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Q&A

How a healthcare overhaul could affect you

Lawmakers are considering options and costs for currently insured and uninsured Americans.

July 27, 2009|James Oliphant and Noam N. Levey

WASHINGTON — Here are some key questions regarding the effort to overhaul the nation's healthcare system:

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I have health insurance and I'm happy with it. Why does the nation need to overhaul healthcare?

Polls indicate that most Americans are satisfied with their coverage. But the White House and other advocates of overhauling healthcare say people are probably paying more for insurance each year. Premiums for employer-provided plans have risen four times faster than wages, and are now double their cost nine years ago. Deductibles are rising as well. Supporters of the legislation contend that healthcare costs are a drag on the economy.

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How many proposals are there?

The Senate's Health, Education, Labor and Pensions Committee has passed its plan on a party-line vote. A competing plan from the Senate Finance Committee -- which has the task of figuring out how to pay for the overhaul -- is expected within two weeks. Then the two proposals will be merged by Senate leaders.

In the House, three committees have signed off on an overhaul bill, but the Energy and Commerce Committee has yet to produce its version, which is likely to feature some significant changes. House leaders would like the chamber to vote on a final bill before the House leaves for its August recess.

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Which bill does President Obama support?

The president hasn't endorsed any of them. The White House has preferred to detail what it considers to be the necessary elements in any package and let the legislative process fill in the blanks. But expect the administration to be heavily involved as the House and Senate bills are refined.

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What do the plans working through Congress have in common?

There is consensus that more money needs to be invested in preventive medicine, while creating incentives for doctors and hospitals to provide quality care. There is also a strong push to create a more competitive marketplace for health insurance, either through the creation of cooperatives, state-supported "gateways," or a federal government "public option" that would compete with private insurers. Supporters say competition would drive prices down.

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I don't have health insurance. Would I be forced to buy it?

A requirement to have health insurance is likely to be part of a final bill, similar to the way many states require auto insurance. Today, an estimated 47 million people are without insurance and millions more are considered to be underinsured. Democrats in Congress argue that people with insurance are in effect subsidizing those without, because their premiums are higher than they would be otherwise.

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What if I can't afford health insurance?

A final bill is expected to provide for government subsidies to assist people who can't afford insurance. The bill is also likely to feature some expansion of the federal and state Medicaid program to cover those slightly above the poverty level.

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How is the government going to pay for this plan?

That's the most contentious issue in Congress. Democrats hope to find most of the money by making Medicare, Medicaid and other programs more efficient. But that may not generate enough savings. In the House, advocates are calling for a tax on wealthy Americans. In the Senate, lawmakers are looking at other possible sources of income, including a fee to be paid by insurance companies.

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What if I am happy with my coverage? Will I be forced to switch to some other plan?

The White House and Democrats insist that if you are content with the insurance you have, you won't be required to switch. But Republicans and other critics say that if the government creates an insurance program, some employers will stop covering their employees, forcing them onto the government plan or another insurer.

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Who could sign up for the government insurance?

Initially, the plan would be open only to a few groups, including:

* People who work for companies that do not provide insurance.

* People who cannot afford the insurance offered by their employers.

* People who work for small businesses that elect to make the government plan available to their employees.

* People making up to four times the federal poverty rate -- that is, $43,320 for an individual or $88,200 for a family of four -- could be eligible for assistance to help pay the plan's premiums.

House leaders originally proposed limiting eligibility to businesses with fewer than 10 workers in the first year of the program and to 20 in the second. The Senate health committee has proposed limiting eligibility to businesses with 50 employees or fewer. The Senate Finance Committee is still working on a proposal that may not even include a government plan.

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Couldn't businesses just dump the coverage they provide now and then their employees would sign up for government insurance?

They could, but they might get hit with a penalty. There is debate about whether some businesses would drop coverage because paying the penalty would still be cheaper.

Small employers would be exempt from this penalty.

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So, with all the restrictions, how many people would be eligible for the government plan?

By 2019, the Congressional Budget Office estimates as many as 36 million people will be eligible. But the CBO also thinks only 11 million Americans will sign up, while 160 million will have private insurance.

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Why is that?

The government plan will be able to offer lower premiums than private plans, but people often look at factors beyond the cost of premiums, including the cost of co-payments, deductibles and the size of the network of providers. For example, many federal employees can choose among more than a dozen health plans, but not all of them have chosen the cheapest one.

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joliphant@latimes.com

noam.levey@latimes.com

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