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Showdown Over Health-Care Reform Bill Nears

$940 billion overhaul would give 31 million more Americans access to health insurance

FRIDAY, March 19 (HealthDay News) -- Health experts say that the furiously debated $940 billion health-care reform bill moving toward a vote for passage in Congress this weekend really boils down to one simple tenet: More Americans should have access to health insurance.

"The big impact is the coverage of 31 million uninsured individuals, and that includes about 15 million people with incomes below 133 percent of the poverty line, [through an expansion of Medicaid]," said Karen Davis, president of the Commonwealth Fund in New York City. "Basically, it makes a big dent in the number of uninsured and underinsured. That's far and away the biggest impact."

Thomas R. Oliver, associate director for health policy at the University of Wisconsin Population Health Institute, described the legislation as "a dramatic effort to really get at the core questions of accessibility and affordability of coverage." Oliver is also a professor of population health sciences at the University of Wisconsin School of Medicine and Public Health, in Madison.

Though stating that the effort "is a sweeping change," Oliver also acknowledged that the bill, if passed, would be "disappointing to many who believe that the most constructive thing that we need to do as a nation is to bring all Americans into adequate, basic insurance coverage."

He does, however, believe the latest bill is a step toward that goal.

House Democrats unveiled the bill Thursday evening, saying its chances of passage were sharply enhanced by a report released earlier in the day by the Congressional Budget Office that estimated the bill would reduce the federal deficit by $138 billion over the next 10 years, the Associated Press reported.

Democrats hope that the House will approve the bill already passed by the Senate, though many legislators take issue with some provisions of that bill. But both chambers would also vote on fixes to the legislation agreed to with the White House. A final vote could come Sunday, the wire service said.

As it stands, the bill would place penalties on many businesses that don't provide coverage for their workers, according to the AP. Though that could mean millions of new paying customers for hospitals, doctors, drug companies and insurers, Medicare cuts would mean that hospitals would have to operate more efficiently to stay afloat. Insurance companies would face unprecedented federal regulation, and health-care industries would be hit with new federal taxes. There would also be a new tax on investment earnings for upper-income households, according to the wire service.

Though Democrats are working hard to ensure they have the votes to pass the bill, House Republican leader John Boehner of Ohio said his party's lawmakers will "do everything that we can do to make sure this bill never, ever, ever passes."

If it does find its way into law, implementation of the bill's provisions would be staggered over the next four years and beyond.

"Most of the insurance expansion won't happen till 2014, although there will be some changes in the rules right away," Davis said.

As the bill now stands, taking effect in 2010:

  • Insurers would no longer be able to exclude high-risk individuals from getting a policy, nor would they be able to dump people who develop medical problems. "That guarantees the availability of coverage for people with serious health problems," Davis said.
  • Young adults, up to age 26, would be eligible for coverage under their parents' policies, she said.
  • Ceilings on annual or lifetime benefits would be eliminated, Davis said.
  • The "doughnut hole" in prescription coverage for seniors would shrink and eventually disappear. Special deals on brand-name drugs for seniors would fill the interim period, the Associated Press reported.

Longer-term changes would include:

  • Setting up regional health insurance exchanges that various groups -- including self-employed people, those without employer-based health coverage, high-risk individuals and small businesses -- could tap for coverage.
  • Adopting portable health insurance, meaning people could take their coverage with them if they left a job, Davis said.
  • Stricter regulation and scrutiny of the health insurance industry.

However, a question remains as to how affordable health insurance would be, even with subsidies.

Individuals and families could be fined for not having insurance, but those penalties would "pale in comparison with out-of-pocket costs, even with the subsidies," Oliver said. "A number of people will simply make the choice to pay the fine because they can fit that into their monthly [budget], while they cannot fit health insurance premiums, even with substantial subsidies, and we're talking hundreds of dollars vs. thousands of dollars."

Plus, no one really knows what the final bill will look like, said Dr. Nancy W. Dickey, president of the Texas A&M Health Science Center and vice chancellor for health affairs at the Texas A&M University System.

Though the House appears poised to pass the Senate bill, it includes a number of adjustments that people outside of the legislative process have not yet seen, she said, although some items have remained relatively consistent in the back-and-forth on the bill.

"If a bill passes, I think it's fair to say that there will be insurance reform, and one of the most frequently cited is doing away with pre-existing condition limitations," Dickey said.

"I think right now there are four or five things that seem to have stayed on top of the discussions, but how it will actually read when we get there, I don't know," she said.

More information

The Commonwealth Fund has more on the health-care reform bill.

SOURCES: Karen Davis, Ph.D., president, Commonwealth Fund, New York City; Thomas R. Oliver, Ph.D., professor, population health sciences, University of Wisconsin School of Medicine and Public Health, and associate director, health policy, University of Wisconsin Population Health Institute, Madison, Wisc.; Nancy W. Dickey, M.D., president, Texas A&M Health Science Center, and vice chancellor, health affairs, Texas A&M University System; Associated Press

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