What's in health care proposals for 5 Americans

Dec 20, 2009 By CARLA K. JOHNSON , AP Medical Writer
In this Dec. 10, 2009 photo, Carol McKenna, 68, speaks during an interview in Pembroke Pines, Fla. If McKenna believes the claims of the insurance industry and many Republicans, she and her husband are among the most at risk to be hurt by Congress' health proposals. If Democrats are telling the truth, they be among those with the most to gain. She refrains from any worry, or any premature celebration. She simply believes, "It'll work out." (AP Photo/Wilfredo Lee)

(AP) -- As Congress gets closer to a final health care bill, many Americans want to know: What's in it for me?

The answer is: It depends.

On your age and . Whether you own a business and whether it's big or small. Whether you're insured now and who provides that insurance. In the end, it will depend on how House and Senate negotiators will merge the proposals, and how their vision gets translated into regulations.

Five Americans shared their stories with The Associated Press. Here's an educated guess on how the package taking shape in Congress might affect them.

---

Name: Holly Brown

Home: Round Lake, Ill.

Age: 28

Employment: Student, working part time, receiving unemployment benefits.

Household income: about $15,000.

Coverage: Insured, but struggling to afford it.

Brown was laid off last year from a job she'd held for four years. She's stayed insured because of the government COBRA program, which allows workers to remain on a health plan for 18 months after they leave their jobs, if they pay the premiums.

Brown works part time and studies medical imaging at College of Lake County. She has a chronic lung condition and was in the in November with flu and . She's paid about $1,000 in medical bills this year that her insurance didn't cover.

She doesn't know how she'll pay her $500 premium this month because a government subsidy that helped her afford the premium has expired.

"It's scary to think about what's going to happen if I can't make the payment by the end of the month," Brown said.

The health care overhaul taking shape in Congress would require her to buy or pay a penalty. She could pick a plan offered through new state-based insurance exchanges and she would qualify for a subsidy to help pay her premiums because she makes less than 400 percent of the poverty level ($43,320 for an individual in 2009). But all those benefits wouldn't kick in until 2013 in the House bill (2014 in the Senate legislation). Because of her medical problem, she may be able to qualify for coverage during the transition period by going through high-risk insurance pools called for in the legislation.

---

Name: Glenn Nishimura

Home: Little Rock, Ark.

Age: 60

Employment: Consultant to nonprofit groups.

Household income: $55,000, including wife's earnings.

Coverage: Uninsured since COBRA expired in May.

Nishimura left a full-time job with benefits in October 2007 thinking he'd be able to find another good position.

Then the recession hit.

He's now a self-employed consultant. Since May, he's been without health insurance. For 18 months, he bought insurance through the COBRA program. When that ran out, he tried to find other coverage. He's been turned down by five insurance companies because he has high blood pressure and high blood sugar levels, even though he's otherwise healthy, has never been hospitalized and controls his conditions through diet and exercise.

"I could get H1N1 or get into an accident and I would be potentially bankrupt," Nishimura said. "It's an untenable situation."

The Medicare buy-in proposal considered in the Senate could have helped Nishimura get insurance, as would portions of both the House and Senate bills that would ban denials for pre-existing conditions. But opposition from moderates and a few liberals is forcing Senate Democratic leaders to scrap the idea of a buy-in to get a bill completed.

Nishimura said he e-mailed President Barack Obama suggesting that lowering the Medicare eligibility age to 55 or 60 would create jobs. "I know a lot of people who would like to retire early, but can't because of health care," he said.

----

Name: David W. Brown

Home: Philadelphia

Age: 47

Employment: Owner of BrownPartners, an advertising and marketing agency. Seven employees. $336,000 in annual wages paid.

Household income: $150,000, including wife's earnings.

Coverage: Provides health, dental and vision coverage to employees.

An ad agency owner, Brown has been able to offer health insurance to his seven employees, but has had to cut benefits because of rising costs. Like other business owners, Brown is trying to figure out what will emerge from Congress and how it will affect him.

"We haven't been able to be as generous as we have in the past," Brown said of the insurance plan he offers his workers. "The good thing is, not a lot of folks are leaving because somebody else has a better plan."

Health care overhaul might help Brown and his wife with coverage for their daughters, now age 17 and 20. The proposals would allow young adults to stay on their parents' insurance plans as dependents into their mid-20s.

Brown would be able to shop for insurance for his workers through a health insurance exchange. Neither of the bills would require him to provide coverage. Both bills provide tax credits to help small companies with average wages of less than $40,000 provide health insurance. But pay levels in Brown's agency are above that cutoff.

---

Name: Robert Hansen

Home: Seattle homeless shelter

Age: 58

Employment: vendor, Real Change street newspaper.

Household income: $12,000, including tips.

Coverage: Uninsured.

Hansen used to work selling beer and peanuts at Seattle's now-demolished Kingdome. "Age caught up to me, running up and down the stairs, the physical labor," said the 58-year-old Seattle native.

Hansen has been homeless since 1994. A top-selling vendor of a weekly newspaper called Real Change, he makes about $1,000 a month. He eats his evening meal and finds a bed at a Catholic Community Services shelter.

The tingling in his feet and the occasional purplish color of his hands worry him. It's been so long since he's had a thorough physical exam that he's not sure if his symptoms could mean a serious health problem such as diabetes. He's uninsured and finds care in community clinics and emergency rooms.

Hansen and most other poor adults without young children don't qualify for Medicaid, the state-federal program that helps low-income families with health care. The proposals in Congress would expand Medicaid coverage to people such as Hansen.

In the leading Senate proposal, people with incomes up to 133 percent of the federal poverty level ($14,404 for an individual in 2009) could enroll in Medicaid. The House bill makes the cutoff 150 percent of the poverty level ($16,245 for an individual in 2009).

---

Name: Carol McKenna

Home: Pembroke Pines, Fla.

Age: 68

Employment: Retired payroll coordinator

Household income: About $39,000 from Social Security and some earnings by husband as mattress salesman.

Coverage: Medicare Advantage policy administered by AvMed Health Plans.

If McKenna believes the claims of the insurance industry and many Republicans, she and her husband are among the most at risk to be hurt by Congress' health proposals. If Democrats are telling the truth, they will be among those with the most to gain.

The 68-year-old retiree refrains from any worry, or any premature celebration. She simply believes, "It'll work out."

McKenna and her husband, Morty, who turns 78 on Sunday, are in private Medicare Advantage plans, which many Democrats have called wasteful and which have been made a prime target for major cuts. But Morty McKenna also falls in the coverage gap in Medicare's prescription drug program - the "doughnut hole" - that the health bills have promised to close. More than 3 million Medicare beneficiaries a year hit this gap and start paying the full cost of their drugs until they qualify for catastrophic coverage.

She said the government must "get rid of the abuses" and that pharmaceutical companies "need to step up and be accountable." For now, though, she's just waiting to see what actually happens.

Explore further: Urbanization of rural Africa associated with increased risk of heart disease and diabetes

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ForFreeMinds
3.7 / 5 (3) Dec 20, 2009
It's interesting that most people are satisfied with their (mostly employer provided) medical insurance. David Goldhill, author of "How American Health Care Killed My Dad" - see http://www.cato.o..._id=129, explains just how screwed up the health care market is. For example, he found that people covered by Medicare (which is threatening to bankrupt the USA) actually pay more out of pocket than before Medicare was enacted. The reality is that if we had a free market in health care, it would be less expensive and better. Kind of like the market in Lasik surgury, or medical care for pets.
frajo
3 / 5 (4) Dec 20, 2009
if we had a free market in health care, it would be less expensive and better
And unaffordable for the needy.
I'm impressed with the universal lack of care for the needy by the Free Markets fundamentalists. Do you propose to just let them die?
marjon
not rated yet Dec 20, 2009

if we had a free market in health care, it would be less expensive and better
And unaffordable for the needy.
I'm impressed with the universal lack of care for the needy by the Free Markets fundamentalists. Do you propose to just let them die?

The USA used to have charity hospitals and still have free clinics.
Health insurance companies cannot compete across state lines. Ergo there are 50 separate insurance plans that each insurance company must provide. Each state mandates different coverages. Some basic, some cover hair transplants. There is NO free market there.
Walmart, CVS and Walgreens are opening clinics in their stores are lower costs. Some governments oppose these, eg. City of Boston.
Free markets worked for Lasik eye surgery, costs down, quality up.
freethinking
3 / 5 (2) Dec 21, 2009
I pulled this article from the "Investor's Business Daily." It provides some very interesting statistics from a survey by the United Nations International Health Organization.
Percentage of men and women who survived a cancer five years after diagnosis:
U.S. 65%
England 46%
Canada 42%
Percentage of patients diagnosed with diabetes who received treatment within six months:
U.S. 93%
England 15%
Canada 43%
Percentage of seniors needing hip replacement who received it within six months:
U.S. 90%
England 15%
Canada 43%
Percentage referred to a medical specialist who see one within one month:
U.S. 77%
England 40%
Canada 43%
Number of MRI scanners (a prime diagnostic tool) per million people:
U.S. 71
England 14
Canada 18
Percentage of seniors (65+), with low income, who say they are in "excellent health":
U.S. 12%
England 2%
Canada 6%
freethinking
3 / 5 (2) Dec 21, 2009
Other than worse health care, we get raised taxes, government intrusion into our every day lives, government funded abortion (democrats will get this done no if's and or buts), illigal immigrants will get health care paid for by legal people in the US, loss of freedom.
Simonsez
1 / 5 (1) Dec 21, 2009
I didn't mean to give frajo a 5 star rating. ARGH PHYSORG FORUMS RATING SYSTEM.

I really wanted to give freethinking a 5 star for the statistics post. There are the numbers; we clearly have better health coverage even under our allegedly "broken" healthcare system without government intrusion, than other leading countries.

To those that argue free market is "too expensive" for the needy, you are more than welcome, nay, encouraged to hold fundraisers and donation drives to help pay for the healthcare of the needy. Stop reaching into my pocket without asking (ie giving federal government the authority to spend my tax dollars AND take away my freedom to choose). Please do not misunderstand; I give every year to charitable organizations such as United Way. The thing is, it is and should remain MY CHOICE to do that, not the government's.
marjon
1 / 5 (1) Dec 22, 2009
"A BRAVE NHS whistleblower could land a record damages pay-out from the General Medical Council - after it branded her 'mentally ill' in a secret smear campaign.

Dr Rita Pal went to the watchdog five years ago, claiming seriously ill elderly patients were being helped to die in Midland hospitals.

But instead of taking her shocking complaints seriously, the GMC turned on her.

CattoTop-ranking staff openly questioned her sanity and even talked of launching a probe into whether she was fit to practise"
http://www.nhsexp...il.shtml
That is the same tactic the democrats are using against opponents of the government take-over of health care. Accusing them of being mad, racist, N A Z I s, etc. (From a speech by a RI Senator.)
freethinking
3 / 5 (2) Dec 22, 2009
If you read the democratic election bill, I mean the fund corrupt organization bill, woops, I meant the health care bill, guess which group of nuts get money.......
any guess?
come on.... they're nuts, they support democrats, prostitutes, illigal immigration, underage prostitutes....

In the health care bill... there is money to support ACORN, the democrats favorite child prostitute, illigal immigration, election fraud, front group...

winthrom
2.5 / 5 (2) Dec 27, 2009
Politics by right wing nuts, as usual, condemn the weak, the poor, the wretched. Since there were arrogant folks in the third reich with similiar ideas, democrats often see parallels. While not always true, the "haves" typically disdain the "have nots". The party of the "haves" certainly disdains the party of the "have nots". My father once said that "the rich and poor both have the right to sleep under bridges but only the poor seem to take advantage of the priviledge." The modern bridge to sleep under is either the shelter or the grates on the city street. Take a look: If you can still condone this kind of inequity, NAZI is your correct name.
marjon
1 / 5 (1) Dec 27, 2009
Politics by right wing nuts, as usual, condemn the weak, the poor, the wretched. Since there were arrogant folks in the third reich with similiar ideas, democrats often see parallels. While not always true, the "haves" typically disdain the "have nots". The party of the "haves" certainly disdains the party of the "have nots". My father once said that "the rich and poor both have the right to sleep under bridges but only the poor seem to take advantage of the priviledge." The modern bridge to sleep under is either the shelter or the grates on the city street. Take a look: If you can still condone this kind of inequity, NAZI is your correct name.

Recall the NAZIs were socialists and the health care 'reform' being shoved down American's throats is socialist.
Competition is the only certain way to lower costs and improve quality for all.
Socialism will force all to sleep under the bridges or obtain poor quality care.
frajo
1 / 5 (1) Dec 27, 2009
Competition is the only certain way to lower costs and improve quality for all.
Obviously, this is not true. There are millions of US Americans who can't afford health insurance.
marjon
not rated yet Dec 27, 2009
Competition is the only certain way to lower costs and improve quality for all.
Obviously, this is not true. There are millions of US Americans who can't afford health insurance.

There is no competition across state lines for insurance, BY LAW. Competition for health care services does exist for LASIK and for ultra-sound screening, Life Line.
Also, most insurance does not cover eyeglasses or contacts. Competition for such services and products is apparent in shopping malls and costs are low enough that people can afford such products.
Competition continues to demonstrate how costs are lowered and quality improved.
The only reason people buy insurance is to cover unexpected high costs. The reason medical insurance is expensive is that it is NOT insurance. It is a pre-paid medical plan. It's like buying insurance for changing oil on your car.
Bottom-line, there is little or no competition in health care. Costs are lower where competition exists.
frajo
1 / 5 (2) Dec 27, 2009
There is no competition across state lines for insurance, BY LAW.
So the old situation is socialism and the new government is gonna change this. You should sing hallelujah.
marjon
not rated yet Dec 27, 2009
There is no competition across state lines for insurance, BY LAW.
So the old situation is socialism and the new government is gonna change this. You should sing hallelujah.

How? There is still no competition or legal reform or anything except more government control.
MA mandated health insurance is increasing costs and driving away doctors.
frajo
1 / 5 (2) Dec 27, 2009
There is still no competition or legal reform or anything except more government control.
There will be 30 million more people insured. This is a good thing, no matter whether by competition or by law.
marjon
not rated yet Dec 27, 2009
There is still no competition or legal reform or anything except more government control.
There will be 30 million more people insured. This is a good thing, no matter whether by competition or by law.

How can it be good when insurance companies will be forced to cover all their medical conditions?
Why should anyone buy expensive insurance when they are healthy? Just wait until you are sick and then buy insurance.
Wait until a flood before buying flood insurance? Sounds like a bad deal for insurance companies who will be put out of business and health care costs will still climb. Doctors will quit. Companies will stop making products like MRIs as there will be no profit.
Why does Canada have so few MRI machines?
marjon
not rated yet Dec 27, 2009
Two major industries in the USA are subsidized by the federal government, health care with Medicare and Medicaid, and university education.
All data shows the health care costs and tuition are rising faster than inflation. Coincidence?
marjon
not rated yet Dec 27, 2009
"In 1967, long-run forecasts estimated that Medicare would cost about $12 billion by 1990. In reality, it cost $110 billion that year. Today, it costs $500 billion."
"since 1965, "U.S. health spending has risen about 2.7% faster than the economy and on current trend would hit 20% of GDP within a decade. Every public or private attempt to arrest this climb has failed: wage and price controls in the 1970s, the insurance industry’s ‘voluntary effort’ in the ’80s, managed care in the ’90s.”

This should be a lesson for those who truly believe that the current healthcare overhaul considered by Congress today will reduce cost in the long run. "
http://www.americ...uch-more
Imagine, data on a science blog!
Bob_B
1 / 5 (1) Dec 28, 2009
You can see the problems by reading these posts. Religious assholes! Why don't the religious folks just let their 'god' take care of them and get off the 'dole?'

If their god wants them to die let them die, they should die.

In simpler terms: renounce religion and you can have full coverage health care.

Let the religious folks die and maybe the society can move forward without all the crappy religions causing wars.
marjon
1 / 5 (1) Dec 29, 2009
You can see the problems by reading these posts. Religious assholes! Why don't the religious folks just let their 'god' take care of them and get off the 'dole?'

If their god wants them to die let them die, they should die.

In simpler terms: renounce religion and you can have full coverage health care.

Let the religious folks die and maybe the society can move forward without all the crappy religions causing wars.

Yes, we certainly can see the problem. And that is socialism. People too willing to act like children and have a nanny state take care of them with no responsibilities.
What is really sad is that socialism has demonstrated its failures yet educated people, like readers of this site, still support such failure.
marjon
not rated yet Dec 29, 2009
Competition is the only certain way to lower costs and improve quality for all.
Obviously, this is not true. There are millions of US Americans who can't afford health insurance.

Millions of people claime not to be able to afford food. Instead of creating government restaurants or grocery stores, the government provides vouchers (food stamps, WIC) so people can choose their own food to buy, with some restrictions based on nutrition value.
Why not provide the needy with vouchers to buy their own insurance instead of taking over the system?
If the emergency was so great, why won't the legislation take effect for over two years?