ProPublica Eye on the Health Care Reform

What Health Care Reform Means for: ‘Young Invincibles’

Using results from a questionnaire we did with American Public Media’s Public Insight Network, we’re looking at how the proposed health care reforms will actually affect people facing common health care coverage situations.

Neil Thurgood, 26

Location: Washington, D.C. Health Care Status: Insured through his wife Household Income: $65,000

His Story:

When Neil Thurgood graduated college in the fall of 2006, his health insurance lapsed while he looked for a job. At the time, he says, “I just kind of figured, I’m young and healthy and everything is cool,” so he didn’t worry when it took longer than planned to find a job. His wife eventually got one that offered insurance, but the premium was still too expensive for Thurgood to be covered.

That wasn’t a problem until January 2007, when Thurgood came down with what he now refers to as “some crazy renegade virus,” which landed him in the hospital with a fever of 105. A spinal tap and a day later, Thurgood was sent home with fuzzy understanding of why he was sick and a bill for about $6,000.

Nearly three years later things are looking up for Thurgood. He’s landed a job and is now insured through his wife’s coverage, which costs them $260 a month. But he’s still paying down his hospital debt.

“I feel bad having those kinds of obligations outstanding,” he said. “It’ll be paid when it’s paid.”

Thurgood is part of the group called “the Young Invincibles.” Young adults between 19 and 29 have the highest uninsured rate of any age group – they aren’t as worried about getting sick, they’re less likely to have jobs that will offer insurance, and they typically make less money than other age brackets so they can’t buy private insurance. In the last year, 47 percent of people between age 19 and 34 went without health insurance at some point, and one in three is uninsured now.

What health reform means to him…

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What Health Care Reform Means for: Medicaid Recipients

Using results from a questionnaire we did with American Public Media’s Public Insight Network, we’re looking at how the proposed health care reforms will actually affect people facing common health care coverage situations. See our previous posts on what health care reform means for the uninsured, the underinsured, small businesses, those enrolled in Medicare programs, and the insured.

Sarah Goodwin, 25

Location: Harveys Lake, Pa. Health Care Status: Medicaid recipient Household Income: $0, but she has a Social Security application pending

Her story:

Sarah Goodwin, who has chronic fatigue syndrome and a slew of immune deficiencies, relies on Medicaid for health coverage.

Medicaid serves low-income and disabled individuals, with the federal government paying for about 60 percent of the program (with a temporary boost of that percentage included in the stimulus bill) and states paying for the rest. Goodwin has experienced firsthand the wide leeway that states are given in determining who is eligible and what services are covered.

In Maine, Goodwin was able to get only temporary Medicaid, which meant she was constantly reapplying, and having to fight to get the medications she needed. Two years later, she has moved from Maine to Pennsylvania, where she says she’s had a better experience. “The Medicaid people here are really helpful,” she says.

Most of the Medicaid-covered services that Goodwin uses are free, with some doctors charging a $3 co-pay.

“I’m really happy with the Medicaid that I have right now, and I would hope that it would stay the same,” she says.

For those, like Goodwin, who have chronic conditions, Medicaid can be a lifeline.

“If I ever miraculously get better, I’m still going to be uninsurable,” she says.

What changes would mean for her:

Goodwin has seen the two sides of Medicaid: first in Maine, where the program didn’t meet her needs, then in Pennsylvania, where it did. Some states offer coverage for children from families with incomes as high as three times the federal poverty line. Other states cut off eligibility at 100 percent of the poverty line. Some states cover childless adults, some don’t. Physical therapy may be covered with a $1 co-payment – or not at all. This variability among states is one of the major complaints about Medicaid, and is one that the Senate and House health care bills attempt to remedy. (You can check out the highs and lows of coverage here.)

Both the Senate and House bills would require all states to have the same income cutoff for Medicaid.

The Senate bill would expand Medicaid to cover those with incomes up to 133 percent of the federal poverty line (about $14,000 for a single person) starting in 2014, while the House bill would expand it to 150 percent, or about $16,000, a year earlier. The Congressional Budget Office estimates that both bills would result in as many as 15 million new Medicaid enrollees by 2019.

Both bills would make low-income adults, like Goodwin, eligible for Medicaid coverage, even if they don’t have children. Currently, only 15 states offer such coverage — which the states pay for on their own. And many of those states have closed their programs to new enrollees because of funding concerns.

To address disparities among states in benefits for childless adults, both bills would define a minimum benefits package, which would include mental health services. The House bill goes one step further, requiring that beneficiaries be offered preventive services and vaccines with no co-payment.

The biggest difference between the House and Senate bills regards another disparity among states that can have a big effect on how easy it is to get care. Medicaid as a whole tends to pay less than other insurers for health services – and in some states a lot less. This means it may be difficult to find doctors willing to accept Medicaid patients.

To avoid this, the House bill would incrementally increase Medicaid payments for primary care to the higher rates paid by the Medicare program. The Senate bill has no such increase.

Medicaid is already notoriously expensive, accounting for about one-fifth of all state spending. Critics of the expansion have argued that expanding the program is an unfunded mandate that would break states’ already strained budgets.

Under both bills, the federal government would pay a higher share of the cost of new Medicaid enrollees than it pays for people in the program now.

In the House bill, the federal government would pay the full cost of coverage for new enrollees until 2015, when the percentage that Washington covers would be set at about 90 percent.

The Senate bill would pay the full cost of new enrollees for the years 2014 to 2016, then gradually adjust the share that Washington pays. From 2019 onward, the federal government would pay 32.3 percentage points more of the cost of each new enrollee. (This would be about 90 percent on average, but with considerable variation from state to state.)

There’s a catch though: States that already offer coverage to adults beyond federal requirements would get less federal help in the years before 2019. Not surprisingly, these states aren’t happy about this, arguing that they are being penalized for their efforts to cover more uninsured residents.

Though the changes would not be cheap for states or the federal government, for Goodwin, they would likely mean easier access to a bolstered Medicaid program.

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What Health Care Reform Means for: Those Already Insured

Using results from a questionnaire we did with American Public Media’s Public Insight Network, we’re looking at how the proposed health care reforms will actually affect people facing common health care coverage situations. See our previous posts on what health care reform means for the uninsured, the underinsured, small businesses, and those enrolled in Medicare programs.

Tracy Bullion, 46

Location: Fort Wayne, Ind. Health Care Status: Happy with her insurance—and worried about the cost of reform. Household Income: $110,000

Her story:

Tracy Bullion and her husband—along with their three kids, ages 11, 14 and 18—are happy with their health insurance, which they get through her husband’s employer. “We’ve got good eye, good dental,” she says. “And we’ve worked a long time for it.”

The Bullions pay about $350 a month for a premium. The family has enjoyed good health, except for a lump in Bullion’s breast last year, which turned out to be benign. Their payments for tests on the lump amounted to “$50 here, $100 there,” she said.

Bullion worries that an expanded government role in health care, including a public option, would negatively impact the coverage she has – and the federal budget.

“I just hope that we see a bill out there that makes sense, that isn’t going to put us in such deep, deep debt to where our children and grandchildren are going to be paying for it for the rest of their lives,” she said.

What changes would mean for her…

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What Health Care Reform Means for: The Underinsured

Using results from a questionnaire we did with American Public Media’s Public Insight Network, we’re looking at how the proposed health care reforms will actually affect people facing common health care coverage situations. See our previous posts on what health care reform means for the uninsured, small businesses, and those enrolled in Medicare programs.

Mary and Mack Kroner

Age: 53, 57 Location: Austin, Texas Work Status: Employed Health Care Status: Underinsured with a high deductible Income: Combined $50,000 per year

Their story:

Mack is a self-employed cab driver and Mary is a self-employed writer; they both pay for their own health insurance. Though together they pay about $600 a month in premiums, they have what Mary Kroner calls “junk insurance.”

Rapidly rising premiums have forced them to increase their deductible every year, and now they have a policy with a $5,000 deductible per illness per year. That means that they’ve been paying essentially all their health care costs out of pocket. Mary pays $100 for her annual mammogram—a must because her sister had breast cancer—but she skips recommended pelvic exams. A recent colonoscopy recommended for Mack after he showed signs of bowel cancer cost them $1,376, roughly half their monthly income.

“We just bite the bullet and don’t attend to things because we can’t afford it,” Mary said.

What health care reform means for them…

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What Health Care Reform Means for: Medicare Programs

Nov. 17: This post has been updated.

Using results from a questionnaire we did with American Public Media’s Public Insight Network, we’re looking at how the proposed health care reforms will actually affect people facing common health care coverage situations. This is the third in a series (Part 1, Part 2).

Graydon DeCamp

Age: 75 Location: Elk Rapids, Michigan Work status: Retired Income: About $75,000, including SSI

Medicare Advantage has been a major flash point in the health care reform debate, giving fodder to opponents of reform who say that Medicare would be cut to pay for the proposals. Our analysis of the impact of reforms on one very satisfied Medicare Advantage member finds the changes would be a loss for many seniors, but a win for taxpayers.

About Medicare Advantage: The elderly can participate either in traditional Medicare, which is administered by the government, or in Medicare Advantage, which subsidizes managed care plans administered by private insurance companies.

What health care reform could mean for Graydon Decamp…

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