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

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

Uninsured often leave chronic illnesses undertreated

Millions of uninsured Americans are either not receiving proper treatment for their chronic diseases—like diabetes, high blood pressure, and high cholesterol—or they don’t even know they have these conditions, according to a new study. The results underscore how the lack of adequate medical care increases the risk of disabling and deadly complications that can arise from these conditions, such as stroke, heart attack and kidney failure.

The study, published in Health Affairs, found that about 51 percent of insured people with high blood pressure did not have their condition under control, but this jumped to 58 percent in those who lacked insurance. And an alarming 77 percent of uninsured people with high cholesterol were receiving inadequate treatment compared to 60 percent of those with insurance.

In addition, about half of uninsured adults (18-64 years old) with diabetes or high cholesterol were unaware that they had these conditions. Among those with insurance, the number drops to only about 25 percent.

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:

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

 

Buzzword: The Hatch-Waxman Act

What does it mean? The Hatch-Waxman Act (formally known as The Drug Price Competition and Patent Term Restoration Act) first passed 25 years ago in 1984 helped make inexpensive generic drugs available to consumers. This law streamlined the process by which generic drug manufacturers could apply for Food and Drug Administration approval of their drugs once the patent on a brand-name medicine expired. Under this law, generic manufacturers can forego expensive clinical trials and instead gain FDA approval based on less costly studies that show their drugs are equivalent to brand-name medicines. This cut the expense of bringing a generic drug to market, which lowered the cost of these medicines for consumers. Generic drugs now comprise more than 60 percent of prescriptions filled—up from 19 percent in 1984, when this law was first enacted. (Learn 10 more ways to cut your drug costs.)

Why the buzz? Now 25-years old, the Hatch-Waxman Act has helped consumers save money even while health-care costs have generally soared. The Act provides generics that are just as safe and effective as brand-name drugs, but at a far lower price—often prices up to 70 percent or less of the brand-names. However, this law has also been used by brand-name drug makers to block generic drugs from becoming available to consumers. Brand-name drug makers have used provisions of the Hatch-Waxman Act to extend their patent that delay generic drugs from entering the market. In addition, brand-name drug makers have made deals with generic manufacturers where the generic firm keeps its drug off the market in exchange for payments from the brand-name firm. Both drug manufacturers benefit from these arrangements, but consumers lose out. (See best drugs for less for related information.)

Another emerging issue that is currently being debated in Congress is that the Hatch-Waxman Act does not provide for an FDA approval process for generic versions of biologics. These branded medicines are important therapies that are used to treat certain cancers, multiple sclerosis and other serious diseases but they can cost more than $100,000. The availability of generic biologics could dramatically reduce prices and save consumers significant amounts of money. Congress is currently considering legislation that would pave the way for FDA approval of generic biologics, or biosimilars, but so far, the issue remains unresolved.

Uninsured and not 65 yet? Here's how health-care reform would help

There’s never a good time to be uninsured, but losing your coverage after age 55 can be a real disaster because by that age, a lot of people have developed some kind of pre-existing condition that makes them terrible risks in the eyes of health insurance companies.

Case in point: Rick Cristo, 63, of Scottsdale, Ariz. Here’s what he wrote recently in a comment on one of our blogs:

I have been on Cobra for 16 months and my coverage expires in October. I have tried to qualify for a private policy but have been turned down because I had Prostate Cancer in January 2008 and had it removed surgically and have had no signs of cancer since. I am 63 years old my wife is 53 years old and we can't get health insurance; do I have any options?

Cristo lost his job as a mortgage broker during the housing market collapse and neither he nor his wife has been able to land a job with health coverage since. He’d be happy to keep his COBRA plan, even though it costs more than $900 a month, because it’s comprehensive and took good care of him during his prostate cancer treatment. But he can’t. The existing COBRA law says his coverage runs out after 18 months, no exceptions.

Do Americans really love their health insurance?

That’s exactly what some officials are claiming. Sen. Orrin Hatch, R-Utah, said on ABC’s "This Week" program on Aug. 16 that "Eight out of ten Americans are basically pleased with the—with their health care insurance."

That’s not what more than 37,000 readers told us. According to our recent survey, only 64 percent of readers said they were very or completely satisfied with their plan, a lukewarm response that's a slight drop from the 67 percent in our 2007 report.

In terms of services we rate, that puts satisfaction with health insurance above satisfaction with cable TV, a perennial whipping post, but below pharmacies and real-estate agents.

What’s more, our readers say annual premium costs have climbed markedly, by about $500, over the last couple of years.

The myth that will not die: Health care for immigrants

You can depend on it. Whenever we write an article or a blog about the woes of the U.S. health care system, at least one person writes back to complain about how illegal immigrants get free health care.

Some recent examples:

One of the biggest costs in Healthcare is not even mentioned in Obama's plan.....Illegal Aliens get free healthcare!!

It just boggles my mind that we take care of ILLEGALS and their families and the unemployed but offer no assistance to a hard-working, tax-paying AMERICAN CITIZEN.

And an anti-reform chain email that’s circulating in various versions on the Internet ups the ante by claiming that the House health care bill* says that "HC will be provided to all non-US citizens, illegal or otherwise, will be provided with health care services."

To get this latter assertion out of the way first, it’s a fiction. The bill specifically says that that undocumented aliens aren’t eligible for subsidized health insurance. See for yourself:

It’s unclear where the larger urban myth of "free health care for illegals" originated, but it’s not true either.

Health Reform AdWatch: Can you make that a little more bland?

With our elected officials back home in their districts for the August recess, TV and internet ads about the proposed health-reform legislation are reaching fever pitch—especially in key states where congresspeople remain undecided or may switch sides. Since part of Consumer Reports’ mission is to comment on truth (or lack thereof) in advertising, we can’t resist diving into the melee and offering our AdWatch analysis of some of the more prominent health reform spots. Our goal over the next few weeks will be to help you weed through the madness, and direct you to comprehensive, well-researched information you can rely on to make up your mind about the various reform options. When possible, we’ll try to critique the ads in pairs in order to compare what opposing sides are saying.

First, though, we thought we’d start with two examples of what you might call the "vague pro-reform ad." A sign of changing times if there ever was one, these ads are sponsored by the pharmaceutical industry and insurance companies, respectively, both of whom are spending big bucks this time around to support health reform—on their own terms, of course. Result: two ads that are a little confusing and strangely bland.

Harry and Louise return, say little

The characters are familiar: It’s Harry and Louise, the fictional couple who appeared in 1994 in a series of insurance industry-sponsored ads that were largely credited with derailing Clinton-era health reform.  Now the couple is back, but singing an entirely different tune. This time, the spot is co-sponsored by Families USA, a consumer advocacy group, and the Pharmaceutical Researchers and Manufacturers of America, the key lobby group for the pharmaceutical industry. (Yeah, health reform makes for strange bedfellows.) Back at their kitchen table—cleverly updated to include a laptop—Harry and Louise chat about how much we need to reform the health care system. They keep it vague, and painfully simplistic. "We need good coverage people can afford," Louise says. "Coverage they can get." (You think?) Her cryptic closing words: "A little more cooperation, a little less politics, and we can get the job done this time." True? Yes. Useful? Informative? Not so much. Though we are glad to see H and L looking so fit after 15 years. They must have good health coverage.