The House’s healthcare reform bill looks like it’ll cross the $1 trillion mark, according to the nonpartisan Congressional Budget Office. Many Democrats have promised a bill that would cost less, and initial CBO estimates agreed with them. However, they have since added billions more in funding health insurance for the retired, as well as more spending on public health and increased reimbursements for preventative care services. Some of these provisions are intended to garner more support from important populations, such as senior citizens. These modifications bring the estimated total of the bill to at least $1.2 trillion over ten years.

Breaking the trillion dollar threshold makes reform of the health insurance industry more difficult to achieve. Nancy Pelosi has previously claimed that the bill would cost about $900 billion; still a massive sum, but short of the trillion mark.  It seems to be a sort of psychological block, even among Democrats whom are otherwise supportive of the bill. The new CBO estimate is closer to Republicans’ claims of $1.3 trillion. The big question is whether it’s worth the price. Supporters would argue that the eventual savings from health insurance plans would allow the nation to pay off that debt in time (after all, America managed to pay off its decades-long national debt by the end of Bill Clinton’s second term), but others feel that it’s a pointless gamble.

With all the controversy over the public option proposed by Democrats in their healthcare reform bills, the number of Americans who will actually be covered by the public option is surprisingly low. Speaker of the House Nancy Pelosi estimates that just six million (2%)  of the population under 65 years of age will choose the government run health insurance program. One out of five individuals who are buying insurance on their own or in a small group (and will participate in the insurance exchanges central to the House’s bill. would take the public option. The most important issue that has been lost in the debate is providing affordable health insurance to the nation, whatever form it takes.

The public plan might not be the panacea to increased health care costs its supporters claim it will be. The people most likely to be attracted to it will be those with pre-existing conditions private insurers are less likely to cover. Therefore, average health insurance quotes would be cheaper with a private plan, steering the healthier segment of the population away from the public option. Less stringent regulations that allow the less healthy to use more medical services and see more specialists would also drive up costs. (Private insurance companies sometimes limit their offerings based on profitability.)

All in all, the public option doesn’t seem to be as far-reaching as first expected, at least for now. Most Americans will continue to have health coverage through their employers. Senior citizens already have Medicare. What about the masses of low-income uninsured individuals and families? It turns out that most of them will be covered through Medicaid, another government program that will be expanded.

(Image: Speaker Pelosi under CC 2.0)

Last year, a representative from Texas was the true Republican maverick in the presidential race. Ron Paul may not have won the nomination, but he is still bringing his unique libertarian perspective to Congress’ table. His proposals for healthcare reform are no different. He recognizes that the current health insurance situation is untenable, but is against governmental involvement. Recently, he presented several intriguing bills to the House of Representatives.

1. The Comprehensive Health Care Reform Act of 2009 would give Americans a 100% tax credit on their health care costs (e.g. prescriptions, hospital stays, doctor visits). Health Savings Accounts (HSAs) with high-deductible health insurance plans would also be tax-free. Low-wage employees who don’t file tax returns can have the credit refunded against their payroll taxes, so the bill would help those who need it most afford healthcare. Currently, only medical expenses that reach over 7.5% of an individual’s income can be deducted.
2. Dr. Paul’s Coercion Is Not Health Care Act of 2009 would forbid the government from enacting a health insurance mandate. There has been some speculation as to the legality of such a mandate. Congressional Democrats, along with the Obama administration, believe that it has to be part of healthcare reform legislation. Their view is that universal coverage must include the young and healthy in order for the insurance pool to afford covering those with pre-existing conditions. This interference in the free market is anathema to Paul. Incidentally, if there is no public option, such a mandate might not be necessary.
3. Finally, his Freedom From Unnecessary Litigation Act of 2009 would save money through indirect tort reform. This act would establish so-called “negative outcomes insurance”, which would pay off if a patient’s medical treatment goes wrong; it would also offer a tax credit to make the purchase more affordable. The goal is to decrease some of the unnecessary (and costly) testing done in order to avoid malpractice liability, as well as lessen the need for hospitals and physicians to carry billions of dollars in insurance.

As Paul is himself a doctor, his views on the healthcare industry are worth listening to. His opinions tend to be shortchanged in the House because he doesn’t walk in lockstep with either party’s platform, giving his bills little chance of passing.  However, many Americans–who fear socialized medicine, yet acknowledge that we need more affordable health insurance as soon as possible–could find something to applaud in his plans.

So far, Republicans in Congress have mainly expressed opposition to the healthcare reform plans proposed by the Democrats. They haven’t offered many solutions of their own, but that’s about to change.  John Boehner, the most powerful member of the minority party in the House of Representatives, has promised that the GOP will present an alternative bill that doesn’t entail major government involvement or adding to the national debt. Obviously, there will be no public option in this version.

Boehner acknowledges that the current system isn’t ideal. How does he plan to give more Americans access to health insurance? These are several things Republican healthcare reform bill would do:

• Severely decreasing the number of medical malpractice lawsuits. This would lower health care costs through a reduction in the unnecessary tests given by overly cautious doctors. Malpractice insurance can also cost doctors millions of dollars per year. As a bonus, it doesn’t hurt that trial lawyers tend to support and contribute to Democratic politicians; this measure wouldn’t affect many GOP supporters.
• Creating a pool that allows small businesses and individuals to buy affordable health insurance in large groups. That proposal is similar to part of the Democrats’ healthcare plan. It’s pretty noncontroversial.
• Repealing the regulations that prevent people from going across state lines to buy health insurance plans. Some states, such as New York, regulate the industry more than others. These regulations include prohibitions on denying insurance to people with pre-existing conditions, for example. While these measures allow more people to be insured, they also result in higher health insurance premiums. Boehner believes that creating a nationwide free market will be more effective in lowering healthcare costs than a public option.

A Republican plan wouldn’t include a health insurance mandate, and would avoid tax increases. It sounds nice, but would it actually be successful? Even party leaders admit that their proposals wouldn’t come close to covering most of America’s uninsured.

All of the usual suspects have spoken on healthcare reform: the uninsured, the already insured, politicians, doctors…but McDonald’s? Their CEO, Jim Skinner, recently spoke about affordable health insurance during a meeting in Boston. Like many people, Skinner believes that the current system needs an overhaul as soon as possible. However, he didn’t reveal whether or not McDonald’s supports the public option, preferring to take a cautious approach on the issue.

Skinner’s remarks, as reported in the Boston Globe, mainly focused on the need to protect small businesses in any healthcare reform bill. You may wonder why a massive multinational corporation such as McDonald’s cares about the plight of small business owners. Well, the vast majority of McDonald’s restaurants (85%) are owned by franchisees who operate independently, albeit with support from the corporation. He believes that while increased access to a health insurance plan is important, it shouldn’t come at the expense of small business. There is a possibility that reform might come with an undue burden on companies and franchise owners buying small group health insurance for their employees. If their savings were jeopardized, millions of Americans could lose their coverage. Clearly, this would defeat the purpose of Congress’ health care reform efforts, and would be opposed by McDonald’s.

What does Jim Skinner think about the charge that his company and other fast food restaurants are part of the problem of soaring healthcare costs by promoting obesity? He pointed out the offering of milk and fruit in some children’s Happy Meals, as well as the expansion of the menu to include healthier selections. Above all, it’s a choice to eat at McDonald’s. Although they could certainly do more to support health (i.e. post calorie counts prominently on the menu everywhere, as they are legally required to do by New York City), there is merit to Skinner’s perspective. As a franchise, McDonald’s has a unique perspective on health insurance from both the small business and large corporation side.

(Image: Official McDonald’s Corporate Website)

The medical device industry, which manufactures and sells items such as heart stents and artificial hips, has kept a low profile during the healthcare reform debate. However, that doesn’t mean that they won’t be affected. Their products are very important to many patients, but help drive up the cost of your health insurance plan. That’s probably why the House of Representatives’ healthcare reform proposal includes $20 million in taxes–coming from a 2.5% sales tax. AdvaMed, the industry’s lobbying group, is obviously unhappy with this and believes that the tax will be detrimental to the American economy.

What would medical device makers consider a more acceptable bill? One that:

• Exempt small companies, defined at those making less than $100 million
• Would be tied to specific products, presumably with more profitable products being taxed a higher rate
• Was at least partly deductible as an expense and,
• Doesn’t take effect until 2013.

As it turns out, the medical device industry was lucky. An initial Senate proposal doubled the fee to $40 million, so AdvaMed has expressed its gratefulness for the reprieve. Such a break was probably going to happen anyway, in exchange for moderate Democratic Senator’s Evan Bayh’s support. Bayh represents Indiana, a state that is the headquarters to many medical device companies. Will the goal of affordable health insurance still be achieved with this corporate giveaway?

(Image: stevendamron under CC 2.0)

Following her Senate counterpart’s reveal of his healthcare reform plan earlier this week, Speaker of the House of Representatives Nancy Pelosi has now unveiled her chamber’s proposal for expanding affordable health insurance coverage. As expected, the House’s plan is farther-reaching than the Senate’s and more similar to the one outlined by President Obama during his campaign.  Here’s a quick Q&A on Pelosi’s plan:

Q: How much is this going to cost?

A: It’s projected to cost a whopping $894 billion over ten years.

Q: How is the government planning to pay for reform?

A: It will raise income taxes on couples making over $1 million and individuals making over $500,000 yearly. In addition, Medicare spending will be cut by an unknown amount.  Liberal representatives also floated the idea of having the government dictate the rates paid to health care providers by the public option, but moderates managed to strip out that provision. (The government, as well as private insurers, will instead negotiate payment rates with hospitals and doctors.)

Q: Is a public option included?

A: Yes. Unlike the Senate version, the House’s bill doesn’t allow states to opt out of it. So far, it doesn’t include a so-called “trigger” either.

Q: Will illegal immigrants be covered by the public option?

A: As of now, it’s unclear. That’s one of the main sticking points preventing the House bill from reaching a vote. However, remember that illegal immigrants are already receiving a form of public healthcare: hospital emergency rooms are required to serve everyone who comes in.

Q: What about abortion? Will it be covered?

A: That’s another controversial topic that will see much debate before the bill hits the House floor. A handful of pro-life Democrats will probably try to have abortion coverage removed from the public option in order for it to receive their votes. Meanwhile, some pro-choice representatives oppose a bill that doesn’t include abortion services. Either way, the Democrats have a solid majority in the House and can afford to lose some votes in either direction.

Q: What if I have a pre-existing condition and can’t get insurance?

A: These reforms are supposed to change that. Health insurers will no longer be allowed to deny coverage to people with pre-existing conditions. They won’t be able to charge those with pre-existing conditions significantly more, either.

Q: When will healthcare reform take effect?

A: It’s hard to believe, but the bill won’t fully kick in until 2013. By then, a mandate will require everyone who can afford it to buy health insurance. They can be insured via the newly created exchange (consisting of private insurers, in addition to the public option), by their employer, or an existing government program such as Medicare or Medicaid.

Q: But I need health insurance now! What can I do in the meantime?

A: The government is putting together a temporary program to insure individuals and families that have been rejected by private insurers. Otherwise, do you really want to wait for the government’s health insurance plan? Keep in mind that the House bill needs to be reconciled with the Senate bill before there’s a final vote, and that could take months.

(Image: U.S. House of Representatives Portrait)

Over the past week or so, the public option has been on a roll. Democratic leaders of Congress have insisted that some form of a public option be included in their healthcare reform bill, considering it an essential step in providing the nation with more affordable health insurance. It wasn’t going to be an easy battle. Senator Joe Lieberman has expressed his opposition to such a government-run plan. The independent senator–who used to be a Democrat and still caucuses with the party–cites budget concerns as his primary reason for rejecting it, and believes it isn’t the right time to go into even deeper debt. A less charitable view is that he wants to continue receiving funds for his re-election from major health insurance companies, many of which are headquartered in his home state of Connecticut. Only Lieberman himself knows his motivations for sure.

Lieberman has stated that he will vote with Harry Reid in the initial procedural vote that allows the bill on the full Senate floor for further debate, but vows to be part of the inevitable Republican filibuster against any final bill that includes the public option health insurance plan. Leaders should take him seriously, since he’s well-known for switching sides: he even campaigned for John McCain during last year’s presidential campaign. Nobody said getting 60 votes in the Senate would be easy; don’t be stuck without a health insurance plan in the meantime.

(Image: Official U.S. Senate Portrait)

Senate Majority Leader Harry Reid has joined the strong push for a public option in Congress’ healthcare reform bill, but its inclusion is not guaranteed. The provision’s fate is in the hands of moderate Democrats. Despite the ability for individual states to opt out of the government-run health insurance plan, centrist Democrats like Senators Ben Nelson and Max Baucus are still leery of voting for it. You should get a health insurance quote while you wait for the endless wrangling of votes to finish, since garnering 60 Senate votes to pass this bill will no doubt take awhile. The fact that several politicians in the party have received large campaign contributions from the health insurance industry doesn’t help.

Why the delay? The Senate and the House of Representatives have to debate exactly what form the public option will take, and moderates hold its fate in their hands. They need to compromise between comprehensive health coverage and cost. Gaining Republican votes is a lost cause at this point, so party leaders will be forced to exert their power. For example, Reid may try to convince a swing vote with a seat on a prestigious Senate committee–that a Senator will only get if he or she votes with him on healthcare reform. The more liberal House has a more comprehensive public option proposal included in its bill, and it must be combined with the bill in the generally more conservative Senate prior. Afterward, it’ll see even further amendments by the rest of Congress before a final vote. There is also the possibility, albeit less likely, that some liberal politicians will vote against the bill because it doesn’t do enough to reform our health insurance system. However, centrist politicians receive more attention from leaders because they are the wild card. Can you wait for Washington to decide, or would you prefer to be safe and get health insurance quotes from multiple insurers now? If, years from now, you like what the public option shaped up to be better than your existing health insurance plan, you’ll be able to switch–but if you’re caught uninsured before then, you’ll wish you hadn’t waited.

Recent studies have found that women under the age of 55 are more expensive to insure than their male counterparts. Why are their health insurance costs higher? A lot of it seems to come from the unfairness of biology:

• Most women need maternity care at some point in their lives, while men don’t. (Still, women who choose not to have children don’t get discounted health insurance quotes.)
• Although this disparity reverses in old age, cancers that almost exclusively affect women (e.g. breast and ovarian cancer) tend to strike at a younger age than exclusively male diseases like prostate cancer. In addition to the high cost associated with cancer treatment, health insurers must also cover preventative measures, such as Pap smears and mammograms.
• On average, women visit the doctor more regularly and use more prescription medication than men. This is most likely primarily due to a higher tendency for women to be proactive when it comes to their well-being, rather than a case of the female gender being sicker.

All of these factors cause insurance providers to consider women’s health insurance policies higher risk, and they charge more as a result.

Many consider the practice of gender rating discriminatory and counter intuitive, as it penalizes women for using greater quantities of preventative care–even though prevention is a proven way of reducing health care costs by a far larger sum.  Health insurance companies are willing to eliminate gender rating in certain instances. The Senate Finance Committee’s healthcare reform bill bans insurers from giving individuals and small groups a different health insurance quote based on their gender, but the definition of a small group is arbitrary. It could be as small as 50 or 100 employees. A firm with just 51 employees and a predominately female workforce could pay up to 20% more than the national average to insure its employees–and employees will have to cover more of that cost themselves.

Democratic Senator Barbara Mikulski is calling for the end of this practice altogether, including in large corporations. While she has been gathering support from other congresspersons in her quest, the health insurance industry’s lobby has been fighting to retain the exception that would allow gender rating to continue in the large group market. Their argument is that some businesses will decide to offer their own insurance (as opposed to buying it in the group market) after seeing their premiums increase. It’ll be extremely interesting to see how this plays out. Will Congress give into the insurers, believing that their support in eliminating gender rating for individual and small business health insurance is more urgent? After all, at least those working for large companies tend to have at least some form of employer-sponsored health insurance plan.

(Image: jfrancis under CC 2.0)