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Sec. Kathleen Sebelius

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Giving Americans Better Health Insurance Choices

Posted: 07/10/11 11:40 PM ET

For nearly 180 million Americans whose health insurance today is provided by their workplace, getting coverage is pretty straightforward. They can choose from a range of plans offered by their employer that fit their needs and family budget. And for the most part, these plans include strong patient protections.

But for Americans who work for smaller companies, or buy insurance on their own, or are uninsured, the insurance market is much more treacherous. Insurers usually charge a lot more -- small employers pay an average of 18 percent more for coverage than their larger competitors -- and plans come with more strings attached. Rates can jump by double digits without much warning. Finding and enrolling in coverage is often complicated and confusing. And in the individual market in most States, coverage can be denied based on a person's health.

Starting in 2014, the Affordable Care Act will provide a new alternative for those in this broken market. Discrimination against people with pre-existing conditions will be illegal. And individuals and small business owners will be able to purchase private health insurance through state-based competitive marketplaces called Affordable Insurance Exchanges.

Exchanges will give Americans competition, choice, and clout in the health insurance market. They'll be transparent marketplaces where insurers will compete on the basis of cost and benefits. They'll allow individuals and small business owners to pool their resources so they have the clout that big businesses have today. And people will have a choice of health plans to fit their needs.

These Exchanges will share some key features.

First, they will serve as a one-stop shop where you can easily see your private insurance options, compare prices and benefits, and pick the plan that's right for you and your family.

Second, Exchanges will set conditions to ensure that insurers compete only on price and quality. Today, some insurance companies try to avoid enrolling sick people or skimp on care to keep their costs down. Exchanges will help prevent that from happening and be able to set standards for health plans on quality, coordination of care, and costs.

Third, they'll ensure a basic level of coverage. All plans sold in the marketplaces will offer a minimum package of benefits similar to those offered by employers today, so you can be confident the plan you buy will protect you if you get sick. And you will have the freedom to choose from a range of plans to find the one that includes your doctor and meets your needs.

This is how Members of Congress get their health insurance today. And once these reforms are fully in place, buying insurance will become much more like buying a home appliance or an airline ticket. The insurance customer -- not the insurance company -- will be in the driver's seat.

We are well on the way to this new reality, with states led by both Democratic and Republican Governors moving forward to establish Exchanges. Altogether, 49 states have accepted grants to help plan and operate their Exchanges, and over half of states have taken additional action such as passing legislation or taking administrative action to begin building Exchanges.

Bipartisan support for Exchanges isn't surprising. When they are up and running, state Exchanges will save money for their residents by making the health insurance market more competitive and accessible, a goal that leaders from both parties can get behind. In fact, our nation's first Exchanges were established by Republican governors in Massachusetts and Utah.

Today, we will be releasing draft proposals that set minimum requirements for Exchanges while giving states the flexibility they need to design an Exchange that works for them. These proposals build on over a year's worth of work. In developing them, we looked at the models of Utah and Massachusetts, held countless meetings with stakeholders, and consulted closely with state leaders, consumer advocates, employers and insurers. But we want to hear more, so we will be traveling across the country to gather input, and we fully expect to modify our proposals based on what we hear from the American people.

For too long, insurance companies have had the upper hand. The new competitive market will flip that history on its head and give consumers the clout they need to get a fair deal. We have a long way to go until 2014, and it will take time to make sure the insurance market works properly for consumers and small businesses. But for millions of Americans, those days are finally within sight.

 
For nearly 180 million Americans whose health insurance today is provided by their workplace, getting coverage is pretty straightforward. They can choose from a range of plans offered by their employe...
For nearly 180 million Americans whose health insurance today is provided by their workplace, getting coverage is pretty straightforward. They can choose from a range of plans offered by their employe...
 
 
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HUFFPOST SUPER USER
blueken
Finger Picking blues man
09:56 AM on 07/12/2011
The theory behind health insurance exchanges is to create a larger risk pool, so that expenses are spread out between a larger group of premium payers. Wouldn't single payer national health care do that? Here in Mass, we have an inurance exchange, and guess what? All of the "choices" you have cost just about the same, and they cover the same things. So you don't really have competition, you have price fixeing. At the end of the day, the only way we are going to control health care costs is, the many who are well pay for the few that are sick.
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Ranta
I don't need no ****** badges.
08:53 PM on 07/11/2011
Canada started with single payer on one province. It worked so well that it spread to other provinces and then the whole country. Our only real hope is if that happens here. Vermont is now fighting to have that right. All we need is one state to lead and I'm not talking about Romneycare like in Mass.
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BumpyKnight
Born OK the first time
04:44 PM on 07/11/2011
With all due respect, Sec. Sebelius, private insurers and competition have no place in healthcare finance whatsoever. From beginning to end your post was riddled with references free market ideology. Even "buying insurance will become much more like buying a home appliance or an airline ticket". Do you understand how many will be left out? Everyone knows the effect of competition on those who compete. Have you considered the competition that this places patients into? This cannot but result in a mortality rate inversely proportional to wealth.
Single-Payer NOW
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flyovermark
...Obamacare is tyranny...
05:38 PM on 07/11/2011
Insurance is simply a financial instrument, BK, no different than an annuity, a trust, or a will. It manages the risk to your financial health of an unplanned or unforeseen expense. Insurance can manage the risk of expense resulting from a house fire, a lawsuit, a car wreck, property theft, and uncounted other events that could present financial disaster. Health insurance manages the risk of an unforseen medical expense, and since medical bills can be paid with CASH and other means, and not exclusively with insurance, it most certainly DOES have a place in healthcare finance. Mandating that an individual purchase a government-approved health insurance plan, for no other reason or economic activity than being alive, is a capitation tax, and because Obamacare ignores the Constitution's restrictions on a capitation tax, is an unlawful abuse of federal authority.

...Obamacare is tyranny...
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BumpyKnight
Born OK the first time
05:08 AM on 07/12/2011
The problem with what you call "Obamacare" is that it hasn't removed these profit-motivated privateers who have managed to insert themselves between you and your doctor. Since a means of spreading risk is necessary, we(the people) should do that for ourselves. You shouldn't use the word "tyranny" in defense of these privateers by the way.
Yes, single-payer.
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HUFFPOST SUPER USER
raker
04:03 PM on 07/11/2011
Health insurance is a swindle.

Full health care coverage for all.
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flyovermark
...Obamacare is tyranny...
05:41 PM on 07/11/2011
If the former, then isn't the latter is a swindle for all?
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HUFFPOST SUPER USER
raker
06:24 PM on 07/11/2011
No. Health insurance takes the lion's share as profits; no health care, just skimming and grabbing and impoverishing and exploiting. Medicare works, although in my opinion it is wholly inadequate. The solution is government-sponsored, first-dollar health care coverage for all. No insurance, period.
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HUFFPOST SUPER USER
DustyMills
A liberal tree-hugging Oregonian...
03:10 PM on 07/11/2011
My apologies to Secretary Sebelius, but I wonder if any of these wonderful changes to our healthcare system will ever see the light of day..........

The HC insurance industry has a stranglehold on our medical care, THEY make the rules, THEY decide who receives medical care and how much they will pay for it, THEY pull strings in Washington like no other industry, to insure THEY have the representation needed to maximize profits....and they have the republicans helping them.

Our government has grown corrupt through it's appeasement of allowing special interest control of the process.........and with that, the ability to legislate in the best interests of the people.
02:53 PM on 07/11/2011
What surprises me about this post is the first few lines. Do even 180 million people (out of about 300 million) in the U.S. even have a job. let alone one with health insurance? The biggest employer, Walmart, doesn't even provide it.
02:36 PM on 07/11/2011
The trouble is, emergency rooms are already being shut down, health care costs have already escalated, Medicare premiums are rising fast, Social Security no long gives any cost of living raises, banks pay next to nothing on moneymarkets and cds anymore for the first time I can remember, and what's more life expectancy WILL GO DOWN, not up as those who want to raise the retirement age think, due to economic stress and other factors. Obama's program may not even last until 2014 at the rate the Republicans are going, aided by the MSM and corporations.
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02:28 PM on 07/11/2011
My husband is changing jobs and we have elected to buy private coverage as his new employer's plan is too expensive and we're able to find less costly insurance if we go it alone. But as I was looking through the available plans this weekend, I was a little ticked off at the limited choices I had-if insurance companies could sell across state lines, that would increase competition and lower prices wouldn't it? And yet this very simple measure was not included in the health care bill. Why not?

The type of insurance that suits us best would be a high deductible plan with little or no benefits for routine office visits. But this won't be available to me in 2014, right? The government knows what kind of care I'll need or want better than I do? The government knows better how I should spend my health care dollars? I don't think so.
02:26 PM on 07/11/2011
The Sec'y of HHS thinks we need to lower health insurance costs by 18%? I can't afford $1500 a month, nor can I afford $1200 a month.

Unless this minimum level of coverage is meaningful (i.e., controls for deductibles, caps, exclusions, etc.) the exchanges will be no better than what we've had in NY and NYC for some time now: a website where I can view a variety of unaffordable options...
02:43 PM on 07/11/2011
For your information, by Medicare costs are only $312 a month with full coverage. But these premiums are steadily increasing - 20% in 8 months - with no cost of living raises in my Social Security and virtual non-interest on my savings for the first time in my life. I thought you should know this' since the Democrats aren't very good at messaging even when the facts are on their side, and hope Medicare is still affordable for you without more drastic escalations when you are old enough.
Of course healthcare is all free for a lifetime (though paid comfortably by taxes) and much superior in every other prosperous country.
And we wonder why we have a debt and job crisis along with a healthcare crisis. They are all intertwined.
02:16 PM on 07/11/2011
Texas has had the 'Health Insurance Risk pool" for at least 15 years. set up by George W. Bush. here is how it works. if you wish to sell insurance in Texas your company must contribute to this fund. If you apply for insurance and are declined by two companies, then this fund has to provide insurance to you. No one needs to be without insurance in the state of Texas. another pace setting plan by the truly progressive state in the country. Listen and learn!
09:41 PM on 07/11/2011
Then why does Texas have the highest percentage of uninsured in the country?
10:08 PM on 07/11/2011
Because Texas has a lot of illegals that WILL NOT CONFORM!!!
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02:05 PM on 07/11/2011
It's odd that the secretary avoids mentioning all of the health care waivers her department has granted since it's passage. If the coverage is so great, why all the waivers?
09:42 PM on 07/11/2011
The waivers are for one year and are intended to cover the gap between now and 2014, after which they will be unnecessary.
02:03 PM on 07/11/2011
This whole plan, as pawltry as is, could easily be sabotaged before or shortly after is begins by the usual suspects - the health insurance industry, Republicans and The Media.
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flyovermark
...Obamacare is tyranny...
05:45 PM on 07/11/2011
...more likely by the Supreme Court.... (snicker)
01:50 PM on 07/11/2011
As Wendell Potter, who worked for the insurance industry for over a decade, says, nothing short of the elimination of private health insurance companies and the single payer system similar to what every other prosperous country in the world have, will work. Period.
Those who think this will cost too much in taxes don't understand how much the healthcare crisis and and the job crisis, not to mention the debt ceiling debate, are all intertwined.
The safety net is much broader in all these countries and health care costs per capita are drastically lower. And yet taxes pay for this. Quite comfortably.
Reduce military adventurism and costs drastically and this argument become even more plausible.
And yet the Democrats and the Media almost obstruct these obvious solutions. Obama has improved the situation, but even his pawltry measures seem extremely vulnerable in the future.
Opposition to affordable healthcare has gone on steroids. The propaganda has really taken root, so optimism should remain on hold for now.
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HUFFPOST SUPER USER
DustyMills
A liberal tree-hugging Oregonian...
02:37 PM on 07/11/2011
Well said, krocklin.........

F&F
01:42 PM on 07/11/2011
Since the current lot of Republicans have come into power - starting in 1980 - the debate between government's role in healthcare has gone on steroids with the Republicans getting equal media coverage for an untenable position, especially on healthcare.
Healthcare costs way more for Americans than the citizens of any other prosperous country and is escalating, including for those on Social Security and Medicare. Federal aid for hospitals and emergency rooms has been cut drastically. Emergency rooms are being closed down altogether in my area, Los Angeles, drastically just in the last few years.
Not only have health care costs gone up, and the profits of healthcare companies gone up as well, Social Security payments have been frozen and healthcare premiums have risen drastically.
Those who don't receive these, who may be too young, are not aware of this. My Medicare premiums have risen in less than a year by $60 a month with no cost of living raises for two years.
The democrats Don't even use these alarming facts in their arguments. No messaging whatsoever.
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HUFFPOST BLOGGER
Miles J. Zaremski
Attorney, essayist and commentator
01:40 PM on 07/11/2011
Why not establish a public option where the government provides only seed money for an entity that will compete with the private markets? Why not make this public option part of the discussions on raising the debt ceiling that invariably will involve reduction in benefits presently provided our nation's seniors? If Medicare is a social entitlement program that is on "the table" in some dimension, why not insert a pubic option into Obamacare that will lower rates for all Americans, including those 65 and older? And, why not finally establish by way of proclaiming it that health care should be a right for all Americans?
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flyovermark
...Obamacare is tyranny...
05:53 PM on 07/11/2011
Healthcare is already a "right" for all. No one is prevented from seeking medical care, but they are expected to pay for the care they get. What isn't a "right" is free medical care, and we pay dearly to provide care to our most vulnerable as it is. The federal government would have to take over the medical entire medical industry, set wages for personnel and set prices for services and supplies, in order for a public option to be sustainable. Check out the accomodations available in rent controlled areas, against those where rent is not controlled, and it becomes clear that a public option is a path to inferior medical care.