Would Health Care Reform Help You?

(ed. note: I'm turning the blog over to my friend, Barbara O'Brien, for an important discussion)


Many obstacles and stumbling blocks remain in the way of health care reform. The House and Senate bills will have to be merged, and then the House and Senate both will vote on the final bill. We don’t yet know what will be in the final bill, or if the final bill will be passed into law. Passage will be especially difficult in the Senate, where it will need 60 votes to pass. It is still possible that after all this angst, just one grandstanding senator could kill the whole thing.

But just for fun, let’s look at what conventional wisdom says will be in the final bill and see if there is anything in it that will be an immediate benefit to people with peritoneal mesothelioma and other asbestos-related disease.

It is likely that the final bill will provide additional funding for state high-risk insurance pools. Currently more than 30 states run such pools, which are nonprofit, state-sponsored health insurance plans for people who can’t buy insurance because of pre-existing conditions. The biggest problem with such pools is that, often, the insurance they offer is too expensive for many who might need it. Both the Senate and House bills provide $5 billion in subsidies for state high-risk pools to make the insurance more affordable.

Under the Senate bill, beginning in 2014, private companies would no longer be able to deny coverage to adults with pre-existing conditions, nor could they charge higher premiums for people with pre-existing conditions. Until then, the state high-risk pools could provide some help.

Closing the Medicare Part D coverage gap — also called the “doughnut hole” — is another potential provision that could help some patients with asbestos-related disease. The “doughnut hole” is the gap between the coverage for yearly out-of-pocket expenses provided by Medicare Part D and Medicare’s “catastrophic coverage” threshold.

For example, in 2009 Medicare Part D paid at least 75 percent of what patients paid for prescription drugs up to $2,700. After that, patients must pay for all of their prescription medications until what they have paid exceeds $6,154. At that point, the catastrophic coverage takes over, and Medicare pays for all but 5 percent of the patient’s drug bills. The final health care reform bill probably will provide for paying at least 50 percent of out-of-pocket costs in the doughnut hole.

You may have heard the bills include budget cuts to the Medicare program, and this has been a big concern to many people. Proponents of the bill insist that savings can be found to pay for the cuts, and that people who depend on Medicare won’t face reduced services. But this is a complex issue that I want to address in a later post.

The long-term provisions probably will include many other provisions that would benefit patients with asbestos-related disease, including increased funding for medical research. Although there are many complaints about the bill coming from all parts of the political spectrum, on the whole it would be a huge benefit to many people.

— Barbara O’Brien
March 4, 2010