How health reform may affect a family
A lot of big numbers have been thrown around for the health-care overhaul bills in Congress. But how would the plans actually help the average family of four with no insurance? Nancy Marshall Genzer reports.
The costs of an overhaul to health care (iStockPhoto)
More on Health
TEXT OF STORY
Kai Ryssdal: We have known the broad outlines of the Senate's health-care bill for a while now. But we figured now that we have the specifics -- it was officially released last night -- it might be good to figure out what consumers are going to get for the bill's $849 billion price tag. What'll it do for your average family of four with no insurance? That was today's assignment for Marketplace's Nancy Marshall Genzer.
NANCY MARSHALL GENZER: So, we've got a fictional family of four with no insurance. We'll put 45-year-old George at the head of the family. He works at a restaurant. Let's say he earns $66,000 a year. George had a heart attack a few years ago. To get an idea of how his family would fare under the health-care overhaul, I called the Center for American Progress.
Ellen Marie Whelan is the center's associate director of health policy. She used an online benefits calculator to crunch the numbers for George and his fictional family.
ELLEN MARIE WHELAN: And he works in a restaurant and let's say he works in a restaurant that has less than 50 employees. And we're going to put that he has to purchase his own insurance because his employer has not chosen to offer him health insurance.
By Whelan's calculations, George would be able to insure his family for $15,000 a year under the health-care overhaul proposals. The government would pay almost half of that, leaving George with a bill of about $6,300. Where would George buy his insurance? Because of his income and the fact that his employer doesn't insure him, George can shop for a policy in an insurance exchange.
Elizabeth McGlynn of the Rand Corporation explains how the exchange works. She says there'll be a Web site to log onto.
ELIZABETH MCGLYNN: So people could go on and compare the different plans that are being offered in their state. They'll all have standard benefit packages, so it'll be easier than it often is to know what you're getting from the different health-insurance companies who are offering the policies.
But what if George decides not to buy insurance? Whelan says he would pay a fine under the Senate plan.
WHELAN: So he'd have to pay $285 the first year. And that quickly goes up in a couple years to $750 per person, half for kids.
George's employer wouldn't be fined, because his restaurant has fewer than 50 workers.
Sara Collins is an economist with the Commonwealth Fund. She says our fictional family is pretty typical of today's uninsured.
SARA COLLINS: Right now if you don't have coverage through an employer, there are few places for you to turn to, except the individual insurance market, and if you've had a heart attack or other pre-existing health conditions, it's really tough to get an affordable policy or maybe not a policy at all.
It's not clear when our fictional family can get their insurance. The debate over the legislation is likely to drag into next year.
In Washington, I'm Nancy Marshall Genzer for Marketplace.
Comments
Comment | Refresh
11/21/2009
Nancy forgot to mention that "George's" INCOME goes down to $59,700 because now he has to pay $6.3 K a year for insurance. Like many Americans who are in good health, he might choose to "roll the dice" and pay for each health service he uses. For example, if he goes to a primary care doc maybe twice a year, he'd pay maybe $250 that year for health care. Whereas if he gets a normal 80/20 policy for $6,300 a year with a $25 co-pay for primary care, his two office visits would cost him $6300 plus $50 = $6800 that year.
From San Antonio, TX, 11/20/2009
The saddest thing to me this legislation only ends up punishing the people who currently don't have health insurance. What type of government extorts their citizens to either pay $500 a month or lose $250 a year to stay in their current situation? We've never heard about any legislator being smart enough to propose reform to fee for service, portable medical records, or the separation of health care and health insurance through flexible spending accounts. All three of which are the crucial reforms that could actually create a better atmosphere for medicine. The last thing any industry needs is management by people only care about a biannual popularity contest.
From Miami, FL, 11/20/2009
There are two enormous concerns; the first is addressed in most of the above comments; $7500 out of pocket costs for coverage? This family would have to be very unusual to be willing to plan and spend ahead for what most think will not happen to them. Second, most of the plans pay 75% of the costs; so after more than 10% of gross income, the deductibles and co-pays could still bankrupt a middle income family faced with a major medical illness. Our congress should be appalled; but they aren't.
From Babylon, NY, 11/19/2009
I was horrified at the figures in this story; your hypothetical family will still have to come up with an extra $500 or more a month or be penalized! They are likely just getting by, and where is that supposed to come from in their budget? Once again, the politicians will be congratulating themselves on a historic acheivement, while Mr. and Mrs. Everyman are still struggling to choose between health care and food or electric! After so much debate, THIS is what congress has to offer? Disappointing, to say the least. Thanks for delivering the facts!
From Milan, MI, 11/19/2009
$849 billion price tag? Only if you accept the Democrats' creative accounting--one of the bills started counting revenue immediately but went into effect three years later, leaving the ten-year CBO score with ten years of revenue but only seven years of costs. And entitlements *always* run *way* over budget.
You should also have mentioned that this "fine" that "George" would have to pay if he didn't buy insurance would be enforced by the IRS, which is an unprecedented and unwarranted step.
From San Francisco, CA, 11/19/2009
$66,000 a year? At a restaurant? What fantasy land are you guys getting your numbers from? Try $30,000 to $45,000 a year, and I live in very expensive town.
Post a Comment: Please be civil, brief and relevant.
Email addresses are never displayed, but they are required to confirm your comments. All comments are moderated. Marketplace reserves the right to edit any comments on this site and to read them on the air if they are extra-interesting. Please read the Comment Guidelines before posting.
You must be 13 or over to submit information to American Public Media. The information entered into this form will not be used to send unsolicited email and will not be sold to a third party. For more information see Terms and Conditions and Privacy Policy.