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Questions from readers about healthcare debate

Would illegal immigrants be covered under Obama's plan? How does the U.S. compare to other nations on per-person cost? How would Medicare change?

September 07, 2009|Kim Geiger and James Oliphant

WASHINGTON — Here are some reader questions on the national healthcare debate:

Do the various plans under consideration cover illegal immigrants?

The White House and congressional leaders have stressed that any extension of health coverage will not include illegal immigrants. But critics maintain that as the House bill stands now, illegal immigrants would be able to apply for federal health insurance subsidies because they don't have to verify their residency status. Some advocates of immigrant rights maintain that illegal immigrants should be covered because it would be cheaper to do so than treat them in hospital emergency rooms.

To process insurance paperwork, my doctor's practice has almost three times as many office workers as medical staffers. Do any of the plans address these kinds of costs?

Yes, but not everyone is convinced that the proposals go far enough. Those critics argue that making the healthcare system more efficient -- especially through the use of information technologies and a coordinated approach to treating patients -- could save billions of dollars. But the current bills contain fiscal incentives, not mandates, to achieve such innovations.

We've heard a lot about how much the Democrats' healthcare plan would cost federal taxpayers. What would it cost taxpayers at the state and local levels?

That's not clear. States worry that if Medicaid is expanded to cover people above the federal poverty line, they could be stuck with part of the tab, since states share the costs of the program. But there's also an argument that if more people are insured, local governments will spend less on hospital care for uninsured people.

How would Medicare costs and benefits change under the proposed legislation?

The House is considering a change that would raise the prescription premium while lowering beneficiaries' total spending on prescription drugs. The 20-year plan to close a much-criticized coverage gap is estimated to result in higher premiums for Part D plans, but lower average drug spending. For patients who spend small amounts on prescription drugs, this change would raise premiums more than it would lower out-of-pocket costs. For patients who require a lot of expensive drugs, buying prescriptions would become more affordable.

The House bill would also reduce federal spending on Medicare Advantage plans -- the private alternatives to traditional fee-for-service coverage. Some fear that could lead insurers to offer less attractive packages or stop participating in Medicare Advantage.


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