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Why is health insurance provided through your employer? And other questions about our healthcare...

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The Antidote To Your Burning Health Care Questions

As we approach the presidential election in November, Weekend Edition is seeking your questions about issues and candidates in a new segment called Reporter Hotline. This week, we answer inquiries about health care.


Why Is Insurance Employer-Based?

Question from Bob Dunne of Cedar Park, Texas: "Why do you have to work to maintain health insurance? In other words, I know many people who won't quit their jobs because they're not working for the salary; they're working for the health insurance."

Doctor writing a prescription.
Enlarge iStockphoto.com

Answer from NPR's Julie Rovner: "Well, you have to go back to World War II. The U.S. had wage and price controls, but also a labor shortage because so many men were part of the war effort. So one of the ways employers started to differentiate themselves was by boosting benefits, and health insurance was one of those benefits they started offering. After the war, there was a huge boom in hospital building, so it made sense for more people to have hospital insurance, and our system kind of grew up as an employer-based one.

"By the time health care got so expensive that insurance was a real necessity — rather than something that was just a nice fringe benefit, which was around the 1970s — really we as a country were sort of settled into the idea of having that employer-based system. In fact, it was President Richard Nixon who first proposed the idea of getting everyone covered by requiring all employers to provide health insurance to their workers. That came in response to the Democrats' proposal of that same era to have a tax-funded insurance plan for everyone.

"Later on, the Democrats would pick up Nixon's idea and propose that so-called employer mandate. In response, Republicans came up with the idea of requiring individuals to have their own coverage, which is of course what ended up passing first in Massachusetts under then-Gov. Mitt Romney, and then in the Affordable Care Act, which we have today."


Candidates' Plans For Women's Health Care

Question from Majal Perry of Monterey, Ky.: "I really want to know what each candidate's health care solution would specifically mean for me and other women like me, who are in their mid-20s, working, but low- to lower-mid-income and without insurance. How would their plans cover me should I ever choose to have children?"

Answer from Rovner: "Well, you're one of those people who would likely face a very stark difference between the two candidates' plans. Under the Affordable Care Act, starting in 2014, you'll likely be able to afford your own insurance through one of the health care exchanges, and you'll probably qualify for a subsidy. Insurance companies also won't be able to charge you more because you're a woman of child-bearing age, and they will have to cover maternity benefits. None of those things are true now.

"Gov. Romney hasn't told us enough about what he would do to replace the Affordable Care Act, which he wants to repeal, to know if he'd offer any of those same protections. He does have some proposals he said would improve competition and potentially lower prices for insurance for people like you, though."


Are Doctors Accepting Fewer Medicare Patients?

Question from Patrisha Thomson of Los Angeles: "A social worker I know who works in the medical field was telling me that many doctors are not accepting Medicare patients because they're not receiving the amount of money that really makes it a reasonable income. I would be interested to know how prevalent that is. And if that's true, what has changed?"

Answer from Rovner: "There's a continuing standoff in Congress about the way doctors are paid under Medicare. This predates the health law. This goes back to the late-1990s, and actually, if Congress doesn't do anything, doctors are going to see their pay cut by 27 percent more.

"So we are hearing more anecdotal evidence, at least, about doctors not taking new Medicare patients in particular. This is something that's going to come up again in the context of this fiscal cliff at the end of the year, something Congress has to deal with along with these expiring tax cuts and the potential for big budget cuts, and it is something that is definitely on policymakers' radar screens."

Weekend Edition host Scott Simon: "Let me understand this complaint — are doctors saying they're not getting reimbursed for the full value of the service they render?"

Rovner: "Mostly it's that they've not had any kind of real inflation increase really in a decade now. And that's because of this funding formula that is calling for cuts. Congress has mostly been cancelling the cuts, but they've not been giving them any increases.

"So they're getting less and less in the way of Medicare reimbursement compared to how much their cost of providing the care is going up. To be fair, most doctors continue to accept Medicare patients, to take Medicare, but it's getting more and more difficult for a lot of doctors to do that."

New World Peace

by on Oct. 13, 2012 at 8:48 PM
Replies (21-30):
Naturewoman4
by Platinum Member on Oct. 14, 2012 at 10:49 PM

Sorry stacymom, I completely disgree with you.  The Gov. IS taking from us!  I can't believe anyone would say they aren't.  The Ins. Co. & our Gov.  Like I already have said, Obama when he first took office. He promised the American people that ALL our Healthcare premiums would go down.  What I didn't realize was he met for some.  He lied imo.

Quoting stacymomof2:

I agree.  Take it up with the insurance companies, they are the ones taking your money, not the government.  They are a private, for profit business, not controlled by Obama.  Without the government actually controlling them and placing caps on rates there is nothing else they can do.  I wanted to see a single payer option that kicked out insurance entirely.  Failing that I wanted to see a public option, a reasonably priced government sponsored option for health coverage.  However that was stomped out by Republicans, who started yelling about socialism and death panels.

Quoting nomadbrat83:

Great so 400 percent of the poverty level for a married dual income family will ONLY have to pay about 8000 a year max in premimums. So theoretically that means hubby and our premiums could be raised from 6k a year to 8k a year. Wonderful. Also what happens to those once they break that 400 percent threshold?

Quoting stacymomof2:

People disagree with the ACA because it requires people to purchase health insurance or pay a tax.  Other people disagree with the fact that private insurance companies will benefit from more people purchasing their product instead of the government taking charge of the cost problem (this is my problem with it.)  Still others are swayed by insurance company propaganda which tells people they will be forced to raise prices in order to provide the level of service the government is requiring them to provide.

I still don't know what you are saying about "some people get Obamacare and some don't."  ALL insurance must follow the requirements of the ACA.  EVERYONE gets the opportunity to shop for the best price on the "competitive marketplace" that states are beng required to set up.  If you are talking about the government subsidies, the qualificatations to get the subsidy are 400% of poverty level.  There are limits on cost...

Premium Limits for Consumers Based on Income

Income

Premium Limit

Up to 133% FPL

2% of income

133 - 150% FPL

3 - 4% of income

150 - 200% FPL

4 - 6.3% of income

200 - 250% FPL

6.3 - 8.05% of income

250 - 300% FPL

8.05 - 9.5% of income

350 - 400% FPL

9.5% of income

In other words if you make up to 400% of the poverty level, you will not have to pay more than 9.5% of your income towards health care.  If you make 150% of poverty level you will not have to pay more than 4% of your income towards health insurance premiums.

Just FYI the ACA requires insurance companies to use 80% of the money they collect to provide care, and 20% to administrate it.  As you know any for profit insurance company is going to cry against this, since it is in their best interest to pay out as little as possible on claims.  The ACA outlaws the practice of insurance companies of refusing to pay claims to customers in good standing for reasons such as "they lied about how tall they are on the application."  The ACA requires well visits and perscriptions to be covered in order to qualify as "insurance" under the act.  They require insurance companies to cover pre-existing conditions.  

 

Quoting Naturewoman4:

Can you tell me something Stacy just a question.  Why is it that the majority of Americans are against Obamacare then?  I appreciate your discussing this with me, without any personal attacks.  You give me info. to think about.  What I meant by saying how some people are going to be able to get lower premiums, then others.  I agree that those that are having a really hard time to begin with, SHOULD get Healthcare at a lower rate.  But, what I'm saying is that I feel EVERYONE should be getting it at a lower rate.  EVERYONE should be able to get Obamacare, if it is going to save them money. 


I believe the reason why the majority of Americans are not wanting Obamacare is because it will cost them more for their Healthcare.  It will also affect Medicare, which already 716B was taken out of that fund, to put into Obamacare.  I just wonder, why is it IF the MAJORITY of Americans didn't want Obamacare, why is it jammed down our throats? 


Quoting stacymomof2:


It does help everyone.  It give subsidies to employers so they can offer insurance.  It give subsidies to people so they can pay for insurance.  Maybe you can tell me what you mean by "someone can get a break on their insurance, and others don't."  Because the only qualifying factor is income.  The ACA applies to everyone.  


Quoting Naturewoman4:


Thanks for explaining that better.  I call it Obamacare, because even Obama had no problem with being called that.  I just feel ALL Americans should be able to get Ins. that is affordable.  Under the Affordable Care Act.  I just don't think it's right or fair, that some can get a break on their Ins., while others don't.  Why not help everyone?  Except, for families that earn above a certain amount, for which they can afford their own. 


Quoting stacymomof2:


I don't think you understand what "Obamacare" is (it is actually called the Affordable Care Act.)


It isn't insurance, it just sets up markets where insurance companies have to bid against each other for your business. It sets standards as to what actually qualifies as insurance, and requires people to be have insurance or be taxed.  There are subsidies available for people to help pay for coverage.


There is nothing called "Obamacare" that you go out and buy, it's regulations apply to the insurance market.  If you are insured there are no changes, except they will have to follow the consumer protection guidelines that the ACA sets.


I agree that a single-payer system is really the only thing that makes sense.


Quoting Naturewoman4:


I understand that, but it seems like it would be better if we just did like what Canada did.  That way no one has to worry about be uninsured, & EVERYONE benefits.  Then, for those that chooses to purchase their own, choose they're own Dr.'s & Hospitals they can.  If Obamacare is affordable, why can't ALL Americans have the choice to purchase it. 


Quoting jessilin0113:


I think if we had a viable public option, we WOULD see premiums go down.  But insurance is the only game in town, so they are free to raise premiums and prices higher and higher, and there is nothing to stop them.


 




 




 




stacymomof2
by Ruby Member on Oct. 14, 2012 at 11:08 PM

I see all my posts are for naught.  

Obama and the government aren't making money off of your insurance premiums.  Your insurance company is.  If they are raising it they are getting the money.  Not the government.  wow

Quoting Naturewoman4:

Sorry stacymom, I completely disgree with you.  The Gov. IS taking from us!  I can't believe anyone would say they aren't.  The Ins. Co. & our Gov.  Like I already have said, Obama when he first took office. He promised the American people that ALL our Healthcare premiums would go down.  What I didn't realize was he met for some.  He lied imo.

Quoting stacymomof2:

I agree.  Take it up with the insurance companies, they are the ones taking your money, not the government.  They are a private, for profit business, not controlled by Obama.  Without the government actually controlling them and placing caps on rates there is nothing else they can do.  I wanted to see a single payer option that kicked out insurance entirely.  Failing that I wanted to see a public option, a reasonably priced government sponsored option for health coverage.  However that was stomped out by Republicans, who started yelling about socialism and death panels.




NWP
by guerrilla girl on Oct. 14, 2012 at 11:11 PM
1 mom liked this

Have you ever heard of the phrase "trying to store water in a shoe"?

Quoting stacymomof2:

I see all my posts are for naught.  

Obama and the government aren't making money off of your insurance premiums.  Your insurance company is.  If they are raising it they are getting the money.  Not the government.  wow

Quoting Naturewoman4:

Sorry stacymom, I completely disgree with you.  The Gov. IS taking from us!  I can't believe anyone would say they aren't.  The Ins. Co. & our Gov.  Like I already have said, Obama when he first took office. He promised the American people that ALL our Healthcare premiums would go down.  What I didn't realize was he met for some.  He lied imo.

Quoting stacymomof2:

I agree.  Take it up with the insurance companies, they are the ones taking your money, not the government.  They are a private, for profit business, not controlled by Obama.  Without the government actually controlling them and placing caps on rates there is nothing else they can do.  I wanted to see a single payer option that kicked out insurance entirely.  Failing that I wanted to see a public option, a reasonably priced government sponsored option for health coverage.  However that was stomped out by Republicans, who started yelling about socialism and death panels.





New World Peace

franmoor
by on Oct. 16, 2012 at 8:33 AM

That was really a great article you've shared. I know someone who does want to stay in a certain company because of insurance benefits. His son has an asthma and having health insurance really helps them with the bills. Sometimes, I do hope that we can decide on our own if we really want to have an insurance or not since it becomes compulsary nowadays.

NWP
by guerrilla girl on Oct. 16, 2012 at 12:05 PM

My kids grandparents cannot relocate to the state where we live because of this. They would like to spend their remaining years near the family, but we had to move for work and they have to stay put because of insurance.

I would love to have a single payer system, like Canada's. I would love to see private insurance go bye bye.

Quoting franmoor:

That was really a great article you've shared. I know someone who does want to stay in a certain company because of insurance benefits. His son has an asthma and having health insurance really helps them with the bills. Sometimes, I do hope that we can decide on our own if we really want to have an insurance or not since it becomes compulsary nowadays.


New World Peace

americanmomm
by Bronze Member on Oct. 16, 2012 at 12:15 PM

 obama himself will be exempt from "obamacare" rules and regulations.  that pretty much sums it up imo.

NWP
by guerrilla girl on Oct. 16, 2012 at 12:46 PM

Not true.

Quoting americanmomm:

 obama himself will be exempt from "obamacare" rules and regulations.  that pretty much sums it up imo.


New World Peace

KenneMaw
by Bronze Member on Oct. 16, 2012 at 12:59 PM

Very good article.   I see many people saying the US needs to be like Canada and the UK, but part of the problem is that the US has 10x as many people (Canada - 34million, UK -62 million, and US 312 million), plus we have illegals that get healthcare as well.    These other countries have much higher taxes, so can fathom the amount of money it will take to cover 312 million people?   What money will be left in my paycheck for my own family?    Then let's add over govt bureaucracy to the mix - they take at least 45-60 days to pay bills and right now, as the article states, they pay doctors and hospitals only a small portion of their fees (then regular insurance rates go higher to make up for the difference that medicare/caid aren't paying).   Finally, people think their healthcare will be free - no.  They will still pay a premium and it might not be that much lower than what they pay now.  Do I have a solution, no, however, I am just not sure a govt sponsored health care plan is the right answer for the USA. 

KenneMaw
by Bronze Member on Oct. 16, 2012 at 1:02 PM

One more note - companies can decide whether to continue to offer insurance or pay a fine. for most companies, it is cheaper for them to pay the fine.  

americanmomm
by Bronze Member on Oct. 16, 2012 at 2:13 PM

 True.  Sadly.  Because he and his family are covered by the Federal Employees Health Benefits Program, he, nor his family will ever be subject to the confines of Obamacare.

Quoting NWP:

Not true.

Quoting americanmomm:

 obama himself will be exempt from "obamacare" rules and regulations.  that pretty much sums it up imo.


 

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