October 20, 2009 | BY Regan Mathias
The great health insurance debate has been raging since the 2008 primaries. For the most part, legislative leaders aren’t arguing about whether reform is needed, but about how to do it. But in this war of words between Democrats and Republicans, it is hard to distinguish fact from fiction. Below are 10 terms you need to know when following the health insurance reform debate.
1. Public Option
The public option refers to government-run health coverage that would be similar to Medicare. The public option would not be mandatory. Individuals covered by the public option would be able to choose their doctors. The public option would not set plan prices for all insurance companies. Those who oppose the public option worry that it may force private insurers out of business if its prices are too low.
2. Pre-Existing Conditions
A pre-existing condition is any health condition or illness that individuals had prior to their first day of initial coverage on a new plan, including pregnancy. An insurer does not have to provide coverage for a pre-existing condition. Insurers have been accused of stretching the definition of pre-existing conditions to avoid paying for costly procedures. If health coverage becomes mandatory for all individuals, insurers will no longer be able to deny coverage on the basis of pre-existing conditions.
3. “Death Panels”
“Death panels” is a term used to describe rumors surrounding Medicare reform that would cover appointments with doctors to discuss living wills and other issues dealing with the end of life. The government will not be able to determine whether or not someone is worthy of health care. Reform will not require seniors to undergo counseling on how to end their lives sooner.
4. Health Care Co-Operatives
A health care cooperative, or co-op, is a member-owned system that offers a network of health care providers or contracts out for medical services. Co-ops are not for profit. There are currently co-ops in the United States that successfully provide medical care for their members. Co-ops are being offered as an alternative to a public option in some health reform bills.
Medicare is a federal program that provides health care for people aged 65 and older and people with certain disabilities. Medicare benefactors have already benefited from reform. Sen. Max Baucus, D-Montana, negotiated a deal with the pharmaceutical industry this summer that created medication discounts for seniors.
Medicaid is a government program that provides health care for low-income individuals and families. It is administered by the states. Medicaid does not give money to individuals. Payments are instead sent straight to the health providers. Health insurance reform could change who is eligible for Medicaid.
7. Sen. Baucus’ Plan
Sen. Baucus drafted this bill which passed the Senate Finance Committee on Oct. 13. The Baucus Plan would require individuals to have health insurance or pay an annual penalty that would vary by income. Medicaid eligibility would be expanded to include everyone with an income up to 133 percent of the poverty line. Employers would not be required to provide insurance, but they would have to reimburse the government for the tax credits used to help individuals buy their own insurance. The plan does not include a public option, but instead calls for health co-ops.
8. Senate HELP Committee Plan
The Senate Health, Education, Labor, and Pensions (HELP) Committee’s Plan would require individuals to have health insurance. Those who do not would be subject to a tax penalty. The plan would set up state gateways, which would certify participating insurers and provide enrollment in Medicaid. Medicaid would be expanded to include everyone with an income up to 150 percent of the poverty line. A public option would be created through the state gateways.
9. House Tri-Committee Plan
The House Tri-Committee Plan would require individuals to have health insurance or pay a 2 percent income tax that could not exceed the national average of health care premiums. A National Health Insurance Exchange would be created to offer four levels of benefits. A public option would be created through the exchange, but would only be available to people without coverage. Medicaid would be expanded to include everyone with an income up to 133 percent of the poverty line. Employers would be required to offer insurance. Employers would also be required to pay for 72 percent of individual premium costs or pay 8 percent into the exchange. Small businesses would be exempt.
10. House GOP Plan
House Republicans have created their own health insurance plan, but have yet to file a bill. The plan does not require individuals to have coverage. There would be no public option. State health care exchanges would be encouraged, but not required. Medicare and Medicaid would not be expanded, but beneficiaries would be able to transfer their coverage to another plan if it is better suited to them.
Tags: Health care reform
About the Author
Regan Mathias: Regan Mathias is a senior at The University of Texas at Austin majoring in Government, Sociology, and Women’s and Gender Studies. She is from Houston, but spent several years of her childhood in Indonesia. Regan is particularly interested in women’s issue, including reproductive rights and the portrayal of women in the media. She believes in voting on issues and the quality of the politician themselves – not parties. However, her commitment to civil rights and civil liberties almost always aligns her with the Democratic Party.