What’s In It for Me?


Dave Mann

Here’s an exercise: Go to your local supermarket, stop 10 people—any 10 people—in the store and ask them how national health care reform, if it were passed by Congress, would affect their lives. You’d get some odd looks and some rambling answers. But I doubt more than one person out of 10 could explain what the proposed Senate or House bills would actually do to the health care system or whether he or she would benefit.

This is a major problem with the health care debate: The public doesn’t know what the bills would do.

For this, I blame the White House and Democrats in Congress, neither of whom have made an effective case for reform or made enough of an effort to explain the reform plans to an apathetic public. I also blame the media.

The health care debate has been one distraction after another. Much of the reporting has centered on ludicrous distortions like death panels or supposed cuts to Medicare services (neither of which are really in the bills). The media and elected officials also seem obsessed with the politics of health care reform. I bet a lot more people in the supermarket could tell you what happened in the Massachusetts senate election than could explain how many uninsured Americans would be covered under the reform plan (about 30 million).

Now health care reform is enduring a near-death experience. Polls find that only 42 percent of Americans support the proposals. But—as the Kaiser Family Foundation recently found out—when survey respondents are asked about specific parts of the bills, they’re overwhelmingly in favor. A huge majority of Americans support eliminating pre-existing conditions, covering the uninsured, extending the life of Medicare, creating health insurance exchanges and other provisions.

The main question for many Americans—myself included—is: Will the reform plans improve my health care?

So let’s look at how the reform proposals, if enacted, would benefit specific groups of Texans. (I’ve taken the following data on the nonprofit Center for Public Policy Priorities’ health care policy page. Go here for more details.)

If the current bills are passed:

1. All co-pays for immunizations, doctor visits for kids and teens, and well-woman exams would be banned. Many Texans would have no more out-of-pocket expenses for preventive care. (This provision takes effect six months after the bill is signed.)

2. Parents could keep their kids on their health plans up to age 27. This is a huge change. If you’re 24 years old and uninsured, your parents could immediately insure you through their policies. Are you hearing this recent UT grads?

3. The so-called “donut hole” in the Medicare prescription drug benefit would be closed. Older Texans on Medicare who are still struggling to afford their medications would see an immediate benefit.

4. The government would provide assistance to buy health insurance. The bills would offer subsidies to middle-class individuals and families (those earning 400 percent of the poverty level or less—about $88,000 a year for a family of four.) About six million uninsured Texans would qualify for help, according to CPPP.  (Six million people—that’s the populations of Houston and Dallas combined). If you’re a single Texan earning $30,000 a year, you would receive some cash assistance to buy insurance. This provision would take effect by 2014.

5. Expand Medicaid to cover the poorest families. This would provide insurance to about one million Texans who are currently uninsured, according to CPPP. (Texas has a miserly Medicaid program that doesn’t cover many adults, leaving some of the poorest Texans uninsured.) If you’re earning $14,000 a year or less, you would be covered.

6. By 2014, insurance companies could no longer deny coverage based on pre-existing conditions. So, if you know someone who’s uninsured (or underinsured) and was diagnosed with, say, skin cancer—and I use this example because someone i know was in a similar situation—then that person couldn’t be denied coverage.

That’s just a sampling. There are many other provisions in the bills, of course. (For instance: Changes to Medicare that would reduce the nation’s debt; out-of-pocket spending caps that would help prevent medical bankruptcies.)

But there’s no doubt that—despite claims to the contrary from some statewide officials—health care reform would help millions of Texans lead healthier lives.