The huge House health care bill: what’s in it for me?

This is the second of two articles on health care reform. Yesterday, Lauren Callahan examined whether the “Healthy San Francisco Program” could work in Oakland.

The health care reform bill the House of Representatives approved last month (HR 3962) adds up to 2,014 pages, most of them containing a lot of Roman numerals and subclauses in parentheses. As the Senate has debated its version of a health care bill, we recently printed out the whole daunting pile that is HR 3962 and asked San Francisco-based health policy expert Lucy Johns to haul it to her office for a few days to examine its potential impact on four East Bay residents, each of whom faces a different health insurance situation.

Click the play button below for an interactive presentation on Maureen, a nurse insured by her employer; Sadri, a coffee shop owner who insures himself and his employees; Micah, a shop clerk with no health insurance; and Jesse, an HIV patient on disability. The text of the article about the House health care bill continues after the presentation.

HR 3962: a quickie intro to the House bill’s biggest things
The health care reform bill the House of Representatives approved in November is intended, according to its legislative preface, “to provide affordable, quality health care for all Americans and reduce the growth in health care spending.” Assuming the Senate’s apparently finalized version of health care legislation is approved this week, as expected, both bills will be then brought to a conference committee in an effort to merge the two documents – which will likely differ on important points that include abortion, the public option and whether younger Americans can buy into Medicare.

If the conference committee can come to agreement, the joint bill will return to the House and Senate for a vote.  At that point, any individual senator might still be able to hold up the bill by filibustering–but over the weekend, the Democrats appeared to have secured the 60 votes necessary to end a filibuster.

Senate Majority Leader Harry Reid had said he hoped to hammer out a bill by Christmas.  But according San Francisco-based health care consultant and policy analyst Lucy Johns, a more realistic timeline suggests the conference committee meeting will take place after the New Year. Meanwhile, the House bill is the principal tangible document that outlines possible major changes in the health care system during the coming years.

And what’s in this mammoth document, anyway? Not a lot of specifics, according to Johns.

“Everything we say now is completely speculative,” she said. “Conference committee is where the real pressure to get something done happens.”

The House bill covers an enormous amount of territory, including a long section dedicated just to Indian Health Services. But its main provisions affecting the majority of Americans are these: It prohibits insurance companies from denying coverage on the basis of pre-existing conditions, or from dropping insured people because they have developed costly health problems. The bill raises the income threshold for Medicaid, the government health care program for the poor, making many more eligible for those benefits.

It creates a national health insurance exchange in which people who do not have employer-provided coverage, and who are not eligible for public programs, can buy insurance. It also provides subsidies to help lower-income people afford coverage. The bill requires employers in all but the smallest businesses to buy health coverage for their full-time workers, or else pay into a national exchange fund; the bill provides credits to certain small businesses to help offset that cost. And it requires most individuals to have “acceptable health coverage,” through their work or the policies they buy themselves, or else pay an annual penalty based on income.

Trying to apply those legislative provisions to specific personal cases is a challenge, Johns said. Much of the language in HR 3962 is vague. Nonetheless, Johns agreed to consider the situations of four Oakland and Berkeley residents and suggest what might be in store for them, based on what’s in the current House bill. (Her answers appear in the multimedia presentation above.)

The “public option”: three common misconceptions.
This health care policy fight often presents itself as one great mess of misconceptions and language hardly anyone really understands. Johns offered her clarifications on three of the misconceptions, all regarding the much-discussed and ill-understood “public option.”

First misconception: That the “health insurance exchange” proposed in the House bill is the public option. The health insurance exchange will be a single point of entry, Johns said, one place where uninsured people can choose among many health options to provide them with health insurance. The public option is intended to be one of those choices–health insurance, like Blue Cross, but in theory cheaper because the government is providing it.

Second misconception: That the public option would necessarily save money, either overall or for individual buyers. “The concept of the public option is that the federal government would provide access to health services, including doctors, hospitals, drugs and other services,” Johns said. Since the government would be such a big purchaser, and cover so many people, in theory it would then be able to set the rates it would pay providers. The House proposal last summer set payment at current Medicare rates. “There was a great uproar,” Johns said. “Medicare does not pay as much as providers think they need.”

So now the House bill says the public option will pay the providers “negotiated” rates. With many thousands of providers, Johns said, such negotiation would likely be the task of a health commissioner. “A public option won’t be able to save money unless they can negotiate reasonable rates,” she said.

Third misconception: That insurance through a public option would be available to anyone. Not the case, according to Johns. The public option as currently envisioned would be “terrific” for some of the “35 million uninsured people buying through the exchange,” she said, but many would be kept out. Insurance companies have fought vigorously against a public option, she points out. “All summer they pushed back very hard, directly and indirectly through privately-funded organizations, with a simple message: if we have a public option available, the insurance industry will die.” The House didn’t buy that argument; the current bill includes a public option, but it is still unclear whom it would cover, what it would cost individuals and what it would provide. That is one of scores of details and disagreements to be resolved in a House-Senate conference committee–now that the Senate appears to have agreed on a bill of its own.