Understanding health care legislation

Two local forums offer insight into national health care debate

The topic of water cooler conversations across the county came home to Blount County on Tuesday, Sept. 1.

Health care coverage, the current health care legislation and health care options are filling the news channels and newspaper pages as the President and Congress try to hammer out a way to improve and fund health care programs.

Blount County residents who wanted to ask questions about health care legislation had plenty of opportunities morning, noon and night on Tuesday.

The first started at 7:30 a.m. Tuesday morning at the Blount County Chamber of Commerce, where James P. Gelfand, senior manager of Health Policy at the United States Chamber of Commerce, gave the first of two presentations to manufacturers, business and civic leaders on what the national and local chambers are doing in response to the proposed health care legislation.

That evening, Maryville College’s Center for Strong Community’s offered residents a 90-minute forum on the legislation being proposed. The meeting, held at the Blount County Public Library, featured panelists Micky Roberts, Blount County Health Department Director; Tony Garr with the Tennessee Health Care Campaign; Carole R. Myers, PhD, assistant professor with the University of Tennessee College of Nursing; and Billy Newton with the Maryville College Center for Strong Communities.

Gelfand focused on ways for the free market to curb health care costs and provide more widespread coverage. He said “public option” coverage, in which the federal government would pay for people’s coverage, will only create a larger bureaucracy, cost more money and be unfair competition to private insurance companies.

During the Center for Strong Communities forum at the library, Myers outlined different aspects of legislation and what is needed to ensure universal coverage of Americans. The “public option” was also discussed, with Myers contending that this could create competition and force down the price of premiums for citizens.

At the library

Real health care reform will happen when more is spent on ensuring wellness and preventing illness and than treating it.

That’s the take Blount County Health Department director Micky Roberts had Tuesday night on the current debate in Congress and towns across the United States as law makers attempt to hammer out health care legislation. That was one of the few comments that drew an extended applause during the Community Forum for Health Care Reform at the Blount County Public Library.

“Very, very few dollars are spent on primary prevention. Until we shift to primary prevention and people not engaging in risky behavior, we will always be paying for a problem instead of the prevention the problem,” Roberts said.

Roberts said that, statistically speaking, Blount County ranked at or above other counties when looking at the health of the community. “We’re doing pretty well. The only one where we fall behind is in stroke - cardiovascular disease,” he said.

Myers said she relied on the Institute of Medical Scientists, a group of scientists who advise government on health care issues. “They developed five principles for health care coverage in the early 2000s. They looked at how we take care of 47 million uninsured Americans,” she said. “These principles can be used to evaluate various reform proposals.”

Myers said the principles are:

Health care should be universal. “Every American should have access to health care coverage.”

Health care coverage should be continuous. “You should no lose coverage because you quit your job or move.”

Health care should be affordable to individuals and families. “No longer should medical bills be the No. 1 reason for bankruptcy.”

Health care should be affordable and sustainable and health insurance should enhance health and well being by promoting access to high quality care that is effective, efficient, safe, timely, patient-centered and equitable. “We should have care that works for us.”

Myers said that the federal government has just as much right to mandate that people buy health coverage as state governments do to mandate that drivers have auto insurance.

“There would be a tax penalty if we passed an individual mandate, and you didn’t comply. If you couldn’t afford it, you would receive a subsidy,” she said.

“Opponents say, ‘Government shouldn’t tell me what to do.’ Others say employers might be inclined to offset the cost of benefits by cutting pay or instituting lay offs. Proponents say that for all other proposals to work, everyone has to be covered. And the government would come to your rescue with subsidies if you weren’t able to pay for your coverage.”

Another proposal would include expanding current programs, i.e., Medicaid and Medicare. “Medicaid is for folks with less than adequate financial means. Most uninsured Americans are part of working families. The majority of people uninsured in this country come from households where there are working adults,” she said. “The idea is to raise the level you have to earn to qualify for Medicaid.”

Myers said the new public option plan would basically be a government-run health plan similar to Medicare. “Proponents say the public option would make the private plans more honest by being more competitive. The private plans would have to work harder to compete with the public plan,” she said. “Opponents say the public option would have an unfair advantage.”

Myers said the public plan, a non-profit option, would have less overhead, less of a marketing budget and premiums would be lower. “Our country is one of the few that allows health insurance companies to be private,” she said.

Myers said insurance exchanges would be created via websites. “There are ways to bring sellers and buyers together. You would have ‘one-stop shopping’ for a whole array of plans. All of them would have to have minimum levels of benefits,” she said. “Comparison shopping would be easy.”

Myers said proposals could also include new coverage standards. “These are things like banning insurance companies from refusing you coverage because of pre-existing conditions or canceling policies because you have been hospitalized or in a car accident,” she said. “This would level the playing field. Rates couldn’t vary except for age, smoking and where you live.”

Myers said reform also could bring streamlining of administration because 20 cents of every health care dollar is spent on administration. “There are opportunities for improvement if we could manage our administrative costs. Why are administrative costs so high? One is we do not have standardization. We don’t use one common claim form. That adds a lot of costs.”

Myers said reform also could include comparative effectiveness research, but that this isn’t a “death board,” set up to decide who lives or dies. “This is research that analyses the impact of different treatment options for different patients,” she said.

When asked how the public option would be funded, Garr said if the public option can’t be fully-funded, it would have to cut back somewhere. “Do we want to make an effort to cover everyone or cover only some?” he asked. “If you cut it back, someone loses out. Those who lose out are middle-income earners. (Those) working for small employers are going to be left out.”

Newton said the organizers were happy with the attendance at the meeting. “I especially appreciate the speakers being very even-handed and sticking to informational presentations,” he said.

At the Chamber

James Gelfand, senior manager of Health Policy at the United States Chamber of Commerce, said businesses voluntarily spend $500 billion every year to pay for health coverage.

“Most Americans get health coverage from employers. Premiums have risen much faster than inflation -- doubling over the last 10 years,” he said.

Gelfand said that U.S. Chamber representatives worked with lawmakers who were crafting HR 3200, the House Health Reform bill. When it got to the vote, however, “it looked nothing like anything that was suggested,” said Gelfand. “I would liken it to a nuclear explosion, a complete shock. None of the hard work seemed to be reflected.”

What the legislation did look like, said Gelfand, was legislation that was proposed back in 1993 when President Clinton attempted health care reform that was heavy on government bureaucracy and spending.

Gelfand outlined what he said was simply a word game to create new phrases that would be more acceptable to the public in selling the health care reform.

For example, he said, “nothing is ‘government run,’ rather it’s ‘the public option.’ There are no more ‘mandates.’ What we have now is ‘shared responsibility.’ There is no such thing as a ‘Cadillac plan.’ It is now coverage that is ‘meaningful.’ And there is no talk about the ‘free market.’ Instead, we talk about ‘what is fair.’”

Gelfand said using this language softens public opinion for proponents of the plan, but that the plans and words behind the phrasing is the same as it was before. He said it is often easy for proponents of the public -- or government -- option to sway people in their favor using statements such as, “We need more competition to keep insurance companies honest. We need a shared public option.”

Education and understanding exactly what is being proposed are the answer to individuals making up their minds and then informing their legislators.

“What if I said, ‘Do you favor imposing a new government entitlement plan that increases costs for everyone with private insurance and that could lead to a take-over of (the insurance industry) with a single payer, UK style of health care?” he said. “It’s a matter of how the debate is being framed. As we’ve had to educate the public, people are starting to understand what it’s all about.”

Gelfand said Medicare and Medicaid aren’t efficient and the costs for health care would double or triple under the current proposed plan. “Government has a bad track record of running health care,” he said.

Gelfand said another problem is the employer mandate. “It’s not just saying an employer has to offer health care, it has to be the government plan with standards set by HHS. If you don’t meet standards, your business will be liable for a 2 to 8 percent payroll tax,” he said.

Gelfand said employers would have to pay three-quarters of the premium. “The plan would have to resemble the federal employees’ health care. Health savings accounts will be gone, and high deductible plans that appeal to young folks will be gone,” he said.

Gelfand said the cost of the plan are numbers ordinary folks can’t get their arms around: more than $1 trillion.

“There will be a $540 billion surtax. They say that is to be a tax on the wealthy, but small businesses would face the new surtax, and there would be $239 billion added to deficit,” he said.

On top of that, Gelfand said the costs are frontloaded over a 10-year period. “You would have a tax but no program until the last years. In year 11, the budget explodes, and it is no longer paid for. Then you then have to raise taxes or raise the deficit, and your children are paying China back,” he said.

Gelfand said that, according to the Congressional Budget Office, under the new plan, as proposed, health care costs will increase, the federal deficit will increase, and people will have fewer choices.

The plan favored by the U.S. Chamber of Commerce is “simple and affordable,” he said. “It is a three-point plan to lower costs, increase coverage and improve quality. Focus on cost, insurance reform and create a real market place,” he said. “ We support an all-of-the-above strategy to controlling costs.”

Gelfand said the U.S. Chamber advocates aggressively regulating insurance companies. “I didn’t come up with this,” he said, “the insurance companies did.”

Gelfand said the U.S. Chamber’s proposal offers an end to pre-existing conditions. “There will be no more turning people away,” he said. “Get everyone in the game and make it fair. When you hear insurance companies are the villains, you’re being distracted. They are agreeing to do this,” he said. “We just have to change the rules tomorrow, and people who are uninsured can get health insurance.”

Gelfand said the U.S. Chamber also advocates making it easier to purchase health insurance.

“Create a vibrant market to purchase insurance plans. If you have ever compared rates on an Internet site like Orbitz or Travelocity, well, comparing insurance ought to be just that simple,” he said. “People should be able to easily compare insurance policies and prices. This means building a web site.”

Gelfand said the U.S. Chamber’s plan gets more people insured at a lower cost with an improved quality of health care and the cost of it is almost negligible.

“The plan on the table in Congress is over 1,000 pages long, and you have the chairman in Congress saying ‘There’s no point in reading this. It’s too complicated.’ It will cost over $1,239,000 over the first 10 years.”

Gelfand said so far the debate in Congress has been between conservative Democrats and more liberal Democrats because they have majorities in both houses of Congress.

“There is one last hope for bipartisan reform - the ‘gang of six’ - three Democrats and three Republicans on the Senate finance committee. They are very close to coming to an agreement,” he said. “Word on the street is the Congressional Budget Office thinks the bill in the Senate Finance Committee would actually lower costs and bend the curve. We’re taking a wait-and-see approach.”

Gelfand said it is the hope of the U.S. Chamber that broad-scale reform gets scaled back, and there is a compromise. “What would a compromise look like? It would take out the government health care plan’s overbearing federal control and be left with cost controls, insurance reform and a new market place,” he said.

Local comments

After the Chamber meeting, Maryville City Manager Greg McClain said understanding legislation is critical. “Obviously reform needs to take place, but it needs to be well thought out,” he said. “It’s too complicated as it stands now.”

Alcoa City Manager Mark Johnson said it is important to understand the proposals and the potential outcomes. “In my estimation, reforms are needed but it’s not as crucial a problem as painted by some in Congress and the media,” he said. “I think when you analyze the number of truly ‘uninsured,’ that number is probably not as big as we think. There should be a better way to address that than to upset the entire apple cart.”

Blount County Mayor Jerry Cunningham said proposed legislation as it is is frightening. “It’s another step toward socialized medicine as far as I’m concerned,” he said. “If the liberal wing push through the legislation, it could well bankrupt America. Our grandchildren and great grandchildren will be paying off this massive debt to China.”

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