Obamacare

Katie Glueck

Like most who watched the news this summer, Jess Klein knew that somewhere, health care town hall meetings looked less like forums for debate and more like partisan bloodbaths. But the SESP ’09 grad was sure that a meeting in her hometown of Fairfax, V.A., would be different. She figured that in an affluent, educated, left-leaning D.C. suburb like Fairfax, conversations would be civil and informative.

The “Obama is Hitler” signs were her first clue to the contrary.

“I really thought the town hall meetings would be a media distortion, but they turned out to be an accurate portrayal,” Klein says. “It was just as bad as the stuff you seen on the news.”

Klein, who went to hear Rep. Jim Moran (D-VA-8) and former Democratic National Committee Chairman Howard Dean speak at a meeting in a high school gym, says attendees’ partisan rancor made substantive debate impossible.

“The second you walked in, people supporting health care reform were lined up with signs, and the people who were opposed were carrying ‘Obama is Hitler’ and ‘Obama is the Joker’ signs, so right away, people divided themselves,” she says. “People were yelling at each other and Dean couldn’t even speak. There was lots of booing and no respect.”

Scenes just like this one played out in health care-focused town halls across the country this summer, with only marginally more polite discussion taking place in the halls of Congress.

” ‘Controversial’ is the word I’d use to describe the health care debate,” says Dr. Bernadine Healy, who is, among other things, the health editor of U.S. News and World Report, former president of the American Red Cross and former director of the National Institutes of Health. “Ideological camps are battling with each other, focused on the role of government in medicine.”

But how does all that ideology play out in reality? And why should you care? On the off-chance that you have better things to do than wade through thousands of pages of legislation to answer that question, The Weekly breaks down how the health care debate affects your body and your bank account.

Defining the debate

Despite this summer’s health care drama, or maybe because of it, President Barack Obama reaffirmed his commitment to passing a health care reform bill in his Sept. 9 address to Congress. He called for stable, universal and cheaper health insurance. Those objectives aren’t inherently controversial, says Greg D’Angelo, a health care policy analyst at the conservative Heritage Foundation’s Center for Health Policy Studies. “The broad goals everyone shares are covering the uninsured and reducing rapidly growing health care costs,” D’Angelo says. “The question is, what’s the process? What’s the policy? And how do we get from here to there?”

Igor Volsky, a health care researcher and blogger at the Center for American Progress, says finding a solution that achieves these aims gets messy because health care is such a broad issue, with implications for so many people.

“We’re trying to reform (one-sixth) of the economy,” Volsky says. “It’s a big task and it’s hard to expand coverage while containing costs. A whole lot of special interests, providers, insurers and pharmaceutical industries all have a stake in the system, too, so it’s hard to get everyone to agree to one reform package.”

But Congress sure is trying. This summer, three committees in the House of Representatives developed variations of a massive health care bill. They’re currently working on merging those three bills into a comprehensive piece of House legislation. On the Senate side, one committee produced a bill back in July. In mid-September, the Senate Finance Committee unveiled a different health care plan, which started out as a bipartisan initiative but was ultimately abandoned by Republicans. That legislation is still being debated in committee. Both bills will have to be combined into one Senate health care bill. After the House and Senate committees finalize bills, then debate will begin again on whether or not to pass them. (Note: the following explanation of the legislation is based off of the proposals as they stood at press time.)

Are you willing to gamble?

Clearly, the health care legislating process is long and arduous. But our generation may have a unique stake in this debate: nearly 40 percent of uninsured Americans are between the ages of 18 and 34, making us the largest component of the uninsured pool, D’Angelo says. Healy of U.S. News attributes the vast numbers of uninsured young people to the staggering costs of insurance plans, and the fact that health insurance is frequently tied to jobs. That can make finding coverage tricky for all those recent – and unemployed – grads out there. “Young people have been frozen out of the system in a terrible way,” Healy says. “For most young people, particularly those caught in transition periods, insurance is prohibitively expensive.”

A misguided sense of invincibility may also cause 20-somethings to forego health care for rent payments (or beer money).”Young people tend to be willing to gamble,” she says. “They can’t afford to put thousands down (on health insurance), so they think, I’m healthy, I can worry about that when I get older.”

Start worrying. It’s the law (or it may be soon).

But if the proposed legislation becomes law, everyone will have to find comprehensive insurance.

According to both the House and Senate bills, we will ultimately have to possess health insurance that meets government regulations, whether through private insurance companies or some form of government-funded insurance (more on that later). Employers will also be required to chip in for our insurance, though different bills call for different employer commitments. Tough financial penalties await anyone – individual or employer – who doesn’t shell out for insurance (although there are some exceptions made for small businesses).

“We want to make sure everyone buys into the system so there’s a bigger pool, making insurance cheaper for everyone,” says Volsky of the Center for American Progress.

OK, so I have to have health insurance – what will that cover?

President Obama has repeatedly promised if citizens like the health care coverage they have now, they can keep it. That’s true, but what your plan covers may have to change.

“The plan you’re in has to meet quality standards that are the very bare minimum of what we think of for comprehensive coverage,” Volsky says. “This eliminates the worst kinds of health care plans that necessitated reform in the first place.” That may mean tossing out the skimpy-but-cheap options many recent grads select now, like high-deductible health plans, also known as catastrophic insurance. These plans don’t cover routine check-ups, but they will kick in if catastrophe strikes – like, say, you break your neck bungee jumping. If the health care legislation passes, we’ll have to get plans with comprehensive government-mandated coverage, Volsky says. But some, like Healy, argue that not all young people need those benefits – or should have to pay for them.

“Younger people need minimum benefits,” she says. “They probably need catastrophic care, and they can pay for a gyno visit. But the bills say they must buy a comprehensive policy, rather than a risk-adjusted policy for being 20.”

Risky Business

The legislation also forbids insurance companies from taking individuals’ risk factors, or pre-existing conditions, into account. In the status quo, Volsky says, insurance companies can and do charge people more, or outright refuse to insure them, if they suffer from pre-existing conditions. Anything from cystic fibrosis to obesity can count against someone. If this legislation goes into effect, insurance companies must accept everyone, regardless of risk factors.

Similarly, insurance companies wil
l set premium rates based on income, rather than pre-existing conditions. The legislation also sets special conditions for age: under the House bill and one of the Senate bills, young, healthy people will pay up to half of what older, sicker people (under age 65) pay for premiums (the ratio changes slightly in the Senate Finance Bill). But that still amounts to a minimum of $4,000 a year for us under the House bill, while right now, young people can find policies for $600, according to Healy.

“If they’re mixed in with a pool that includes the 63-year-olds, then they have to pay way beyond what a 20-year-old should pay (due to the riskier pool young people will be a part of),” Healy says. It’s really a disproportionate tax on the young.” But it’s a “tax” that some Democrats argue will pay off for the individual, both now and in the future, because of its emphasis on preventive care.

“The problem with the argument “Isn’t that unfair?” is it’s short-sighted,” Volsky says. “It’s only unfair for ten or 20 years of your life (until you need insurance). And if you have access to primary care when you’re young, you can prevent chronic conditions down the road, which are what account for 75, 80 percent of our insurance expenditures right now.”

“It’s like Orbitz.com…”

To help the uninsured explore health care options, both the House and Senate bills call for the establishment of a Health Insurance Exchange.

“Think of the Exchange as an Orbitz.com for insurance,” Volsky says. “On Orbitz.com, you type in where you’re going, how long you’re staying, press enter and get nine different options. An insurance exchange works in a similar way. You’d go to the exchange, say, ‘I’m so-and-so, I have these needs and take this kind of medication, what would be the best option for me?’ And the Exchange would provide you with (insurance plan) choices available.”

The Exchange would be open to all individuals and some employers. It would include a pool of private insurance companies plus, under the House bill, a government-run insurance alternative known as the public option.

This option is perhaps the most controversial aspect of the health care debate: When people say we’re on the path to socialized medicine, this is what they’re referencing. That’s because some think, according to D’Angelo of the Heritage Foundation, the public “option” ultimately wouldn’t be an option at all, especially for employees. Since most employers would be required to pay for a substantial part of their workers’ premiums, employers would overwhelmingly opt for the cheaper public plan, he says.

“This is not an option,” D’Angelo says. “That’s a misleading way of selling it. Eighty-eight million Americans would end up on the public option because employers will drop their current insurance. It undermines the employer-based system.”

Obama, however, says the public option would have to be self sufficient and wouldn’t have an unfair advantage over private insurance companies. Instead, the relationship between public and private insurance would look kind of like the relationship between state and private schools, providing choice and competition, he says.

The latest Senate bill skirts the issue altogether. Instead of offering a public option, it proposes non-profit health insurance co-ops , kick-started with 6 billion federal dollars in loans and grants. James D’Angelo, a Communication ’09 grad and account executive at a Chicago political consulting firm (and no relation to Greg D’Angelo of Heritage), says the co-ops, instead of a public option, would compete with private insurance companies. They look like private companies, except they’re non-profits, so they don’t have to pay taxes. That means they can offer lower premiums, he says. People who receive government subsidies would be directed to a co-op, he says.

But the co-ops, meant as a compromise, have taken a lot of flak from both the left and the right. Liberals are still holding out for a public option, while conservatives say the co-ops look too much like the public option.

“A co-op would be extremely similar to the public option,” says D’Angelo, the former president of NU College Republicans.”Bureaucrats would be in charge of administering health insurance – they just wouldn’t be government bureaucrats – and it would be started with federal feed money.”

But if some sort of government involvement in health care can bring down medical costs, then that’s important to consider, says Jamila Bahrainwala, a Weinberg junior who interned at the Cleveland Clinic last summer.

“People are worried about government takeover, but I saw how much doctors charge their patients and it’s actually unbelievable,” the pre-med student says. “To save people’s lives and to not make people bankrupt, the government needs to get involved.”

Change you believe in?

At that health care town hall meeting in Fairfax, Jess Klein saw ugly signs, screaming protestors and, as she put it, “democracy in its truest form.” The only thing missing from the picture? Young people. “The vast majority of people I saw there were middle-aged,” Klein says. “It was kind of surprising, considering Obama’s (ability to) engage youth.”

The “youth vote” – voters between the ages of 18 and 24 – came out overwhelmingly for Obama in the last election. But that enthusiasm for politics hasn’t extended to the health care debate, Volsky says. “The problem is, we don’t think it’s an issue for us; it’s an issue for old people and we’re healthy, so whatever.”

But a “whatever” attitude doesn’t protect our best interests, Healy says. “Young people have got to understand that they need to have health care and ought to be playing a role in determining what kind they (get),” she says. “The decisions made now won’t kick in fully until a lot of people in your generation are pushing into their thirties. So it’s critically important that you get involved, to see if you can make this better. No one is speaking for you.”