| FootnoteTV, Footnote Fahrenheit, and more | By Stephen Lee |
Health Coverage (last updated January 27, 2004) (back to top) Most people in the United States have health insurance, with most people under 65 years old having coverage through their employment, and with some covered by Medicaid. But about 40 million people under 65 years old (about 16-17 percent of that population) did not have any health insurance in 2001, according to the U.S. Department of Health's annual report on national health trends, and a political debate continues as to how the United States can address these people's health needs. President Bill Clinton proposed a complicated plan to re-organize the health care system into one managing competition between insurance companies, but this plan was rejected in the early 1990s. Since then, modifications to health care have been more piece-meal, aimed to improving aspects of the current system such as helping seniors pay for prescription drugs, increasing coverage among children, or ensuring the portability of health care for those changing or losing jobs. For example, the Medicare Prescription Drug, Improvement and Modernization Act of 2003, which President George W. Bush signed into law in December 2003 and which he hailed in his 2004 State of the Union address, primarily deals with prescription drugs for seniors. It provides some relief to a major problem for that group, but does not address the problems of the uninsured. Currently, health coverage in the United States is now provided through a combination of private and public programs. Most people are covered through their workplace, and some are covered by public programs:
 Democratic Candidates' Plans for the Uninsured (last updated January 27, 2004) (back to top) Each Democratic presidential candidate has some kind of a plan to get coverage for more of the estimated 40 million people (about 20 percent of the U.S. population) who did not have health insurance in 2001. These plans often involve (1) expanding the existing State Children's Health Insurance Plan (SCHIP) and (2) giving more Americans access to a plan equivalent to the health plan available to members of Congress and to federal workers. The following table compares some features of the health-care plans proposed the two leading Democratic candidates, former Vermont Governor Howard Dean and Massachusetts Senator John Kerry. This information is taken from the plans available on the candidates' websites.
Prescription Drugs (last updated January 27, 2004) (back to top) The new prescription-drug plan enacted in December 2003 addresses the growing dependence of seniors on prescription drugs for their health care and the rapidly-growing cost of prescription drugs over the past decade. The plan helps Medicare beneficiaries save money on their annual prescription-drug costs, though some say that the plan should have done more to control the underlying prices. The United States spent about $140.6 billion on prescription drugs in 2001, or about 10 percent of all national health expenditures. This amount has grown faster than overall health costs; prescription-drug costs made up about 5 percent of all national health expenditures in 1990. Under the new plan, Medicare recipients will be able to choose prescription-drug plans that will cover prescription drugs based on the amount they spend in a year: Medicare will cover 75% of annual drug costs between $250 and $2,250 in drug spending and will cover about 95% of the costs above $3,600. Medicare recipients can also get drug-discount cards that can reduce the cost of covered prescription drugs. Accordingly, the amount of savings will vary widely and is hard to predict at this stage, especially since not all prescription drugs necessarily will be covered by the new plans and discount cards. Seniors with annual prescription-drug costs less than $810 a year probably will not save much money, if any. Seniors who would otherwise spend $2,250 in prescription-drug costs will save around 50%, but seniors who would otherwise spend $5,120 will save about 20 percent. The following graphs show how much a senior would pay and save on annual drug costs under the new prescription-drug plan, assuming that the annual premium will be about $420 ($35 a month) but not taking into account the savings offered by the new drug discount cards.   Patient's Bill of Rights and HMOs (last updated August 14, 2001) (back to top) The fight over patients' rights is a reaction to the changing nature of American healthcare and a 1974 law that many feel has not kept pace. With about 30 percent of the United States population enrolled in a health-maintenance organization, the patients' rights debate centers on how enrollees in these and other managed-care plans can use the legal system to hold such plans financially accountable for their actions. Under current federal law, people enrolled in health plans are generally barred from suing managed care organizations and other insurers. Managed-care organizations and other employee benefit plans are strictly regulated by the Department of Labor under the federal Employee Retirement Income Security Act of 1974, and thus are exempt from many state laws; many courts have dismissed lawsuits against HMOs because of this preemption clause, though others have allowed suits based on the quality of care offered, rather than the denial of benefits. Congress has failed to achieve a workable patients' rights bill in recent years; the House and Senate have both passed different versions but failed to make a compromise. Democrats generally want expansive rights to sue in federal and state courts with few limits on the amount of damages that can be awarded. Republicans, on the other hand, want to limit lawsuits to certain courts and to limit the damages that can be awarded; they say that such lawsuits will hurt other enrollees by forcing costs up. Other sticking points include whether patients should be required to exhaust rights to administrative appeals and whether employers should be liable if they participate in medical decisions. While Congress has stalled, patients' rights have moved further in some states. About a fifth of the states now have laws explicitly authorizing suits by enrollees against their managed care organizations, with Texas the first in 1997 (other states include Arizona, California, Georgia, Maine, New Jersey, Oklahoma, Washington and West Virginia). Most states also now have "external review" systems under which people enrolled in a managed-care program can appeal a denial of coverage on medical-necessity and other grounds to a state agency or a state-certified body. Such state measures vary in strength and may be invalidated by a federal patients-rights bill. All of this debate stems from the changes in the American private health-insurance market since the 1980s. Healthcare costs and private-insurance premiums skyrocketed in the 1980s, and managed-care plans emerged as ways to hold health care providers such as hospitals and doctors more accountable for quality and cost. Health maintenance organizations, one prominent type of managed-care plan, cut costs by requiring members to deal with a pre-selected network of doctors and hospitals and by reducing the frequency of surgeries, hospital stays, and expensive medications. This helped keep healthcare affordable and within the reach of many people, but also limited the kinds of care one could get and led to the decisions that patients now want to sue over. About 80 million Americans are covered by a HMO plan. Another 100 million Americans are covered by preferred-provider organizations (PPOs), another form of managed-care plan whereby groups of medical providers that contract directly with employers or health-insurance carriers to provide services to enrollees. With general agreement that patients should be able to take their MCOs to court, Congress has still failed several times in recent years to reach agreement on just how to enforce these rights. The House and Senate passed conflicting bills in 1999 and 2000 but could not iron out major policy differences. The same may happen again this year. In June 2001, the Senate passed by 59-36 a bill sponsored by Senators Edward Kennedy (D-Mass.) and John McCain (R-Airz.) that would allow patients to sue MCOs in state court and also in federal court if the MCO did not exercise "ordinary care" in making its decisions. If successful, patients could win up to $5 million in the equivalent of punitive damages and would have compensatory damages limited only by state law. The bill would also make employers potentially liable if they directly participate in medical decisions that harm patients. President George W. Bush said he would veto a final bill that looked like the Senate bill. Two months later, in August 2001, the House passed a bill supported by Representative Charles Norwood (R-Ga.) by 225-203; this bill would allow patients to sue MCOs in state court and would limit damages for pain and suffering as well as punitive damages to $1.5 million each, with no limit for economic damages such as lost earning potential. Now the House and Senate must make a compromise version of the bill or see federal patients' rights stall for a third year in a row. Sources: Bryan A. Liang, Health Law and Policy: A survival guide to medicolegal issues for practitioners (Butterworth-Heinemann, 2000). Uwe Reinhardt, The Managed-Care Industry in Perspective, available on-line here. The Kaiser Foundation. Health Care Coverage (last updated July 27, 2002) (back to top) About 16.5 percent of the U.S. population under 65 years of age, roughly 39.2 million people, had no health insurance coverage in 1998. Two-thirds of the population had private health coverage through their workplace, and about 8.8 percent had health coverage through Medicaid.  |
|
 Index / Home FootnoteTV Footnote Fahrenheit Footnote Media Issues Cases Resources Footnote Comics Site FAQ Search via Google Election 2004 
Issues | ||||||||||||||||||||||||||
|
|