Healthcare (January 2010)

Insurance reform empowers individuals, families

As Congress nears an historic vote to reform our health insurance system, there are many reasons for American families to root for them to succeed. The legislation will slow rising premium costs, so that employers can continue to offer health benefits and wage increases. Dozens of innovative pilot projects will be funded to give doctors and hospitals incentives to provide better care. It will reduce the burden of debt we’re passing on to our children, cutting the deficit by $100 billion over the next 10 years. But perhaps the biggest benefit for everyday Americans is that they and their doctors will have more control over their healthcare decisions.


As Congress nears an historic vote to reform our health insurance system, there are many reasons for American families to root for them to succeed. The legislation will slow rising premium costs, so that employers can continue to offer health benefits and wage increases. Dozens of innovative pilot projects will be funded to give doctors and hospitals incentives to provide better care. It will reduce the burden of debt we’re passing on to our children, cutting the deficit by $100 billion over the next 10 years. But perhaps the biggest benefit for everyday Americans is that they and their doctors will have more control over their healthcare decisions.

Health insurance markets today are failing American families. Insurance companies have all the power. In today’s market, too many insurance companies can collect premiums for years, only to cancel your coverage when you get sick. All they need to do is find a mistake on your paperwork from years ago. If you’re one of millions of Americans with a pre-existing condition like high blood pressure or diabetes or arthritis, or if you once had breast cancer, insurance companies can refuse you coverage. Or they might sell you policy with a cap on your benefits, so that your insurance disappears when you need it most.

Some say that Americans could shop around for a better deal. But families usually don’t have a lot of options. In 39 states, one or two insurance companies control at least half the market. These plans are often so full of fine print that it’s hard to tell how much security they provide. And if you have the time to read all that fine print, you may find out that the answer is: not much. Some of these plans don’t even cover basic preventive care, leading to stories like the one I read recently about a mother who had to put off getting a her own check-up and mammogram until her son broke his arm and used up their family’s entire deductible.

Our health insurance system makes many Americans feel powerless. People who have insurance are afraid to lose it. So they stay at jobs they don’t like and put off their plans to start their own business. Or they pay hundreds of dollars a month for a policy they know offers only threadbare protection. When we’re healthy, many of us take our health insurance for granted. But in the back of our minds, we know we’re just a pink slip or a bad test result away from being a victim in a health insurance market that doesn’t meet our needs.

Health insurance reform is going to give American families better choices. Reform will create some simple and long-overdue rules for insurance companies: no denying coverage based on a preexisting condition, no annual or lifetime caps on benefits, and if you paid for your policy, it can’t be taken away. And because it saves money and saves lives, insurance companies won’t be allowed to charge for preventive care like checkups and screenings that keep people healthy and out of emergency rooms.

Reform will make getting health insurance easier than ever by creating a new consumer-friendly marketplace called an exchange. Instead of hunting through the yellow pages for plans and then scouring their fine print, consumers will be able to make decisions easily, compare benefits and prices, and have affordable choices

Perhaps most importantly, a lot of the old worries about insurance rules will go away. You won’t have to worry about your application getting rejected because your child has asthma. That will be illegal. You won’t have to read through hundreds of pages to figure out whether checkups are covered. They will be. And you won’t need an expert to choose the plan that is right for you. The key details will be easy to read and easy to compare.

For too long, Americans have been at the mercy of insurance companies in markets that are unfair, uncompetitive, unaffordable, and closed off to millions of people. By passing health insurance reform, Congress will empower families to get the health insurance they need. Then insurance companies will have to work to earn your business. It’s about time.

Sebelius is secretary of the Department of Health and Human Services.

Don’t get between doctor and patient

When my committee marked up the House version of healthcare reform last year, we voted to prevent rationing.

This is the beginning, not the end

As the 111th Congress begins its second session, we are poised to pass landmark legislation to reform America's healthcare system. This is a prize that has eluded Congresses and presidents going back to the Roosevelt administration — the Teddy Roosevelt administration. It will be an achievement on par with passage of Social Security in 1935 and Medicare in 1965.


As the 111th Congress begins its second session, we are poised to pass landmark legislation to reform America's healthcare system. This is a prize that has eluded Congresses and presidents going back to the Roosevelt administration — the Teddy Roosevelt administration. It will be an achievement on par with passage of Social Security in 1935 and Medicare in 1965.


Understandably, many have been distracted by the often-strident debate surrounding health reform. However, it bears remembering that the debates leading up to passage of Social Security and Medicare were no less turbulent. Advocates of change faced bitter resistance, and were obliged to make pragmatic compromises. But by persevering, they dramatically improved the health and economic security of the American people. And they laid a solid foundation on which subsequent Congresses would build.

Today, we understand why earlier attempts at comprehensive health reform failed. We have seen that the health insurance industry and other entrenched interests are extraordinarily powerful. By passing the Patient Protection and Affordable Care Act, we will finally break their stranglehold. And we will usher in three landmark reforms.

First, we are going to extend access to quality, affordable healthcare coverage to nearly every American. An estimated 30 million Americans who do not have coverage will get it thanks to this bill. By itself, this is an historic achievement every bit on par with passage of Social Security and Medicare.

If you already have insurance and you're happy with it, you will be able to keep it. However, the Congressional Budget Office estimates that, thanks to the bill, premiums will be lower for the vast majority of Americans, including small businesses and the self-employed; the same policy will cost 14 to 20 percent less in the individual market under the Senate bill. Through new health insurance exchanges, people who currently do not have access to affordable coverage will be able to easily shop and choose from a menu of quality health plans — much in the way members of Congress and federal employees are able to do today.

A second great reform in this bill is an array of provisions cracking down on abuses by health insurance companies — abuses that currently leave most Americans just one serious illness away from bankruptcy. Among other things, this bill will extend coverage to people with preexisting conditions, and eventually it will ban outright the practice of denying coverage due to preexisting condition. It will stop insurers from canceling the policies of people who get sick. And it will stop discrimination against women, who now pay premiums up to 48 percent higher than premiums for men.

A third great reform is something I have championed for many years. Our bill includes a broad array of provisions designed to jumpstart America's transformation into a genuine wellness society. For example, it will require reimbursement for recommended preventive services such as mammograms without deductibles or other cost-sharing requirements.  It will expand Community Health Centers, and will help businesses to create workplace wellness programs. It will require large chain restaurants to post basic nutrition information right on the menu, so consumers can make informed, healthy choices.

In short, our bill will begin to transition our current sick-care system into a true healthcare system — one focused on preventing chronic disease and keeping people out of the hospital in the first place.

To be sure, the path to securing 60 votes was paved with painful compromises. That's also the way our predecessors were able to get the votes to pass Social Security and Medicare, both of which had big gaps in coverage when they were first enacted. Our predecessors passed bills that were less than a full loaf, and then they came back for more in later years.

Instead of that "partial loaf" analogy, I like to think of this bill like a starter home. It is not the mansion of our dreams. But it has a solid foundation, giving every American access to quality, affordable coverage. It has an excellent, protective roof, which will shelter Americans from the worst abuses of health insurance companies. And this starter home has plenty of room for additions and improvements. Let's be clear: This bill is the beginning of health reform, not the end.

We can learn one final — and hopeful — lesson from the history of Social Security and Medicare. Those programs originally pitted Democrats against Republicans, left against right. But, today, they are hugely successful programs that enjoy overwhelming bipartisan support.

I predict the same success and eventual bipartisan support for the health reforms now before Congress. We are going to create a reformed insurance and healthcare system that works not just for the healthy and the wealthy, but for all Americans.


Harkin is the chairman of the Senate Health, Education, Labor and Pensions Committee.



Senate bill would cut Medicare and expand taxes, debt

A year ago, I started working on healthcare reform as part of an effort in the Senate to come up with a bipartisan solution to the problems facing America’s healthcare system.

Build on an enduring model of primary care

Community health centers provide high-quality primary care at a significant savings for millions of Americans, but 60 million people in this country still lack meaningful access to primary healthcare, dental care, mental health counseling and low-cost prescription drugs.

AARP shows more interest in its bottom line than help for seniors

When the AARP endorsed the House Democrats’ version of health reform on Nov. 5, AARP vice president Nancy LeaMond said that “we can say with confidence that it meets our priorities for protecting Medicare, providing more affordable health insurance for 50- to 64-year-olds and reforming our healthcare system.”

Wellness provisions to pay dividends

It’s a new year on Capitol Hill. And as we usher in 2010, now is the time for all of us to cast a new, fresh perspective on our national healthcare debate as the House and Senate finalize the legislation in the coming weeks.