Below is a transcript of the online discussion on health care reform, held April 30, 2009 with Ron Pollack, executive director of Families USA, and Karen Ignagni, president and CEO of America’s Health Insurance Plans.
Welcome to the Campaign for an American Solution web chat!
moderator-1: Welcome Karen Ignagni and Ron Pollack.
Karen_Ignagni: Thank you. We are delighted to be here today.
Ron_Pollack: Happy to join you today.
Karen_Ignagni: We are happy to take your questions now.
MarinCA asks: Do your organizations support a public plan option? Why or why not?
Karen_Ignagni: We proposed an aggressive series of market reforms to ensure that all Americans have coverage, no one falls through the cracks, and no one is discriminated against due to their health status.
Ron_Pollack: Families USA does support a public plan option. We believe that this creates options for families; helps to create a benchmark for costs; and provides opportunities for securing important data that will help the overall health care system.
Chris asks: I'm a doctor and am concerned about how health care reform will impact my patients. Will I still be able to give them the attention they need if we extend health coverage to all Americans? How do you propose we address the physician shortage?
Karen_Ignagni: We have also proposed aggressive regulation, transparency requirements, and measures to ensure that patients are protected. If all of this is accomplished then the question is why is a government-run plan needed?
Karen_Ignagni: Chris, are you a primary care physician?
Karen_Ignagni: As a country, we must get everyone covered.
Ron_Pollack: I believe that good health care reform will include an increase and improvement in primary and preventive care. There is no doubt that health care reform needs to address the increasing shortage of primary care physicians and nurses. Also, since health care reform needs to address quality of care, I believe a greater emphasis will be place on physicians spending more quality time with their patients.
Karen_Ignagni: We also need to ensure that physicians, particularly primary care physicians, receive financial incentives to coordinate care for patients.
Karen_Ignagni: We have long supported loan forgiveness programs for primary care physicians and believe that more can be done by way of funding medical school costs for individuals who choose primary care.
David-GMA asks: Why should the American public trust health insurance companies to support reform when they were the ones to kill it last time?
Karen_Ignagni: David, thank you for your question.
Karen_Ignagni: We have committed to supporting comprehensive health reform and have offered a series of proposals that would change the way our plans are regulated.
Jeffrey_Pankow asks: It is not clear to me how HEALTH CARE COSTS are going to addressed by the administration's health care reform legislation.
Karen_Ignagni: At the health care summit I was quite impressed by President Obama's passionate commitment to bending the cost curve and had the opportunity to listen to OMB Director Orszag discuss preliminary thoughts about how to accomplish that objective.
Karen_Ignagni: I believe this commitment is serious and that our ability to accomplish this objective is integral to reform being sustained.
Ron_Pollack: Health care costs clearly need to be addressed as a priority in health care reform. I believe that costs can be addressed by a variety of measures, none of which are single, silver bullets. The measures needed to bring down the cost curve include, but are not limited to: promoting greater use of preventive care; ensuring that we receive improved coordinated care; and securing better information about the best science for providing care so that we reduce the amount of care that is unhelpful or even harmful.
Colton Smith asks: I saw on Fox News that Obama plans to have the government take over all of health care. Are your groups going to fight that?
Ron_Pollack: This is plain nonsense; that horse won't ride. As President Obama has repeatedly stated, if you like the coverage you have today, you will be entitled to keep it. The old canards about government takeovers and socialist medicine are not simply outdated and wrong, but they betray a simplistic ideological approach to health care reform.
Karen_Ignagni: The goal of health care reform needs to be to achieve a balance between the best of the public and private sectors. We have been concerned with the projections of how many individuals would move from private employer-based coverage to a government-run plan under certain scenarios.
Linda-II asks: Ron why are you working with the insurance companies? Aren't they opposed to Families USA and universal coverage?
Ron_Pollack: One of the things I have learned from various iterations of health care reform is that none of the stakeholders totally agree or disagree with one another. We have disagreements on some key issues (e.g., Medicare Advantage, public plan option, etc.) but we do have agreement about the imperative of securing universal coverage. Towards that end, we are willing to work with others even if we disagree on some other matters.
Karen_Ignagni: We have a hundred years of failed attempts to pass health reform in this country. Virtually every time this was tried stakeholders worked mostly within their own sectors. If we are going to achieve reform - and we must - it's important for different groups to work together and get it done.
James asks: I hear a lot about comparative effectiveness research. Isn't this just another form of rationing?
Karen_Ignagni: Comparative effectiveness means giving consumers information about quality and cost that they have a right to know. In every other sector of our society we, as consumers, have access to this type of information. It's time for health care to enter into the 21st century and give consumers the information they need to make the decisions that are right for them.
Ron_Pollack: Comparative effectiveness allows physicians, nurses, and patients to learn what are the best ways of treating different illnesses. I believe that having as much information about the best science on health treatments will help everyone and the health care system as a whole.
jiminmissouri asks: I'm a small employer. Where do you see the best opportunities for reform lie for small businesses? I expect higher costs and lower benefits under a government-run plan.
Karen_Ignagni: Small businesses have a difficult time purchasing health care today because they must comply with state requirements with respect to benefits that must be offered to their employees. Large businesses have more flexibility. If we develop an essential benefits package that all Americans have access to that will give more small businesses affordable options.
Ron_Pollack: I believe that health care reform is critically important for small businesses. Small businesses will be helped if we bend the cost growth curve downward, and they will also be helped if we achieve health insurance market reform that protects people (and the businesses that hire them and seek to provide health coverage for their workers) so that different, higher premiums no longer are charged for people with pre-existing health care conditions. One final point: Small businesses that provide health care coverage for their workers pay a "hidden health tax" to pay for the uncompensated health costs of the uninsured; if we achieve universal coverage, this tax will be eliminated.
Cherie from Boston: I'm a PhD student writing from Boston. Should we hold out until Congress finalizes a new Obama-approved bill, or support HR676?
Karen_Ignagni: I believe health care reform will be passed this year.
Karen_Ignagni: The challenge for Congress is to create a uniquely American solution that can pass and be sustained. Polls show overwhelming support for this direction and in Washington there is a new attitude about the ability to accomplish this objective.
Ron_Pollack: There are tens of millions of people who are uninsured and tens of millions of others who are underinsured. I believe that we, as a nation, have a moral responsibility to help these people so that they have access to high-quality affordable coverage and care. President Obama does not support a single-payer system, but he does support providing high-quality, affordable coverage and care for everyone. We should support this.
Karen_Ignagni: Ron is right about the hidden tax that all Americans with insurance are paying and with reform those taxes would be reduced.
John asks: I think everyone should be required to carry insurance. Otherwise, people just go to the emergency room and all the rest of us foot the bill. Everyone feels bad for the uninsured, but they are the ones making health care too expensive. I know a guy who is uninsured but drives a BMW. It’s a joke.
Karen_Ignagni: We agree and believe that there is overwhelming support for the concept of personal responsibility in health care. Each American is paying more than a thousand dollars to finance the costs associated with the medical care provided to those who choose not to be insured.
Ron_Pollack: The overwhelming reason people are uninsured is because they can't afford the premiums. We need to make coverage affordable, both by bending the cost growth curve downward and by providing subsidies for people who can't afford coverage and care. If we do this, a requirement that everyone should obtain coverage would be sensible.
Karen_Ignagni: The most expensive thing we could do is nothing at all. Bringing everybody into the system would save the country $50 billion and ensure that we can emphasize primary care and early intervention.
Mary Lynn from Oklahoma asks: My husband and I are lucky to get good health benefits from my job. Will Congress make changes to that? And what happens if I get laid off because there is no way we could afford it.
Karen_Ignagni: Members of Congress are working very hard to build on the employer-based system and to reduce costs to ensure that your employer will be able to maintain coverage. Health care is one of the most important benefits for working families and everything possible needs to be done to protect them.
Ron_Pollack: President Obama and congressional leaders have made it clear that people who like the employer-based health coverage will be able to continue with such coverage. Today 160 million people have such coverage, and this will not be taken away from anyone. If you get laid off, you may have several options: (1) secure coverage with new subsidies so that you can afford it while you are laid off; or (2) obtain COBRA coverage that could become affordable through subsidies that help you afford such coverage. Good health reform will provide options for you that you never had before while enabling you to keep your current coverage if you like it.
Karen_Ignagni: In the stimulus bill a special provision was added to provide financial help to workers who lose health care coverage when they become unemployed. We strongly supported this provision as an important part of shoring up the safety net.
Gretchen asks: All the prescriptions keep going up. We are supposedly in a recession but drugs are the only thing that cost more. What a racket. Are you going to change that?
Karen_Ignagni: Cost containment is going to be a major part of health reform.
Karen_Ignagni: Every stakeholder group will be challenged to be part of this conversation and participate together in making the system more affordable.
Ron_Pollack: Cost reform should affect, in a positive manner, the costs throughout the health care system. A key facet of reform is to make the overall health care system more efficient, effective, and cost-effective.
Matt_z asks: The Washington Post recently did a story on a hospital in Pennsylvania that charges a flat fee per procedure, regardless of how many times a patient has to come back for follow-up care. Is this beneficial for patients or only insurance companies?
Ron_Pollack: This is a good thing because it is designed to pay for quality of care rather than quantity of care services. This system places a much better emphasis on providing the best care for patients such that, if they are hospitalized, they are unlikely to be readmitted.
Karen_Ignagni: This is an important development because reimbursing hospitals for the care required to treat the patient episode encourages those facilities to focus on quality, safety, and performance. One of the major problems we have in our system today is readmissions post hospital care. This model provides strong incentives for facilities to reduce those high rates.
moderator-1: We have about ten minutes left in our forum. We will do our best to answer all of the questions time allows.
RoyfromOR asks: Ron I am puzzled why you are working with the people who brought us Harry and Louise?
Ron_Pollack: Roy, as you may know, Families USA -- together with some of our traditional allies -- produced advertisements with the original Harry and Louise. They are now on the side of health care reform and believe it should be a top priority for our nation.
Karen_Ignagni: That's a good thing.
Ben asks: All this talk about the uninsured, but the real issue is health care costs. That’s why people are uninsured in the first place. Hello, where is the plan to LOWER costs??
Ron_Pollack: Costs and coverage need to go hand in hand. You are right in saying that health care costs are critically important. The health reform framework developed by President Obama, and the reforms I believe we will see from congressional leaders, will emphasize both facets of reform. We must expand coverage but, of course, if costs are not dealt with in an effective manner, such coverage will diminish over time.
Karen_Ignagni: Ben, you are right about costs being the issue, but it is important to align both strategies - cost containment and access expansion - because if we don't get everyone in the costs will continue to be artificially inflated for those who are now covered. That's because the cost of treating these individuals flows through the system and becomes a surtax for everyone with insurance.
Karen_Ignagni: We have time for one more question.
Pete765 asks: Your insurance companies want to force us to buy their products. That’s not right. I like my health care but how you can tell people they have to buy something that most people can’t afford? That will never stand up in court.
Ron_Pollack: Once we make health coverage affordable (including through the provision of subsidies for people who otherwise can't pay for insurance), it makes sense to have a requirement that everyone have coverage. A person who refuses to secure coverage (even though he or she can afford it) would force others to pay for his or her care when an unexpected health problem arises. These cost shifts hurt others, and they should be avoided.
Karen_Ignagni: Currently people are falling through the cracks, face pre-existing condition limitations, and pay according to their health status - all because we don't have everyone part of the system. Massachusetts now requires everyone to participate and no one falls through the cracks or has to subsidize those that refuse to purchase coverage. At the same time, it is important that the government provide a financial helping hand to ensure that working families can afford this protection and that aggressive cost containment features are part of reform.
moderator-1: Thank you for your time today.
Ron_Pollack: I appreciate the thoughtful questions asked today. We need to get meaningful health care reform achieved this year, and I hope that we create a more favorable and thoughtful context for reform that avoids the problems experienced in past, failed efforts. Towards that end, we look forward to working with those on issues we agree on, and I hope that we have a thoughtful debate on the other issues as well.
moderator-1: Thank you again. Please visit www.familiesusa.org and www.americanhealthsolution.org to stay informed and updated on the health care debate.
A full transcript of this forum will be available shortly.
Thank you all for coming - the full transcript of this forum will be available at www.americanhealthsolution.org.
