In an interview with President Obama on 60 Minutes Sunday night, it was apparent Steve Kroft was taking his questioning down a broad path. “It seems to be all the compromising is being done by you,” was one question. “If you look at the poll numbers, nobody’s particularly happy with you,” was another. When it came to the health reform plan, Kroft told the president that “fifty-one percent of Americans don’t like yours.” Kroft left health care at that point. Obama came back to it later when he called the health care bill “a perfect example of compromise. We didn’t get the public option, you know. We trimmed our sails.” And he returned to health reform at the end when Kroft asked him to name his greatest achievements as president.
There was, he explained, saving the auto industry and stabilizing the financial system. And health care? The president answered: “Putting in place a system in which we’re gonna start lowering health care costs and you’re never gonna go bankrupt because you get sick or somebody in your family gets sick.” And then the interview was over, and Kroft had run out of time to explore these assertions. Maybe Kroft can do that some other time. Maybe other journos can too.
In the spirit of prompting a challenge to the president’s statement, I offer a few threads that might be woven into a campaign story. First, there is considerable disagreement among experts whether the Affordable Care Act will make health care and health insurance affordable. It’s not even certain that one of the act’s strongest cost containment measures, the Independent Payment Advisory Board, which is required to make recommendations for trimming Medicare costs, will survive Congressional challenges next year.
Second, a Great Cost Shift is taking place that will mean everyone—those currently insured and those who will get coverage in 2014—will have to dig deep in their wallets to pay for their medical care. It’s the “more-skin-in-the game” approach, and companies are marketing skimpy insurance policies to make policyholders feel more pain as a method of controlling costs. Use fewer services, and the price of care will drop. These new products come with humongus deductibles and coinsurance (not to be confused with a copayment, which is a set amount you pay to go to the doctor). High coinsurance, a percentage of the bill you must pay, is becoming the new norm. One plan marketed by Cigna comes with a $5000 individual deductible and $10,000 family deductible for in-network services. They double for out-of-network care.
You can hardly call this insurance, especially since the policy covers only 70 percent of the bills if someone stays in the network and 50 percent if he or she goes out. This summer, Helen Darling, who heads the National Business Group on Health, told The Hill shifting from copays to coinsurance was a “more subtle way to increase what the consumer pays.”
Those who are supposed to be helped by the health reform law will feel the pinch, too. The “bronze” policy, the cheapest one offered in the state shopping services, will cover only sixty percent of a person’s medical expenses. Guess who pays the rest? If you’re on the hook for forty percent of your health care bills and get really sick, medical bankruptcy may not be out of the question—contrary to what the president promised. Those on Medicare may also find they are required to have more skin in the game. The president told Kroft early in the interview he had already agreed to reform Medicare and Medicaid and cut discretionary spending. No follow-up from Kroft. Still valid questions for all.