What Health Care Reform Means for You

August 11, 2009

Many opponents of health care reform, including industry lobbyists and those who favor the status quo, have been disseminating myths intended to sink any attempts to reform our broken system and lower costs for middle-class families.  Below are answers to some of the most frequently asked questions about plans for reform and the truth about what reform will mean for American families.

Q: Will tax increases on middle-class families be part of health insurance reform?

A:  No.  President Obama has pledged – and I support him – not to raise taxes on families earning less than $250,000, including as a part of health care reform.  To the contrary, health care reform means lower costs for middle-class families, not tax increases. 

America’s broken health care system has created a de facto tax on working families that is increasing by double digits each year.  The average family of four contributed nearly $3,400 towards their health care plan in 2008.  That’s 12 percent more than they contributed in 2007.

These massive premium increases don’t go to pay for better check-ups or prescription drugs – they help pay the multimillion salaries of health insurance executives and cover the cost of health care for the 47 million uninsured Americans.  .

We have to take back our health care system by lowering costs, offering choices, and increasing accessibility so that working families no longer have to worry about being one pink slip away from losing their health care.  It’s irresponsible to allow health care costs to consume an every-increasing percentage of middle-class incomes.

Q:  Has Senator Merkley read the text of health care reform legislation?

A:  As a member of the Senate Heath, Education, Labor and Pensions Committee, Senator Merkley spent weeks in committee meetings not only reading the Affordable Health Choices Act, but working with his colleagues on the details to make sure the bill will help small businesses, promote wellness and preventive care, lower costs, address workforce shortages and give all Americans more choices. 

Q: Will health care reform mean that we’ll have a “government takeover” of the health care system?

A:  No.  Every health reform option being debated by Congress right now is predicated on making our existing private health care system work better, so everyone has access to affordable private coverage without worrying that an insurance company bureaucrat will cut off their coverage just because they’re sick.  In fact, the Affordable Health Choices Act will create a gateway where individuals and businesses can go to compare benefits and costs from different private health insurance plans as well as an additional public health insurance option available to those who want it.  This approach will lower costs by allowing more insurance companies to compete in every area of the country.  It will also hold insurance companies accountable for the services they provide and the premiums they charge.

Q: I really like the health insurance and doctor that I have right now.  Will health care reform mean that the government will choose my doctor instead?

A:  No.  If you like your current health insurance, you will be able to keep it.  And you will be able to continue seeing your current doctor.  Health care reform would simply give you the choice to change insurance providers if you so choose.  Increased competition among insurance providers will force those companies to keep costs low and improve service.  The legislation will also make it illegal for your preferred insurance company to turn you away, charge you higher premiums, or drop you just because you’re sick.

Reform also means that if you do get sick, your insurance company can’t refuse to pay for needed services.  Too often insurers look for any excuse to cancel policies and leave you without any protection – health care reform will stop this practice and allow you to keep seeing your doctor if you become seriously ill.

Q: Won’t health care reform result in major tax increases for small businesses?

A:  No.  To the contrary, health care reform will help small businesses afford health care, which is proving tougher to afford each year.  Large corporations can spread these costs out over hundreds of employees, but small businesses have less capacity to manage health care and less leverage to negotiate rates. 

Senator Merkley introduced an amendment to the Affordable Health Choices Act that will allow more small businesses to enter into the health insurance gateway if they so choose, providing them with the same purchasing power as large businesses.  By providing more choices for small businesses, we can lower costs and ensure that more Americans can receive health care coverage through their employers.  Moreover, the bill Senator Merkley voted for will provide new tax credits to small businesses that offer insurance to help them afford the cost.

 Q: A lot of people are worrying that people worry that health care reform will lead to rationing.  Will I be denied access to certain tests or procedures that could save my life?

A:  There is no proposal that would give the government any say over what procedures your health care provider can offer.  But make no mistake – our current health care system is already plagued by rationing.  Insurance companies are the ones who decide what doctor you can see and what treatments you can receive or even whether you will have coverage at all.  Health care reform will do several things to eliminate much of the rationing happening today, including:

• Preventing insurance companies from denying coverage because you have a pre-existing condition;
• Preventing insurance companies from cancelling coverage because you get sick;
• Banning annual and lifetime limits on coverage;
• Prohibiting insurance companies from dropping coverage for the seriously ill; and
• Preventing discrimination based on gender.

Decisions about medical care should be made by doctors and patients – not insurance company bureaucrats.

Q: I have Medicare and I’m happy with it.  I’ve heard that because much of the cost savings are going to come from Medicare that my coverage will be hurt. Will reform be taking money away from seniors?

A: Not at all. The savings being proposed from Medicare won’t threaten patient care for seniors or anyone else.  The Administration is going after big subsidies to insurance companies, overpayments to drug companies, and waste, fraud and abuse that do nothing to make sure that our seniors receive high quality care. These changes help us to stabilize Medicare and put it on better financial footing.  What’s clear is that if we don’t begin to rein in escalating health care costs, Medicare will be threatened over the long-run.

Furthermore, we can take steps to rein in the cost of Medicare Part D – the prescription drug program – by instituting commonsense reforms like allowing the federal government to negotiate drug prices.  Currently, the government is prohibited from doing so, essentially allowing drug companies to charge whatever they’d like.  That’s one major reason why drugs provided through Part D cost an average of 58% more than those provided through the veterans health program.  Allowing the federal government to negotiate prices will lower prescription drug costs for American seniors.

Finally, many of the cost increases in the Medicare program mirror those in the health care economy as a whole.  When we implement practices that encourage preventative care and disease management and bring more Americans under the umbrella of stable health services, costs will go down across the board.

Q: I have Medicare and I’m happy with it.  I’ve heard that because much of the cost savings are going to come from Medicare that my coverage will be hurt. Will reform be taking money away from seniors?

A: Not at all. The savings being proposed from Medicare won’t threaten patient care for seniors or anyone else.  The Administration is reducing wasteful subsidies to insurance companies, overpayments to drug companies, and waste, fraud and abuse that do nothing to make sure that our seniors receive high quality care. These changes help us to stabilize Medicare and put it on better financial footing.  What’s clear is that if we don’t begin to rein in escalating health care costs, Medicare will be threatened over the long-run.

Furthermore, we can take steps to rein in the cost of Medicare Part D – the prescription drug program – by instituting commonsense reforms like allowing the federal government to negotiate drug prices.  Currently, the government is prohibited from doing so, essentially allowing drug companies to charge whatever they’d like.  That’s one major reason why drugs provided through Part D cost an average of 58% more than those provided through the veterans health program.  Allowing the federal government to negotiate prices will lower prescription drug costs for American seniors.

Finally, many of the cost increases in the Medicare program mirror those in the health care economy as a whole.  When we implement practices that encourage preventative care and disease management and bring more Americans under the umbrella of stable health services, costs will go down across the board.

Q: I’ve heard that there are going to be cuts to Medicare Advantage.  I receive health coverage through Medicare Advantage and I’m afraid of losing my benefits.  Are the proposed cuts going to hurt my coverage?

A: Before I get into details, I want to be clear that if you’re already enrolled in a Medicare Advantage plan, nothing will change. 

Medicare Advantage is the part of the Medicare program that allows beneficiaries to sign up for coverage in private insurance plans. 

Right now, Medicare pays these private plans on average 14% more than they pay traditional Medicare.  In fact, all Medicare recipients are paying more to help subsidize these private insurance plans, even though only a quarter of seniors are enrolled in them. There is no evidence that this extra payment leads to better quality care for Medicare beneficiaries.

Insurers, not beneficiaries or the Medicare program, determine how these overpayments are used – and a significant portion is used for marketing and other administrative costs, not improving patient care. This means that seniors do not get the full overpayments back in the form of extra benefits.

Reducing subsidies to private plans will save the federal government, taxpayers, and Medicare beneficiaries more than $100 billion over the next 10 years.

So, the Finance Committee is looking to reduce inefficiencies in the Medicare Advantage program, which may result in changes to extra benefits in the future.  But all beneficiaries will continue to receive the standard Medicare benefits that all seniors are entitled to.

And just to reiterate: if you have Medicare Advantage right now, your benefits will not change.

Q: There is a serious shortage of primary care doctors. Will health care reform address this problematic gap?

A: We can have the best health insurance options in the world and people still won't get needed care if we don't increase our workforce of primary care physicians and nurses. The legislation that Senator Merkley has been working on strengthens our provider networks by establishing a loan repayment program for allied health professionals, nurses, and mental and behavioral health services providers.  The Affordable Health Choices Act also increases funding for the National Health Service Corps to provide more scholarships to medical students who choose to work in areas facing doctor and nursing shortages.

Training for nurses is another sector of primary care workforce development that needs additional support.  It’s important for reform to include increased grants and loans for nursing students and increase the ranks of nursing faculty members.

Q: I’ve heard that one section of health care reform legislation that requires seniors to talk to the government every five years about how they want to end their lives.  Is this true?

A:  No.  The special interests who want to kill health reform are trying to scare seniors.  The House of Representatives bill includes a provision that simply provides access for seniors who want it to discuss topics like hospice care, preparing a living will, providing medical power of attorney, and -- if they request it -- end of life decisions with their doctor and medical staff.  Just like any medical discussion you have with your doctor, these discussions would be covered under Medicare rather than paid for out of pocket by seniors.  These counseling sessions are not mandatory.  They are simply made available to those who wish help planning ahead for potentially difficult decisions.