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Q&A

Readers' questions on healthcare reform

Insurance for Congress members, changes to Medicare, the two kinds of triggers, and more.

September 13, 2009|James Oliphant

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

What kind of insurance do members of Congress have, and what do they pay for it?

Members of Congress can buy insurance through the Federal Health Benefits Program, which is open to all federal employees.

It offers a large variety of plans that can be tailored for individuals and families. There are no exclusions for preexisting medical conditions.

Because of the large pool of employees covered by the program, it can encourage insurers to offer more affordable premiums.

Typically the government will pay as much as three-fourths of a premium, with the employee paying the rest. Congress members pay that cost like everyone else.

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In his speech to Congress, President Obama talked about savings that could be achieved by changing Medicare. Will that affect the services I receive from the program?

The proposal is to make Medicare and the rest of the healthcare system more efficient without reducing services. Healthcare economists say that eliminating wasteful and duplicative practices in the system could save hundreds of billions of dollars. Reforming the way Medicare pays doctors and hospitals could also result in substantial savings. The White House is also advocating reducing payments to Medicare Advantage, a private insurance program for seniors that receives federal funds.

What's all this talk about triggers?

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The word is associated with two different concepts.

First, the White House was reported to be considering a proposal from Sen. Olympia J. Snowe (R-Maine) that would delay implementation of a government-run insurer, the so-called "public option," until it is determined that a private insurer in a specific region had failed to provide more affordable coverage. Snowe's trigger is viewed as a possible compromise between congressional supporters and opponents of a public option.

The other kind of trigger, cited by President Obama on Wednesday, would serve as a cost-control mechanism. If the healthcare bill fails to motivate providers to streamline their practices, then the trigger would kick in. It would use the threat of reduced Medicare payments to persuade those providers to ramp up their efforts.

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Sen. John McCain has proposed having the government cover high-risk individuals with preexisting conditions. How is that part of the healthcare overhaul?

It's a stopgap measure designed to benefit people who have been denied coverage because of preexisting conditions, and it's intended to last only until the insurance exchanges expected to be created by the healthcare legislation are up and running -- probably in four years or longer.

Once those exchanges are in place, any insurer who sells plans through them would not be allowed to deny coverage based on preexisting conditions.

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joliphant@latimes.com

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