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Healthcare winners and losers

In the race to pass the economic stimulus bill, lawmakers made changes that left out millions of middle-class Americans who have lost their jobs and are struggling to pay for health insurance.

February 17, 2009|Noam N. Levey

WASHINGTON — John Peeler, an unemployed computer technician in South Carolina, may soon get health insurance for his wife and three children. Four months after being laid off, he is one of the lucky jobless Americans who could receive thousands of dollars in government subsidies from the new stimulus plan.

Susan McKowen, a 62-year-old breast cancer survivor from Illinois, is not so fortunate. Though she too lost her job in the current economic crisis, she won't be getting help with health insurance under the new law.

When President Obama and his allies pulled together the $787-billion bill that he is to sign today, they talked about helping workers like Peeler, McKowen and others rapidly swelling the ranks of America's more than 46 million uninsured.

But in the scramble to pass a bill, lawmakers made changes that left out millions of middle-class Americans who have lost their jobs and are struggling to fill a prescription or pay for a visit to the doctor.

That reflected a frenzied process in which sometimes arbitrary decisions were made to speed agreements and satisfy a dizzying array of political interest groups working to influence the massive bill.

During last-minute negotiating, provisions were cut that would have opened the government-run Medicaid insurance program to the unemployed, a move opposed by more conservative lawmakers.

Another provision to allow older jobless workers like McKowen to keep their employer-based coverage until they qualified for Medicare was eliminated amid opposition from business groups.

Even the rules governing which workers were eligible for aid were picked on the fly, officials acknowledged. Sensitive to businesses' concerns, senior Democrats decided to give health insurance subsidies only to workers who lost their jobs after September, even though the recession began nearly a year earlier.

That means Peeler, who was laid off in November, is eligible for assistance; McKowen, laid off 13 months ago when the recession was starting, is not.

"It's just a matter of trying to balance interests and hold the line on spending," said Sen. Ben Nelson of Nebraska, a centrist Democrat who helped negotiate the compromise that narrowly cleared the Senate.

Despite the cuts, the aid package represents one of the largest federal investments in healthcare in history, totaling more than $147 billion, or nearly a fifth of the bill.

It includes $87 billion to help states shore up their Medicaid programs, which cover more than 55 million poor children, families and disabled people. States reeling from the economic downturn have been cutting services for months.

The legislation also commits $19 billion to increase the use of information technology in healthcare, a long-delayed objective that policymakers think is crucial to lowering costs and improving quality.

The National Institutes of Health will get nearly $10 billion for research into cancer, heart disease and other illnesses. And lawmakers directed more than $1 billion to boost government efforts to study the comparative effectiveness of medical procedures, pharmaceuticals and devices, another step deemed crucial to long-term health reform.

But the cuts in aid highlight one of the most vexing healthcare issues confronting Washington -- the growing number of middle-class workers who are losing health coverage as companies cut their payrolls.

An estimated 3.6 million jobs have been eliminated since the recession began at the end of 2007, the Department of Labor said.

Unlike the very poor who rely on Medicaid, most of these people had not looked to the government for healthcare, instead securing insurance through their employers or buying it themselves.

Now without incomes, some are faced with paying more than $1,000 a month to buy a new insurance policy or to keep the coverage they had at work under the federal COBRA law, which requires workers to pay the full cost of their premiums, picking up what their employers once paid.

Peeler, 39, looked at getting COBRA coverage when he was laid off in November from an apartment management firm. But he quickly calculated he couldn't afford the premium -- more than $1,300 a month.

He said his unemployment check of $326 a week barely covered the mortgage and the groceries. And his wife, who had been looking for a job since the beginning of last year, couldn't find full-time work.

Nor could Peeler find private insurance. Every insurer he consulted refused to cover treatment for his daughter's mild psoriasis and his son's asthma, both classified as preexisting conditions.

"Private insurance is a joke," said Peeler, who had never before sought public assistance.

The stimulus package may ease the burden for as many as 7 million people like Peeler who lose their jobs between September and the end of this year. Under the bill, the federal government will pick up 65% of COBRA premiums for nine months.

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