Lisa Hill is one of 18 volunteers who attended an Organizing for America meeting hosted by OFA Regional Field director, Kyle Juvers at the Arnold Branch Jefferson County Library on Saturday, September 12.  Hill’s son Adam, now 18, was diagnosed with leukemia at age seven.  He recovered, but last year he was diagnosed with epilepsy.  Frequent calls from the school nurse forced Hill to leave her job.  Her husband is a business owner, a union plumbing contractor, and since most of his employees get their insurance through their union, he can’t buy group health insurance reasonably for his business. 

Hill currently insures her family through COBRA, but she says that will run out in June of 2010.  She worries that her son won’t be able to buy insurance as an individual, and that his health will limit his work options. 

Like many people on all sides of the healthcare reform debate, Hill believes that most people are vulnerable under current healthcare policies.  “If you lose your job, you’re going to lose your healthcare,” she says.  “COBRA extends 18 months.  That’s it – if you can afford it.”

Talk about how to fix healthcare and there’s no longer consensus.  While Hill and other OFA volunteers support the Americans’ Affordable Health Choices Act, Richard Blowers, Jefferson County Chair for the Constitution Party, question its viability and envision different solutions.

“I just think that we would be better off addressing some of the big problems right away,” Blowers says.  “Let’s address tort reform.  Missouri has a form of tort reform right now and it has helped, but on the federal level they need to be willing to look at that.  Not just say, well, the trial lawyers are too big of an obstacle, so we’re not even going to address that.” 

“They refuse to put any kind of tort reform in the bill,” Blowers says, “but they build their own tort reform into the bill for the government regulators.  You can’t sue the government for decisions that they make about your healthcare.”

Blowers believes that insurance regulations should be left up to each state.  “Because as far as states’ rights go, in the beginning of the country the states got together and said – everybody was concerned about their individual state,” he says.  “So when they enumerated the powers of the federal government, they were very careful in what they enumerated for them to do and it was very limited.  It was basically things that the individual states could not do, like common defense, the defense of the nation.”

Blowers would like to see something done about the role of pre-existing conditions in healthcare, too, but thinks that it’s only a small part of the problem.  “I mean if you have healthcare, and say you’re diagnosed to be a diabetic, say you lose your job and you lose your healthcare, well the next job that you get, it might be very difficult for you to get insurance because of that pre-existing condition,” he said.  “But really that’s a small number of people compared to the numbers that they’re throwing around.”

Jim Hubbard, Deputy Communications Director for Rep. Russ Carnahan’s office believes that the American’s Affordable Health Choices Act will resolve the issue of pre-existing conditions. 

“The fact is that no one could be denied coverage for either their condition or their spouse’s or their children,” Hubbard says.  “Certainly healthcare is expensive and certainly people will have to continue paying their fair share for it, but because of the fact that we’re spreading around the cost it will be cheaper and more available for people.  Just because they might have higher risk of a certain condition doesn’t mean that we couldn’t – we would make it more affordable for them to have coverage.”

Although the bill still allows the insurance companies to assess risk when determining rates, Hubbard believes that if it passes it will make insurance affordable for high risk individuals. 

“There will certainly be higher risk for people but what would be different is that they wouldn’t be able to be denied coverage at all,” he says.  “By creating this pool of people, by presenting a public option, which the estimates are that only three percent of people would opt into, and in fact private insurance would increase under this plan, you’d be spreading the cost further along, reducing the cost for everyone, making it affordable for everyone because that’s where there’s a problem, that people are being priced out of it today and leading to bankruptcies.”

Hubbard says that Carnahan is pleased with the bill. 

“I think what he likes most about it is the fact that it’s a uniquely American solution that will build on what works and fix what’s broken because right now the healthcare system is broken for too many Americans,” he said.  “I think the fact that it’s uniquely American, it builds on what works and fixes what’s broken.  Right now health insurance companies have a monopoly on healthcare and instead of that persisting, we’ll put doctors and patients in charge and lower cost, offer more choices and improve the quality of healthcare.”

Hubbard doesn’t have cost estimates for the public option. 

“It would depend on what plan they’re a part of,” Hubbard says.  “Most people receive their coverage through an employer.  Their employer would have the option that they have today of choosing whatever healthcare plan they want to provide their employees.  There is some confusion that people will be forced to take one plan with the public option but that’s not the case at all.  It would add competition to the market which is something that not only the congressman supports, but most people when you explain it to them they support because competition works.  If you make it fair for everyone, that would be best.”

Hubbard also points out that businesses with fewer than 25 employees will receive incentives to purchase insurance for their employees.  “Small businesses, people that are self-employed, they would be given an incentive to buy their – if they employ, to cover their employees – but then they’re also given, like for example, a small business with 25 or fewer employees, they would get a tax credit of up to fifty percent of the cost of providing health insurance to their employees.  So the fact that that and other initiatives would make them benefit from insurance market reform.”

Blowers expresses concern that too many small businesses will receive penalties if they can’t afford to provide acceptable coverage for their employees. 

“It seems like right now the only increase in employment is government,” Blowers says.  “The number of their employees is going up but the private sector is dropping, and if you think about it, government employees don’t contribute anything.  I’m sure there’s a few out there that do, but in general a government employee, they take a paycheck which is tax dollars, and all they really do is manage something or they redirect tax money wherever it’s going.  They’re not producing anything.  They’re not contributing to the production of a product, or like with my job, I keep industrial equipment running so that that business can continue to manufacture what they make or perform the services that they do. So if you had less government, less government employees, less drain on the economy, and then those people go into the productive side of the economy, that’s where you grow.  That’s where you get rid of debt. That’s where you collect tax money.  That’s where the country grows.  It’s in the private sector.”

Under this plan, employers with more than 25 employees will pay eight percent of their average employee wages to the Health Choices Commissioner “for deposit into the Health Insurance Exchange Trust Fund,” per employee for whom they don’t provide insurance.  Employers with 25 or fewer employees will be exempt if their annual payroll is less than $250,000, and there’s a sliding scale with a maximum of 8% of payroll to be paid into the Trust Fund for employers with annual payroll exceeding $400,000.  Based on Missouri’s minimum wage of $7.25 per hour, a company with 25 employees each working 40 hours per week would have an annual payroll of at least $377,000 which would put them in the six percent bracket for “employer contributions in lieu of coverage.”  The requirements for acceptable coverage include employer contributions of at least 72.5 percent for a full-time employee and at least 65 percent for the employee’s spouse and qualifying children, with proportionate contributions based on average work hours of part-time employees.

“That’s a penalty,” Blower says.  “How many small businesses are going to be able to afford to do that?  You have to help the small business.  That would be, lower the corporate tax rates.  Give them incentive to grow.  I go to a lot of different businesses, and a year and a half ago I could see businesses pulling back.  You didn’t see expansion.  They were pulling into a safe zone.”

Hill says that her husband’s business paid $70,000 in taxes last year.  “People can’t say that we’re deadbeats and we don’t want to work and get a job because we do pay a lot of taxes in a year’s time.  Now we’re cool with that.  That’s fine.  But I feel like healthcare is a basic human right.  Obama has laid it out very well.  No one will go without insurance.”

Hubbard believes that this reform will improve the economy.

“This is a serious challenge that our nation is facing right now,” Hubbard says.  “The rising cost of healthcare is one of the greatest economic threats to our country and the fact is that we must do something, especially if we’re wanting to put our economy back on track.  I think there is some confusion out there.  I think what is unfortunate about the debate is that people have tried to inject lies and scare tactics into it.  There’s plenty to agree and disagree on but there’s certainly a lot of common ground, like for instance on denying coverage to people with pre-existing conditions, lowering costs, and giving people individual choice, which is all included in this reform legislation.  I think the congressman is hopeful that we’ll get something done this year and continue efforts to get our economy going again.”

Blowers worries that the public option will put insurance companies out of business, limiting options in the long-run. 

“The problem is, if you come out with a plan like this that’s got the government option and it in short order puts insurance companies out of business because they can’t compete, they can’t make money doing it and then they close their doors, then in five years they say, no, this isn’t working so good, and then the Supreme Court says we can’t do this, what are you going to do?”  Blowers asks.  “Go back and reinstate those insurance companies after they’ve shut their doors?” 

Hubbard thinks that the bill will improve private insurance offerings.  “The congressional budget office has estimated that private insurance would actually go up, and the way that they would afford it is that they’re making huge profits today,” he says.  “The insurance companies are not struggling.  The people trying to afford coverage are struggling.  By adding a public option – by adding further competition to the market – although only three percent of people would be using it, that three percent is enough to encourage and incentivize the insurance companies to cut their costs and offer more competitive prices for those seeking coverage.”

Blowers also worries that if the government limits what doctors can earn, it will reduce the quality of care available. 

“Who in their right mind is going to go through 10 years of medical schooling and go into debt $150,000 or $200,000 if they’re going to come out and make the same amount of money per government regulation as somebody that spends four years or a pediatrician or a podiatrist that has six years of training compared to my 10 or 12, that’s going to take away from the quality of the doctors and surgeons that we have here,”  he says.  “To think it won’t is just naïve.” 

Without reform, Hill worries that people in her son’s situation will have limited job and insurance options.

“He’s not going to be able to probably become a plumber,” Hill says.  “I would be very surprised if he would be able to become even an auto worker with having seizures.  How can you do that when you are subject to having seizures?  There’s limitations.  I see him maybe working at the zoo, possibly, or Schnuck’s bagging groceries maybe, but is that going to pay for a health insurance policy?  How do people like that survive? 

If the bill passes, it will limit people’s out-of-pocket expenses such as copayments and deductibles and affordability credits will be available to US citizens and legal residents that meet the income criteria and don’t have other coverage available through their employer or Medicaid. Tiered affordability credits will be available for individuals and families below 400 percent of the Federal Poverty Level, with an annual income $43,320 for a single person, or $88,200 for a family of four, for example.  Beginning the second year, the affordability credits will also be available to employees whose employer based insurance premiums exceed 11 percent of their annual income. 

Blowers distrusts that this bill will limit the public option and affordability credits to citizens and legal residents.  He says that his wife recently had to show multiple forms of ID to renew her driver’s license, even though, in theory, her eligibility was verified with previous renewals.

“Where’s the rules stipulating what you have to go through to prove your citizenship to get it?” he asks.  “That’s the kind of transparency and honesty that we’re looking for.”

Blowers wishes healthcare reform would address discounts that are currently exclusive to insurance companies. 

“I had my shoulder operated on a couple of years ago and the total bill that I saw was $11,000,” he says.  “But in that bill I saw what the doctor – that wasn’t in the hospital but it was in a surgical center – what they got, what the anesthesiologist got, and what the doctor got for performing the surgery.  It was like $4,200.    Where does the other $7,000 go?”

“If I don’t have insurance, should I be required to pay the $11,000?” Blowers asks.  “Or should I be required to pay what obviously the doctors and the facility, what they’re willing to accept, this amount of money, the $4,200 for the surgery.  Why do they feel they have to charge me, if I don’t have insurance, $11,000 when from somebody else they’re willing to accept the $4,200?  There’s a big discrepancy there.  And who dictates that – the insurance companies?”

Hubbard would also like to see the discrepancy between costs to insurance and costs to self-pay patients addressed.

“I think that’s an important conflict you’ve brought up,”  Hubbard says.  “To get around that, we’re wanting to negotiate those kinds of prices for everyone.  In theory, and the hope is, lower the cost for everyone.”

Another shared viewpoint between Hubbard and Blowers is in redundancies that raise healthcare costs.

Hubbard talks about Carnahan’s goals for healthcare reform. 

“It’s important to him for it to be deficit-neutral and not add to the deficit and he absolutely will not support a bill that adds to the deficit,” he says. “But he also wants to look for other cost-saving measures, whether that’s in electronic records, which we’ve already done a great deal of investment, and eliminating redundancies in the system, that sort of thing.  That’s something he’s continually working on to make it even more efficient and save additional funds.”

Hubbard elaborates on the redundancies.

“For instance doctors won’t be incentivized to do redundant tests, or if you go from one doctor to the other they’ll be incentivized to make someone better rather than do duplicative tests,” he says.  “For instance, sharing medical records.  So much is wasted today with offices not communicating with other offices.  If someone is sent to a specialist, the same test has to be done again.  That’s obviously wasteful.  If we’re able to share those records and get more efficient, that’s cost-saving.”

Blowers thinks that tort reform would introduce more common sense to healthcare and reduce redundant and unnecessary testing.

“The defensive medicine that goes on to protect themselves against those kinds of lawsuits – the doctor wouldn’t have to run six tests to find out you have arthritis” Blowers says.  “He might be able to do two tests and come up with the accurate diagnosis.  That cuts down on the total number of dollars spent on healthcare if you can come up with the diagnosis as quick as possible with the least amount of cost without having to run six or eight tests just to cover your butt.” 

“Let’s say if I got a sore throat and I call the doctor,” Blowers says.  “If the doctor knows that there’s strep going around or swine flu or whatever, he’ll say I need to get you in here to do some checks on you.  Or if there’s really nothing going around, he’ll issue me a prescription.  I don’t take up his office space.  If I have a headache, take some Tylenol and go to bed.  Don’t go to the emergency room and get x-rays and brain scans because you’ve got a migraine.”   

The Americans Affordable Health Choices Act is available online at:
http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf