It’s not clear what the public took away from the PBS NewsHour segment on health care last night. Perhaps confusion, or perhaps nothing that would help their understanding of the Second Battle of Health Reform. The segment featured a bit of reporting by the NewsHour’s health reporter, Betty Ann Bowser, and anchor Judy Woodruff questioning a grinning dueling duo of congressmen—Republican Dan Lungren from California and Anthony Weiner of New York. But neither Bowser’s reporting nor Woodruff’s interview did much to clear up the misinformation and deceptive comments made by both combatants.
Bowser set the tone with predictive commentary from Republican supporters of repealing the health care law and from House Minority Leader Nancy Pelosi, obviously opposing it. Then Bowser picked up the administration’s pre-vote propaganda piece, reporting that a study from HHS Secretary Kathleen Sebelius’s shop “found as many as 129 million Americans under age 65 have preexisting conditions and could be rejected for coverage if the law is repealed.” The insurance industry, Bowser noted, said the numbers were exaggerated.
The NewsHour should have known better. Yes, millions of Americans do have health problems that disqualify them for insurance in the individual market. But most of those people are covered under their employers’ policies, where it doesn’t matter how sick they are. The current restrictions matter only in the individual market where fewer than 20 million Americans now get coverage. After the law is fully effective, millions of sick people will still get coverage from their employers. The insurers have a point here. Geez. It would have been nice had the NewsHour acknowledged that maybe the administration study needed some work.
Woodruff, for her part, let the dueling duo spout off without pinning them down when they didn’t answer her questions or offered misleading, off-point comments. She asked Lungren for evidence that health reform is a job killer, as Republicans argue. He replied that not a single economist thinks raising taxes in the midst of an economic downturn is a good idea and that the government is looking at more than 200 major companies “who have asked for waivers saying that they cannot go forward with what’s imposed on them under this bill, lest they lose jobs. If, in fact, it doesn’t have the effect of killing jobs, those waivers wouldn’t be requested. And, in fact, we wouldn’t have the secretary suggesting that they be done.”
Whoa! Those waivers were all about businesses and insurers offering mini-med policies—the kind with skimpy benefits that don’t meet the mimimum standards set by the new law. That was supposed to be a protection for consumers. But insurers, union health plans, and employers petitioned HHS to continue selling these policies using the logic that some coverage is better than none. HHS agreed. Too bad the NewsHour didn’t use some logic of its own and correct Lungren. Instead Woodruff turned to Weiner for his take on job killing. He argued that the tax subsidy in the law helps create jobs.
But the uninsured going to emergency rooms seemed to be Weiner’s real talking point. In answering Woodruff’s question, Weiner said that if we don’t cover people “they just go into hospital emergency rooms and pass along the costs to taxpayers in California and taxpayers in New York.” A drag on the economy, he added. Woodruff asked Weiner to talk about the costs of providing coverage for the uninsured. “It’s much less expensive to have them get insurance than it is to keep paying their bills in emergency rooms,” he told viewers.
The NewsHour blew it once more. As Campaign Desk reported last summer, emergency room use has increased in Massachusetts even though almost every resident now has insurance under the state’s mandate. We also praised an AP story for making the point that ER use will likely grow under health reform, bringing more crowding and longer waits. The NewsHour missed a chance to clear up a common misconception. The uninsured are not the culprits in emergency rooms usage. A few years ago, a solid study from the Kaiser Family Foundation and the Actuarial Research Corp. found that those without insurance were no more likely to use the ERs than those with coverage.
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The uninsured are not the culprits in emergency rooms usage. A few years ago, a solid study from the Kaiser Family Foundation and the Actuarial Research Corp. found that those without insurance were no more likely to use the ERs than those with coverage.
That may be well and good - but the issue isn't merely frequency of use - it's who pays for that use.
Even if insured and uninsured persons went to the ER at identical rates with identical expenses - the bill for the insured visits would be paid by private insurance (or by the individuals as out of pocket)
The relevant questions are
1) What is the total expense of those uninsured ER visits?
2) What % of that expense is passed on to bills paid by other patients and their insurance? and
3) Do either of those numbers change under the new health law?
#1 Posted by Sotto Voce, CJR on Fri 21 Jan 2011 at 02:37 PM
Sotto Voce,
Taxpayers will foot the bill for Obamacare under which Medicaid has been expanded to 133 percent FPL and subsidized plans will be available for those citizens who are found eligible to shop at the Exchange.
So no matter how you slice it - ER usage, insured, uninsured - taxpayers, both state and federal, will pay for all of it AND will also be required to purchase plans that the gov't (health benefits commissioner) has decided are affordable based on a person's prior year income. Many probably won't be able to use the insurance b/c of the skimpy coverage (will be underinsured) OR they will be forced by the IRS to pay a costly penalty and will end up in the E.R. when they need medical care. See Trudy's ten-part series on the MA plan in the cjr archives. (The MA plan was the marketing tool and model for Obamacare.)
It's a myth that insuers are passing these costs onto policyholders. Insurers use all kinds of spin to cover their greedy habits. The biggest of all is "cutting health care costs." This really means cutting out the costs they have to pay out that impair their bottomline. They try to sell this concept as the reason your premiums continue to rise.
Obamacare is not going to change this, and it also has no cost containment. Neither does the MA plan.
If the federal (and MA) gov't were truly concerned about providing access to care and cutting health care costs, both would have gotten rid of the insurance companies and implemented a single-payer system which works quite well in all other industrialized countries.
I attended a presentation made by former CEO of the MA Connector Authority Jon Kingsdale (Connector = Exchange in Obamacare) in August 2007 or 2008 (don't recall the year) at our local hospital during which he tried to sell the "great success" of the MA plan (model for Obamacare) to docs and nurses and those from the community who stopped by to hear this. Someone asked him who is paying for the subsidized plans that are available for residents whose income is up to 300 percent FPL (Obamacare = 400 percent FPL for a subsidized plan), and the answer was: state and federal taxpayers will have to pony up.
As Trudy points out in her story above, ER usage increased in MA when this plan was implemented. Why? I know of two reasons. People couldn't find doctors who would take subsidized patients because the reimbursement rates were too low, so overhead wasn't covered nor was expanding their practices to accommodate the newly insured. So, if you are sick, have insurance but can't find a doctor in the one and only network available in your area, where do you go? The E.R.
And, there are residents in MA who couldn't afford the affordable, subsidized, plans the state told them that they could afford or couldn't afford employer insurance and weren't eligible for a subsidized plan, so these health care criminals did not purchase coverage because they chose to buy food and pay the mortgage, rent or property taxes OR they signed up but found they couldn't afford the insurance or couldn't afford to use it b/c of the copays during months when they had to pay for a car repair or food prices were high so ended up having to go to the E.R. in spite of the MA mandated health insurance law.
MA powerbrokers tried to pawn off this increased use of the E.R. as: the newly insured need to be taught how to use their insurance.
Four years into this scheme, and the local hospital in my county sent out a letter to docs to inform patients that there's a program available to help pay the deductibles and copays for a colonoscopy for residents who are up to 400 percent FPL and can't afford to use their insurance. The letter points out that it is a known fact that many in western MA are underinsured and can't afford a colonoscopy, one of the most important . . .
This is not about use of the E.R. but does say that the MA plan with it's subsidized insura
#2 Posted by dianne, CJR on Tue 25 Jan 2011 at 04:37 AM