Health Care Reform FAQ: March 2010

To download a printable list of this FAQ as a PDF file, click here.

In the next few days, the House will consider a vote on the Senate Health Care Bill.  If the House passes the Senate Bill it will return to the Senate for further amendments.  These legislative proposals are very complex and subject to a variety of interpretations on the part of both those who support the Bills and those who do not.  FAN, in an effort to clarify the issues and continue to provide information, offers a set of frequently asked questions (FAQs).

How many people in the United States have no access to health care and why?

There are between 46 to 47 million people in the United States that do not have access to health care insurance.  Half of these people are without access for one year and half of them rotate within a given year.  20% of the uninsured have enough money for insurance but choose not to buy it.  About 18% of all people without health care insurance are children (between the ages of 0-18), especially those in poverty, many of whom are Hispanic between the ages of 12 – 17.  8% of those who are uninsured are undocumented.

How does health care reform legislation address those people who do not have access to insurance?

All people will be required to buy health insurance unless the cost of a family’s insurance premium exceeds 8% of household income (in such cases a subsidy will be provided). Means such as the heath care exchange and subsidies will give people access to insurance.

How many people do not have access to health care because they have a pre-existing condition?

There are about 4 million people in the United States who do not have access to health care insurance because of a pre-existing condition. The common list of pre-existing conditions is: serious heart disease, high blood pressure, cancer, diabetes, and asthma. Even people with hay fever or prior accidental injury can be denied coverage.
Insurance companies will frequently provide coverage but exclude coverage of pre-existing conditions.

Are there certain factors or a pattern of discrimination that keeps people from health care insurance?

The people most likely not to have health insurance are people who need individual insurance (not provided by the employer) and people who are employed by small businesses or who may own small businesses. Low wage workers tend to be vulnerable to the escalating cost of insurance.

What is the average income of those who do not have access to health care insurance?

Eighty percent of people who do not have access to health care insurance have incomes less than three times the federal poverty level or $66,000 for a family of four.  Twenty percent of the uninsured are in households with incomes that exceed three times the federal poverty level and are generally regarded as people who can afford insurance but choose not to purchase it. 

Sixty-seven percent of the uninsured are members of families with an income that is less than 200% of the federal poverty level (for a family of four, $44,100)

Considering the current Bill passed by the Senate, is there any more cost efficient way to provide access to health care insurance?

Some legislative proposals (not the Senate proposal) would eliminate the mandate and reduce federal subsidies for purchase but in effect cover fewer people. There is no more efficient way to cover as many people than the current bills without eliminating the employer-based health care system in the United States.

How are proponents of the current health care reform bill able to claim that eventually health care spending will be reduced? 

Many experts do not claim that current legislative proposals would decrease the cost growth of health care. The factors that contribute to the high cost of health care are systemic.   Dr. Guy Clifton in his book Flatlined illustrates the systemic factors that contribute to high medical costs.  A significant factor is waste. “The magnitude of waste is so large that the only way to significantly reduce health care cost is to follow a targeted federally led initiative to reduce waste.”  Pending legislation does not tackle high cost in a comprehensive way, but does address abuse and efficiency.

In times of high budget deficits how are these changes affordable?

It is likely politically impossible to expand coverage and cut cost in the same legislation.  With or without passage of current insurance reform bills the country must decrease the rate of cost escalation of Medicare. The most likely scenario is a second round of health reform that will be focused exclusively on health care cost rather than coverage

Who will have to pay more to make these changes?

Everybody will have to pay more.   The operative principle is the common good.  More people would have access to health insurance.   People would be healthier, and more people will enjoy the benefits of a healthy life. 

 
What is the moral imperative to health care reform? 

The Catholic Bishops have a longstanding interest in health care reform.
(See Catholic Values on the Cusp of Health Care Reform by Fr. Thomas Nairn, OFM 
for a perspective.)  From a Franciscan view, health care reform promotes the Franciscan value of care for creation and care for marginal people.  For a list of FAN principles for health care reform, visit http://www.franciscanaction.org/healthpolicy

How does the current Bill passed by the Senate address the issue of federal funding of abortion? Is this different from the current situation?

Both the House and Senate Bills ban the direct federal funding of abortion.  The issue is on the question of indirect funding.  The House Bill bans any funding of abortion by plans purchased with federal subsidies.   The Senate Bill allows for insurance carriers in federally subsidized plans to cover abortion but requires that coverage be paid for separately by beneficiaries.  There is concern that this will force all persons who get subsidies to personally pay for a part of a plan that supports abortion.  It appears that no tax payer dollars would go to abortion in these subsidies, but persons who qualified for a subsidy and were anti-abortion, might have to pay into the abortion fund even with no desire for this part of the plan.  (For example, suppose a family qualifies for subsidy assistance and then goes to get a plan through the insurance exchange.  The plan costs $500 per month.  It is determined that the value of the abortion coverage in this plan is $25 per month.  The family qualifies for a $400 subsidy; they would be required to pay the additional $100.  However, because of the inclusion of abortion coverage in the plan they would only receive $375 in subsidy assistance.  They in turn would be required to send a check to the insurance provider for an additional $25.   Theoretically the family has an option for a plan that does not cover abortion; however, this plan is not guaranteed to be as good as other plans.  If a pro-life family wanted the better coverage, they would also be required to pay their own money into an abortion fund or take a potentially lesser valued plan.)

There is also concern that Community Health Centers who receive Federal funding will not be prohibited from using these funds for abortion services.  This can be easily fixed in the legislation and should be. See Five Questions for Sr. Carol, an interview with Sr. Carol Keehan of the Catholic Health Association,  In addition; the USCCB has a policy paper (PDF) that attempts to explain the nuances of abortion and health care funding.   The USCCB remains strong in their desire that we pass health care reform that does not support abortion funding.

Please let us know if you would like to offer more FAQs or need further information.

~ Rev. Larry Janezic, OFM
FAN Interim Executive Director