News from Advocacy for Patients with Chronic Illness, Inc.

No Vacation for Health Care

Once again, the bulk of this month's newsletter will focus on health care reform on the federal level.

THIS IS A CRITICAL MOMENT. If you care -- and you'd better, because this is about YOU -- please read and ACT.

The good news is that there seems to be real consensus on some really important issues (as best we can tell as of today). If any version of health care reform passes, once it takes effect, there will be no more pre-existing condition exclusions; insurance will be available to everybody, and you won't be charged more because of your health problems or claims history. There most likely will be a firm cap on out-of-pocket expenses, so there will be no such thing as catastrophic loss ever again. Medicaid will be expanded significantly to cover people with incomes at around 133% of the federal poverty level, and for the first time, adults without children who have not been found to be disabled by the Social Security Administration will be covered. There will be premium subsidies for the middle class (the question remains how high one's income can be and still qualify for a subsidy), and there will be subsidies for small businesses that provide insurance for their employees, or they will be exempt from requiring to provide insurance. It's also likely that the effects of the "doughnut hole" gap of coverage in Medicare Part D at least will be moderated somewhat; the drug companies have agreed to provide discounts on drugs when a beneficiary is in the doughnut hole.

There are still some issues as to which there is not yet complete agreement. Some want a public option to compete with private health insurance. Indeed, the Commonwealth Fund came out with a report that found that a public option -- a choice of a plan that is run by the government, which would be available IN ADDITION TO all of the private insurance plans on the market -- would save $200 billion over 10 years. Most importantly, it would keep insurance premiums down because the private insurers would have to compete with the public option. However, conservative Democrats (so-called Blue Dogs) and Republicans would prefer not to have a public option. There is talk about a possible co-op plan, sort of a network of insurers all offered through some sort of public or non-profit vehicle.

And there's still a lot of talk about how to get it paid for. As best I can tell, if there's a robust public option, we generate $200 billion right there. We will reduce excessive payments to private insurers who run part of the Medicare program for a cost that greatly exceeds what it costs the government to run the exact same program. By reining in costs and eliminating excesses, health care reform largely will pay for itself. In any event, the President has promised that he will not support anything that is not deficit-neutral, so the horror stories you've been hearing just aren't true.

We are close, folks. We really can get health care reform this year (effective dates will be a way off, but at least we'll know what to expect).

But none of this happens if the Bills don't get to the Floor. There will be a House version and a Senate version (right now, there are two Senate versions). The House has to pass its version and the Senate has to pass its version before the real work to reconcile the two can begin in what's called the "conference committee." None of this is certain to happen.

If you care -- and I believe everybody on our email list does -- you MUST ACT NOW. Call the Capitol switchboard and ask to be connected to your members of Congress. 1-800-828-0498. We need to flood them with calls.

In addition, August is the month during which Congress takes its recess, which doesn't mean they don't work; but it does mean they are at home IN YOUR DISTRICT. Go to events where they will be present and talk to them. Call the local office of your member of Congress. Ask to meet with them or meet with staff. Call and tell them how much this matters to you.

What should you say to your member of Congress? Keep it personal -- tell your story, why you care. Were you denied coverage because of a pre-existing condition? Did your insurance company deny coverage for something your doctor said you needed? Have your premiums increased to the point at which you are choosing between paying your mortgage and paying for your health insurance? Are you a small business owner struggling to provide insurance to your employees? THAT's what you should be talking about.

To find your Senators, go here. To find your Representative, go here.

NOTE: Things are changing so fast that updating you once a month may not be enough. So for more frequent updates, please check out our blog, where we continue to post updates related to health care reform efforts throughout the month.