BY KATHERINE SCHEIRMAN, M.D.
Published: September 5, 2009
Dr. Katherine Scheirman, Regional Director, Doctors For America
We have been getting a lot of scary misinformation from opponents of health care reform, including from some elected congressional representatives. As a doctor, I know health care is a personal and emotional topic. As it is now, those younger than 65 can lose their health care at any time if they get sick, lose a job or just can't afford ever-increasing costs. These reforms will make sure that you and your family never lose your coverage, and you will never go bankrupt paying for care.
I want to share with you how health reform will benefit all of us. Although there are still some areas where agreement hasn't yet occurred, the broad outlines of reform have passed four of five congressional committees working on it. These proposed reforms are mainstream ideas that will make our existing system better and ensure that all citizens are able to get the care they need, all without increasing our budget deficit.
For those who have health insurance through a job, new protections will ensure that you get the care you have paid for. Pre-existing conditions will be covered; there will be no cost-sharing for preventive care, no exorbitant out-of-pocket expenses and no annual or lifetime caps on coverage. You can't be dropped if you become seriously ill and insurance renewal is guaranteed as long as your premiums are paid. Young adults up to age 26 can continue on a parent's policy.
For those on Medicare or Medicaid, there are no changes, except that pharmacy benefits increase in Medicare to close the "doughnut hole," saving seniors money. Overpayments to private insurance companies in Medicare Advantage programs will be ended.
The major costs of reform will be for the 47 million American citizens (720,000 Oklahomans) who do not have health insurance, and debate continues about how best to help them. Some with low incomes will become eligible for Medicaid. Those who make too much for Medicaid (between $14,404 and $32,320 for singles, $29,327 to $66,150 for a family of four) will receive subsidies to help them purchase insurance in an insurance exchange, somewhat like Congress and other federal employees get to do through the Federal Employees Health Benefits Program.
It is still unclear whether they will be required to buy a for-profit plan, or if they will have a choice to buy into a program similar to Medicare (the "public option"). People who make more than these amounts would not get subsidies but would buy health insurance in the exchange.
Veterans who get care through the Veterans Administration, and military families who get care through military hospitals or Tricare would also see no change.
There are proposals in the bills to increase the number of family doctors and the payments they receive. Programs to research better ways to prevent illnesses and injuries, including hospital-acquired infections and falls that kill patients, cause suffering and cost millions, is included.
The American Medical Association answers more questions at www.ama-assn.org.
Scheirman, a retired U.S. Air Force colonel, is a graduate of the University of Oklahoma College of Medicine and is Co-Region 7 director of Doctors for America.
For those who have health insurance through a job, new protections will ensure that you get the care you have paid for. Pre-existing conditions will be covered; there will be no cost-sharing for preventive care, no exorbitant out-of-pocket expenses and no annual or lifetime caps on coverage.