Consumers Union backs the House health reform bill

With millions of Americans desperate for affordable, quality health care, Consumers Union has chosen to endorse H.R. 3962, the Affordable Health Care for America Act. This bill would greatly expand coverage of the uninsured and provide new protections for the insured. "Health care is a consumer crisis with its crippling costs, its unreliability, and lack of access for too many Americans," said Jim Guest, president of Consumers Union, the nonprofit publisher of Consumer Reports. "By creating a more secure, affordable health care system, the House bill goes a long way towards solving the crisis."

Consumers Union has advocated for health reform since the organization was founded in 1936, and last month our advocates ran their first-ever ad pressing for better health care for all consumers. In addition, CU believes the health reform bill would:

• prohibit insurance companies from denying coverage for pre-existing medical conditions
• create a one-stop "exchange" where all insurers present their information in the same format, so you can easily compare the price and quality of different insurance plans
• allow small companies to easily offer their employees coverage through the exchange
• allow Medicare to negotiate with the drug companies to get lower prices for prescription drugs
• provide good insurance options if you lose your job, change employers, start your own business, go back to school or develop a medical condition

From CU's President: Pressure still needed on health reform

In a recent column I talked about how, for the very first time in Consumers Union’s history, we decided to air a TV ad about health care.  In the ad we talk about the high cost of health care for consumers and the serious need for reform.

CU has advocated for health reform since our organization was founded in 1936.  But this was the first time we had ever run a TV ad that called on policymakers to find solutions for more affordable, reliable care.

The ad aired last month in Washington, D.C.  Following the success of the ad, we sent an e-mail to our “e-activists” to ask for their help in raising money to run the ad elsewhere.  The money was raised through the Consumers Union Action Fund, which we started three years ago.  The response was overwhelmingly positive, and we are now planning to air the ad in the state of Maine.

Why Maine?  For the past year, our consumer advocates have been working in states like Maine to hear consumers’ personal stories about health care.  We’ve gone door-to-door to meet Mainers and find out how they’re dealing with the cost of health care.  Some people told us how they’ve had to cut back on the care they needed because they could no longer afford it.  We heard people’s concerns about losing their health coverage or having their care denied by an insurance company.  

Pressing the White House on health reform: Medicare

Polls show that older Americans are more dubious about health reform than younger people. That’s understandable in a way, because they’re the only group that already has guaranteed health care and thus has less to gain from reform. Meanwhile, the bills under consideration propose cutting hundreds of billions of Medicare dollars over the next decade to help pay for reform. No wonder seniors are worried.

 I asked Nancy-Ann DeParle, director of the White House Office of Health Reform, to address the concerns of Medicare beneficiaries.

"There’s nothing in these bills that is cutting Medicare benefits," she said. "Beneficiaries will still have access to their doctors and the same benefits they have now. But … there are a number of ways in which we can make Medicare more efficient and actually strengthen it, make it more solvent."

For example, she said that right now, Medicare pays hospitals tens of billions of dollars extra to cover the care they give to uninsured patients who can’t pay their bills. "As the uninsured get covered, we can lower the payments," she said.

Further savings will come from health technology that makes doctors and hospitals more efficient, and from going after Medicare fraud more aggressively, she said.

I asked her specifically about Medicare Advantage, the private Medicare plans that now insure about one in four Medicare beneficiaries and are slated for significant cuts in the various reform bills.

Pressing the White House on health reform: Small business, high-risk pools

Small businesses face the same kinds of problems buying health insurance as individuals do: premiums that rise sharply if anyone gets sick, high administrative costs, and all-round insecurity.

In my conversation with Nancy-Ann DeParle, director of the White House Office of Health Reform, I brought a question from a reader named Roland: "How will this help a small-business owner? I have two employees in addition to myself. Health-care costs are draining my business." (View a story about a small-business owner and a ski-industry worker).

DeParle responded that health reform will be a "win-win for small business." All the bills under discussion in Congress include tax credits to help businesses with up to 50 employees buy coverage on the national health exchange. Moreover, unlike larger business who would (under the House legislation, at any rate) be required either to provide coverage for workers or pay into a national kitty, small business would be exempted from this so-called "pay or play" rule.

And, she added, buying coverage on the exchange "will be substantially less expensive for small business" than the health plans they can buy today. "If you’re four people … and one of you has a baby or gets sick, the insurance company is going to jack up your rates next year," she explained. "They have to cover their costs. … If we pool over a larger group they can set rates that are much more affordable."

Pressing the White House on health reform: Doing away with bad policies

Under the health-reform proposals in Congress, if you can’t get insurance from an employer, you’ll be able to buy a policy through an insurance exchange. But how good will those policies be? We’ve heard from many consumers who bought their own health insurance and wound up with bad policies that were full of holes.

We asked Nancy DeParle, the director of the White House Office of Health Reform, about this problem. Nancy Metcalf, from Consumer Reports Health, told her about Gary Clausen from Atlantic, Iowa, who bought what he thought was a decent health insurance policy. But when Gary got sick with colon cancer, he discovered that his policy wouldn’t cover his chemotherapy, leaving him with a bill of more than $200,000. We asked DeParle how health reform would protect people from this kind of financial disaster.

“Those kind of policies won’t be offered anymore in this new market,” DeParle said. “They’re called ‘Mini Med’ policies, where it looks like it’s a good insurance policy, but when you actually read the fine print, a lot of things aren’t covered.”

Pressing the White House on health reform: Cut costs, not benefits

As Congress tries to hammer out a compromise to overhaul the nation’s health-care system, Nancy-Ann DeParle, the director of the White House Office of Health Reform, sat down with Consumer Reports Health’s Nancy Metcalf, who brought questions from our readers about how reform would affect people in their situations.

For the next four days, we’ll post video segments from the interview, which took place Oct. 24 at the Old Executive Office Building next to the White House.

Today we raise two common concerns about health reform that are almost at odds with one another. On the one hand people want relief from rising health-care costs. But on the other hand, some people are afraid that cost-saving measures will deny them the medicines and treatments their doctors say they need.

So, we asked the health-reform czar, is it really possible to cut health-care costs without cutting health-care benefits?

Talking with a White House bigwig about health reform

Well, technically not big at all – Nancy-Ann DeParle, director of the White House Office of Health Reform is so petite that when she arrived for our interview Friday morning, we had to switch to smaller chairs because the ones we had chosen, she said, “make me feel like I’m in kindergarten.” But we covered a lot of ground on a subject that is anything but small. I’ll have full details (and a video) early next week, but here are some preview highlights from her answers to the questions we assembled from the experiences and suggestions of our readers:

• The elimination of medical underwriting – a feature of every one of the bills before Congress – is an underappreciated boon for consumers. Once insurers are barred from using pre-existing conditions to deny or limit coverage, or charge people higher premiums, they’ll no longer have any reason to look into anyone’s medical history. Insurers right now spend untold billions investigating and evaluating applicants’ medical histories, DeParle pointed out – especially those who get their insurance as individuals or as part of small employer groups. After reform, that money can be spent on providing health care, instead of denying it.

• I asked her what relief might be available right now for people who can’t get or afford coverage because of pre-existing conditions while they wait for full reform to begin in 2013. She said the Administration is working with Congress to set up a temporary national high-risk pool that could be up and running within a year of the passage of a reform bill, complete with subsidies to make coverage more affordable. Folks shut out of the market because of their health history could buy health insurance there for the time being.

-- Nancy Metcalf, senior program editor 
 

Here’s your chance to ask the White House about health care

On Friday morning, I’ll be heading to the White House to videotape a conversation with Nancy-Ann DeParle, Director of the White House Office of Health Reform (aka the President’s health reform czar – or maybe czarina?).

We’re lucky to get this time with her, because she’s been spending long, long hours lately in hard negotiations with Senate leaders over the shape of the health reform legislation that Congress will likely be voting on within the next few months.

Unlike political reporters interested in who’s up and who’s down, and what this or that Washington insider does or doesn’t support, I want to ask DeParle the questions that matter to regular consumers. And for this, I need your help.

I already know I’ll be asking about issues like whether consumers who currently can’t get or can’t afford insurance will be able to secure truly affordable coverage after reform. And about what people who are hurting now are supposed to do in the three-year gap between when reform legislation passes in 2010 (and some sort of legislation seems increasingly likely to pass) and when the actual reforms go into effect in 2013.

So, what would you like to ask Nancy-Ann DeParle? Maybe you’re concerned about Medicare, or about the security of the coverage you get on the job. Maybe you’re worried about how your son who just graduated from college, but can’t find a job, is supposed to afford health care. Maybe you wonder just how, exactly, the public plan we’re hearing so much about would affect you and your family.

Ask away. About anything at all related to health reform. We’ll be taking suggestions right up until Thursday night. (Please submit questions in Comments.)

–Nancy Metcalf, senior program editor

Health care reform: Continuing the conversation

Our new survey on the continuing woes of our health care system has drawn considerable comment from people with passionate views both for and against the reform legislation being debated in Congress.

We’re guessing that some of those who have come here are new to Consumer Reports and may not be aware of the work we’ve been doing for years on the U.S. health system, such as the visitor who wrote:

Give us reviews of the insurance companies so that we the consumers can make informed decisions.

As longtime readers know, we’ve been reporting on health insurance for the past several years. Subscribers can access our Ratings of PPOs and Ratings of HMOs, and all visitors can learn how to select good health plans, avoid bad ones, and make the most of the coverage they have.

Several commenters pointed to cancer survival statistics showing that Americans live longer after diagnosis with many cancers than do people living in European countries with universal health care. These statistics are a favorite of health-reform foes, but FactCheck.org, a project of the nonprofit Annenberg Public Policy Center of the University of Pennsylvania, cautions that:

Poll: Americans paying more for less health care

As health reform slowly churns its way through the halls of Congress, our latest survey reveals that most Americans continue to face health-care woes. More than half of consumers report rapidly rising health-care costs, and over a quarter said they’ve endured recent cuts in coverage, according to the latest national poll of 1,002 adults from Consumer Reports National Research Center. And such troubles have forced many Americans into difficult choices, such as putting off a doctor’s visit or a medical procedure, or forgoing prescription drugs.

Our poll suggests it’s not just the uninsured or those with junk insurance who worry about health costs. Most Americans, 73 percent, are concerned that they may face a major financial loss due to an illness or accident, that needed services will be denied by a health insurance company, and that they won’t be able to afford health coverage in the future.

Overall, 28 percent of Americans reported loss of coverage or benefit reductions, and cuts were seen across all income levels. And given the current economy, such cuts could have a real impact on the health of Americans. In a previous survey we found that trying to save on prescription drugs can lead to risky behaviors. This poll bore that out—about half of Americans—51 percent—reported that they had to make one or more difficult medical decision due to costs in the last year, including:

• Putting off a doctor’s visit (28 percent)
• Inability to pay for medical bills or medications (25 percent)
• Putting off a medical procedure (22 percent)
• Declining a medical test (20 percent)
• Not filling a prescription (20 percent)
• Using expired medications (15 percent)
• Skipping a scheduled dose (15 percent)
• Splitting pills (13 percent)
• Or sharing a prescription with someone else (9 percent)

These findings underscore the importance of comprehensive health care reform. Consumers Union has called for reform that makes insurance simple, covers everyone, improves information on health-care quality, helps employers offer better plans, rewards quality care, lets doctors be doctors, and provides freedom to choose your plan.

Now CU’s president, Jim Guest, has released an ad—the first in our history—calling on lawmakers to fix the health-care system. “Too many Americans are just one pink slip away—or one major illness away—from losing their health coverage,” says Guest. “That’s why policymakers need to find a solution this year.”

Underinsured, the sequel

Health care reform isn’t just about covering the uninsured. It’s also about making sure that those who do have insurance can rely on it to pay the bills if they get sick, without leaving them with unmanageable debt. Sadly, that’s often not the case today, as Kaiser Health News documents in a series of reports done in partnership with National Public Radio.

The struggles of Jim and Martha Martin and their teenage daughters Sara and Rebekah, profiled in one of the articles, show how inadequate insurance can be. The parents, who live in Maine, hold down five part-time jobs between them yet have only limited coverage, mainly Martha’s plan (which only covers her) from her part-time supermarket deli job, and Sara’s through a student policy offered by her college. It’s nowhere near enough.

More medical bills are coming. Martha needs to have a hysterectomy next month, and she says her insurance will pay only $1,000 of the hospital bill.

For the Martins, 2009 is starting to look a lot like 2008. Last year they paid $6,210 in health insurance premiums for themselves and daughter Sara, plus another $13,955 in uncovered hospital bills after Rebekah's surgery.

It added up to almost 45 percent of their total income of $44,815.

We’ve explored the dilemma of the underinsured repeatedly in the past several years (see our health insurance reports from 2007 and 2009). Right now we’re in the process of analyzing the reform bills under consideration in Congress to see if they will give real relief to hardworking, struggling families like the Martins.

—Nancy Metcalf, Senior Program Editor

 

Consumer Reports Index: Health costs a leading money problem for consumers

As the health care reform debate drags on, Americans continue to suffer from the high costs of health care, according to the Consumer Reports Index for September, a monthly survey that tracks trends in consumer sentiment. The latest results illustrate the urgency consumers face in the current health care marketplace.

In the month of August alone 13.8 percent of Americans reported that they were unable to afford medical bills or medications, making that one of the leading negative economic events consumers faced. And 8.5 percent of Americans lost health insurance or had their coverage reduced last month.

For the first time in our survey, the ability to pay for medical bills and medications was eclipsed by credit card rate increases and penalty fees, which affected 15.6 percent of the population. Other economic troubles include missing a payment on an important bill (9.7 percent), being denied a personal loan (6 percent), losing a job (5.6 percent), missing a mortgage payment (2.4 percent), and having a home foreclosed on (0.7 percent).

Who lies?

"You lie!" shouted Joe Wilson, a Republican Representative from South Carolina, last night, during the President’s address to Congress, as Obama insisted the Democratic health reforms "would not apply to those who are here illegally." Later, Wilson called the White House to apologize, but said he still disagrees with the President’s statement.

Who’s really lying here? The charge that health reform measures will spend your tax dollars to cover illegal immigrants claim often pops up in our comments when we cover health reform efforts. So we took a closer look. Here’s what we found:

The House healthcare reform bill specifically says that undocumented aliens aren’t eligible for subsidized health insurance.

Illegal immigrants aren’t eligible for any of the major government-run health programs, including Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) available today. And legal immigrants have to be in the U.S. lawfully for five years to sign up for these programs, and they have to meet the same eligibility standards as anyone else.

A tale of two lumps: U.K. vs. U.S.

Listening to our president last night, I was reminded of what happened to me as an American living in Brighton, England, several years ago. No, this isn’t a story of medical error and tragedy—it’s just a story of routine health care and two small journeys that give some perspective on what patients go through in England and in the U.S.

I’ve found a lump in my breast twice: In the U.K. four years ago and last year here in the U.S. In both cases, I went to my primary-care doctor and received thorough and compassionate care. But after that, the series of small events highlight the deep flaw I’ve found in the American health-care system.

After finding the lump

U.K.: The nurse practitioner made an appointment for me to go to the special breast unit at my local hospital the next day.

U.S.: I left with a prescription for a mammogram and a list of about 15 imaging centers to call. The next day I made my way through the list, trying to find one that would take my insurance and see me quickly (not as easy as it sounds). In the end I had a choice of three places: one that was nearby but offered a rude receptionist; a second that asked me a barrage of detailed questions I simply couldn’t answer, and left me so frustrated that I burst into tears and hung up; and a third that was far away, but seemed reasonably efficient. I checked all three out on the Internet to find patient reviews. Two hours after making the first call, I put on my thickest skin and made an appointment with the first one to be seen in four days.

The mammogram

U.K.: I showed up at the specialty center and had a mammogram after waiting a half-hour or so. The nurse asked me to hang around while the doctor read the scan. After another hour, the doctor came out and showed me the lump, said they weren’t sure about it and wanted to do a sonogram. After another half-hour, I had a sonogram and needle aspiration.The doctor told me it was a cyst and to be aware that the lump might fill up again.

Turning point for health-care reform

After a tough August, when health reform was under attack, President Obama will try tonight to convince lawmakers and Americans at large that health reform is necessary. We checked in with the director of Consumers Union's health reform campaign, DeAnn Friedholm, to see what she's looking for tonight:

"A lot of people are terribly confused at this point. The President needs to explain clearly how his plan will provide better health care, not just for people without insurance, but for those who have coverage and are still paying too much. He needs to re-energize the fight to help provide people with high quality, affordable health care that they know will be there, even if they lose their jobs or get really sick. Every day we delay health reform, more consumers go bankrupt, more people die needlessly, and the nation’s long-term economic situation worsens."