| I sat in on Congressman Himes' "telephone town hall" tonight, and took notes. For those who weren't able to participate, I'll try to reconstruct it to the best of my ability. I missed bits here and there but I think I got most of it. I haven't included any of my opinions, just what I took down.
The Congressman began by saying that health care reform was important to him. He said the current system is not sustainable. Costs rising 10% to 12% per year put great burdens on the government. He claimed that most of the auto industry's problems were caused by the costs of medical care for retirees and employees.
He feels that it is morally problematic that 50 million Americans don't have health insurance. Those without insurance treat at emergency rooms which is expensive and the cost of which is picked up by taxpayers and private insurance companies. This ends up being a "tax" of roughly $1100.00 per family.
The House bill will allow people with employer-provided insurance to keep it. It calls for an insurance "exchange," open to all. Private insurers will no longer be able to turn away those with pre-existing conditions. The bill includes Government subsidies to help pay for insurance for those making up to 400% of the Federal poverty level. Everyone would be required to buy insurance, either private or public. [and he said something I didn't catch regarding 2.5% of adjusted gross income.]
Himes' concern is that the bill doesn't address the inefficiencies in the current health care system. There are not adequate cost control mechanisms to control waste and fraud. He is delighted that Congress is taking on health care reform and gratified it wants to provide health care for all. He is gratified that the bill seeks to alter private insurance companies' behaviors re: recision and pre-existing conditions.
He is disturbed that not enough is done to address the underlying inefficiencies in the system. The current system operates on a "fee for service" model, which lends itself to ordering unnecessary services to clients. He wants to move to a system that rewards good results instead. Health care providers should have a stake in good health rather than in making money by ordering unnecessary tests and services. If Congress was serious about health care reform, they'd contain costs by doing away with inefficiencies and wouldn't be taxing the rich to pay for it. He sees the tax code returning to 1990s levels. We are faced with big economic problems and can't just go to the highest earners -- can't do that every time we have a deficit.
He thinks what is going on now is the "start of the discussion" and hopes there are more than three weeks more in the process. He hopes Congress takes more time.
Then he took questions:
Someone from Westport had fears about the impact of the bill on small business and asked what the impact of the bill would be on a business with ten employees.
Himes said employers would be required to provide insurance to employees or pay a penalty. He has discomfort with a penalty [and/or the word "penalty"]. He clarified that businesses with an annual payroll below $250k would be exempt from the penalty. Businesses with payrolls between $250k - $400k would pay a graduated penalty between 4% and 6%. Those make up 4% of all businesses. He said he had signed a letter to the speaker regarding the effect of the bill on small businesses.
Bill from New Canaan, who is dependent on his employer-provided health insurance expressed concern about being taxed on his insurance benefits.
Himes said the bill as written includes no tax on insurance benefits, and that it was not under consideration. He pointed out that taxing health insurance benefits was John McCain's idea during the Presidential campaign, and that Obama opposed it. He said some economists believe there should be a tax on the benefits as a way of covering some of the cost of the reform. He doesn't disagree with that.
Sarah from Oxford said she heard people would be forced to sign up for the public plan if they lost their insurance.
Himes explained that if people lose their jobs/insurance, they are eligible for the exchange, in which private companies compete with the public option. You choose. The idea is that the competition from the public option will lower the price offered by the private insurers. The bill includes affordability credits to help those who have lost their jobs.
Then there was a survey for the participants: "How should we pay for health care reform?" Options were 1) Do nothing (no reform); 2) Tax insurance benefits; 3) Increase taxes on high wage earners and; 4) Eliminate costs in the system.
Caller Maria from Fairfield was worried about "the insurance industry going national" like Great Britain.
Himes said this is a completely different system from nationalized health care -- a uniquely American system that includes choice, because Americans love choice.
[I missed a bit on the concern about companies turning employees loose in a private v. public system.]
Nils from New Canaan cited page 16 of the bill concerning whether people can go outside the exchange if they want to change insurance coverage. Will private plans be allowed? Himes said private plans in existence would be grandfathered, and private plans would have a five year grace period to meet the minimum standards contained in the bill. There would be no restrictions on buying additional coverage, or "gold plated" plans.
Barbara from Monroe brought up Medicare and was concerned about the parceling of services and cut backs on treatment. She asked if there was a possibility that Medicare will pay for more preventive care under reform.
Himes said the good news was that the "donut hole" now in effect in Medicare is closed in the bill. The bill also eliminates the cost-share for preventive care. The bad news is that Medicare is currently economically unsustainable. Medicare currently reimburses for everything a doctor orders. He thinks that at some point judgements will need to be taken. Patients go to MD.com and then ask their doctors for 20 tests. The doctors, who get paid for doing the tests in the current fee-for-service system, just order them whether they're necessary or not. He said treatment must be evidence-based. Barbara asked who would be making the decisions/treatment plans and Himes discussed the HMO model [I missed bits of that] He said there is a need to change your discussion with your doctor so the treatment you get is not volume-based -- that you get the two tests you need and not the 18 you don't.
Cindy from Darien is concerned about paying for programs. She thinks providing insurance for everyone is good for the country but how do we address people who aren't supporting taxes. She is afraid illegals -- the "underworld" -- will benefit from the proposed reforms. Himes made it clear that the bill contains no coverage for undocumented aliens. He pointed out that leaves 12 million people without insurance under this plan. Right now the system is paying for them and there will be no change in that. They will go to emergency rooms with big problems and hospitals will continue to have unreimbursible costs from treating them. Humanity requires you to treat people who show up. We need a comprehensive immigration policy and secure borders.
Lily in Stamford asked about increases in private insurance premiums, with Anthem asking for a 30% increase; it will be a good plan if the bill brings down private insurance costs.
Himes said he is not satisfied with the cost containment provisions in the bill. He mentioned that the bill will cap overhead expenses for private firms in the exchange at 15%.
Rick from Monroe talked about the CBO director's comment that the bill would expand federal costs and drive the economy into the ground. He is concerned about imposing penalties on small business.
Himes agreed that could be bad if done wrong. He said again that the bill doesn't do enough towards cutting fundamental costs. He has not made peace that it doesn't cut fundamental costs and encourage healthy lifestyles. It doesn't encourage new doctors and nurses who will practice health-based medicine rather than specialize because that's where the money is. He can see voting against the bill if it is not done right. The US is paying twice what the rest of the world does on health care and isn't high on the list for quality care.
Another survey: "What type of reform do you want?" 6) No change (no reform); 7) Single payer; 8) hybrid as in the current bill; 9) hybrid with no public option.
Rick in Westport expressed concern about the speed with which this bill is being acted upon. There are contradictions in the plan. Medicare is full of waste and fraud and no one has ever dealt with it. It will be pushed through, like the stimulus and like cap and trade. Congress is hiding something.
Himes said Congress isn't trying to hide anything. He thinks more time should be taken. Getting the bill done fast is due to concerns that are political -- he said the President and Speaker think that health care reform will die a death by a thousand cuts if things go slower. Himes said it was necessary to act quickly on the stimulus because we were losing 20,000 jobs a day. He said the energy issue had been talked about for a long time. [missed a bit here] He said there have been 80 hearings on health care [missed some here]. He said he did not say Medicare's problems are caused by waste and fraud. Seniors love Medicare. Medicare says yes to everything. It runs more efficiently than private plans do.
Howard, who works in the medical field, wants to know how private plans can compete with a public option.
Himes said the private plans will be capitalized up front and that money is repayable. They will be asked to provide a "plain vanilla plan" which will compete with the public option. He said costs can be cut by the private sector -- Medicare functions more efficiently, has no advertising costs, no high executive salaries...
Jackie from Westport brought up the issue of pre-existing conditions.
Himes said those in the exchange are forbidden to reject people based on pre-exisiting conditions. right thing to do. It is expensive to filter people out. Talked about buying his own insurance and the company sent someone to his house to question his wife and him -- asked if they were going to have more children. Would have rejected them if they were. It's expensive to do that to reject people. No recision allowed in exchange. Morally wrong.
Gene in Monroe said he realized Himes' caution about due diligence, but said there was danger in procrastination. He asked if small businesses can buy into the public program for employees.
Yes, they can participate in the exchange. Companies with 10-25 employees will get a tax credit of 50% of the cost. Businesses can also get together and buy in to plans as a group.
That was the end of the questions.
Himes has a health care blog on his website now. Call his offices in Bridgeport and Stamford with questions and comments. |
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