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HEALTHCARE Q & A

Breaking down the healthcare bills' projected costs

Readers also ask about the penalties for not buying health insurance; changes that veterans would see; interstate insurance plans; and whether the 'public option' would cover mammograms.

November 28, 2009|By James Oliphant and Kim Geiger

Reporting from Washington — Some reader questions about the proposed healthcare legislation in Congress:

How reliable are Congressional Budget Office cost estimates for the healthcare bills? I keep hearing that the bill is much more expensive than the CBO says.

The CBO's job is to give lawmakers an idea of what a bill would cost over the first decade it was in force. In the House and Senate healthcare bills, some of the costs wouldn't take effect for several years, but some of the savings would take effect immediately. This is why some critics have said the cost estimates are off.

For example, Senate provisions to expand coverage for many Americans would cost an estimated $10 billion from 2010 to 2013 -- and then $589 billion from 2014 to 2019. So the CBO puts the 10-year cost at $599 billion.

The difference is even more pronounced in House coverage provisions: $4 billion from 2010 to 2012, and then $887 billion from 2012 to 2019, for a combined 10-year cost estimate of $891 billion.

Meanwhile, much of the Medicare savings would take effect right away, as would some taxes.

In effect, then, the CBO's estimates are based on a full decade's worth of savings, but less than a decade's worth of spending, because of how the various provisions are timed.

Is it true that I will be fined if I don't carry health insurance? I am on a fixed income and am already struggling.

Yes, that's generally true. The fine under the Senate bill would be $750, to be phased in over several years. The House bill's penalty would be 2.5% of your adjusted gross income.

However, the Senate bill would exempt people whose insurance would cost more than 8% of their income.

And if your income is close to the federal poverty line, you might be eligible for government subsidies to help pay for insurance.

Any penalty could be deducted from your income tax refund. If that were insufficient, you would owe the balance by the end of the tax year.

The president has said that the healthcare proposals would not affect veterans. If everyone must buy healthcare, what about veterans like me who have no health insurance?

Assuming you receive medical care through Veterans Affairs, you would be exempt from the requirement to carry health insurance.

Active-duty military should not see any change in their TRICARE benefits either.

Some believe allowing private insurers to sell policies across state lines would also result in more competition among insurance plans and would benefit consumers. Critics say this would reduce the quality of healthcare because it would bypass state healthcare laws.

But how is this any different from the so-called public option pushed by these same critics? Wouldn't the public option also only have to meet the less strict minimum federal standards and thus bypass state laws?

Federal standards covering new insurance "exchanges" as well as any public option -- a government-run insurer -- would supersede regulations that are stronger in some states, say critics of the Senate bill.

However, in other states, the new standards would increase consumer protection and coverage.

Advocates of allowing interstate insurance plans say that such plans would achieve many of the goals of the public option without the government's involvement.

Would the government-run option pay for mammograms? What would the guidelines be?

The Department of Health and Human Services would determine what a public option would cover (except in the case of abortion, which Congress is to address). It is expected to set an "essential benefits package" that a public plan as well as private insurers on a new insurance exchanges would have to offer.

Health and Human Services Secretary Kathleen Sebelius says current federal policy, in which Medicare pays for annual mammograms for women 40 and older, won't change despite a recent government panel's recommendation that most women under 50 skip mammograms. Her remark is seen as a sign that a public option would probably cover mammograms.

joliphant@latimes.com

kim.geiger@latimes.com

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