For years President Andrew Jackson was locked in a battle over Indian lands with a Cherokee chief. NPR’s Steve Inskeep on the history of that rivalry, how it led to the "Trail of Tears" and helped set the stage for the Civil War.
The House prepares to vote this week on a measure to repeal the health care law. Diane and guests explore how undoing the legislation might affect medical coverage, costs for consumers and jobs.
- Ron Pollack executive director of Families USA, a national non-profit organization for health care consumers.
- Sudeep Reddy economics reporter, The Wall Street Journal.
- Joseph Antos Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute.
MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Last March, President Obama signed a new health care law. Republican lawmakers vowed to undo it. The House is voting on a repeal today. Republicans say the health care law will hurt the economy and crush job growth. Democrats argue the opposite. Many economists and health care experts say the reality lies somewhere in between. It won't create as many jobs as Democrats estimate, and it won't hurt the job market in the way Republicans contend. Some provisions of the law have already taken effect, others to be phased in.
MS. DIANE REHMJoining me in the studio to talk about health care, Ron Pollack of Families USA, Sudeep Reddy of The Wall Street Journal and Joseph Antos of the American Enterprise Institute. Little later in the program, we'll welcome your calls, your e-mail, your tweets and your postings on Facebook. Good morning, gentlemen.
MR. RON POLLACKGood morning, Diane.
MR. SUDEEP REDDYGood morning, Diane.
MR. JOSEPH ANTOSGood morning, Diane.
REHMGood to have you all here. The House bill is called Repeal the Job-Killing Health Care Law Act. What evidence, Sudeep, is there that it will hurt jobs and job growth?
REDDYWell, Diane, the reason this was named in this way is because Republicans, as part of their mandate, were -- was to really -- they decided to focus on jobs in the beginning. Everything they do needs to be somehow directed toward the idea of jobs, even if it doesn't necessarily have something to do with jobs. And so, in this way, this is kind of a political ploy to make it seem like it's about jobs in the near term. The health care bill is not going to really affect job creation in the near term in any meaningful way that we're going to be able to notice.
REDDYIt does have some important long-term effects, and so, by focusing it this way, it kind of redirects attention from some of the more important issues. And there is certainly evidence on both sides in the long term that you will see some effect on business from higher taxes or mandates that could raise their costs. But you also see some benefits for the health care industry, some efficiency improvement in the health care sector that could lower costs for business as well.
REHMSo you said that there's some indication that there could be some job growth. But how about job killing?
REDDYJob killing is a very difficult thing that was measured here. And it was, in part, based on an estimate from the Congressional Budget Office, that the number of jobs in the economy would be reduced as a result of the health care bill. In part, that's because a lot of people who -- the CBO estimated a lot of people who were working might decide not to work because they'll have other access to health care, and it actually was largely because of the size of the labor force being reduced. So it's not people's jobs being destroyed, but people choosing on their own to move out of those jobs. And so that's where the job destruction comes from.
REHMAnd, Ron, you believe that the health care bill would not hurt job creation?
POLLACKThat's right. And, in fact, there was a study about a week ago from Harvard economist David Cutler that estimated that repeal of the Affordable Care Act would destroy 250,000 to 400,000 jobs. Now, David Cutler supports the president and the Affordable Care Act. But what's interesting is Forbes has had two stories in the last two weeks about how this is going to affect businesses, particularly small businesses. Small businesses are going to be helped and already being helped.
POLLACKThey're getting a tax credit for the provision of health care benefits for their workers, and there are 4.8 million small businesses that are eligible for this tax credit. According to Forbes, this has resulted in insurance companies that sell to small businesses a significant increase in the number of people who are getting coverage. So it means that for small businesses, it is more affordable. Coventry Health said they had an 8 percent jump in enrollees from small businesses. UnitedHealth said they have 75,000 new employees of small businesses in...
REHMAll based on passage of the health care bill?
POLLACKYeah, and, in particular, the tax credit subsidy that small businesses are receiving -- Blue Cross, Blue Shield of Kansas City said that they had an astounding 58 percent increase in the number of small business employees who are enrolled. So, obviously, small businesses are finding it more affordable now that they have this tax credit.
REHMAnd yet, Joseph Antos, Republicans argue that requiring small businesses to provide health insurance is ultimately going to result in fewer jobs and slower economic growth.
ANTOSWell, Diane, small businesses aren't going to be required -- very small businesses aren't going to be required to offer coverage. I got to say about Ron's statistics that a -- you can always get an impressive percentage increase off of an extremely low base. The fact is that this...
REHMIs that what you think he's using?
ANTOSOh, there's no...
POLLACKWell, I could...
ANTOSLet's go over the numbers.
REHMOkay. All right. Stop, please.
POLLACKWell, what -- well, wait, just a minute.
ANTOSThe fact is that the subsidy only goes to businesses with employee -- less fewer than 25 employees and with average salaries -- very low average salaries -- I can't remember the exact number -- but extremely low salaries. And so the fact is that this is -- like a lot of things in this bill, this is another one of those subsidies that, as long as you don't look at the details, looks pretty good. On the question of whether jobs will be created or destroyed, I've got to say that there's way too much emphasis on CBO numbers.
ANTOSThe Democrats want to say that CBO's cost figures and deficit reduction estimate must be exactly right. But then they want to say that the half a percent reduction in the labor force that CBO projects is somehow not right. So you got to make up your mind. Do you believe CBO, or don't you? And I think there's reason to be skeptical that any economist -- I'm one -- can really predict the future.
REHMJoseph Antos of the American Enterprise Institute, Ron Pollack of Families USA, Sudeep Reddy, he's an economics reporter for The Wall Street Journal. Do join us, 800-433-8850. Sudeep, how are we to make sense of these conflicting reports, statistics, attitudes, statements? How does the American public know what to believe?
REDDYA lot of people are falling back on their prior principles of what they felt about government regulation and government involvement in the economy. And this is clearly an expansion of the role of government in the health care sector, and that's in order to add 30 million people who were previously uninsured to the insurance system. And that's -- if you don't believe that the government should have a role there, then you're probably going to be against that.
REDDYAnd if you do believe the government should have a role, then you step in there. You have to remember, though, that this was largely built around a campaign promise from President Obama to deal with the un-insurance problem -- on the uninsured problem. And he has dealt with that in large measure through this bill. This doesn't necessarily fix in a very clear fashion the long-term expenditure problem of adding entitlements. We've had this problem for years with growth in health care expenses and with Medicare and Medicaid.
REDDYAnd there were dozens, if not hundreds, of measures built in to this bill that are designed over the long term to lower health care cost. We just don't have evidence of it right now. There are a lot of experiments. And so we don't really know yet what the effects of this will be until you go out five, 10 years. And it's possible that once we get out to that point, we will find that health care costs aren't coming down quickly enough, and we will need to do more. But in dealing with the campaign promise, that was, in large part, achieved from this.
REHMAnd, of course, Republicans are also responding to a campaign promise by bringing this up now to repeal it.
REDDYThat's exactly what they've done. And they campaigned on that in November, and they're going to make that an issue. The bill in the House is very likely to end in the House. It's going to be passed. It's going to go to the Senate. It's a dead-end there. But there are a lot of other things Republicans will be doing. They're going to take this to their various committees and look for ways to prevent funding for implementation of the health care law. They're going to look for ways to somehow take it apart without doing a wholesale repeal. And they're going to find ways to really poke at it in every way possible because that's what their base wants. And it's going to be campaign issue going into the fall of 2012.
REHMFrom what The Wall Street Journal polls tell us, however, does the public want another congressional session spent on health care when the whole past two years has focused on virtually nothing else?
REDDYWhat the polls are often telling us is that people don't understand this bill because it is such a large bill and such a complicated bill. And that's what we're finding. When you take apart pieces of it, you're going to find mixed views. If you're looking at pre-existing conditions and making sure insurance covers that, that's going to have widespread support. So Democrats are picking up on that. When you look at cost and the impact on government expenditures, that tends to have less support, and so, depending on which piece of it you pick up, you're going to find supporters and opponents on each side..
REHMAnd that's exactly what we're going to come back to, the major provisions of the bill that have already taken effect, Ron. You've got some very important ones.
POLLACKYes. There are a significant number of things that are already in effect. So as we said, small businesses are receiving a tax credit of up to 35 percent of their costs. Young adults under 26 years of age can stay on their parents' policies. Children who have pre-existing conditions, like asthma, diabetes, they no longer can be excluded from health care coverage.
REHMBut the adults don't come on until 2014 with a pre-existing condition.
REHMAll right. Short break, and when we come back, we'll talk further and take your calls.
REHMAnd we are back talking about the health care legislation repeal that is being debated and, perhaps, voted in the House today. The Senate Democrats will likely not vote to repeal it. Just before the break, Ron Pollack of Families USA was talking about the provisions that are already in place. You have a whole group of provisions not going into effect until 2014. What else is in there right now, Ron?
POLLACKWell, in addition to the small business tax credit, young adults getting coverage through their parents and the pre-existing condition protections for children, seniors are getting a significant benefit. As you know, seniors have this big prescription drug coverage gap euphemistically called the doughnut hole. Last year, people who fell in that hole received a $250 check. This year, they get a 50 percent discount on the drugs that they purchased. Ultimately, that doughnut hole is eliminated entirely. Seniors are also receiving screenings and preventive care with no deductibles, co-payments, out-of-pocket costs. They're no longer lifetime capped. So somebody has a major illness or an accident, there's no lifetime cap that denies payments to people when they really need it.
REHMI think Joseph Antos has a comment.
ANTOSYeah, that's a 2014 provision, Ron. This year, it's $750,000. And as you may remember, the McDonald's corporation, and a bunch of other companies as well, requested a waiver from this so that their low-wage employees can continue to buy health insurance coverage.
REHMHere's an e-mail from Ross in Richmond, N.H., who says, "I was just able to get our daughter, who graduated from college, with over $100,000 in student loans back on our family policy. If they repeal, will she be kicked off?" Sudeep.
REDDYIf there were a repeal, then those kinds of provisions would be removed. And that's kind of one of the political difficulties of this bill, is there are a lot of things that are appealing to people at a very practical level when you look at it. Pre-existing conditions, coverage of young adults -- all of these things are appealing, but a lot of them were made possible by the addition of 30 million people to the insurance system, by some of the added taxes down there. There are all sorts of things that have to pay for these costs to the insurance system that were built in. And if you repeal it, you repeal the entire thing. And the big question is if you want to repeal it, you need to replace it. And replace it with what? The prior system was clearly unsustainable on both a social level in terms of who it covered and on a cost level in terms of what it's doing to the government.
REHMJoseph Antos, let's talk about the mandate aspects of the bill and the fact that, what, now you've got 26 states that are protesting, have taken this to court. Ultimately, it's likely to go to the Supreme Court?
ANTOSYeah, I'm sure that's the case. But let's project down the road. The Supreme Court generally picks the narrowest possible provision of any case and rules on that. And so let's imagine that they say that some aspects of the mandate is unconstitutional. They're certainly not going to say that the whole bill is unconstitutional, but they might say that the mandate is unconstitutional. What would the government's reaction be if this was a decision made in Barack Obama's administration? I think the answer is clear. They'd say, okay, well, we tried. But insurance companies, that's your problem now. We'll put out a big publicity campaign, try to get people to recognize what their responsibility is and what the opportunities are, but it's up to you to sell the insurance because the rest of the bill, the rest of the legislation hasn't changed.
POLLACKYeah, I think that if the Supreme Court does the unusual thing and finds it unconstitutional, which would actually break decades of (word?) -- I used to be a law school dean. I used to litigate in the Supreme Court -- would be unusual for the Supreme Court to strike as unconstitutional any portion of this legislation, including this individual responsibility provision. However, if it was struck, then there are some alternatives that, no doubt, people will try to get adopted in its place. Now, I think that the individual responsibility provision is most effective. However, if that were declared unconstitutional, I could see a number of things that would be tried.
POLLACKNumber one, you could look at what happened in 2003 with a Medicare legislation when they created the prescription drug legislation. They did not require seniors to purchase prescription drug coverage. But they did say for each year that they delayed purchasing, they would have to pay a surcharge on the premium. So there was a financial disincentive for them not to purchase coverage in a timely manner. I think you would make sure that people could only get enrolled in certain enrollment periods so you could avoid somebody who's in an ambulance saying, I'm going to buy insurance before I get to the hospital. There are a number of things you can try. I don't think they're as effective as the individual responsibility provision, but they certainly would be attempted.
REHMNow, Sudeep, isn't the mandate the reason -- or at least part of the reason -- that the insurance companies went along with the administration because it did bring in 30 million more people to be insured?
REDDYThat's exactly right. And that's why we've gotten to this point where we've spent decades trying to come up with a plan that would actually pass, and very little will actually pass, as we found. And that's why you have this really complicated bill that throws all sorts of things in it that both sides are going to attack. And even Democratic supporters don't like aspects of it and are trying to take apart some of those provisions. But that was one of the reasons the insurance companies did come in and, ultimately, come behind this bill.
REHMWhat provisions are Americans expressing the most concern about?
REDDYIt depends on which group of Americans you look at. If you were to look at people who are small business owners, they might question whether -- if they're at that threshold of 50 employees -- where you have to start or you're required to have care -- then they may say it'll hold up their business. If you're in the highest income brackets, you're probably going to be most concerned about tax, which is added, starting in three or four years down the line. That's going to be a tax on people on earned income -- so capital gains and dividends -- that is going to pay for some part of this bill. So it all depends on which aspect you're looking at. There are people who are in payroll offices that don't like -- who don't like parts of the bill because it's going to add to their administrative requirements.
REHMBut, Joe, you say if Republicans fix the mandate portion, then they'll make -- that will make health reform less objectionable.
ANTOSWell, I guess I didn't say that. But I suppose that for a lot of people on the conservative side, they would agree with that. But they would also see other big challenges, other problems that they think need to be resolved. I think one of the biggest ones is the overreaching in terms of the huge amount of money that the federal government has not only promised, but promised in perpetuity. We're talking about a trillion-dollar set of subsidies, some of it involving sending people into the Medicaid program, some of it involving subsidies, and the exchange is to buy heavily regulated private insurance. And, I think, many Republicans and many conservatives look at that and say, well, how are we actually going to -- going to be able to pay for that, knowing the track record of Congress, which is natural, of course? Politicians and human beings like the good things, and they don't like the paying.
REHMAnd here's an e-mail from Lisa in Ohio. She says, "Whenever the nonpartisan CBO issues a report contrary to what Republicans want stated, they think the claim is flawed. However, Republicans praise any CBO they like. It just doesn't work both ways." Sudeep.
REDDYThat's exactly how it's worked on both sides. And you have people attacking CBO because you -- they didn't look at one piece of it in this particular approach or that approach. And that's going to happen. This is going to -- that's just the nature of politics, where people will attack the numbers and the messenger in that sense. But there is a much bigger picture here that CBO has addressed, and that's the unsustainable increases in medical costs. And they've been -- CBO has been talking about this for a long time, how, as a share of our economy, health care has gone in the past 50 years from 5 percent. It's now over a sixth of our economy, and it's...
REHMAnd that if we don't?
REDDYExactly. And if we don't deal with this problem in the near term, the government expenditures for health care are going to be so large and unsustainable that they will actually drown out the rest of the government budget.
REHMYou know, it's interesting that with this voting on the repeal that's coming up today, one wonders why Democrats were not more forceful before the first vote to accept this health care law, why they weren't -- and especially the president himself -- why they were not more forceful in pushing for the elements you've already talked about, Ron.
POLLACKYou know, I'm -- one of the reasons, I think, this is an opportunity for those of us who support the Affordable Care Act is -- I mean, let's face it. I hate to say it, but those of us who support the Affordable Care Act did not do quite the effective job we should have done and...
POLLACKWell, I think that when you're in a debate that's trying to pass legislation, two things happen simultaneously. Number one, people push the bill, but, number two, each is pushing for its own specific provisions. Different organizations push for this provision or that provision. There's fractiousness. We haven't...
REHMOn the Republican side, there was no fractiousness.
POLLACKThat's absolutely right. Now, there is a very different dynamic. Those who support the Affordable Care Act -- Democrats and lots of organizations were doing a press conference this morning. There are going to be 150 organizations standing shoulder-to-shoulder, saying, don't repeal this legislation. Now, there's cooperation. Now, there's cohesiveness in terms of support of the legislation. And what's going to be very interesting is that some of the Republican leaders in this repeal effort said, look how many Democrats are going to deflect and are going to support the repeal. Well, I predict that when the vote takes place later today only a small fraction of the Democrats still in the House who voted against the Affordable Care Act will support the repeal.
REHMWhat's your reading, Sudeep?
REDDYI think Democrats are going to stay united on this and find a way to campaign in the other direction because if they even show -- the ones who show some hesitancy on this are going to be attacked and attacked very furiously going into their next election in the fall of 2012.
REHMSo they'll vote against repeal?
REDDYExactly. There may be a very small number.
REHMSudeep Reddy, he is economics reporter for The Wall Street Journal. And you're listening to "The Diane Rehm Show." John in Concord, N.C. wants to know why the Obama administration has granted over 220 health care reform waivers to unions, corporations and nonprofits. John -- Joe.
ANTOSAll right. This is what I was referring to when I mentioned that the elimination of the cap on benefits doesn't occur until 2014. This year, it's $750,000. And the reason for the waivers is -- well, frankly, thanks to The Wall Street Journal and McDonald's Corporation, they managed to get a story placed sometime in August on the front page of the Journal that said that several tens of thousands -- I don't know the number -- of their workers who tend to be low-wage workers wouldn't be able to buy insurance that they had been voluntarily purchasing because the premiums which -- would skyrocket.
ANTOSNow, these are called mini-med plans. These are the kinds of insurance policies that, if you had a choice and you had the money, you wouldn't buy. But people were voluntarily buying them because they wanted some protection. The waivers are basically to allow them to continue to buy those plans. It's -- I think it's notable that it isn't just corporations like McDonald's and Home Depot and so on that are involved in this, but there are a lot of union plans that are exactly in this situation. So, on the one hand, the union is really pushing for this. On the other hand, a number of unions obviously represent lower wage workers, and they have the same problem.
REDDYWell, the waivers and the reason these waivers came about are, in part, because of the politics of it and seeing companies start to attack the plan, that they needed to come up with some kind of system, at least in the short term, to deal with this. And I wonder, in the long-term, how many waivers are going to be coming there.
ANTOSWell, it's temporary, right?
POLLACKFirst, we have to understand, these waivers are in this interim period leading to 2014. So these are not permanent waivers.
POLLACKThere's a transition period every time that you pass major legislation. And so some of the things that require major changes, they're going to be accomplished incrementally. So let's be clear. These waivers are only during an interim period, and they won't exist after 2014.
REHMAnd tell me about members of Congress and what kind of insurance they have, Sudeep.
REDDYThey have very good insurance, and a lot of them don't want to lose that insurance. And that's part of the debate that we had during the -- this bill coming up is, should the American people have the kind of insurance that members of Congress and members of the executive branch have access to? And, clearly, right now, tens of millions of Americans do not, and that's part of the debate that we've had all along about health care. If you go back to even the 1990s, when we actually saw some caps on cost through managed care, people were unhappy with the system then. And so we've had a system that most people, when they're buying in, aren't completely happy with right now, and whether they're going to be happy down the road is a very important question.
REHMAnd, Ron Pollack, you were telling them using a story about congressmen like Andy Harris.
POLLACKYeah, Congressman Andy Harris from the eastern shore here in Maryland, he ran on a platform that said, we're going to repeal the Affordable Care Act. And then, when he and his colleagues who were new members of Congress received their orientation, he was told that his health care coverage, courtesy of the American taxpayer, would not go into effect till Feb. 1. He would have a four-week delay. And he had a hissy fit and said, you know, I think I should be getting this coverage today.
POLLACKWell, ironically, he wants to withdraw from the American people many of the benefits and rights that he will receive. I mean, there are a whole bunch of things -- the protection against pre-existing conditions, subsidies to make premiums affordable. Members of Congress get about 75 percent of their premiums subsidized by the American taxpayer -- prescription drug coverage without a gap like people in Medicare receive. And eliminating that gap, he wants to repeal. So it's really a double standard.
REHMAll right. When we come back after a short break, we'll hear from Kate in Kalamazoo, Robert in San Antonio and Dan in Syracuse, N.Y.
REHMAnd now it's time to open the phones. First, to Kate in Kalamazoo, Mich. Good morning to you.
KATEGood morning, Diane. You are such a wonderful informer for us. Thank you for all your hard work.
KATEI guess I would like to have it clarified. I supplied my own insurance for years and got no tax breaks, and, now, I'm finally insured by a corporation. But isn't that tax from a corporation a tax break for them? So isn't my insurance now subsidized by the government anyway?
REDDYYes. Yes, it is. Actually, there are two tax breaks. One of them – and I don't think anyone should object to, and that is the contribution of the employer makes towards your benefits are considered an employer business expense. And so that's a tax break in a sense, but it's no different from the tax break they get for buying materials to produce their products or paying your wages. The tax break that you get is that the employer's contribution is not treated as income to you. And so you're saving, you know -- I think the average person is probably in about the 15 percent federal income tax bracket. There's another roughly 15 percent payroll taxes. So the average person is not paying roughly 30 percent of taxes on that form of compensation. It's a pretty good deal.
REHMAll right. To Alamance County, N.C. Good morning, Toni.
TONIYes. Hello. Thank you for taking my call.
TONII'm not a disinterested party, but have not focused much on this debate in the past. I'm a trust, you know, recipient, and, you know, it doesn't affect me personally. But with the shootings last week, I decided maybe I need to be more in touch with what's going on and pay a little more attention to public debate. And one of the comments I heard, I believe, on a show earlier in the week or last week on one of your programs was the idea that we need to talk more civilly towards each other, particularly in debate. And one your program's participant mentioned the concept of calling the legislation what it is and not using terms that might seem to be inflammatory to the other side.
TONIAnd yet, just this morning, on my local news, one of our North Carolina representatives in Congress, right now, mentioned the health care debate and referred to it as Obamacare. And I was so frustrated because I -- I am Democrat. I -- but I want to have an open mind in bringing it back to the table. There probably are some aspects that need to be tweaked. But my first inclination was just to think more the same. I don't want to think more the same. I even reached out and called my congressman's office and the other office to say I want to listen to the debate. But when I hear terms like that, it makes me just want to turn it off again.
REDDYThis is, unfortunately, part of the supercharged atmosphere in Congress right now where partisanship is a driving force. With the specific issue of naming of bills, this particular bill was, for a number of reasons, called the job killing act initially. Now, Speaker Boehner is trying to call it the job destroying act after what happened in Arizona. And so it's gotten into a level of ridiculousness. And this has happened over the years with the Patriot Act and a number of other bills where they were designed to kind of force people into a corner. And it would be better if we went back to some very simple names for our bills and what they're about.
REHMAs opposed to, for example, death panels.
REDDYExactly. And things like that. And there may be a point -- right now, Obamacare is being used as a pejorative. Maybe when people see this current health care law, like they see Medicare, as a right and an entitlement, that, maybe, President Obama will like that at some point. But he certainly won't right now.
REHMToni, I'm glad that you're really making an effort to inform yourself as what each and every one of us needs to do. Thanks for your call. Here's an e-mail from David in Dallas, Texas, who says, "I did not support the health care bill initially. But after the bill, my insurance agent came back to me and showed me how I can afford it. Thanks to provisions in the health care bill, I am now covering all my employees. They couldn't be happier. I did not support it before. But, now, I unequivocally support this bill. I even turned in my resignation to my local Tea Party as I found they just don't understand the reality facing small business today. I am even considering voting for the president's party in 2012." Ron Pollack, that must make you happy.
POLLACKWell, it certainly does. You know, one of the problems that Toni mentioned before -- and that David is exemplifying -- is that we have this vituperative debate, but we don't actually talk about various provisions that are going to affect people. And I think the more people learn about it -- how small businesses are going to be affected, young adults, how seniors, how children, the protections we get from insurance company abuses -- I think we're going to see more like David who are going to say, this is something that's helpful. And, one last thing, I think I agree with what Sudeep said a moment -- Obamacare term was used, really, as a pejorative.
POLLACKIt was used to sort of say, you know, this is a government takeover, other kinds of charges like that. I predict that a few years from now, Obamacare is going to be something that President Obama is going to be very happy about that call because I think the American people, incrementally, are going to support this legislation. And he'll be happy to take a portion of that credit.
REHMAll right. Here is a message from the website. "My wife," he says, "was diagnosed with breast cancer last year. We're both self-employed. We pay for our own insurance. Since it's so expensive to buy health care, our deductible is extremely high. We ended up paying $12,000 in deductibles alone, plus our $650 a month premium before she was treated. What solution to this problem does the Republican Party have? Solutions like enabling cross-state shopping for health care does next to nothing to help us since all of these insurance companies are simply interested in trying to make a profit." It is interesting, Joe, that Republicans have not come up with a plan of their own.
ANTOSWell, you know, they have a problem. They've been in the minority in Congress, especially in the House, for the last two years. And so each member has thrown up, you know, various proposals, knowing full well that these proposals would not even get a hearing in the House. That result is that we entered this year, this Congress, without a clear Republican position that Republicans in the House actually support. So one of the votes that's going to happen after today -- I believe it's scheduled for tomorrow -- is on a House resolution, which means it's not a law. It doesn't go to the Senate. But House resolution that basically says to, really, the Republicans, get your act together -- by the way, this is a Boehner resolution. Get your act together and come up with something that's going to work for the American people.
REDDYEverybody is going to throw out their -- throw up their solutions and say, this is, actually, the plan that will work for us. And the problem with all of this is in their individual form. A lot of these things sound like great ideas, but when you put in into a $2.5 trillion health care system, it falls apart when you're not considering the costs and some of the benefits and the costs of all of these provisions. And so lots of members are going to throw these ideas up there as an alternative. You have to look at what will actually pass politically and what will work economically (unintelligible).
REHMTo Syracuse, N.Y. Good morning, Dan.
DANHello. As I understand it, if you're unemployed or you have low income, you'll have financial help to purchase your insurance through the state Medicaid program. But, I'm wondering, will you be required to spend down any assets that you have to purchase insurance?
POLLACKSo there are two kinds of ways that people are going to be helped. For the lowest income people and families, if you have income below 133 percent of poverty, that's roughly $29,300 in annual income for a family of four, you will be eligible for the Medicaid program, and that's irrespective of assets. However, there are lots of people who have income somewhat higher than that 133 percent of poverty but still can't afford to pay for coverage. And the last person who asked the question about how do I pay for premiums, how do I pay for out-of-pocket costs, those people are going to be helped.
POLLACKThey now will be able -- starting in 2014 -- to go into this new marketplace called an exchange. They'll be able to select the plan from the exchange. And when they do so, if they have income below 400 percent of poverty -- which for a family of four is $88,200 -- they will get a tax credit subsidy to help them afford the premiums. And in addition to that, there will be limitations and out-of-pocket costs that they bear when they need health care services. And so for people who are having difficulty paying for health care, this legislation will help them very significantly in 2014, either through the Medicaid safety net for the poorest of the poor or through these tax credit subsidies for middle class families that can't afford coverage today.
REHMAll right. To Little Rock, Ark. Good morning, Kent.
KENTGood morning. It seems to me that Republicans have attacked this health care bill from just about every angle they can. When it was trying to be passed, they called it socialism, which it really isn't. They called it – they said it would cost way too much money, and it'll cost a lot of money. But there's lots of plans and provisions to provide that money and also a lot of ways it'll save money. And now they're calling it job killing. It seems like this is just the next strategy in how to defeat the health care bill, and they don't really care if it's socialism or if it's job killing or if it costs too much. I guess that's more of a statement than a question, but...
REHMThat's all right. That's fine. Sudeep.
REDDYWell, there was a time when people were attacking Medicare and Medicaid more than they are now. There are still people who are attacking them. And there were -- just about every government program is going to be attacked, whether it's a tax or benefit. There is an important issue here that hasn't really gotten as much attention in this particular debate, and that's the long-term health care expenditure trajectory for our country. We almost have this sense of entitlement for the best doctors, the best technology, the best prescription drugs, and we are on a path where that is just not going to be possible in the long run until costs come down.
REDDYWe've all heard the figure about how we spend more than any other country on our health care, and the results aren't necessarily better than other countries. And so there are some provisions in here that are designed to deal with that, but we don't actually have any certainty that even for the third of the health care expenditures that are paid by the government right now that we're going to bring those down. And that is an actual entitlement problem that is going to pick up a lot more in this debate about the deficit and the debt. But that's a very serious issue.
REHMSudeep Reddy of The Wall Street Journal. You're listening to "The Diane Rehm Show.” To Ormond Beach, Fla. Good morning, Tomasine (sp?) and thanks for joining us.
TOMASINEYes, thank you. Republicans keep talking about the need for tort reform in order to protect doctors and pharmaceutical companies from unnecessary malpractice suits. However, about 3-and-a-half years ago, President Bush's right-leaning Supreme Court decided that if the Food and Drug Administration approved of drug or equipment, then even if you are injured or die from that FDA-approved drug or medical equipment, you cannot sue the pharmaceutical company who made the product. So it seems like it's a phony argument Republicans are making because George Bush and his Supreme Court overly-stacked the legal deck in favor of big pharma.
REHMThis whole question of tort reform has been part of the Republican argument? I don't know about the particular she cites. But, Joseph.
ANTOSRight. Let's talk generally about tort reform. So the issue which every physician in America is concerned about is...
ANTOS...malpractice. Exactly. Now, I think the debate has been way too narrow -- the political debate, not the debate among people who actually understand the issues. It's not just a question of suits that are unreasonable and inappropriate. It's also a question that there are a lot of people in this country who don't get appropriate compensation or don't get an, I'm sorry. It's a very inhuman kind of a system. Unfortunately, the president didn't do much. Last year, he announced that there would be some demonstration projects and a little bit of money for the states to figure something out. Equally unfortunate, most Republicans focused only on limiting malpractice awards without really looking at the big picture. That's something we really need to deal with.
POLLACKI think we will get back to some kind of tort reform. You know, when I was a law school dean, we used to have a sign posted behind me, was a quotation from Chico Marx. It said, if you got a problem, get a lawyer. Then you've got a bigger problem, but at least you got a lawyer. But it seems to me what we will see happening is that for those physicians that practice in accordance to protocols and guidelines, perhaps they will be provided with safe harbor so that if they follow those protocols and guidelines, then they would not be sued for malpractice.
REHMAll right. Let's go to a caller in North East, Md. Good morning, Diana.
DIANAGood morning, Diane. I wanted to mention that Maryland has a wonderful plan called the Maryland Health Insurance Plan, and they coupled that with the federal health insurance plan. And I've recently been unemployed. I didn't know these plans existed. I found them on the Internet. And I pay $235 a month with a $200 deductible. But these plans aren't being advertised, and there's only 8,000 people signed up federally for the program.
DIANAI just was wondering why that is. And the only alternative I had was to marry my long-time boyfriend because insurance would've been $1,079 a month.
REHMI understand that very well. Ron Pollack, very quickly, please.
POLLACKTwo quick comments. One, Maryland has done some very significant things that supplement what the federal government does. But the key point she's raising is all the people who will now be eligible for tax credits, subsidies or expanded Medicaid, we have a task to make sure that those folks get enrolled so that they actually get the protection that the legislation establishes.
REHMDiana, I'm glad you got the help you needed. We'll see what happens in the House today and, indeed, the Senate tomorrow and going forward. Ron Pollack of Families USA, Sudeep Reddy of The Wall Street Journal, Joseph Antos at the American Enterprise Institute, thank you very much.
REDDYThanks for inviting us.
REHMAnd thanks to all of you for listening. I'm Diane Rehm.
ANNOUNCER"The Diane Rehm Show" is produced by Sandra Pinkard, Nancy Robertson, Susan Nabors, Denise Couture and Monique Nazareth. The engineer is Tobey Schreiner. Dorie Anisman answers the phones. Visit drshow.org for audio archives, transcripts, podcasts and CD sales. Call 202-885-1200 for more information. Our e-mail address is firstname.lastname@example.org. And we're on Facebook and Twitter. This program comes to you from American University in Washington. This is NPR.
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