| Public Option means that there would be a health insurance program which covers specific services where the premium is paid to the government, which pays private providers. It is not single payer, it is not socialized medicine, it is not appreciably different from the process of paying an insurance company and receiving the same services. If you have insurance through your employer, you can choose to keep that. Depending on which version of which bill or mark-up you read, you may have the choice of partaking in the public option from the get go, or only later in time if you have employer-paid insurance. In every version of the health insurance bills (except the "we don't do numbers" and full of lies IIE plans, and the House and Senate Single Payer plans) the Public Option AND all health insurance plans provided by private companies, require: - A base set of services
- Coverage for all comers with no denials based on health history, age, gender, or anything else
- Limits to increased charges for age at 2:1, community ratings allowed, plus increased charges for more people on a policy. (That is, you can't get dinged for being age 50 instead of age 23, you will pay more if you are insuring 2 adults and 6 children than you will if you are a single person.)
- No recission
- No lifetime caps on payouts by the insurer, annual caps on out-of-pocket expenses by insureds.
The difference between a Public Option and a Health Exchange is whether or not the government program is one of the options. In an Exchange, the rules for coverage and benefits are the same, but the providers are all the same insurance companies that offer coverage today. And here's the problem: there is NO PROVISION in the Exchange system for the base rate that can be charged by an insurance company. Not in ANY of the plans that include it which I have read. There is also NO PROVISION for prevention of "the deal" that one insurance company has with all the local hospitals. Thus: There is no guarantee that insurance will be affordable to anyone under the Exchange system. Trust me, I've looked. And I believe that since the top end of premiums is capped, the insurance companies will bump up the base rates. Let's look at some numbers. They vary from state to state, so your mileage may vary. These are Pennsylvania numbers from last year, and while the rates have risen, the order of magnitude remains the same. - If you are a 23 year old who needs basic coverage, meaning no preventive care, and capped benefits for major medical (heart attack, cancer, etc.), with a high deductible, no dental, vision or prescriptions, you can get a policy for about $70/month.
- If you are a 40 year old with one pre-existing condition, say: high blood pressure, a previous high-risk pregnancy, a prior, completely treated skin cancer, IF you can get a policy, it will start at about $400/month.
- If you are a 50 year old with a serious pre-existing condition, say, a prior heart attack, Type 1 diabetes, or on-going cancer treatment, you will NOT be able to get health insurance, except from the provider of last resort (Blue Cross/Blue Shield in Pennsylvania) which will offer you limited benefits for a minimum of $900/month, and they will exclude for 2 years anything ongoing (like current cancer treatment.)
Under all the bills with an Exchange, the most they can charge someone is two times the amount they charge the person to whom they offer the lowest premium. BELIEVE ME when I tell you that the $70 premium is going away. The most base rate will have to rise to at least $300/month PER PERSON. The insurance companies cannot give up that 15% - 20% they need for overhead, obscene salaries for C-level employees and profit for the stockholders. (What they call "administrative costs") You could knock at least 12% of the premium cost off if there were a Public Option, as public health insurance programs have administrative costs of 2 - 4% at most. That could decrease to 1% under Single Payer. So when you hear the talk that "exchanges" or "co-ops" are a true change because there will be transparency, and insurers will compete with one another, don't believe it. Think of it like pricing gasoline for your car: a lot of transparency because the prices are posted on the big signs. But there is a minimum none of the providers fall below. And if they can get an extra penny out of you, they will. They don't care about you, they don't care about your car. They care about profit. It's no different here. Without a true public option, or better yet, Single Payer, there is little true change in how insurance is provided. Face it, with an Exchange the insurance companies must accept you, must pay for your treatment, and must cap your out-of-pocket payouts. You will be fined if you make over a certain dollar amount and don't participate. NOWHERE does it say the premiums need to be affordable. |
