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What Health Reform Will Do for America - Two Examples

March 19th, 2010 | Jason Rosenbaum

Two headlines today highlight glaring problems in our health care system that would be fixed if health reform passes.

First, from Pennsylvania, the New York Times headlines “Big Insurance Rate Increase for Pennsylvania Poor”:

Facing a sharp rise in costs, Pennsylvania has almost doubled the monthly bill for a state health insurance program for poor people who do not qualify for Medicaid and are on a waiting list for a less costly option.

On March 1, the cost of the plan rose to about $600 a month, up from $313 a month, for the roughly 2,400 state residents on the waiting list.

Established in 2002, Pennsylvania’s state insurance program, called AdultBasic, covers adults ages 19 to 65 with incomes lower than twice the federal poverty level, or about $21,672 for a single person, at a cost to participants of about $36 per month. About 39,000 people are enrolled in AdultBasic.

About 390,000 other people are on a waiting list to join the AdultBasic program. While they wait, the state gives them the option to pay for the same insurance at a higher rate. It is the cost for members of the waiting list that rose on March 1 to about $600 a month.

Health reform solves this problem.

For families who make 133% of the Federal Poverty Level or less – about $24,000 per year – health reform would allow them to get on Medicaid. Those families who make more than that – up to 400% of the FPL or about $73,000 per year – will be able to purchase heavily subsidized insurance in the Exchanges.

For families making between 133% FPL and 200% FPL ($24,000 – $36,000 per year) – the people affected by Pennsylvania’s rate increase above – their average cost for insurance, both premiums and out of pocket, will be [pdf] around $63 per month for families at 133% up to $244 per month for families at 200%.

The next headline is from Kaiser Health News, “Drug Prices Rise For Seniors Who Reach Medicare Part D Coverage Gap”:

Seniors who hit the coverage gap in their Medicare prescription drug plans and must use their own money to buy drugs are facing price increases that are far outpacing inflation, a new study finds.

According to the Kaiser Family Foundation, prices paid by enrollees in standalone Part D plans who enter the coverage gap increased 5 percent or more since January 2009 for half of 10 brand-name drugs most commonly used by seniors. That’s almost twice the rate of inflation over the same period.

For example, the price of Actonel, a treatment for osteoporosis, increased 8 percent, from $91 per month in 2009 to $98 per month in 2010. Meanwhile, the prices for both Aricept, an Alzheimer’s medication, and Plavix, a drug used to prevent blood clots, both increased by 7 percent during the same period. Aricept’s prices rose from $184 to $198 while Plavix’s rose from $142 to $152. Lipitor, a cholesterol medication, was the only drug surveyed that decreased in price, from slightly more than $86 to just under $86 per month.

The rising prices are part of a longer is sufficient longer-term trend. Between January 2006 and January 2010, the analysis showed, prices of drugs bought by seniors who hit the coverage gap increased 20 to 25 percent for Lipitor, Plavix, Nexium, a drug for acid-reflux, and Lexapro, a medication for depression and anxiety; 39 percent for Actonel, and 41 percent for Aricept. Over the same period, inflation has increased 9.2 percent while prices for medical care have surged 16.1 percent.

Health reform solves this problem, too. Immediately after passage of the bill, seniors will get immediate relief that starts closing that coverage gap. The gap will be completely closed as health reform is implemented.

There are a few more noteworthy immediate affects of reform as well:

  • Prohibit pre-existing condition exclusions for children in all new plans;
  • Provide immediate access to insurance for uninsured Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool; (this will help with the Pennsylvania situation as well)
  • Prohibit dropping people from coverage when they get sick in all individual plans;
  • Offer tax credits to small businesses to purchase coverage;
  • Eliminate lifetime limits and restrictive annual limits on benefits in all plans;
  • Require plans to cover an enrollee’s dependent children until age 26;
  • Require new plans to cover preventive services and immunizations without cost-sharing;
  • Ensure consumers have access to an effective internal and external appeals process to appeal new insurance plan decisions;
  • Require premium rebates to enrollees from insurers with high administrative expenditures and require public disclosure of the percent of premiums applied to overhead costs.

Reform will also help people like 11-year-old Marcelas Owens, who’s mother died because she didn’t have insurance:

And Matt Masterson’s son, who’s pre-existing condition makes him virtually uninsurable, a near death sentence as soon as he’s kicked of his father’s insurance plan in a few years:

Finally, today, the House Energy and Commerce Committee came out with numbers on how reform will help people in every Congressional district.

The vote is coming in the House. It’s likely to take place this weekend. Without reform, none of these problems get solved, and the insurance companies will get to continue their business practices of denying care and carving out coverage while making record profits.

It’s time to for the House to decide, and you should pick up the phone and help them.

*This post originally appeared in Health Care For America Now on March 17, 2010. Reprinted with permission.

About the Author: Jason Rosenbaum is a writer and musician currently residing in Washington D.C. He is interested in the intersection of politics and culture, media consolidation issues, and making sense out of our foreign policy disasters. He currently works for Health Care for America Now and he is also the webmaster for The Seminal.

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