How Some Americans Might Fare Under Health-Care Reform . . .

By Julie Appleby
Kaiser Health News
Tuesday, September 8, 2009

Who will benefit -- and who won't -- if Congress overhauls America's health-care system?

So far, there are two main proposals being debated on Capitol Hill: one authored by the Senate Health, Education, Labor and Pensions Committee and a similar one being put together by House Democrats. Still to act: the Senate Finance Committee, whose approach could differ significantly.

Whatever the details, it's likely that any overhaul would target the individual insurance market, where 17 million people buy their own policies because they don't get coverage through their jobs, are unemployed or are early retirees.

That type of coverage can be expensive and hard to get, especially for people who are older or have preexisting conditions. New rules being debated on Capitol Hill would mean consumers couldn't be rejected because they have health problems, take prescription drugs or are disabled. Insurance marketplaces, called exchanges, would offer a range of policies, possibly including a public or government-run option. Government subsidies would help millions of people buy insurance. And nearly all Americans would be required to have insurance or face a penalty for opting not to do so.

The proposals, which come with an estimated trillion-dollar price tag over 10 years, wouldn't solve all the problems faced by the millions of people who buy their own coverage. Some could still face big out-of-pocket expenses. Others would earn too much to qualify for a subsidy. Premiums would probably continue to rise.

Following are examples of some problems faced by families across the country -- and what the current proposals might mean to them.


Jose Guevara and Flora Ana Granado, Mount Rainier

In a good year, bricklayer Guevara and his wife, who cleans offices, earn about $30,000. Their three children, ages 18, 15 and 3, are covered by Medicaid, the state-federal program for the poor. But when Jose and Flora applied for themselves several years ago, they were rejected because they were not legal permanent residents. (Both were born outside the United States.)

In 2005, they became legal but have not applied again. Their combined income is still low enough to keep their children on Medicaid but is slightly more than Maryland's cutoff for eligibility for parents, about $29,900 for a family of five. (In many states, the cutoff is lower.)

When Jose, 49, or Flora, 40, need to see a doctor, they rely on La Clinica del Pueblo, a community health clinic in the District, which charges patients on a sliding scale. Jose and Flora pay $20 for an office visit. They don't have coverage for hospitalization. Jose says he's not optimistic that proposals in Congress would do much to help families like his. "What I'm hearing is, the only benefit is for the people who are already earning a lot," he says. Lawmakers, he says, should "help the people who need it the most, the poor people."

What proposed reforms might do

The couple would probably be helped by a health-care overhaul. They would have to purchase insurance coverage, but because of their low income they would get a subsidy or might become eligible for Medicaid, which would be expanded significantly under the House and Senate health committee's proposals.

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