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What did health reform do?


“Do you see though, how halfway through that I stopped paying attention? Did you see my eyes glaze over?”

-Jon Stewart responding to DNC chair Tim Kaine’s list of benefits from health reform

The other night on The Daily Show, the guest was DNC chair Tim Kaine- he’s the guy running the Democratic party these days. During the interview, Jon Stewart pointed out that even though health care reform has passed, a lot of people don’t understand what it’s done for them– premiums are still going up, people are still getting dropped from their insurance. Kaine responded with a laundry list of provisions that took effect immediately: children can stay on their parents insurance, seniors getting rebates for prescription drugs, and small business tax credits.

All good stuff but, if health reform is just a pile of things that sound decent but not earth-shattering, people tend to zone out. Unfortunately, health care reform was mostly just that– a whole lot of smaller fixes that will hopefully add up to something substantial. There is one major change from the current system- the exchanges- but even six months later most people still don’t understand what they are or how they’ll work.

We’re not politicians, but we think it’s important that people understand how the new law will affect their lives. And so, here are a few suggestions for what to say the next time someone asks what health reform does for people:

1.  Explain the Exchanges
Again, this is the most important part of health reform and hardly anyone understands it. Here’s your elevator pitch:

Let’s say you lose your insurance coverage– maybe you lost you job and COBRA ran out, maybe you graduated and got dropped from your parents’ insurance, maybe you quit your job to start a small business– whatever the reason. Under health reform you will be able to get secure, affordable coverage.

There will be a website. You can log on, see a list of insurance plans, and choose the one that works best for you. If you don’t make a ton of money, the government will help you pay for it, on a sliding scale. For example, take a family of four making $40,000 a year. Decent comprehensive insurance for that family, depending on age and location, would normally cost anywhere from $7,000 to $32,000. Under health care reform that family will pay around $1950. That’s a discount of between $5000 and $30,000 (up to 93% off the premiums). And if that family makes less than $30,000 they’ll be covered under Medicaid.

Meanwhile, you know all of the tricks that insurance companies use to screw you out of coverage?:

  • pre-existing conditions
  • dropping coverage when you get sick
  • not covering basic procedures
  • annual and lifetime limits
  • ridiculously high copays and deductibles
None of that will be allowed anymore.

2. Mention the tens of millions of people who will get coverage

According to the CBO, 32 million people who have no insurance now will be covered. These people aren’t just deadbeats– the vast majority of them are working people who have either been denied coverage by insurance companies, or don’t get insurance from their employers and can’t afford it on their own. It’s not perfect, but the new law is way better than the current system.

And that’s it- that’s the heart of health care reform.

Once you’ve gone through that, then you can talk about the stuff that kicks in this year: the fact that the new law is expected to reduce the deficit, the Community Health Centers, the stuff to encourage more primary care doctors, the funding for quality improvement research, ways the law could reduce health care costs, etc. But make sure people understand the basics first.

[Note: All the dollar figures on the price of insurance and subsidies come from the nonpartisan Kaiser Family Foundation. To see what your insurance would cost based on your age and income, check out their health reform subsidy calculator.]

{ 2 comments… add one }
  • John Nagle October 28, 2010, 2:27 pm

    Rob, As usual, I appreciate your blog.
    While I agree with you that the bill that was passed does some good things, I am discouraged that the Democratic party did not have enough internal discipline to be able to get much more, and much quicker, so that other major issues like energy and climate change could be passed. And I am disappointed that the party could not mount a coherent picture to the public about what it was doing, probably because there was so much internal dissent involving Altmire and others. There was a window of opportunity for progressive legislation that may not come again for a long time. But I agree with you that the public needs to recognize that something good was done and I appreciate your efforts to fill that need.

  • Rob Cullen November 4, 2010, 1:30 am

    Thanks John–
    You bring up one thing that I still don’t understand about the health care reform process– why the Democratic leaders let the debate drag on so long. Honestly, I think the reform bill is more progressive than most people realize and I think they pushed Congress about as far as it would go on health care. (People forget how many conservative dems there were– between the Blue Dogs and the extremely pro-business New Democrat Coalition, that’s almost 100 Congressional Democrats, and dems needed most of their votes, to pass reform.) And I can sort of understand why Dems negotiated with Republicans at first, even if they didn’t need the votes. But after a couple months, it seemed clear that Republicans were going to vote against reform no matter what was in it. The delays just gave opponents more time to trash the bill with no upside for Democrats, and, like you said, it meant that Congress had less time to work on other issues.

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