee (including Blue Cross/Blue Shield, commercial insurance, HMOs, and self-insured plans), as calculated by the Centers for Medicare and Medicaid Services. Net cost of insurance is the difference between premiums earned and benefits incurred, and includes insurers’ costs of paying bills, advertising, sales commissions, and other administrative costs; net additions/subtractions from reserves; rate credits and dividends; premium taxes; and profits or losses. Private enrollment is estimated by CMS using the National Health Insurance Survey and the Current Population Survey. Source: Kaiser Family Foundation calculations NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http:// www.cms.hhs.gov/NationalHealthExpendData / (see Historical; National Expenditures by type of service and source of funds, CY1960-2008, file nhe2008.zip, Admin.& Net Cost of Priv. Hlth Insurance, Pvt Health Insurance); and private health insurance enrollment data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, Table 4 at http://www.cms.hhs.gov/NationalHealthExpendData/downloads/bhg08.pdf .

Number of Uninsured Growing February, 2010 EQUAL/ Center for Policy Analysis

February, 2010 EQUAL/ Center for Policy Analysis New York Times

Health Care in California
6.6 million uninsured in 2006 = 20 % of non-elderly population
763,000 children uninsured
300,000 significantly at risk for losing their coverage
Health care spending grows two to three times faster than California's economy
Health insurance premiums grow significantly faster than overall health care spending
- source: SB 810

Quality of Care: People Suffer and Die Because of Our Cruel and Unfair System February, 2010 EQUAL/ Center for Policy Analysis

Uninsured: Dying from a Toothache in the U.S. February, 2010 EQUAL/ Center for Policy Analysis A man in his early 20s with a worsening dental infection was unable to afford a dentist. He finally saw a physician who prescribed an antibiotic, but the patient was unable to pay for the prescription. He came to our clinic when the infection had spread to his chest. He died soon after admission. The egregious is commonplace in our non-system. JAMAVol. 286 No. 20, November 28, 2001"Within the System of No-System," Robert L. Ferrer, MD, MPH

Quality/Outcomes
Infant Mortality: 29th in world
Life Expectancy: 78 yrs. (Below other developed nations )
Cancer/Cardiovascular disease rates: Canada, England, most European countries are better
Preventable Hospital Deaths: 100,000/yr.

Potential Years of Life Lost Due to Diabetes per 100,000 Population, 2006 February, 2010 EQUAL/ Center for Policy Analysis *2005 **2004 Data: OECD Health Data 2008 (June 2008).

Mortality Amenable to Health Care: U.S. Failing to Keep Pace with Other Countries Deaths per 100,000 population* * Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections. Data: E. Nolte and C. M. McKee, London School of Hygiene and Tropical Medicine analysis of World Health Organization mortality files (Nolte and McKee, Health Affairs 2008). Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008. Exhibit 2

Lack of Insurance and Mortality
45,000 excess deaths a year are associated with lack of insurance

66% of personal bankruptcies are due to medical debt February, 2010 EQUAL/ Center for Policy Analysis

February, 2010 EQUAL/ Center for Policy Analysis Copyright ©2008 American Cancer Society From Ward, E. et al. CA Cancer J Clin 2008;58:9-31. Uninsured Rates Among Adults Aged 19 to 64 Years by Income Level, 2001 to 2005 LOW INCOME MORE LIKELY UNINSURED

Race, Class, Insurance and Health February, 2010 EQUAL/ Center for Policy Analysis

February, 2010 EQUAL/ Center for Policy Analysis Copyright ©2008 American Cancer Society From Ward, E. et al. CA Cancer J Clin 2008;58:9-31. Breast Cancer: Blacks and Hispanics Diagnosed Later, More Likely Uninsured

February, 2010 EQUAL/ Center for Policy Analysis Copyright ©2008 American Cancer Society From Ward, E. et al. CA Cancer J Clin 2008;58:9-31. Colorectal Cancer Stage Distribution by Race and Insurance Status

February, 2010 EQUAL/ Center for Policy Analysis Copyright restrictions may apply. Haider, A. H. et al. Arch Surg 2008;143:945-949. Adjusted odds of mortality by race and insurance status (n = 311 503 )

We Pay More But Don’t Get More
Higher costs are related to intensity of care
Higher costs are not related to better outcomes

Variations in Cost/Quality
Regions experience different per capita costs
High-cost areas pay 30% more than low-cost areas
Costs are unrelated to health, wealth, outcome
Two determinants of costs:
Supply of providers
Medical decisions/culture

Amazing Fact #1 We Must Cover Everyone To Control Costs (Huh?)

The Costs of Fragmented Coverage
Illnesses and accidents are predictable for large groups over time
But unpredictable for small groups in any year
Problems for small groups
A single catastrophic illness can wipe out funds

Insurance, Access, Costs
Private for-profit insurance companies face incentives to avoid spending premiums
Identify and avoid “risky” patients
Exclude pre-existing conditions
Insurance companies run up administrative costs to avoid “expensive” enrollees (sick people)

Employment-Based Insurance
The U.S. is the only country where most people get health care coverage through work
But there is no requirement for employers to offer or pay for coverage!!!
Large employers: 96% offer
Small employers: 43% offer
(fewer than 50 employees)
Principles of insurance
Cover everyone at risk = Affordability
If not, assume only those at risk will buy = Not affordable

New York Times

Amazing Fact #1 We Must Cover Everyone To Control Costs (Oh!)

(How Did We Get Here? U.S. Path to Private Insurance)
Began in 1930s/Depression
Communities pooled funds in nonprofits to help pay for health care
Continued as tax-free benefit during WWII
Other countries turned to government-financed social insurance, or combined with heavily regulated nonprofit insurance
U.S. medical societies, businesses, and insurance companies opposed these trends

Private Insurance Has Failed Government Plans are More Successful February, 2010 EQUAL/ Center for Policy Analysis

Free Market Cannot Control Costs
Doctors, hospitals, drug companies try to get highest price for best care
Payers try to pay lowest price for best care
Individual patients
Employers
Insurance companies
Government

Why Doesn’t It Work?
Individual patients
Don’t know what care we need, rely on providers
Vulnerable when sick, can’t negotiate
Prices not transparent
Employers
Only cover a small percent of “covered lives”
Part of fragmentation problem
Insurance companies
Generally not big enough to negotiate lower prices with hospital chains, drug companies
If successful, keep savings for profits, other costs
Not sufficiently regulated

Administrative Barriers
Multiplicity of protocols, formularies complicate medical decision-making
Insufficient regulation
Unclear fine print -- not standardized, unknown coverage
State rules can set benefit levels, some standards
Need federal agency with staff and clout to assure accountability

Prevention
Incentives for prevention are undermined
Employer who pays for prevention may not still be the employer in 5 years

Government Can Do It
Big enough to negotiate with drug companies and hospital chains
No profit motive
But now covers less than half the population

Government Successes
Medicare
Veterans Administration
Community Health Centers
Hawaii

Medicare
Popular federal government program covers population over age 65
From 1997 to 2007, Medicare’s cost per beneficiary rose on average 4.4% per year
Private insurance premiums increased by 7.4% per year—a 30% difference over the full 10 years.
Http://www.cms.hhs.gov/nationalhealthexpenddata/downloads/tables.pdf (see table 13)

Hawaiian Health Care System
The Daily Show, Feb. 11, 2010
“ Hawaiians have government-mandated health care and they love it.”
“ We’ve been doing it this way for 40 years.”
Dog the Bounty-Hunter supports Hawaiian health care.
http://www.thedailyshow.com/watch/thu-february-11-2010/the-apparent-trap/

Health Reform Is A Political Challenge February, 2010 EQUAL/ Center for Policy Analysis

Tough Road February, 2010 EQUAL/ Center for Policy Analysis

Some Victories
1965 – Johnson: Medicare, Medicaid
1994 – Clinton: State Children’s Health Insurance Program (SCHIP)

$2.5 Trillion: Spending or Income ? Industry Opposes Income Constraints February, 2010 EQUAL/ Center for Policy Analysis Spending Income Individuals Insurance Industry Employers Pharmaceutical Co.s Governments Hospitals, Physicians

Controlling Costs Means Reducing Income
Effective cost control would improve access and quality
But it involves reducing payments to the health care industry
Provokes political opposition
Political leadership needed to galvanize reform

Politics in 2008: Auspicious February, 2010 EQUAL/ Center for Policy Analysis

Politics in 2010: Challenging February, 2010 EQUAL/ Center for Policy Analysis

Economic Collapse – But Corporations Still In Charge February, 2010 EQUAL/ Center for Policy Analysis

Social institutions weakened: labor, women, civil society - ++Faith Community, online networks growing ++ February, 2010 EQUAL/ Center for Policy Analysis

Corporate media February, 2010 EQUAL/ Center for Policy Analysis

Reform Opponents Just Say No To Stop Reform
Better ideas not necessary
Scare tactics: “government bureaucrats,” “socialism,” “rationing,” “class warfare,” “death panels”
Racial backlash
Immigrants backlash
Political backlash

What Health Reform Bills Do February, 2010 EQUAL/ Center for Policy Analysis

House and Senate Passed Different Bills
House bill generally more affordable, better safeguards for public, costs

Summary of Changes: Coverage, Affordability, Insurance Reform
Coverage
Low Income people: Medicaid expansion
To 150% of poverty (House) or 133% (Senate)
Employed people: Individual and employer mandates
Self-Employed/Small Businesses: Insurance Exchange
? PUBLIC OPTION ? 2013 (House bill) ? 2014 ? (Senate)
Children to age 26 (27) (House/Senate)
Affordability
Premium subsidies related to income
Limits on out-of-pocket costs
No lifetime maximums on cost of care

Coverage
Medicaid: Covers everyone up to 150% of poverty (House)
15 million would be newly covered
Employed people: Individuals and employer mandates
150 million already covered
For the first time, employers required to contribute
Self-Employed/Small Business:
Access to a new Insurance Exchange
21 to 26 million would be newly covered
? PUBLIC OPTION ? 2013 ? 2014 ?

For Those Insured Now: More Secure Coverage
Standards for employment-based insurance
Medicare improved, protected

Insurance Exchanges
Offer regulated plans to everyone without another source of coverage
House version
National exchange negotiates contracts, enforces insurance reforms
Reviews/rejects excess premiums

The Public Option
Gives enrollees choice of a publicly administered program like Medicare
Changes insurance
Health care providers (MDs, nurses, hospitals): No change
Still private or public, as they are now
Politically popular despite massive opposition by private insurance industry
Critical to improve access, affordability

Insurance Reforms: Curbs Insurance Co. Abuses
No denials of coverage: Pre-existing condition exclusions prohibited
Rescissions prohibited
Gender-rating prohibited
Age-rating limited
Administrative costs limited

Insurance Reform: Denials of Care Addressed
20% of claims denied now in California
Rescissions
Means coverage revoked for a person or a treatment
Technically would be prohibited
Still allowed in the case of “fraud or misrepresentation”
A PUBLIC OPTION would have no incentive to deny legitimate claims
Need regulation by Federal Trade Commission (revoke anti-trust exemption)

Now: Women Can Pay More Example: Kaiser Permanente monthly premiums 2010 February, 2010 EQUAL/ Center for Policy Analysis Age Male Female Difference 19-24 $260 $273 5.0% 25-29 $292 $306 4.8% 30-34 326 342 4.9% 40-44 354 372 5.1% 45-49 418 439 5.0% 50-54 476 499 4.8% 55-59 559 559 0 60-64 628 598 -4.8%

Gender Discrimination In Premium Rates Would Be Prohibited February, 2010 EQUAL/ Center for Policy Analysis

Oldest Compared to Youngest: 215% Example: Kaiser Monthly Premium 2010 February, 2010 EQUAL/ Center for Policy Analysis Age Male Female Difference 19-24 $260 273 25-29 292 306 30-34 326 342 40-44 354 372 45-49 418 439 50-54 476 499 55-59 559 $559 +215% (2:1)

Age Discrimination In Premium Rates Would be Permitted but Limited
House bill: 2:1
Senate bill: 3:1
Interim: 4:1
(high risk pool)

What is it going to cost? February, 2010 EQUAL/ Center for Policy Analysis

Affordability: Individuals
Individuals and employers required to pay
Same as all other countries
Premiums
More affordable than now
Absolute limit on plans sold thru Exchange
Still a big concern
Can still be a stretch for some
PUBLIC OPTION would provide choice and bargaining clout

New: Insurance Exchange -- House Bill Example: 4-person family at 200% FPL ($44,000) February, 2010 EQUAL/ Center for Policy Analysis House Senate Premiums $2400 $2772 % Income 5.5% 6.3% OOP Cap $2000 $4100 Max OOP $4400 $6872 Max % Income 10% 15%

Estimates by House TriCommittee Staff February, 2010 EQUAL/ Center for Policy Analysis

Affordability: Deficit Reduction 2010-2019 (CBO)
$132-138 B. (House)
$650B to $1.3 Trillion (Senate bill)
Spending per Medicare beneficiary:
Annual rate of increase (in real terms) cut in half, from 4% over last 2 decades to 2% in the future.

Quality, Cost Control
Primary care expanded
Prevention – no co-pays
Public health workforce expanded
Incentives for providers to practice in teams

What Happens to Medicare? February, 2010 EQUAL/ Center for Policy Analysis

Medicare Changes
Medicare Advantage
House: Eliminate/reduce overpayments
Senate: Competitive bidding
Both: Bonuses for Quality Improvements
Reduce/Reform provider payments
Disproportionate Share Hospital cuts
Control drug prices
House: Negotiate rates, Eliminate doughnut hole
Study geographic differences

Reconciling House and Senate Bills February, 2010 EQUAL/ Center for Policy Analysis

What Do We Need To Fix?
* The public option: our toe-hold on structural change.
Affordable coverage - Strong employer mandate.
House: Pay ~70% of premium, or pay 8% of payroll to Exchange
Senate: $750/year per employee
* Fair financing - Tax income, not hard-won benefits.
Immigrants’ inclusion: allow to purchase thru Exchange
* Accountability for insurance companies
A single national exchange
Eliminate anti-trust exemption – FTC regulation
* State options for innovative approaches

What to Fix
Abortion Coverage – Both bills retreat from current law
Immigrants’ inclusion: allow to purchase thru Exchange
State options for innovative approaches
Senate provision for Medicare waivers
Kucinich amendment: ERISA waiver
Employee Retirement Income Security Act (1974)

Process: Reconciliation
Move some items to reconciliation
Must be germane to the budget
Parliamentarian decides what’s included
House to vote on amendments to Senate bill
Then adopt Senate bill

How can we get a single payer plan in our state? February, 2010 EQUAL/ Center for Policy Analysis

Single Payer: What it Is and Why We Need to Fight For It
A government-sponsored system like Medicare
Everyone automatically covered, most cost efficient, contributes to social & economic equity, good outcomes…
Gives government the authority to constrain health care spending
Who could possibly object to that?

$2.5 Trillion: Spending or Income ? February, 2010 EQUAL/ Center for Policy Analysis Spending Income Individuals Insurance Industry Employers Pharmaceutical Co.s Governments Hospitals, Physicians

Build Momentum Now
A government-sponsored (single payer) system like Medicare would do a better job of controlling costs and covering everyone.
The insurance industry will continue to oppose single payer strongly at the state level.
A strong national bill will build momentum to rein in the industry and keep up the effort for state single payer systems.

Follow the Money State Campaign Contributions 2004-8
Health Industry TOTAL: $132,943,232
Pharmaceuticals
Hospitals & Health Systems
Health Insurance & HMO
Physician Practice Groups and Associations
Nursing Homes
http:// www.followthemoney.org/press/ReportView.phtml?r =408&ext=7&PHPSESSID=da58e785f999fd4ed54c448724038908#tableid7
Provides free online access to public records in all 50 states, to document political donor and lobbyist contributions to policymakers.

Health Insurance & HMO State Contributions 2004-8
Insurance companies $42,233,972
13% to ballot measures.
51% to Officeholders: $21.4 million
3rd top recipient: California Republican Party - $1.3 million
http:// www.followthemoney.org/press/ReportView.phtml?r =408&ext=7&PHPSESSID=da58e785f999fd4ed54c448724038908#tableid7

Reclaiming the Narrative: Democratic Process
Five separate congressional committees had hearings; each chamber had floor debates. That’s hundreds of hours the GOP had to talk about health care, all of it in public view and televised on C-SPAN. And that’s not even including all of the unofficial channels at the Republicans’ disposal. Generally speaking, the party of Rush Limbaugh and Fox Television doesn’t struggle to get across its message.
Jonathan Cohn, TNR

Republican Roadmap for America's Future
Convert Medicare to a voucher program
Reduce federal spending from 14% GDP to 4%
Rely on seniors to shop for cheaper care
Why Not?
Not enough money to pay for care!!!
Imperfect information re: price, quality
Vulnerable when sick – can’t bargain on price

Rely on Your Wits, or on Medicare?
If you simply reduce the money flowing into Medicare, relying only on the wits of beneficiaries to figure out how best to spend what’s left, seniors are bound to end up with less care. That's the Republican method.
But if you also introduce system-wide changes that reward more efficient care and force down provider prices, the dollars in the program really might go farther--so that spending less doesn't always mean getting less. That's the Democratic approach. - Jonathan Cohn, New Republic

The Republican Health Plan NY Times November 6, 2009
Here is the first thing you need to know: It would do almost nothing to reduce the scandalously high number of Americans who have no insurance. And it makes only a token stab at slowing the relentlessly rising costs of medical care.
Despite that, the Republicans are pitching their bill as far more affordable than the Democrats’ approach. But a lot of the Republicans’ savings on premiums come from reduced coverage. Pay less and get less.
Unless the White House and Congressional Democrats push back with the hard facts, the Republicans could use it to spread false hope of a “cheaper” alternative to scuttle real health care reform.

NY Times (cont’d) : Repub Plan
There’s no question that the Republicans’ bill is cheaper because it does so little to help the uninsured. According to the Congressional Budget Office, it would provide $61 billion over 10 years to expand coverage, compared with more than $1 trillion in the Democrats’ bill.
That paltry effort, the budget office estimates , would extend coverage to a few million people who would otherwise be uninsured in 2019, leaving 52 million citizens and legal residents below Medicare age without coverage or about 17 percent of that population, right where it is today. This is a dismaying abdication of responsibility.

Undermines Insurance Regulation
The Republican bill is an amalgam of market-oriented and state-based reforms that conservatives have long proposed, including enhancement of tax-sheltered accounts to help pay premiums and allowing people to buy insurance in other states that might permit skimpier benefits than their home state.
It has some good provisions, such as prohibiting insurers from imposing annual or lifetime caps on what they will pay and automatic enrollment of workers in employer-sponsored group coverage. But it would not prevent insurers from denying coverage or charging higher premiums based on pre-existing conditions.

What We Can Do February, 2010 EQUAL/ Center for Policy Analysis

SUMMING UP
Expanding coverage for health care is crucial
There is an historic chance to move forward
The bills need to be FIXED so that care is affordable and accessible
The bills need to be FIXED to protect abortion coverage and immigrants’ inclusion

SUMMING UP
It is up to us
These are the critical weeks
Opponents still want to kill the bill
It is the public’s job to express our will
It is our elected officials’ job to figure out how to do it

Who Needs to Hear From Us
Senate Majority Leader Harry Reid
Our Senators
President Obama
Speaker Pelosi
House Committee Chairs
Ed & Labor Chair George Miller
Ways & Means – Charlie Rangel, Pete Stark
Energy & Commerce Chair Henry Waxman

A million calls on February 24th and 25th!
Fix It and Pass It!
Call Congress and the White House on Feb. 24th and 25th, to make a HUGE push to fix the Senate bill via reconciliation and to pass it! We need to finish the job on health care reform.
http://www.centerforpolicyanalysis.org/id68.html

Employment Based Insurance
The U.S. is the only country where most people get health care coverage through work
But there is no requirement for employers to offer or pay for coverage!!!
Large employers: 96% Offer
Small employers: 43% Offer
(fewer than 50 employees)
Principles of insurance
Cover everyone at risk = Affordability
If not, assume only those at risk will buy = Not Affordable

Truth2 About Reform2 22 10

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