For many workers, insurance choices may be limited after health care overhaul

[Better Believe It]

For many workers, insurance choices may be limited after health care overhaul
BY MARY AGNES CAREY AND JULIE APPLEBY
17 July 2009


President Obama and leading Democrats have stressed that people who like their employer-sponsored insurance would be able to keep it, under a health care overhaul. But they haven't emphasized the flip side: That people who don't like their coverage might have to keep it.

Under the main health bills being debated in Congress, many people with job-based insurance could find it difficult to impossible to switch to health plans on a new insurance exchange, even if the plans there were cheaper or offered better coverage. The restrictions extend to any government-run plan, which would be offered on the exchange.

Democratic lawmakers and administration officials say the restrictions are critical to maintaining a strong employer-based insurance system, which covers 158 million Americans.

But critics argue that the rules run counter to suggestions from health care reform advocates that an overhaul could provide people with a broader choice of insurance options. The rules, they say, could be especially unfair to some lower-income workers who are enrolled in costly job-based insurance. Also, they argue, the restrictions would hurt the proposed public plan by limiting enrollment.

Jonathan Oberlander, associate professor at the University of North Carolina at Chapel Hill, said the restrictions create a "big gap between the rhetoric and the reality" of health reform. "The rhetoric is that Americans will gain new alternatives," he said. "But the reality is that they are putting up firewalls that are going to restrict the access of people with employer-sponsored insurance to the exchange."

One result, he said, is that any public plan would be substantially smaller than what many backers are envisioning. That would reduce the public plan's power to compete with private insurers and hold down costs, he said. The Congressional Budget Office estimates that nine million to 10 million people would enroll in the public plan by 2019.


Please read the complete article at:

http://www.newjerseynewsroom.com/healthquest/for-many-workers-insurance-choices-may-be-limited-after-health-care-overhaul

[Vincardog]

1. Shocker. Does anyone else believe that maintaining failed employer-based insurance system,

should be our purpose in reforming US Health CARE?

[MNDemNY]

2. Only the health insurance industry.

[Eric J in MN]

3. This is bogus. The public plan isn't competing with private plans...

...if anyone who gets insurance through his or her job is shut out of it.

[FrenchieCat]

6. those who are fortunate enough to have health care provided by the employers......

are already the most fortunate of all. Why would they get to choose outside of what the employer offers? The reason that it is called a benefit is because it is something given based on the employer's decision, not the employee's decision.

[Eric J in MN]

9. If they have high out-of-pocket costs with their insurance through work,

...then they may want something better, instead or in addition.

[elehhhhna]

12. Answer: plenty of employers offer SHIT coverage for HIGH prices.

b/c it's all they can find...and or afford.

[dflprincess]

26. Larger companies who could afford better

are going to shitty programs knowing full well that in the current economy they can treat the employees like crap because they have no where to go.

Last year I had good insurance, this year they gave us a lousy program (with Cigna no less), and next year it's going to get so bad I may not even bother with the preventative tests because I won't be able to afford the deductible if one of them does come back needing follow up.

Face it kids, Obama and most of Congress are going to screw us on this deal and expect us to thank them for it.

[elehhhhna]

32. we got a stiff hike in out-of-pocket costs from Cigna this year --

it's still pretty good coverage & pays for preventine care, and a super-cheap copay for scrips ($5 for generics!) but hub's (Fortune 200ish) company's losing money and expects to do so for I think probably another year. They're trying to do well by the employees, truly, but the annual rate hikes are a killer.

Singlepayer would probably make them close-to if not outright profitable, overnight.

[Mass]

18. Some employer insurances are lousy, because companies cant pay the premium increases and

had to lower what the insurance covered...

Or what they have to pay is too much for them to pay.

[earthboundmisfit]

4. Are there any other countries who have employer-based health insurance?

It seems more like part of the problem than part of the solution... :shrug:

[Eric J in MN]

10. We must maintain the lousy system which no other developed country has because...

...it will please health insurance lobbyists.

[FrenchieCat]

5. So apart from insuring the uninsured, and providing subsidies for those who can barely afford

anything, health care reform is supposed to give workers their cake to eat in the form of allowing them to choose the employer's benefit to them? I think that if one works for a company and is getting healthcare benefits subsidized by their employer, I think these folks will be the ones whose premiums will eventually be reduced based on the lowering of health care cost. To think that these employees already receiving health care coverage through their employers would somehow expect to be put on top of the list of health care reform is really quite shocking.

[Better Believe It]

13. You really don't understand this at all, do you?

Let me try and help.

Employers and their employees would prefer choosing public insurance over private insurance in the expectation that public insurance would provide better benefits at a lower premium cost than "for profit" private insurance. But, they won't be allowed to make that choice!

Under the legislation the overwhelming majority of people and all bigger employers (those with 20 employees or more) won't be permitted to "switch" to the public option, at least until 2015, but will be "required" to obtain private insurance or be fined!

That's why they predict that only 9 to 10 million people will be covered by the public option insurance in 2019 while everyone else will be covered by the private for profit health insurance industry!

This will result in millions of new clients for the private insurance industry. So it's not all bad for the insurance industry.

There is something in it for them. Of course, they will shed the mandatory crocodile tears.

[dflprincess]

27. The point of "reform" was to improve access for everyone

and lower costs.

A plan that does nothing more than prop up a collapsing system by requring most of us to contribute to the insurance companies' profits is not "reform".

[Doctor_J]

7. they already are limited

severely.

[boppers]

8. I haven't been able to afford insurance for 19 years.

Yeah, watch me cry a river for people who don't get to "shop around", so they can have better coverage, or less cost, than me and millions of others who are a heartbeat away from losing their lives due to a lack of coverage.

[ChimpersMcSmirkers]

16. Interesting how the purist pretty much ignored you.

Progress that would help folks like you just isn't good enough.

[boppers]

20. I'd like to be able to shop public, private, etc.

Right now, it's $5,00O a month for me and my partner... she has coverage, I do not.

[Mass]

19. Well, this also means you will have a lousy coverage, because people in good health

will be covered by private insurances while people in bad health will be sent to the public option, increasing the cost for everybody.

[dflprincess]

28. And setting the public option up to fail

so when it becomes obvious that the current "reform" isn't working the for profits and their stooges in Congress can point to the public option and say "see we told you that a government program could never work".

[elehhhhna]

11. workers have insurance choices now? I mean other than yes or no?

ROFLMAO

[Better Believe It]

14. So you think it will stay pretty much the same.

[elehhhhna]

15. hope not. the current "system" is sooooo illogical.

I pay money to someone who KEEPS IT if they deny me care, and I'm supposedly paying them to insure my care? WTF? Kafkaesque!

[bvar22]

17. Only 9 - 10 million by 2019 !!!

THAT is NOT a viable Public Option that has ANY chance of driving down costs OR competing with the For Profits.

9 - 10 Million????
That is a huge FAIL.
By Design !

[ipaint]

22. They need at least 20 million

to make it viable, able to negotiate prices and competitive. No other country forces their gov. plan to compete with for profit health insurance. It guarantees failure proven by the several states who have tried this.

[kath]

25. Yep - MEGA-Fail.

But our bought-and-paid-for "representatives" (NOT!) have to do their masters' bidding.

[Eric J in MN]

21. Can the employer get insurance for all the employees with the public option? NT

NT

[Better Believe It]

23. In many cases the answer to your question is no. And here is how it works ....

If the employer has 10 employees or fewer they qualify for the public insurance option sometime in 2013.

If the employer has 20 employees or fewer they qualify the public insurance option sometime in 2014.

If the employer has more than 20 employees they may be able to get the public insurance option sometime in 2015, if approved by "the commissioner". However, there is nothing in the legislation mandating such approval or requiring the government to make the public insurance option available to all employers for their workers at any time in the future.

[Eric J in MN]

29. There is not much competition, then.

Thanks for answering my question.

Where did you find that info?

[Better Believe It]

30. Check out these articles.

"Public Option" Would Only Be Available To The Otherwise Uninsured
TPM Cafe
July 16, 2009

I'm not sure that people really understand how the "public option" would work, given the rhetoric of the adminstration that people could "keep" their current insurance if they want to or choose a public option.

Last night on The Daily Show, Secretary Sebelius, in response to a question, made things a bit clearer regarding just how the public option would work. She was asked "who would choose" whether or not to use the public option: the employee or the employer? The Secretary said essentially it would be the choice of the employer because if the employer provides health insurance then that is the insurance the employee would have to use. Only if the employer chose not to provide health insurance would the employee be able to enroll in the public option.

Most of the people I know that have employer provided health insurance are glad they have insurance as opposed to not having it, but they hate the plans they have because the expense is totally unreasonable and with each passing year, less and less coverage is provided while costs go up. So, leaving the choice to employers is not the same as providing choice to citizens at all.

http://tpmcafe.talkingpointsmemo.com/talk/blogs/oleeb/2009/07/public-option-would-only-be-av.php?ref=reccafe

-------------------------------------

It appears that the "public plan" may not kick in for employers with more than 20 employees unless "the Commissioner" permits larger employers to join the public plan in 2015!

And congressional aides say only about 9 million will be insured by public plan by 2019! 21 million will be insured by private companies in the exchange by 2019. Another 164 million would be insured with private insurance through their employers.


----------------------------------

The Health Insurance Exchange: It's run nationally, though states can opt out of the national structure and go it alone if they choose, and if they follow federal rules. In the first year, it accepts those without health insurance, those who are buying health insurance on their own, and small businesses with fewer than 10 people. In the second year, it accepts small businesses with fewer than 20 people. After that, "larger employers as permitted by the Commissioner." In other words, expansion is discretionary, not mandated. The only people able to access the public plan in the early years will be on the exchange, and the exchange will be, relative to the population, pretty limited. So the public plan will be limited, and so too will any anticipated savings.

http://voices.washingtonpost.com/ezra-klein/2009/07/the_house_releases_its_health-.html?hpid=news-col-blog


http://www.reuters.com/article/reutersComService_2_MOLT/idUSTRE56D7JX20090714

[kath]

24. CHANGE I DON'T BELIEVE IN.

Sheeee-it!

[Honeycombe8]

31. That's okay for now. Let's get a public option up and running. Then we'll see...

how it can be changed in the years ahead.

I have employer provided insurance. It looks like that benefit will start being taxed. Bummer.

But mainly what I'm concerned about, as far as MY health care, is that I have some way to get health care if I were to lose my job, and after COBRA runs out. I wouldn't be able to afford a private policy. If I were to get a health problem while I had COBRA, then no ins. co. would take me. And I wouldn't be poor enough to qualify for Medicaid (and Medicaid is basically emergency care, and very difficult to use...my sister used it for several years).

I think that is the situation for many people. They're not poor enuf for Medicaid, old enuf for Medicare, and they don't have employer provided ins.

If the bill covers that gap in some reasonable way (no, it won't be GREAT coverage), then I'll be okay with that.

[PolNewf]

33. Exactly

This is the only way a public option will be allowed initially.

[ipaint]

34. I think anyone willing to settle for this needs to be required

to pick one of the 8 and half million working class americans who will remain uninsured and face to face explain to them how they won't be receiving health care and why their sacrifice is acceptable.