There has not been a national issue in recent memory that will have the widespread impact, or hit closer to home than health care reform. For those of us with disabilities, access to quality, affordable healthcare can mean the difference between a life full of possibilities and one full of problems.
Three words: “accessible,” “quality” and “affordable” are at the center of this issue. Without all three in place, health care reform is not true reform. The goal is clear: affordable quality health care for everyone. The path to the goal is anything but clear. But it is important that we all do our best to understand this issue, and speak up about what we want to happen, because the result will affect each one of us.
Here is a coindensed look at the health care plans being debated in Congress, including the proposed bill recently passed by the House Energy and Commerce committee.
Who would be covered: Democratic bill: About 94 percent of the non-elderly population (those not covered by Medicare) would be covered, compared to 81 percent today. Republican proposal: Aims to make insurance affordable and accessible to all, but doesn’t estimate how many additional people would be covered.
What it would cost: Democratic bill: $1.5 Trillion over 10 years. Republican proposal: unknown.
How it’s paid for: Democratic bill: $544 billion from increased income taxes to the wealthy, $37 billion from new business tax increases, $500 billion in cuts to Medicare and Medicaid, and sizeable penalties paid by individuals and employers who don’t obtain coverage. Republican proposal: No new taxes are proposed, but Republicans say they want to reduce Medicare and Medicaid fraud.
Requirements for individuals: Democratic bill: Individual would have to have insurance, enforced through a tax penalty with hardship waivers. The penalty would be 2.5 percent of income. Republican proposal: no mandates.
Requirements for employers: Democratic bill: Employers would have to provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies under $250,000 payroll are exempt. Republican proposal: No mandates. Small business tax credits would be offered.
Subsidies: Democratic bill: Individuals and families with annual income up to 400 percent of poverty level ($88,000 for a family of four) would get sliding scale subsidies to help them buy coverage. The subsidies would begin in 2013. Republican proposal: Tax credits would be offered to “low” and “modest” income Americans. People who buy their own insurance would be allowed to take a tax deduction. Low-income retirees under 65 (Medicare eligibility age) would be offered assistance.
How you’d choose your health insurance: Democratic bill: Through a new Health Insurance Exchange open to individuals and, initially small employers. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules. Republican proposal: No new purchasing exchange or marketplace is proposed. Health savings accounts and flexible spending plans would be strengthened.
Benefits Package: Democratic bill: A committee would recommend an “essential benefits package” including preventive services, mental health services, oral heath and vision for children; out-of pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange and over time would become the minimum quality standard for employer plans. Insurers wouldn’t be able to deny coverage based on pre-existing conditions. Republican proposal: Insurers would have to allow children to stay on their parents’ plan through age 25.
Government-run plan: Democratic bill: A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services. Democrats originally designed the plan to pay Medicare rates plus 5 percent to doctors, but under a recent deal with the fiscal conservatives, the HHS secretary would instead negotiate rates with providers. Republican proposal: No government run plan.
Changes to Medicaid: Democratic bill: The federal-state insurance program for the poor would be expanded starting in 2013 to cover all non-elderly individuals with incomes up to 133 percent of the federal poverty level ($14,404). Republican proposal: People eligible for Medicaid would be allowed to use the value of their benefit to purchase a private plan.
Drugs: Democratic bill: Would grant 12 years of market protection to high-tech drugs used to combat cancer, Parkinson’s and other deadly diseases. Republican proposal: no proposal made.
The measure described above is designed to extend health insurance to millions who now lack it, while at the same time it strives to slow the growth in medical costs nationwide – President Obama’s twin goals. As of this writing, the full House had yet to vote on the bill, which would then have to be passed by the Senate before going to the President to be signed into law.
How much of the above becomes reality remains to be seen. For people with disabilities, the outcome is critical. Proponents of health care reform want change now, and hope Congress will produce approved legislation by the fall of 2009. Those who disagree with the sweeping changes would prefer to delay the changes detailed above.
There is little disagreement that our country’s health care system must change in order to provide quality, affordable care to those who need it the most. We all have a stake in it, and we all need to let our elected officials know where we stand. Get informed. Speak up. Call your members of Congress to make sure they follow through.
Here are three websites where you can get information (and different viewpoints) on health care reform from President Obama, The New York Times and CNN.
