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On One-Year Anniversary, has Health Care Overhaul Helped?

Wednesday, March 23, 2011

U.S. President Barack Obama (C) is applauded after signing the Affordable Health Care for America Act during a ceremony with fellow Democrats in the East Room of the White House (Getty Images)

Welcome to Politics Bites, where every afternoon at It's A Free Country, we bring you the unmissable quotes from the morning's political conversations on WNYC. Today on the Brian Lehrer Show, Rima Cohen, counselor for health policy to Health and Human Services Secretary Sebelius, discussed the one-year anniversary of the Obama health care law.

A year after passage of the Affordable Care Act, Rima Cohen says she's still seeing a deluge of misinformation and confusion about what the health care reform law actually does.

I've seen polling of seniors that says they believe the health reform law takes benefits away from them. Nothing could be further from the truth on that score. The Affordable Care Act (ACA) provides seniors all kinds of new benefits and protections: free preventative care services, new benefits in the prescription drug area that have already started to kick in with subsidies for Medicare Part D coverage...There are a host of benefits for seniors.

But Americans can be forgiven for most of the things they don't understand about overhaul. The sheer number of provisions, mandates, tax credits, revenue measures, regulations, etc., are made even more complicated by their staggered starting dates. State opt-outs begin in 2017, health care exchanges won't be established until 2014, and some new policies have already kicked in.

It's just hard to tell what's going on, and when. And if any of it will really make a difference to health care bottom lines across the country.

To top it all off, President Obama is now perceived as backpedaling on some ACA measures. Last month, he told the nation's governors that he would allow them to opt out of Affordable Care Act provisions and impositions early, if states were able to meet the same desired ends through their own initiatives.

However, Rima Cohen said that it was inaccurate to characterize the president's move as a flip-flop.

Under the current law, states may apply for waivers from some provisions of the Affordable Care Act in 2017 if they can demonstrate that they can achieve the goals of the ACA—expansion of health insurance coverage, health security for Americans—without increasing the deficit. If they can meet those basic goals and think of better ways, ways that are more consistent with local market conditions, then they can apply for this waiver. What President Obama has suggested is that perhaps we should move up the date for which states can apply for the waivers from 2017 to 2014. It's not really a change in position.

Of course, the real question on everyone's mind is: Will my health insurance costs be any lower as a result of the Affordable Care Act? Cohen was adamant that the legislation would control costs, but her words ran counter to a caller who said she already pays $18,000 annually for health insurance, saw a $200/month increase in costs through 2010, and has been notified that she can expect another 10-12 percent increase in her premiums this year.

Cohen responded to the scenario by making two points. First, as was already discussed, much of the health care law has yet to kick in; Americans hoping for immediate results should temper their expectations. Second, premiums aren't necessarily going up because of the Affordable Care Act—and indeed may go down once it's met the goal of covering the uninsured.

One thing I don't hear enough conversation about is the fact that everybody who has health insurance today is paying for those folks who don't have insurance and access the health care system. Those folks don't get free care; they may not be paying for it themselves, but somebody is paying for that care...Everyone having insurance actually reduces costs for those people who currently have insurance and are subsidizing those who don't.

"Any insurance company that blames premium increases on the Affordable Care Act is using that as an excuse," Cohen finished.

While that's not entirely comforting to many citizens dealing with the high cost of health care, Cohen stressed the need for patience on this one-year anniversary and beyond. "Americans may not see the effects yet," she said, "but they will very soon."

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Comments [46]

Gideon Fraenkel

Amidst all the discussion about ACA two matters are neglected. 1) The uninsured are already seeing their doctors, albeit inefficiently and often too late to do much good. The rest of us are paying their bills via our taxes and/or our inflated premiums. 2) The uninsured and inadequately covered are transmitting their poorly treated infectious diseases into the population at large, more so than those among us who are properly covered.
The mandate for all to be covered together with provisions for those who cannot afford the insurance will alleviate these problems. Patients will be more likely to seek medical care before their ailments become critical. There will be fewer visits to emergency rooms.The formerly uninsured will no longer send their sick children to school to infect he other children. So costs will decrease. The population will be healthier which translates into a more stable and stronger economy. This will be good for business. Everybody will be better off, including he wealthy whose assets will increase as the economy improves.

Sep. 13 2012 03:26 PM
Andrew from Manhattan

How are healthcare costs supposed to go down if insurance companies are required to insure more high risk people?

All we are doing is reducing the amount of hospital bill-padding and increasing the amount of insurance company bill-padding.

Our health care costs aren't going to go down until we address societal changes - our ability to sue doctors for damages, our ability to get the best cutting-edge care and equipment, and our ability to keep getting treatment when our odds of survivial are very low. All these things create an unending spiral of costs which will continue.

Mar. 26 2011 09:08 AM
Michael Barnes from Jersey City, NJ

I think the guest, Rima Cohen, was very informative and I really appreciate her extensive knowledge of the new law and the ability to explain it clearly.

I would like to make a strong suggestion:
This bill is now the law of the land. It is what it is, and I think a lot of what is causing people to have negative feelings on the new law is that they don't understand what it is, and how it fully will affect them.

I think we need nationwide town halls - not to debate the law, but to answer questions about the law. There should be a presentation given, handouts on the major coverages, eligibility and costs, and open question and answer breakout sessions. This should happen in municipalities, maybe held at local schools, community centers, etc. If there are suggestions to improve the law, then there should be a 'suggestion box' at each event where folks can suggest improvements after fully understanding the law.

This law will affect us all, and the intent is that it is for the better. The sour grapes and debates of writing the bill are now long over. We need to concentrate on A.) what the law actually IS and DOES, and B) how it might be improved going forward. We can't go backwards, folks. Thoughts?

Mar. 25 2011 11:20 AM
kevin from Suburban NJ

Ms. Cohen's description of 35% tax deduction for employers covering their employees is not available for me as a self-employed individual.
My problem, your average salary to qualify has to be less than $50k. Where in the NY Metro area can you raise a family on that kind of wage?
My policy for a family of 4 just went to 18k.
I believe in covering everyone, but this just is not getting it.

Mar. 24 2011 06:18 PM
cb56 from shore lane 3b


I have paid my health insurance premiums out of pocket for 35 years. The only health issue I've ever had is my teeth; for which I have paid the dentist directly.

I can't understand why a proctologist is covered by health insurance and a dentist is not.

Dental health is conveniently ignored as cosmetic or expensive. Studies are starting to link mouth health to its impact on the heart.

Isn't every other part of your body covered by health insurance; why not your teeth and gums?

Mar. 24 2011 05:42 PM
zelia from nyc

While we can always count on these discussions to be informative, fair, and deep, there seemed something jarringly wrong with this one - but exactly what the problem was only became clear when the next guest spoke about bike lane issues with a sense of outrage that is missing from this and so much discussion of health insurance, as if we just can't wrap our minds around the devastating effects of the financial unavailability of health care (because of co-pays, treatment limits, pre-existing condition exclusions, etc.) even to those with what we now call insurance.

Mar. 23 2011 12:30 PM
Max from NJ Suburbs

Government employees at all levels, including in all branches of the Federal Government, should be required to comply with all laws that they create, enact, or are required to enforce.

Give up two years of your career to serve in Congress, and you and your family have premium healthcare for life at taxpayer expense.

Mar. 23 2011 11:47 AM
mc from Brooklyn

From Max from NJ Suburbs:
"I am struggling to find how the law complies with the Constitution. I can not purchase health insurance offered to residents of a different state, so health insurance is not interstate commerce.

The Tenth Amendment requires that all actions taken by the Federal Government be based on specific rights allocated to the Federal Government, so where in the Constitution does it say that the Federal Government can require me to purchase something, anything, from a private supplier?

Please help me understand this."

Stay tuned Max. The 4th, 6th, 11th and DC Circuit courts will be weighing in on this. And then, depending on the rulings, possibly the US Supreme Court.

Mar. 23 2011 11:45 AM
EllanR from Brooklyn

Not only are the health care plans unaffordable; then you have to pay the co-pays . . . $30 to see your Primary Health Care Provider for the needed referral, pay $50 to see a Specialist (here's hoping the one you want to see is accepted by your plan) and then Physical Therapy prescribed 2x a week at $50 a visit. Yikes.

Mar. 23 2011 11:43 AM
mc from Brooklyn

From savitra:

"good answer to the last question about self-employed and those who don't get insurance from employers. but, what am i supposed to do between now and 2014? not get sick or have any accidents? please?"

You speak my mind.

Mar. 23 2011 11:42 AM
mc from Brooklyn

@marie:
1) Individual plans have to demonstrate that they spend 80% of your premium on health care. This took effect 1/1/11. If they fail to do that they owe you a rebate. This will not vary by state unless the state sets up its own system which is equal or better.

2) Children cannot be excluded for a pre-existing condition now.

3) In 2014 you will be able to buy insurance on the Exchange regardless of pre-existing. It will only vary by state if your state sets up its own plan which is equal or better.

Mar. 23 2011 11:39 AM
Telegram Sam from Staten Island

$350 tax credit vs. $9,000 a year (and rising) I'm paying for so-so private health insurance. She's really not living in the real world, like the rest of the Obama administration. Depressing.

Mar. 23 2011 11:37 AM
Kay from Queens, NYC

How about tax credits for freelancers, a growing section of people? We pay for health insurance in post tax dollars.

Mar. 23 2011 11:36 AM
JPS from NY

Brian, It looks to me like people are really interested in getting updates and asking questions...your show is great. How about planning for a regular update on this ? A clarification about the laws as they affect people - kinds a of a clearing house.

Keep up the good work and this is why I pay for your programming along with others. Yey!

Mar. 23 2011 11:36 AM
Bernie from The Catskills

Brian,

Just tried to go to www.pcip.gov and got an internal server error....guess a lot of people wanted to check it out and it crashed?

from the Catskills

Bernie

Mar. 23 2011 11:36 AM
Xtina from E. Village

Max from NJ Suburbs - it's not called Health Care Reform it's called ACA Affordable Care Act aka Health INSURANCE Reform. You may be calling it Health Care Reform, but that's not its name, so don't ask why you are doing something wrong.

Mar. 23 2011 11:35 AM
Estelle from Austin

Employers should not be required to offer health insurance. They aren't required to now, and yet most do.
The bottom line is that health insurance should be affordable to individuals, so we don't have to depend on others (employers) for such a basic need.

Mar. 23 2011 11:35 AM
steve cosentino from ny city

why when over 65% of americans wanted the public option, did the president dropped it from the beginning of the talks

Mar. 23 2011 11:34 AM
John from Forest Hills

I've just come up with a brilliant idea that will make Tea Party and Anti-Obama people really happy. It's the, "Let 'Em Die Option." Anyone without health insurance (the very rich and especially the very poor) will get absolutely no health care unless they pay the full amount of the bill.

Mar. 23 2011 11:34 AM
Jonas Littman from Greenwich

Pre-existing state run coverage - At least in Ct it is very very expensive ($1330/ month for just my wife ) and goes up by just under 20% every year!

Mar. 23 2011 11:32 AM
John from NYC

Where is the best source to find out information about obtaining health care insurance if you are either currently self employed or unemployed? Do we look to the respective State Health Departments?

Mar. 23 2011 11:30 AM
Max from NJ Suburbs

Why is this called "Health Care Reform" when it is not reforming anything?

If you are looking for something but digging your hole in the wrong place, bringing in a power shovel and bulldozer to dig faster and deeper in the same place isn't going to help.

Mar. 23 2011 11:29 AM
Xtina from E. Village

I am in the same position as the last caller - too poor to afford insurance, make too much to qualify for tax credit assistance.

Ye Ms. Cohen tells the caller she can get these tax credits in 2014! What is the point of having this guest on if she is just going to ignore the question and tell the caller she may qualify for tax credits which the caller just told her she won't qualify for? What a waste of time!

The tax credits are based on 400% above the poverty line; these standards do not apply to New Yorkers where the cost of living is much much higher than anywhere these standards apply, and our Senators Gillibrand and Schumer did absolutely nothing about modifying this standard for New Yorkers.

Mar. 23 2011 11:29 AM
savitra from manhattan

good answer to the last question about self-employed and those who don't get insurance from employers. but, what am i supposed to do between now and 2014? not get sick or have any accidents? please?

Mar. 23 2011 11:28 AM
sally from ny

Midwves. How does the bill promote midwifery care which improves women's health and maternity outcomes at lower cost ?

Mar. 23 2011 11:28 AM
Bob from Chappaqua, N.Y.

Health insurance costs were already escalating enormously for years before
the law was passed.

Mar. 23 2011 11:25 AM
Max from NJ Suburbs

I am struggling to find how the law complies with the Constitution. I can not purchase health insurance offered to residents of a different state, so health insurance is not interstate commerce.

The Tenth Amendment requires that all actions taken by the Federal Government be based on specific rights allocated to the Federal Government, so where in the Constitution does it say that the Federal Government can require me to purchase something, anything, from a private supplier?

Please help me understand this.

Thank you.

Mar. 23 2011 11:23 AM
Estelle from Austin

Are we really supposed to believe that premiums are going to go back down in 2014? That's not generally how corporations do things.
This reminds me of the credit card fee hikes right before that law went into effect.
If insurance companies are taking advantage of the new law to greatly raise rates now, what recourse does a consumer have?
Mine went from $756 to $888. I don't even want to calculate what it will be by 2014 at this rate.

Mar. 23 2011 11:23 AM
Kat Williams from New York City

I'm an independent contractor. I have purchased insurance from Atlantis Health Group for the past two & 1/2 years at a monthly rate of $380. Last month, I received a letter from Atlantis claiming that due to the new Health Care Bill, my new monthly would be $560. I called my primary care physician, and he told me to wait until 2014 as the insurance companies were trying to make money while they could. I now have basic hospitalization coverage at $180/month, but I can't believe that we are getting gouged so much.

Mar. 23 2011 11:21 AM

Oh boy. Don't get sick, and if you do, don't plan to get better. This doesn't have to be soooo complicated. There are models (in other countries) that work. Why are we trying to recreate the wheel?

Mar. 23 2011 11:20 AM
Henry from Katonah

I am already seeing benefits.
In 2008-10 , I was often often told by my medical plan reps that I and family members went over the "wellness maximum." My 2011 plan has no such maximum. As a late middle age person this will make my plan much more worthwhile.
My co-workers ( I work at a multi-city law firm) who I mention this to refuse to be happy abt this change. They believe that the insurance co will find a new ways of not covering our charges.

Mar. 23 2011 11:18 AM
Xtina from E. Village

"and why more than one thousand businesses and unions have now filed for waivers from the bill."

Oh my God! Businesses don't want to spend money to buy their employees health insurance? Shocked, shocked!

Mar. 23 2011 11:16 AM
marie

Questions for Ms. Cohen:
(1) Is there anything in the pipeline to keep down the per cent of the premium dollar going to overhead for those who must buy individual plans? Will this vary by state?

(2)What is the status of the requirement that children under age 26 not be excluded due to pre-existing conditions?

(3) Will adults be able to purchase individual plans regardless of pre-existing conditions? Will this vary by state?

Mar. 23 2011 11:16 AM
Kaveri from Brooklyn

As a freelancer who buys health insurance from Freelancer's Union, I am self employed but not uninsured. Will I be eligible to buy insurance on the new state-based exchange, and if so, is it likely to be more affordable than Freelancers Union Insurance (which is about $300/month)? And when?

Mar. 23 2011 11:15 AM
Joan from Tarrytown, NY

As was the concern of the caller paying over $18,000 for family healthcare, I, too, am concerned with how much the rates have increased in the face of very low inflation. I am a currently underemployed freelance editor, and yet I must pay $14,346.96/year for my individual Oxford HMO--an increase of 12.5% from 2010. The increase from 2009 to 2010 was 19%, and overall, my healthcare costs have more than doubled in just 5 years. It's coverage I really can't afford on my income, and I wish something could be done now to stem--and even reverse--the cost for individuals. Seems like the healthcare providers are being allowed to run wild until the new healthcare plan is in place.
Second point -- why can't the administration do a better job of getting a clear document out to the public about the new healthcare plan? It seems like a no-brainer to do this and try to quell the ignorance on this topic.

Mar. 23 2011 11:15 AM

There's another Part D coverage "gap." There are those on SSR/SSD who can't afford to pay for their drugs and their food. It isn't just an either/or choice of food or drugs, especially with the increasing incidence of Type 2 diabetes & its dietary needs.

Mar. 23 2011 11:14 AM
Kaveri from Brooklyn

As a freelancer who buys health insurance from Freelancer's Union, I am self employed but not uninsured. Will I be eligible to buy insurance on the new state-based exchange, and if so, is it likely to be more affordable than Freelancers Union Insurance (which is about $300/month)? And when?

Mar. 23 2011 11:14 AM
Zev Katz from Manhattan

Ms. Cohen, the cost of my health insurance has risen by 22% since the signing of the "Affordable Care Act". One prescription drug I take has risen in cost by 157%.

In what way is this "affordable care"?

Mar. 23 2011 11:14 AM
Zuzana from NYC

Are foreigners who live and work here legally with proper authorization eligible to enroll?

Mar. 23 2011 11:11 AM
Jay F.

Are dental plans part of Health care?

Mar. 23 2011 11:11 AM
mc from Brooklyn

@Jonas: if they are under 26 and have no other coverage, your plan is required to enroll them. You should check when your plan does its enrollment (usually once a year).

Mar. 23 2011 11:06 AM
Telegram Sam from Staten Island

Why were 3,000+ corporations allowed exemptions from employer rules? I was a supporter of healthcare reform, and I was willing to accept higher premiums short-term in the interest of helping others. But now I feel like I'm expected to sacrifice while big corporations get a break.

McDonalds is a prime example. Their health care plan is a joke, virtually guaranteeing any of their workers who find themselves with a major illness will wind up in a public emergency room. Which means once again I get to pay for McDonalds' employees' healthcare.

Mar. 23 2011 11:06 AM
Struggling to Maintain Insurance from Manhattan

When my COBRA expires, my insurance plan will go from $700 to $1800 per month on the open market. I can switch to the cheapest HMO available on the open market, for about $900 per month.

If I can find temporary work, I will eventually qualify for insurance from Freelancer's Union, and then I will be able to chose from various high deductible HMOs ranging from $350 to $400.

(Of course, in Manhattan, few doctors accept more than a couple insurance plans, and many accept no insurance at all. So, when your insurance changes every year or two, as mine has over the last decade, it's impossible to stay in network anyway. But that's a different story.)

Why can't unemployed or self-employed people buy group-rate insurance NOW? With insurance costing $20K per year for a single person, we can't afford to wait until 2014!

Mar. 23 2011 11:06 AM
Jonas Littman from Greenwich

Portability question: I took my college-aged kids off my policy becasue their college-offered was better and one of the Obama promises was portability. When they leave college will thier policy indeed be THEIRS or will they be left stranded? My insurer wont take them back on my policy becasue of pre-exisiting conditions.

Mar. 23 2011 10:46 AM
mc from Brooklyn

Please ask Ms. Cohen if she has a theory as to why Taft-Hartley multi-employer plans were left out of the language of the legislation. It is very hard for them to figure out how to comply. This may help answer the question Martin Chuzzlewit from Manhattan has.

Mar. 23 2011 10:34 AM
Martin Chuzzlewit from Manhattan

With all due respect to Ms. Cohen, it would be nice to have an alternative (and outside the aministration) evaluation or rebuttal after one year to that of a spinmeister for Sibelius. Duh, will it sound anything but great?
Maybe James Capretta of "e21" (testified before congress last Thursday) or Scott Gottleib of AEI.

Please ask her about the CBO's new appraisal of much higher costs for the program (now that it's been passed, of course), of the Starbuck CEO's alarming words last week and why more than one thousand businesses and unions have now filed for waivers from the bill.

Mar. 23 2011 09:56 AM

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