One huge issue that's received almost no attention in the debate on health care reform is what will happen to health coverage at work. There's been an enormous amount of attention paid to what will happen to the small percentage of Americans - less than 10% - who will get coverage through the new health insurance marketplaces called Exchanges. Will they have access to a public health insurance option? Will the government subsidies be enough to make health care affordable? Will insurance companies be able to raise rates because of health conditions, age, or gender?
This discussion - the one that's dominated the debate - has nothing to do with the majority of Americans, some 150 million, who will continue to get their health coverage at work. During the past decade, coverage at work has deteriorated with employees paying a bigger share of premiums for shrinking benefits. A study of employers released this past fall found that the trend is sure to continue in 2010. A key question is whether reform will deal with this growing problem for most working Americans.
What will happen depends on which reform bill you read. The House bill guarantees people will get good coverage they can afford. But the Senate bill not only fails to protect employees in large firms but also encourages employers in low-and-moderate wage businesses to offer barebones insurance plans and shift workers to part-time jobs.
For the key question most people ask when it comes to health reform - "Will I get good health coverage I can afford?" - the House bill provides unambiguously good news for people at work. The House bill requires all but the smallest employers to offer and help pay for good benefits or pay a percentage of their payroll to the government to help cover the cost of subsidies. Coverage must include a good package of benefits as defined by the federal government. Employers are required to pay a specified share of premiums for individual and family coverage, and the new insurance rules would apply to coverage offered by all employers, large and small. As a result, the House bill will not change a thing for people who get good coverage now at work but will establish a floor to protect people against the national trend toward skimpier benefits and higher costs to employees.
When it comes to a guarantee of good, affordable coverage at work, the Senate bill falls woefully short. Unlike the House bill, the Senate bill doesn't require employers to offer or pay for coverage for their employees. Instead, the Senate bill requires employers with 50 or more full-time employees to pay a fine if any of their employees end up getting subsidies from the federal government for coverage in the new insurance Exchanges. To avoid the fines - which can be substantial - employers can do one of two things. First, they can reduce workers' hours to fewer than 30 a week since part-time workers don't count as employees under the Senate bill. Second, they can offer coverage like barebones plans with very high deductibles and limited benefits and charge employees up to 10% of their wages for that coverage. This would break the promise that health care reform will save families from going bankrupt from medical bills.
The provisions in the Senate bill are not likely to create a problem for some higher paid workers who get good benefits at work now. However, the Senate bill could easily drive low and moderate wage employers - from Big Box stores to home care agencies - to reduce many employee hours to less than 30 a week and make any remaining full-time employees pay for lousy benefits.
In addition to not guaranteeing good, affordable coverage at work, the Senate bill doesn't require employers of 100 or more workers to comply with the new rules prohibiting insurers from charging more to people based on health history, gender, or age.
President Obama and the Congressional leadership have pledged that reform will free people from the fear of high medical costs and abusive insurance practices. To keep that promise, it is essential that the final legislation requires all employers to provide or contribute to good coverage for all employees - full- and part-time - and legislation must regulate insurance company practices throughout the entire health care system.
Richard Kirsch is the National Campaign Manager for Health Care for America Now (HCAN) - the nation's largest health care campaign.
Everyone should write to his Congress-people to demand a fair deal, then try to convince himself that someone will read it and that it will make a difference. Then get ready to pay a lot more for a lot less, if you're fortunate enough not to lose it all, because it will be completely up to the insurance companies to charge what they want and rescind whoever they want to (because of "fraud" on the part of the insured, naturally). Then the IRS will come along to take our last few pennies to cover the penalties for the premiums we still can't afford.
Isn't "Reform" just totally awesome?
I believe we need to separate health insurance from the job market. The two have no logical connection and in fact are only linked by a circumstance of history. Doing this would end the crisis faced by many (like me) who lose their jobs and then their health coverage when they can least afford to manage it.
The answer in three words: single payer system. The CBO studied this years ago and found that our country's total cost for health care would be about the same or slightly less with this system. Everybody covered, no portability issues, no mandates, no requirement to buy insurance from anybody.
Now, good luck convincing our elected representatives of this considering the millions upon millions in campaign contributions flowing to them from the insurance companies.
Employer provided health care was a noble cause back when we were in a world war coming out of a depression, the practice of which should have ended with the war. To me (and I'm sure many others) a benefit infers something of added value when one feels an enticement is required in order to obtain something of value (labor in this case) due to scarcity. Since the vast majority of us are now considered to be expendable anyway, the need for employer provided health care seems even less pointless if that's even possible. I'd rather have higher wages or more jobs and pay for my health care through taxes. It's the only thing that makes sense when that's what all of your competitors from other countries are doing and succeeding at, don't 'cha think?
I know this will not happen now but our US employer based health care system has outlived its usefulness for both employees and employers.
Besides,who in their right mind would trust corporations whose fiduciary responsibility is fundamentally and legally to invested stockholders with either providing directly or funding something as important as one's personal health?
Does the recent behavior of most especially large corporations warrant that trust? I think not.
I've heard the worn out phrase much to often about employees being viewed as assets on the corporate balance sheet. But it is in most cases a dishonest and cruel cliche.
Dr. Rick Lippin
Southampton,Pa
Also the term "corporate responsibility" is in the running for the most oxymoronic phrase of the decade.
Dr. Rick Lippin
Southampton,Pa
Single payer is the ONLY civilized, humane and rational system for providing care.
It would be far better if our politicians stopped treating us like ignorant children and did away with the employer based system so that people could learn the truth and make intelligent decisions.
Either that or remove health care from the backs of employers and implement Medicare for All. IMHO Medicare for All would level the playing field with the global competition and economy. If I remember correctly, that was one of the biggest b*tches Corporate America had for reducing/dropping health care coverage. The for-profit HC cartel has had their hand in the corporate bottom line for too long and sucked profits from the corporations and pay raises from the employees. How come NOBODY mentions this anymore? And why is Corporate America against single payer?
This entire effort has been a miserable display of how eager government is to sell the public's money to private entities in exchange for electoral donations and support.
Which is why people that support this bill . . . are going to be shocked that this does virtually nothing for them.
Which is why people that don't support this bill . . . wonder how we even got this far without addressing the 80-90% of people with health insurance now.