President Obama announced Thursday that insurers will be permitted to extend canceled insurance policies into 2014, due to the difficulties consumers are having enrolling in new insurance coverage through the new online marketplaces.
More coverage: Obama Offers Fix For Insurance Plan Cancellations
A transcript follows.
PRESIDENT BARACK OBAMA: ... It has now been six weeks since the Affordable Care Act's new marketplaces opened for business. I think it's fair to say that the roll out has been tough so far, and I think everybody understands that I'm not happy about the fact that the roll out has been, you know, wrought with a whole range of problems that I've been deeply concerned about.
But today, I want to talk about what we know after these first few weeks and what we're doing to implement and improve the law. Yesterday, the White House announced that in the first month more than 100,000 Americans successfully enrolled in new insurance plans.
Is that as high a number as we'd like? Absolutely not.
But, it does mean that people want affordable health care. The problems of the website have prevented too many Americans from completing the enrollment process, and that's on us, not on them. But, there's no question that there's real demand for quality affordable health insurance.
In the first month, nearly a million people successfully completed an application for themselves or their families, those applications represent more than 1.5 million people. Of those 1.5 million, 106,000 of them have successfully signed up to get covered. Another 396,000 have the ability to gain access to Medicaid under the Affordable Care Act. That's been less reported on, but it shouldn't be. Americans who are having a difficult time, who are poor, many of them working, may have a disability -- they're Americans like everybody else. And the fact that they are now able to get insurance is going to be critically important.
Later today, I'll be in Ohio where Governor Kasich, a Republican, has expanded Medicaid under the Affordable Care Act. And as many as 275,000 Ohioans will ultimately be better off because of it. And if every governor followed suit, another 5.4 million Americans could gain access to health care next year.
So, the bottom line is in just one month, despite all the problems that we've seen with the website, more than 500,000 Americans could know the security of health care by January 1, many of them for the first time in their lives. And that's life-changing and it's significant.
That still leaves about 1 million Americans who successfully made it through the website, now qualified by insurance, but haven't picked a plan yet. And there's no question that if the website were working as it's supposed to, that number would be much higher of people who've actually enrolled. So that's problem number one, making sure that the website works the way it's supposed to.
It's gotten a lot better over the last few weeks than it was on the first day, but we're working 24/7 to get it working for the vast majority of Americans in a smooth, consistent way.
The other problem that has received a lot of attention concerns Americans who've received letters from their insurers that they may be losing the plans they bought in the old individual market, often because they no longer meet the law's requirements to cover basic benefits like prescription drugs or doctor's visits.
Now, as I indicated earlier, I completely get how upsetting this can be for a lot of Americans, particularly after assurances they heard from me that if they had a plan that they liked, they could keep it.
And, to those Americans, I hear you loud and clear. I said that I would do everything we can to fix this problem, and today I'm offering an idea that will help do it.
Already, people who have plans that pre-date the Affordable Care Act can keep those plans, if they haven't changed. That was already in the law. That's what's called a grandfather clause. It was included in the law.
Today, we're gonna extend that principle both to people whose plans have changed since the law took effect and to people who bought plans since the law took effect.
So state insurance commissioners still have the power to decide what plans can and can't be sold in their states, but the bottom line is insurers can extend current plans that would otherwise be canceled into 2014, and Americans whose plans have been canceled can choose to re-enroll in the same kind of plan.
We're also requiring insurers to extend current plans to inform their customers about two things. One, what protections these renewed plans don't include. Number two, that the marketplace offers new options with better coverage and tax credits that might help you bring down the cost.
So, if you received one of these letters, I'd encourage you to take a look at the marketplace. Even if the Web site isn't working as smoothly as it should be for everybody yet, the plan comparison tool that lets you browse costs for new plans near you is working just fine.
Now, this fix won't solve every problem for every person. But it's gonna help a lot of people. Doing more will require work with Congress. And I've said from the beginning, I'm willing to work with Democrats and Republicans to fix problems as they arise. This is an example of what I was talking about. We can always make this law work better.
It is important to understand, though, that the old individual market was not working well. And it's important that we don't pretend that somehow that's a place worth going back to. Too often, it works fine, as long as you stay healthy. It doesn't work well when you're sick.
So year after year, Americans were routinely exposed to financial ruin or denied coverage due to minor pre-existing conditions or dropped from coverage altogether, even if they paid their premiums on time. That's one of the reasons we pursued this reform in the first place. And that's why I will not accept proposals that are just another brazen attempt to undermine or repeal the overall law and drag us back into a broken system.
We will continue to make the case -- even the folks who choose to keep their own plans -- that they should shop around in the new marketplace, because there's a good chance that they'll be able to buy better insurance at lower cost.
So we're going to do everything we can to help the Americans who've received these cancellation notices. But I also want everybody to remember, there are still 40 million Americans who don't have health insurance at all. I'm not going to walk away from 40 million people who have the chance to get health insurance for the first time, and I'm not going to walk away from something that has helped the cost of health care grow at its slowest rate in 50 years.
So we're at the opening weeks of the project to build a better health care system for everybody, a system that will offer real financial security and peace of mind to millions of Americans.
It is a complex process. There are all kinds of challenges. I'm sure there will be additional challenges that come up. And it's important that we're honest and straightforward in terms, when we come up with a problem with these reforms and these laws, that we address them.
But we've got to move forward on this. It took 100 years for us to even get to the point where we could start talking about and implementing a law to make sure everybody's got health insurance. And my pledge to the American people is, is that we're going to solve the problems that are there, we're going to get it right, and the Affordable Care Act is going to work for the American people.
Topics: Health Reform, Politics, Insurance, Marketplace
President Barack Obama discussed the rollout of the federal health law in a White House speech Monday. In the excerpt above, he discusses the technical problems with the federal health insurance marketplace website and what his administration is doing to help consumers get enrolled in an insurance plan.
PRESIDENT BARACK OBAMA: The point is the essence of the law -- the health insurance that's available to people -- is working just fine. In some cases, actually, it's exceeding expectations. The prices are lower than we expected, the choice is greater than we expected.
But the problem has been that the website that's supposed to make it easy to apply for and purchase the insurance is not working the way it should for everybody. And there's no sugarcoating it. The website has been too slow. People have been getting stuck during the application process. And I think it's fair to say that nobody is more frustrated by that than I am, because -- precisely because the product is good, I want the cash registers to work, I want the checkout lines to be smooth because I want people to be able to get this great product.
And there's no excuse for the problems. And these problems are getting fixed. But while we're working out the kinks in the system, I want everybody to understand the nature of the problem.
First of all, even with all the problems at healthcare.gov, the website is still working for a lot of people, just not as quick or efficient or consistent as we want.
And although many of these folks have found that they had to wait longer than they wanted, once they complete the process, they're very happy with the deal that's available to them, just like Janice is.
Second, I want everybody to remember that we're only three weeks into a six-month open enrollment period when you can buy these new plans.
Keep in mind, the insurance doesn't start until Jan. 1. That's the earliest that the insurance can kick in. No one who decides to purchase a plan has to pay their first premium until Dec. 15. And unlike the day after Thanksgiving sales for the latest Play Station or flatscreen TVs, the insurance plans don't run out. They're not going to sell out. They'll be available through the marketplace throughout the open-enrollment period. The prices that insurers have set will not change. So everybody who wants insurance through the marketplace will get insurance. Period. Everybody who wants insurance through the marketplace will get insurance.
Third, we are doing everything we can possibly do to get the websites working better, faster, sooner. We've got people working overtime, 24/7, to boost capacity and address the problems. Experts from some of America's top private sector tech companies who, by the way, have seen things like this happen before -- they want it to work. They're reaching out; they're offering to send help.
We've had some of the best I.T. talent in the entire country join the team. And we're well into a tech surge to fix the problem. And we are confident that we will get all the problems fixed.
Number four, while the website will ultimately be the easiest way to buy insurance through the marketplace, it isn't the only way. Now, I want to emphasize this: Even as we redouble our efforts to get the site working as well as it's supposed to, we're also redoubling our efforts to make sure you can still buy the same quality, affordable insurance plans available on the marketplace the old- fashioned way, off-line, either over the phone or in person.
And, by the way, there are a lot of people who want to take advantage of this who are more comfortable working on the phone, anyway, or in person.
So, let me go through the specifics as to how you can do that, if you're having problems with the website, or you just prefer dealing with a person.
Yesterday, we updated the website's home page to offer more information about the other avenues to enroll in affordable health care until the online option works for everybody. So, you'll find information about how to talk to a specialist who can help you apply over the phone, or to receive a downloadable application you can fill out yourself and mail in.
We've also added more staff to the call centers where you can apply for insurance over the phone. Those are already, they've been working, but a lot of people have decided first to go to the website.
But keep in mind, these call centers are already up and running. And you can get your questions answered by real people 24 hours a day, in 150 different languages.
The phone number for these call centers is 1-800-318-2596. I want to repeat that, 1-800-318-2596.
Wait times have averaged less than one minute so far on the call centers, although I admit that the wait times probably might go up a little bit now that I've read the number out loud on national television.
But the point is, the call centers are available. You can talk to somebody directly, and they can walk you through the application process. And I guarantee, if one thing's worth the wait it's the safety and security of health care that you can afford or the amount of money that you can save by buying health insurance through the marketplaces.
Once you get on phone with a trained representative, it usually takes about 25 minutes for an individual to apply for coverage, about 45 minutes for a family. Once you apply for coverage, you'll be contacted by mail -- by email or postal mail about your coverage status.
But you don't have to just go through the phone. You can also apply in person with the help of local navigators. These are people especially trained to help you sign up for health care and they exist all across the country. Or you can go to community health centers and hospitals.
Just visit localhelp.healthcare.gov to find out where in your area you can get help and apply for insurance in person.
And finally, if you've already tried to apply through the website and you've been stuck somewhere along the way, do not worry. In the coming weeks, we will contact you directly, personally with a concrete recommendation for how you can complete your application, shop for coverage, pick a plan that meets your needs and get covered once and for all.
So here's the bottom line: the product, the health insurance is good. The prices are good. It is a good deal. People don't just want it, they're showing up to buy it. Nobody is madder than me about the fact that the website isn't working as well as it should, which means it's going to get fixed.
And in the meantime, you can bypass the website and apply by phone or in person. So don't let problems with the website deter you from signing up or signing your family up or showing your friends how to sign up, because it is worth it. It will save you money. If you don't have health insurance, if you've got a pre-existing condition, it will save you money, and it will give you the security that your family needs.
In fact, even with the website issues, we've actually made the overall process of buying insurance through the marketplace a lot smoother and easier than the old way of buying insurance on your own. Part of the challenge here is that a lot of people may not remember what it's like to buy insurance the traditional way.
The way we've set it up, there are no more absurdly long application forms, there's no medical history questionnaire that goes on for pages and pages, there's no more getting denied because you've had a pre-existing condition. Instead of contacting a bunch of different insurers one at a time, which is what Janice and a lot of people who were shopping on the individual market for health insurance had to do, there's one single place you can go shop and compare plans that have to compete for your business. There's one single phone number you can call for help.
And once the kinks in the website have been ironed out, it will be even smoother and even easier. But in the meantime, we will help you sign up, because consumers want to buy this product and insurance companies want to sell it to you.
Topics: Health Reform, Marketplace, Insurance, Insuring Your Health
Insuring Your Health columnist Michelle Andrews helps you navigate the new insurance marketplaces that are scheduled to launch on Oct. 1.
<< View Previous Video
Q: Do I have to buy through the marketplace or can I get my insurance on the private market?
A: If you have good coverage available to you, either through your job, Medicare or Medicaid, you probably won’t need to shop for coverage through a marketplace. If you don’t have such coverage though, in most states you'll be able to look for coverage either through the marketplace or on the private market next year. The District of Columbia and Vermont are the only exceptions; all of their individual and small-group policies will be sold through the exchanges.
In other states, new individual and small-group plans sold on the exchanges or in the private market must all cover the same package of 10 essential health benefits and conform to the same cost-sharing standards. But premium tax credits and cost-sharing subsidies that will make coverage more affordable will only be available for plans purchased through the marketplaces. That's worth keeping in mind.
If you make more than 400 percent of the federal poverty level-about $46,000 for an individual or $94,000 for a family of four, you won't be eligible for subsidies on the exchanges and may want to shop there and in the private market. If you're currently insured and you want to hang onto the plan you have, you can do that on the private market as well.
More From This Series: Shopping For Coverage
More Consumer Topics: Insuring Your Health
Q: How many choices will consumers have in a marketplace? Will PPOs and HMOs be included?
A: The number of plans that consumers will have to choose from is likely to vary widely. In some states, only a couple of insurers have announced plans to offer policies though the marketplace, while in others there may be a dozen or more. Even within a state, there will be differences in the number of plans available in different areas. You can expect that insurers will offer a variety of types of plans, including familiar models like PPOs and HMOs.
There will be some important differences, however. All of the plans sold on the exchanges will offer a similar package of 10 essential health benefits that provide comprehensive coverage. How much consumers will owe in cost sharing will vary depending on which of four types of plan they choose.
In a platinum plan, the most generous plan offered, the insurer will pay 90 percent of covered medical expenses and the consumer will be responsible for 10 percent, on average. In a gold plan, the insurer will pay 80 percent and the consumer 20 percent. Silver plans will pay 70 percent and bronze plans 60 percent.
There will also be a high deductible catastrophic plan that's available to people up to age 30. It will cover only limited benefits before the deductible is met.
Q: When a consumer enrolls in a marketplace plan is it for a year of coverage or longer? Can an insurer drop a consumer?
A: As long as you keep up with your insurance premiums and don't lie on your application for insurance by claiming that you're younger than you really are, for example, your insurer can't drop you.
Generally, people will be able to enroll in or change plans once a year during the annual open enrollment period. This first year, open enrollment on the exchanges will run for six months, from Oct. 1 through March of next year. But in subsequent years the time period will be shorter, just a few months long.
There are certain circumstances when people will be able to change plans or add or drop someone from coverage outside the regular annual enrollment period. This could happen if you lose your job, for example, or get married, divorced or have a child.
Q: Will the premiums be more expensive than what is offered on the individual market? How about co-pays, are they comparable?
A: New individual and small-group plans offered both through the health insurance marketplaces and on the private market will all have to offer a package of 10 essential health benefits, including prescription drugs, emergency and hospital care, and maternity care, among other things. They will also have to meet the same standards for consumer cost sharing. So experts don't expect that premiums on or off the exchanges will be very different.
Here's how it will work. There will be four types of plans with different levels of consumer cost sharing. In a platinum plan, the insurer will pay 90 percent of covered medical expenses and the consumer will be responsible for 10 percent, on average. In a gold plan, the insurer will pay 80 percent and the consumer 20 percent. Silver plans will pay 70 percent and bronze plans 60 percent. Within each type of plan, insurers will generally have some flexibility to vary deductibles, copayments and coinsurance.
Even though premiums may be comparable on and off the exchanges, there's a key difference to keep in mind. Consumers who buy a health plan through the online marketplaces may be eligible for premium tax credits there that can substantially reduce the sticker price on their policy.
Q: Is everyone who qualifies treated the same in this new marketplace? Do younger people get lower rates and people with pre-existing conditions get higher rates?
A: Starting next year, no one can be charged higher rates for health insurance because they have pre-existing medical conditions. But there are a few other individual details that insurers can factor in when setting premiums, including age and tobacco use. The law allows premiums for older people to be up to three times higher than those of younger people. That may seem like a lot, but in plans currently sold on the individual market, the differential between the two is often much greater.
The law also allows insurers to charge smokers 50 percent higher premiums for coverage on the exchanges than non-smokers. Smokers do tend to have higher health care costs than non-smokers. Still, a handful of states have decided not to implement this surcharge. They figure that the higher premiums may make coverage unaffordable for some smokers, who typically have lower incomes in the first place. Besides, they say, evidence is scant that charging people more for health insurance actually encourages them quit smoking.
Q: Is there is basic package of benefits that each insurance company must offer if it is part of a marketplace?
A: To ensure that plans sold on the state-based marketplaces provide comprehensive coverage, every plan must cover 10 so-called essential health benefits. The required benefits include prescription drugs, emergency and hospital care, doctor visits, maternity and mental health services, rehabilitation and lab services, among others. In addition, recommended preventive services must be covered without any out-of-pocket costs to consumers.
If states have additional mandated benefits, for infertility treatment or autism, for example, those services will also generally be included in the plans offered through the state marketplaces.
Q: Who can get government subsidies to help pay for insurance obtained through a marketplace? How will that work?
A: There are two types of subsidies that will be available. People with incomes up to 400 percent of the federal poverty level--about $46,000 for an individual or $94,000 for a family of four--may be eligible for premium tax credits to reduce the price of a policy. Cost-sharing subsidies that reduce a plan's deductibles, copayments and total out-of-pocket costs will be available to people with incomes up to 250 percent of the poverty level, or about $29,000.
During the online application process, you'll be asked to provide information about your income, which will be fed into a centralized data hub to determine your eligibility for subsidies.
Subsidies will generally be sent directly to the insurer, and the amount you owe in premiums or cost-sharing will be reduced.
If your income increases during the year, notify the exchange promptly so that you can avoid having to pay any tax credit overpayments. On the other hand, if your income goes down you could be eligible for a bigger subsidy. Either way it's important to notify the exchange if your income changes.
Q: If I don't currently have coverage and I'm required to obtain it because of the individual mandate, how can an exchange help me?
A: Through the marketplace, you can easily compare health plans in your area. But probably the biggest advantage to using the state marketplace is that through it you can find out if you're eligible for subsidies that will help make any health plan you buy on the exchange more affordable. Subsidies will be available to people with incomes up to 400 percent of the federal poverty level, or about $46,000 for an individual. In addition, if you're low income you can also learn if you or your family members are eligible for Medicaid or the Children's Health Insurance Program through the marketplace. If it turns out that you can't find a plan that costs less that 8 percent of your income, the marketplace is where you can apply for an exemption from the individual mandate.
Topics: Aging, Delivery of Care
Two years ago Pathways to Housing helped a homeless Alicia O. find an apartment and get regular medical care, the first steps on her way to changing her circumstances, and improving her life.
Read Related Stories:
<< View Previous Video
Q: When must a consumer enroll in an exchange in order to start getting insurance benefits in January, 2014?
A: The online marketplaces will open for business on Oct. 1. That's when people will be able to begin checking out the health plans that are available in their area and signing up. The open enrollment period will run through March of 2014. If you want coverage to begin on Jan. 1, though, you'll generally need to sign up by Dec. 15 of this year, although some states may allow you a little more time. Still, consumer advocates that I've spoken with say that it's probably not a good idea to put off applying for coverage until the last minute, because during this first year of operation the exchanges will probably be working out some kinks and the process may take longer than expected.
Q: How does someone qualify to enroll in a marketplace? Are the rules the same in every state?
A: Almost anyone can shop for health insurance through the online state marketplaces, sometimes called exchanges, that will open in October. The only real exception is immigrants who are in this country illegally. They can't buy coverage on the exchanges under any circumstances. That's true whether your state is running its own exchange or letting the federal government do so.
Even though practically anyone can shop for coverage on a state exchange, only certain people will qualify for subsidies to make coverage more affordable there. Subsidies will be available to people with incomes up to 400 percent of the federal poverty level. That's about $46,000 for one person or $94,000 for a family of four.
Subsidies will only be available to people who don't have good coverage available elsewhere. So if you're eligible for Medicare or Medicaid, you can't get subsidies on the exchanges. Likewise, if your employer offers good coverage you won't qualify for subsidies. Good coverage in this case means a plan that doesn't cost more than 9 1/2 percent of your income and pays at least 60 percent of your covered medical expenses. If your employer plan comes up short in either of those areas, you could qualify for subsidized coverage on an exchange.
Topics: Politics, Health Reform, Medicare, Health Costs
With the Congressional Budget Office projecting a reduced cost for a long-term "doc fix," Congress may seize the opportunity to end the annual adjustments to Medicare reimbursement rates. Mary Agnes Carey and CQ Roll Call's Emily Ethridge discuss.
>> Listen to their conversation here.
MARY AGNES CAREY: Welcome to Health on the Hill. I’m Mary Agnes Carey. Amid the partisan battles over the 2010 health care law known as Obamacare, lawmakers may be close to bipartisan consensus on another health care issue – overhauling how Medicare pays physicians. Three Capitol Hill committees are discussing how to replace the “Sustainable Growth Rate” – known as the SGR. For years, Congress has passed last-minute patches to the formula to prevent Medicare physician payment cuts. And while there isn’t a unified approach or agreement on how to finance a fix, many analysts say Congress appears closer than ever to replacing the SGR. With us to discuss the latest developments is Emily Ethridge, a health care reporter for CQ Roll Call. Hi Emily.
EMILY ETHRIDGE, CQ ROLL CALL: Hi Mary Agnes.
MARY AGNES CAREY: It’s great to have you here.
EMILY ETHRIDGE: Thanks for having me.
MARY AGNES CAREY: Sure. Give us a little bit of background on the Medicare SGR. When was it created, what was its purpose, and why are people talking about repealing it?
EMILY ETHRIDGE: So this was part of the 1997 Balanced Budget Act. If you go all the way back to then, and we really thought this was a formula that would keep the payment rates for Medicare physicians more in line with the overall growth of the economy. For a few years, it worked out pretty well. For the first five years, it seemed OK. It basically puts a limit on how much physician payments can grow.
Around 2002, things started to get bad. It started calling for cuts. Every year since 2002, it has called for more and more cuts. Drastic – now I think it’s about 25 percent cuts to Medicare physicians if we let this formula take place. However, Congress hasn’t let it actually take place in the past 10 years. They keep doing these short-term patches, which is what everyone knows as the “doc fix.” That makes it actually more expensive every time they don’t let the cuts happen, they give physicians instead this tiny little raise and that means that every year the formula calls for deeper and deeper cuts.
MARY AGNES CAREY: So, as we know, before the August break, the House Energy and Commerce Committee passed a bill to repeal and replace the SGR. How would that measure work and how would they pay for it?
EMILY ETHRIDGE: We don’t know how they’ll pay for it and that is the biggest sticking point right now. That is going to be the thing that really makes or breaks whether this bill happens. Because it’s a pretty big price tag. Only repealing the SGR – just taking away the SGR for 10 years – is about $140 billion. That’s doing that without doing anything else you might want to do. Any other kind of payment models, any other Medicare reforms you might want to try to make. So we’re looking at a pretty big price tag on this bill and right now we have no idea how they make up for that cost.
But the Energy and Commerce bill, it would get rid of the SGR which is a huge goal for everybody. Then we would have a little transition period of five years, where they would just set small payment updates for all Medicare physicians. Then after that, physicians would be able to move into these alternative payment models. The idea here is to get away from the “fee-for-service” Medicare that most stakeholders and health care economists really hate.
MARY AGNES CAREY: That’s traditional Medicare.
EMILY ETHRIDGE: That’s traditional Medicare, that’s what we have now, fee-for-service. You perform a service, Medicare pays the doctor. People say it encourages volume of services over really good quality care. So they would try to put in these new models, under the Energy and Commerce bill, to get away from that and start rewarding the quality of care. Or having better outcomes while saving money for Medicare overall.
MARY AGNES CAREY: And also, there are other committees. In the House, we have the Ways and Means Committee working on the issue. In the Senate, it’s the Finance Committee. Do we know enough now to tell how those approaches might be different from each other and from what Energy and Commerce has done?
EMILY ETHRIDGE: Everyone says Energy and Commerce has a pretty good base of a bill and they like it. However, those other committees don’t like it enough to say that we’re just going to take that up, maybe make a few tweaks here and there and send it along on its way, which would be the fastest option. They seem to each have more, bigger changes in mind. Everyone really wants to put their own stamp on this bill. So I feel like we’re going to get similar-looking bills but not the exact same bill from all three committees.
MARY AGNES CAREY: Now as we both know -- you and I have reported on this for years -- the SGR has been with us for a long time. What’s the reason for all this momentum right now, and is this Congress really going to act to make a change?
EMILY ETHRIDGE: As you said this is really the closest we’ve ever gotten to having the SGR go away. The Energy and Commerce Committee marking up a bill and approving it unanimously – 51 to 0 – so it’s bipartisan support to get rid of this – is farther than we’ve ever come in the history of the SGR. The reason that really put the momentum behind this is, yes, Congress has been working on this for a long time, but earlier this year we got a very favorable score from the CBO, that $140 billion I mentioned earlier. That’s the lowest score, the lowest price tag for getting rid of the SGR that we’ve ever seen, really, in the past, I’d say, five years. So everyone said basically it’s a fire sale on the SGR. Let’s go for it and strike while the iron’s hot. Get rid of this before CBO changes its mind.
MARY AGNES CAREY: While it’s only $140 billion in Washington language it still is a $140 billion. So what are the likely ways for financing? What are the options?
EMILY ETHRIDGE: Traditionally, when they do these small patches they take money out of Medicare somewhere else. They find other ways to cut provider payments elsewhere, maybe cut specialty doctors instead of physicians, or hospitals. They look to Medicare to try to move money from one pile to another. That could definitely happen here, although again $140 billion, plus more most likely, is a big ask. Republicans would love to cut that money from the health care law, from the overhaul, I don’t really think Democrats will be on board with that, but maybe if they could get some of it from it from the health care law, that might be part of a bigger compromise that could happen.
There’s also a lot of talk about tax reform -- tax code overhaul – in some of these committees right now, in Ways & Means and Finance. So it’s possible they might find some things in the tax code that produce savings, and they might just tack that on to pay for it instead.
MARY AGNES CAREY: Speaking of the health care law, we know the House Republicans voted several times to defund all or part of that measure. Are we going to see more of those votes this fall?
EMILY ETHRIDGE: I definitely expect to see more votes in the House on repealing or trying to de-fund the health care law. Right now you have a big group of Republicans who want to de-fund the law – stop it all together – and are willing to put some things at risk to get that to happen.
You don’t have House leadership on board with that yet, and we really haven’t reached a critical mass of those Republicans who want to de-fund the law yet. It’s about a third of the House Republican caucus. So it remains to be seen whether we actually will see that vote this month or possibly next month. But it’s something they’re really working on. And I think if they don’t get that de-fund vote, they’ll get some other repeal votes or delay votes just to keep everybody satisfied.
MARY AGNES CAREY: And I think you’re talking here in the sense of de-funding as part of the continuing resolution to fund the government, correct?
EMILY ETHRIDGE: Right. Exactly.
MARY AGNES CAREY: So if that one doesn’t occur, you may see some more of these rifle shots to de-fund pieces of the ACA.
EMILY ETHRIDGE: Especially when we have a debt ceiling fight again in October, this could certainly come up as part of that.
MARY AGNES CAREY: Thanks so much, Emily Ethridge of CQ Roll Call.
EMILY ETHRIDGE: You’re welcome, thank you.
This was produced by Kaiser Health News with support from The SCAN Foundation.
Topics: Politics, Health Reform
Republicans have made it their "holy grail, their number one priority" to deny millions of Americans health insurance coverage through the 2010 health care law, President Obama said Friday.
During a White House news conference, Obama also said that the American public would have a hard time understanding why Republicans would choose to shut down the federal government over funding for the health law. Some Republicans are pushing their congressional leaders to not agree to any legislation to fund the government beyond Sept. 30 if it includes any money for the health law’s implementation. Here is the complete video segment and transcript of the health-care related part of the news conference:
QUESTION, ED HENRY, FOX NEWS: I want to ask you about two important dates that are coming up. October 1st you've gotta implement your signature health care law. You recently decided on your own to delay a key part of that. And I wonder, if you pick and choose what parts of the law to implement, couldn't your successor down the road pick and choose whether they'll implement your law and keep it in place
PRESIDENT OBAMA: I didn't simply choose to delay this on my own. This was in consultation with businesses all across the country. Many of whom are supportive of the Affordable Care Act, but -- and who -- many of whom, by the way, are already providing health insurance to their employees but were concerned about the operational details of changing their H.R. operations if they've got a lot of employees, which could be costly for them, and them suggesting that there may be easier ways to do this.
Now, what's true, Ed, is that in a normal political environment, it would have been easier for me to simply call up the speaker and say, "You know what? This is a tweak that doesn't go to the essence of the law. It has to do with, for example, are we able to simplify the attestation of employers as to whether they're already providing health insurance or not. It looks like there may be some better ways to do this. Let's make a technical change to the law."
That would be the normal thing that I would prefer to do. But, we're not in a normal atmosphere around here when it comes to, quote/unquote, "Obamacare." We did have the executive authority to do so and we did so. But this doesn't go to the core of implementation.
Let me tell you what is the core of implementation. It's already taken place. As we speak right now, for the 85 percent of Americans who already have health insurance, they are benefiting from being able to keep their kid on their -- on their plan if their kid is 26 or younger. That's benefiting millions of young people around the country, which is why lack of insurance among young people has actually gone down. That's in large part attributable to the steps that we've taken.
You've got millions of people who've received rebates because part of the Affordable Care Act was to say that if an insurance company isn't spending 80 percent of your premium on your health care, you get some money back. And lo and behold, people have been getting their money back.
It means that folks who've been bumping up -- up with lifetime limits on their insurance that leaves them vulnerable, that doesn't exist. Seniors have been getting discounts on their prescription drugs. That's happening right now. Free preventive care, mammograms, contraception, that's happening right now.
I met a young man today on a bill-signing I was doing with the student loan bill who came up to me and said, "thank you." He couldn't have been more than 25, 26 years old -- "Thank you. I have cancer. Thanks to the Affordable Care Act, working with the California program, I was able to get health care and I'm now in remission." And so, right now, people are already benefiting.
Now, what happens on October 1st, in 53 days, is for the remaining 15 percent of the population that doesn't have health insurance, they're going to be able to go on a website or call up a call center and sign up for affordable quality health insurance at a significantly cheaper rate than what they can get right now on the individual market. And if even with lower premiums they still can't afford it, we're going to be able to provide them with a tax credit to help them buy it.
And between October 1st into March, there will be an open enrollment period in which millions of Americans for the first time are going to be able to get affordable health care.
Now, I think the really interesting question is why it is that my friends in the other party have made the idea of preventing these people from getting health care their holy grail, their number one priority. The one unifying principle in the Republican Party at the moment is making sure that 30 million people don't have health care. And presumably, repealing all those benefits I just mentioned -- kids staying on their parents' plan; seniors getting discounts on their prescription drugs, I guess a return to lifetime limits on insurance; people with preexisting conditions continuing to be blocked from being able to get health insurance.
That's hard to understand as an agenda that is going to strengthen our middle class. At least they used to say, "Well, we're going to replace it with something better." There's not even a pretense now that they're going to replace it with something better. The -- the notion is simply that those 30 million people, or the 150 million who are benefiting from the other aspects of affordable care, will be better off without it. That's their assertion, not backed by fact, not backed by any evidence. It's just become an ideological fixation.
Well, I tell you what, they're wrong about that. There is no doubt that in implementing the Affordable Care Act, a program with this significance, there are going to be some glitches. No doubt about it. There are going to be things where we say, "You know what? We should have thought of that earlier"; or "this would work a little bit better"; or "this needs an adjustment."
That was true of Social Security. That was true of Medicare. That was true of the children's health insurance program, that was true on prescription drug program Part D that was rolled out by a Republican president and supported by Republicans who are still in the House of Representatives. That's true, by the way, of a car company rolling out a new car. It's true of Apple rolling out the new iPad.
So, you know, you will be able to whenever you want during the course of the next six months and probably the next year find occasions where you say, ah-ha, you know what, that could have been done a little better or that thing -- they're kind of making an administrative change. That's not how it was originally thought this thing was going to work.
Yes. Exactly. Because our goal is to actually deliver high quality health care for people and to reform the system so costs start going down and people start getting a better bang for the buck. I make no apologies for that.
And let me just make one last point about this.
The idea that you would shut down the government unless you prevent 30 million people from getting health care is a bad idea. What you should be thinking about is how can we advance and improve ways for middle class families to have some security so that if they work hard, they can get ahead and their kids can get ahead.
QUESTION, JESSICA YELLIN, CNN: Thank you, Mr. President.
And following on what you just said, Republicans in the House might give that you choice soon to either allow the government to shut down or see Obamacare defunded. Would you choose to let the government shut down to ensure that Obamacare remains funded?
OBAMA: Well, you know, I'm not going to engage in hypotheticals.
I can tell you that the American people would have difficulty standing why we would weaken our economy, shut down our government, shut down vital services, have people who are not getting paid, who then can't go to restaurants or shop for clothes or all the other things that we're doing here, because Republicans have determined that they don't want to see these folks get health care.
Again, they used to say they had a replacement. That never actually arrived, right?
I've been hearing about this whole replace thing for two years. Now I just doesn't hear about it, because basically they don't have an agenda to provide health insurance to people at affordable rates.
And the idea that you would shut down the government at a time when the recovery is getting some traction, where we're growing, although not as fast as we need to, where the housing market is recovering, although not as fast as we would like, that we would precipitate another crisis here in Washington that no economist thinks is a good idea.
I'm assuming that they will not take that path.
I have confidence that common sense in the end will prevail.
QUESTION: And if they do, sir? Do you have to make that choice?
OBAMA: We'll see what happens. We got a couple months.
QUESTION: When is the last time you spoke to Speaker Boehner about the budget?
OBAMA: Fairly recently. Yeah, probably right before they left.
KHN's Mary Agnes Carey talks with Politico Pro's Paige Winfield Cunningham about the latest Republican effort to delay or repeal Obamacare provisions, including putting off a mandate on individuals to carry health insurance.
MARY AGNES CAREY: Welcome to Health on the Hill, I'm Mary Agnes Carey. The Obama administration's decision to postpone, by one year, a requirement that companies with 50 or more workers offer health insurance or pay a fine has brought heavy criticism from Republicans on Capitol Hill.
Today, members of the House Ways & Means health subcommittee examined the administration's decision to postpone the health law's employer mandate. With us to discuss the hearing is Page Winfield Cunningham of Politico Pro. Thanks for joining us.
PAIGE WINFIELD CUNNINGHAM: I'm glad to be here.
MARY AGNES CAREY: Paige, you and I have covered a lot of these hearings on the Affordable Care Act, which is also known as the ACA. And today, I heard a lot of what I've heard at some of those other hearings: Democrats defending the law, Republicans attacking it. What was new?
PAIGE WINFIELD CUNNINGHAM: You’re absolutely right. We've heard the same arguments over and over again from Republicans. But what I think was new today was that they do have a new piece of ammunition to throw at the same target. And that is now that the administration is giving employers another year to comply with the law, Republicans are trying to make the case that this is really unfair to individuals and families who are also going to be faced with this mandate. And they're saying, "If you’re going to treat one person, give one party the special treatment, you really should apply it across the board to everyone."
But, they're really trying to use that argument to aim at the same thing, and that is the overall health care law. So you're hearing a lot of the same arguments that the law is not ready; that the administration is saying it will be, but it won’t; other parts of the law have already been repealed; the exchanges aren't all rolling out as the administration thought with some states refusing to run them themselves. So they're trying to feed all of this into that broader argument that the health care law is just fundamentally flawed.
MARY AGNES CAREY: What did Democrats say about this delay in the employer mandate? Do they support it?
PAIGE WINFIELD CUNNINGHAM: Absolutely. They're trying to make the case that the administration is just listening to the business community, which has been very vocal over the last year, saying that they need more time, they need more details about the regulations, that that they’re not going to be ready on Jan. 1.
So Democrats are saying: "Hey, the administration is doing its best job to roll out a really big, complicated law. They’re just listening and being attentive." You also saw ranking member Jim McDermott (D-Wash.) talk a lot about how this is really just one small piece of the law. It’s not really going to affect that many people. There was a small portion of folks that were expected to get employer-sponsored coverage next year. But in the broad scheme of things, this is just one piece of the puzzle.
So they’re saying Republicans are really blowing this up too much.
MARY AGNES CAREY: This isn't the only hearing on this subject. Kevin Brady (R-Texas), who heads the Ways & Means health subcommittee, said they're going to have another hearing next week. They'll have a witness from Treasury there to discuss the delay. We know there are other Hill committees with hearings on the horizon.
How might those be different? What might we learn in addition at those hearings?
PAIGE WINFIELD CUNNINGHAM: I think Republicans are really trying to capitalize on this opportunity before the August recess, so you’re right, they’re rolling out a lot of hearings. We might even see one come out of the Education & the Workforce Committee, which has a little bit of jurisdiction.
I think they’re trying to really drill down and find out why the administration made this decision, what was going on behind the scenes. But mostly they really, I think, want to call the administration out and make them publicly talk about this and really put them on the hot seat and force them to answer questions about this. There had been some suggestions by Republicans that the administration didn’t have the legal authority to do this. So that’s probably going to be part of the discussions, as well.
MARY AGNES CAREY: You mentioned this is now in the political arena, as well. House Speaker John Boehner has promised additional votes on the ACA. Tell us about those.
PAIGE WINFIELD CUNNINGHAM: It is going to be a really busy month. There could be three votes this month before they leave for recess. One would be to also delay the mandate for individuals and families. That could possibly be paired with another bill that would basically do what the administration has already done, which is delay the employer mandate. The Republicans want to force Democrats to vote on that [employer provision], and then hold a vote on individuals and families, to kind of call them out that way. And then a third vote would be on a bill sponsored by Congressman Tom Price. That would be to basically ban IRS from doing anything to implement the law.
So we could see three votes on that coming down the pipeline very soon.
MARY AGNES CAREY: Who does this bring political leverage to in the midterms? The Republicans? The Democrats? Both?
PAIGE WINFIELD CUNNINGHAM: It's a little hard to say at this point. Probably Republicans, because they’ve been trying to make a case all along that this law was not going to be ready in time, and here’s a piece of evidence they can point to. I guess the thing working in favor for the Democrats is: The business community had been very, very vocal about wanting a delay and wanting some changes. This decision is allowing the administration to say: Hey, we’re listening to you, we’re attentive to what the stakeholders are saying.
So we’ll see how it plays out. But Republicans are going to keep this in the forefront as much as they can.
MARY AGNES CAREY: Thank you so much, Paige Winfield Cunningham.
<< Back To Main Story: Pittsburgh Researchers Look For Ways To Prevent Depression In Seniors
Marilyn Franz talks about working to get her life back.
Video by Judy Graham and Francis Ying.
In California Friday, President Barack Obama praised the health law benefits already in place and talked about the state's health insurance marketplace. He also placed a special emphasis on touting the law to the state's Latino population.
Here's a transcript of his remarks:
OBAMA: These leaders from California's government, the California Endowment, and major Spanish-language media outlets have joined together to help implement the Affordable Care Act here in California and to educate folks about how to sign up and shop for quality affordable plans. And their efforts have already shown some excellent results in the biggest insurance market in the country.
There are two main things that Americans need to know when it comes to the Affordable Care Act and what it means for you. First of all, if you're one of the nearly 85 percent of Americans who already have insurance, either through Medicare or Medicaid or your employer, you don't have to do a thing. You've just got a wide array of new benefits, better protections, and stronger cost controls that you didn't have before, and that will over time improve the quality of the insurance that you've got, benefits like free preventive care, checkups, flu shots, mammograms, and contraception.
You are now going to be able to get those things through your insurance where they previously were not -- didn't have to be provided, protections like allowing people up to the age of 26 to stay on their parents' health care plans, which has already helped 6 million Americans, including 6 million young Latino Americans.
Cost controls like requiring insurance companies to spend at least 80 percent of the money that you pay in premiums in your actual health care costs, as opposed to administrative costs or CEO pay, not overhead, but that money has to be spent on you. And if they don't meet that target, they actually have to reimburse you. So in California, we're already getting reports that insurers are giving rebates to consumers and small-business owners to the tune of $45 million this year.
So already we're seeing millions of dollars of rebates sent back to consumers by insurance companies as a consequence of this law. All of that is happening because of the Affordable Care Act. All of this is in place right now already for 85 percent of Americans who have health insurance.
By the way, all of this is what the Republican Party has now voted 37 times to repeal, at least in the House of Representatives. And my suggestion to them has been, let's stop re-fighting the old battles and start working with people like the leaders who are on stage here today to make this law work the way it's supposed to.
We're focused on moving forward and making sure that this law works for middle-class families, and that brings me to the second thing that people need to know about the Affordable Care Act. If you're one of nearly 6 million Californians or 10 million -- tens of millions of Americans who don't currently have health insurance, you'll soon be able to buy quality, affordable care just like everybody else. And here's how.
States like California are setting up new online marketplaces, where beginning on October 1st of this year, you can comparison shop an array of private health insurance plans side-by-side, just like you were going online to compare cars or airline tickets, and that means insurance companies will actually have to compete with each other for your business. And that means new choices.
See, right now, most states don't have a lot of competition. In nearly every state, more than half of all consumers are covered by only two insurers, so there's no incentive to provide you a lot of choices or to keep costs down. The Affordable Care Act changes that.
Beginning next year, once these marketplaces are open, most states will offer new private insurance choices that don't exist today. And based on early reports, about 9 in 10 Americans expected to enroll in these marketplaces live in states where they'll be able to choose between five or more different insurers.
So, for example, here in California, 33 insurers applied to join the marketplace. Covered California then selected 13 based on access, quality and affordability, four of which are brand new to your individual market. So what's happening is, through the Affordable Care Act, we're creating these marketplaces with more competition, more choice. And so the question is, what happens to cost?
Now, a lot of the opponents of the Affordable Care Act said -- you know, they had all kinds of "sky is falling," doom-and-gloom predictions that not only would the law fail, but what we'd also see is costs would skyrocket for everybody. Well, it turns out we're actually seeing that -- in the states that have committed themselves to implementing this law correctly, we're seeing some good news. Competition and choice are pushing down costs in the individual market, just like the law was designed to do.
The 13 insurance companies that were chosen by Covered California have unveiled premiums that were lower than anybody expected. And those who can't afford to buy private insurance will get help reducing their out-of-pocket premiums even further with the largest health care tax cut for working families and small businesses in our history. So about 2.6 million Californians -- nearly half of whom are Latinos -- will qualify for tax credits that will in some cases lower their premiums a significant amount.
Now, none of this is a surprise. This is the way that the law was designed to work. But since everybody's been saying how it's not going to happen, I think it's important for us to recognize and acknowledge, this is working the way it's supposed to.
We've seen similar good news, by the way, not just here in California, but in Oregon and Washington. In states that are working hard to implement this law properly, we're seeing it work for people, for middle-class families, for consumers.
Now, that's not to say that everything's going to go perfectly right away. When you're implementing a program this large, there will be some glitches. There are going to be some hiccups. But no matter what, every single consumer will be covered by the new benefits and protections under this law permanently.
So the bottom line is, you know, you can listen to a bunch of political talk out there, negative ads and fear-mongering geared towards the next election, or alternatively you can actually look what's happening in states like California right now. And the fact of the matter is, through these exchanges, not only are the 85 percent of people who already have health insurance getting better protections and receiving rebates and being able to keep their kids on their health insurance until they're 26, and getting free preventive care, but if you don't have health insurance, and you're trying to get it through the individual market, and it's too expensive or it's too restricted, you now have these marketplaces where they're going to offer you a better deal because of choice and competition.
And if even at those lower rates and better insurance that you're getting through these marketplaces you still can't afford it, you're going to be getting tax cuts and tax credits through the Affordable Care Act that will help you afford it. And that's how we're going to make sure that millions of people who don't currently have health insurance or are getting a really bad deal on their health insurance are finally going to get it.
But -- and here's my final point. To take advantage of these marketplaces, folks are going to need to sign up. So you can find out how to sign up at healthcare.gov, healthcare.gov. Or here in California, you can sign up at coveredca.com, coveredca.com.
Because quality care is not something that should be a privilege. It should be a right. In the greatest country on Earth, we've got to make sure that every single person that needs health care can get it. And we've got to make sure that we do it in the most efficient way possible.
One last point I'm going to make on this, because there are a lot of people who currently get health insurance through their employers, the 85 percent who are already out there, and they may be saying, well, if -- if this law's so great, why is it that my premiums still went up?
Well, part of what's happening across the country is in some cases, for example, employers may be shifting more costs through higher premiums or higher deductibles or higher co-pays, and so there may still be folks who are out there feeling increased costs not because of the Affordable Care Act, but because those costs are being passed on to workers. Or insurance companies, in some cases, even with these laws in place are still jacking up prices unnecessarily.
So this doesn't solve the whole problem, but it moves us in the right direction. It's also the reason why we have to keep on implementing changes in how our health care system works to continually drive better efficiency, higher quality, lower cost. We're starting to see that. Health care cost inflation has gone up at the lowest rate over the last three years that we've seen in many, many years. So we're making progress in actually reducing overall health care costs while improving quality, but we're going to have to continue to push on that front, as well. That's also part of what we're doing in the Affordable Care Act. All right?
But the main message I want for Californians and people all across the country, starting on October 1st, if you're in the individual market, you can get a better deal. If you're a small business that's providing health insurance to your employees, you can get a better deal through these exchanges. You've got to sign up, healthcare.gov, or here in California, coveredca.com. All right? So, thank you very much.
Topics: Insuring Your Health, Insurance
Michelle Andrews answers a reader question about having to repay an insurer that says it reimbursed too much after the patient received care from an out-of-network provider.
QUESTION: I recently received a bill from my insurer related to a pre-approved operation three years earlier with an out-of-network provider. The insurer says it mistakenly reimbursed me too much and I owe $9,100. Can they do this? – Lisa.
ANDREWS: They may be able to ask you to repay that money. These situations can come up for different reasons, but often you’ll see it in instances when someone receives care from an out-of-network providers, as you did. The insurer may send the check – or checks – directly to you, the health plan member, leaving it to you to pay the provider who delivered the care. According to insurance industry experts I spoke with, from the insurer’s perspective, that approach is sensible since they don’t have a contractual relationship with the out-of-network provider. Unfortunately that may mean that you – the health plan member – are responsible for repaying any amounts that the insurer sent you and later determines that it overpaid, even if you sent that money directly to the provider, perhaps without even cashing the check. If you want that money back to repay the insurer, you may have to go looking for it from the provider.
Topics: Health Reform, Politics
President Barack Obama gave a speech Friday on the health law, and he emphasized his administration's commitment to moving forward with a full rollout of all the law's provisions. Here is the transcript of the president's remarks released by the White House:
Thank you. Thank you so much, everybody, and welcome to the White House. I want to thank Carol for the wonderful introduction.
And let me just start off with a public service announcement to dads, partners, kids of America -- Sunday is Mother's Day. You should not forget. You can't go wrong with flowers, a homemade card, giving some mom -- giving mom some relief, some quiet time. That is appreciated.
So it's a day when we put moms first. And I still remember one time I said to Michelle -- this is back when we had just gotten married and I think Malia had just been born, and we were fussing around Mother's Day, and I said, but you know, how come we do so much stuff on Mother's Day? She says, because every other day is Man's Day. So this is like one day. And there was, as usual, profound insight in Michelle's remarks because moms so often put themselves last; so often they put everything else before themselves.
And that's particularly true when it comes to things like health care. Moms take care of us. ... Sick kids, aging parents, grumpy husbands. And I know there are lots of moms out there who often go without the care that they need, or the checkups they know they should get, because they're worrying that co-pay has to go to gas, or groceries, or the new soccer uniform instead. Or worse, they know the unfairness of being charged more for their health care just because they're a woman, or the stress of trying to manage a family budget when health care costs are impinging on it, or trying to insure a sick child only to be told "no" over and over again.
So we decided that needed to change. In a country as wealthy as this one, there was no reason why a family's security should be determined by the chance of an illness or an accident. We decided to do something about it.
Thanks to the women in this room and people all across the country, we worked really hard -- and it's now been more than three years since Congress passed the Affordable Care Act and I signed it into law. It's been nearly a year since the Supreme Court upheld the law under the Constitution. And, by the way, six months ago, the American people went to the polls and decided to keep going in this direction. So the law is here to stay.
And those of us who believe that every American deserves access to quality, affordable health care have an obligation to now make sure that full implementation moves forward the way it needs to.
Basically, there are two main things that the American people need to know about this law and what it means. First, if you're one of the nearly 85 percent of Americans who already have health insurance -- whether it's through your employer, or Medicare or Medicaid -- you don't have to do a thing. This law already provides you with a wide array of new benefits, tough new consumer protections, stronger cost control measures than existed before the law passed. And those things are already in place -- you're benefiting from, you just may not know it. Making sure that insurers can't take advantage of you. Making sure that your child can stay on your health insurance until they're 27 years old. So a lot of those provisions are already in place providing help and assistance to people all across the country.
Now, second, if you're one of the tens of millions who don't have health insurance, beginning this fall, you'll finally be able to compare and buy quality, affordable private plans that work for you. So that's what you need to know. If you've already got health insurance, this has just enhanced it. And if you don't, you're going to be able to get it.
For three years now, this law has provided real and tangible benefits to millions of Americans. Women in particular now have more control over their own care than ever before. And I'm pleased to be joined today by many women who wrote in to tell us what the Affordable Care Act means to them.
Carol Metcalf told us, "My oldest child is 22, recent college grad, a traumatic brain injury survivor with a rare genetic lung disease. Without the Affordable Care Act, he would have been removed from our family health insurance policy this year. And his health is excellent, but the cost of maintenance is overwhelming. And given his history, he would be virtually uninsurable under the old set of 'rules.' Instead of contemplating law school, all of his resources would have been channeled into somehow, somewhere, finding health insurance." That's what Carol wrote.
So Carol and her son Justin are why the Affordable Care Act lets young people stay on their parent's plan until they turn 26. And today, as she put it, "now Justin's future is governed by what he wants to achieve, not what health insurance mandates." And, by the way, Justin is here -- a fine-looking young man right here. Sunday is Mother's Day. Just wanted to make sure you remembered that.
Alycia is the mother of Avey, who is a beautiful, sweet, 3-year-old girl who also happens to have leukemia. Imagine what that's like for a parent. While you’re just figuring out how to take care of a baby, you've got to figure out how you're going to pay for expensive treatment that could save your baby's life.
Any parent knows that there is nothing we won't do to take care of our kids. And it's nice to have somebody getting your back. And that's why the Affordable Care Act made it illegal for bad actors in the insurance industry to discriminate against kids like Avey. And today, Avey is doing just great. She was here just a second ago, where is she? There's Avey -- hey, sweetie! So Alycia wrote in -- she said, "The health care law is about people like me. It's AlyciaCare."
And because of AlyciaCare -- the Affordable Care Act -– insurance companies can no longer impose lifetime limits on the amount of care you receive, or drop your coverage if you get sick, or discriminate against children with preexisting conditions. And women now have access to free preventive care like checkups, and mammograms, and cancer screenings, so you can catch preventable illness on the front end. And that provision has already helped more than 70 million Americans with private insurance. That's already happening. A lot of people don't know it, but you've got those protections.
Because of the Affordable Care Act, young adults under the age of 26, as we talked about, are able to stay on their parent's health insurance plan -- and that's already helping more than 6 million young adults.
Because of the Affordable Care Act, seniors on Medicare receive free checkups and preventive care with no co-pay or deductible, and get a discount on their prescription drugs. That has already saved over 6 million seniors more than $700 each. That's already been happening. Seniors may not know that they've been getting $600 discounts, but it's there.
Because of the Affordable Care Act, insurers now have to justify double-digit rate increases publicly, for everybody to see. And most states have new authority thanks to incentives under this law to reject unjustifiable rate increases. Insurers are now required to spend at least 80 percent of the money you pay in premiums on actual health care -– not on profits, not on overhead, but on you. And if they fail to meet that target, they actually have to reimburse you -- either with a rebate or lower premiums. Millions of Americans discovered this last year -- they opened an envelope from their insurance company that wasn't a bill, it was a check. That's already happened. A lot of people don't know it, but that's what the Affordable Care Act is all about.
Beginning this week, as part of the law's price transparency tools, we made public the prices that different hospitals charge you for most common services, so you can see if you're getting what you pay for. And soon, bad actors in the insurance industry will never again be able to discriminate against you just because you've gotten sick in the past. They can't discriminate against you because you've got a preexisting condition. And, by the way, they can't charge you more just for being a woman. Pregnancy will no longer be considered a preexisting condition.
And finally, beginning this fall, if you're one of the millions of Americans who don't have health insurance, you’ll finally have the chance to buy quality, affordable care just like everybody else.
So here’s how this is going to work. We're setting up a new online marketplace where, beginning October 1st, you can go online, or talk to organizations in every state that are going to have this set up, and you can then comparison shop an array of private health insurance plans. You can look at them side-by-side, just like you'd go online and compare cars. And because you'll now be part of a new pool of millions of other Americans, part of this exchange, insurance companies will actually want to compete for your business the same way they compete for the business of a big company with a lot of employees.
So once these marketplaces are up and running, no one can be turned away from private insurance plans. Period. If you're sick, you’ll finally have the same chance to buy quality, affordable health care as everybody else. If you can’t afford to buy private insurance, if it's still too expensive -- even though you're getting much better prices through these exchanges than you would in the individual market, going out there by yourself, or if you work for just a small company that doesn't have a lot of leverage with insurance companies you're going to have a better deal through these exchanges -- but if you still can't afford it, then you're going to get help reducing your out-of-pocket premiums with the largest health care tax cut for working families and small businesses in our history.
So what does all this mean? It means that if you lose your job, or you change your job, or you start that new business, you'll still be able to purchase quality, affordable care that's yours -- and you'll have the security and peace of mind that comes with it. If you're a young person expecting to try many different jobs and careers until you find one that suits you, you'll be able to buy insurance that goes with you, travels with you, that gives you the freedom to pursue whatever you want without the fear that illness or accident somehow derails your dreams.
So there's a lot that this law is already doing for Americans with insurance, and there is a lot more that is going to happen for folks who don't have insurance. But we've still got a lot of work to do in the coming months to make sure more Americans can buy affordable coverage. And with something as personal as health care, I realize there are people who are anxious, people who are nervous, making sure that we get this done right.
So I'm here to tell you, I am 110 percent committed to getting it done right. It's not an easy undertaking, but if it were easy, it would have already been done a long time ago. Undoubtedly, there will be some mistakes and hiccups as the thing gets started up, but we're learning already from them. For example, when the prototype of the application to join the marketplace came in at 21 pages -- the initial first cut at it -- we said, you know what, we can do better than that. It's now three pages long. Three pages. By the way, the industry standard is actually about 17 pages. So three pages is good. That's a lot shorter than the application you generally have to fill out now for private insurance.
But this is going to be a lot of work. And obviously, there is still a lot of political bickering over this law. The same folks who fought tooth and nail four years ago and tried to make political hay out of Obamacare, they're still telling tall tales about its impact. Some small businesses are being told their costs are going to go up, even though they're exempted from the law or they actually stand to benefit from it. And whenever insurance premiums go up, you're being told it's because of Obamacare -- even though there's no evidence that that's the case. So right now there are a whole bunch of folks out there, their insurance company decided to jack up rates, and they're automatically assuming, well, somehow the law had something to do with it. No, that had to do with a decision the insurance company made. In some cases, employers may be shifting more costs onto employees because they think that will help their bottom line. It's convenient to somehow say, well, it must be the new law. It's not the case.
So precisely because there’s been so much misinformation, sometimes people may not have a sense of what the law actually does. And that misinformation will continue -– at least through the next Election Day.
But what all the people on this stage understand is this is too important for political games. Most moms and dads don't think about politics when their kid gets sick. They're thinking about doing whatever it takes to make sure that child is well. This is an issue of personal security. This is personal to Carol and Alycia and anybody who's ever known the injustice and anxiety of a broken health care system. That's what this is about. That's why we fought so hard to make this happen. And that's why we're determined to get it done right.
And we're going to need everybody out there to make sure --get the right information. Don't just read a blog -- or some commentary from some pundit that has a political agenda. Make sure you know what the actual facts are, because you stand to benefit if you're not already benefiting from this thing. Don't let people confuse you. Don't let them run the okiedoke on you. Don't be bamboozled.
Now, there's one more person I want to mention here today -– somebody who I’ve spoken of several times over the past few years. When I first received a letter from Natoma Canfield, she was a self-employed cancer survivor from Ohio; she'd always done the responsible thing by buying her own insurance on the private market, even though it was very expensive.
A few years ago, her insurance company charged her over $6,000 in premiums, paid for only $900 worth of care, told her they'd jack up her rates another 40 percent anyway -- even though she'd been cancer-free for more than a decade. Despite her desire to keep her health insurance -- despite her fears that she would get sick again -- she finally just had to surrender her coverage. Couldn't afford it. Hung her fortunes on chance. And just a few weeks later, she fell ill, and was diagnosed with leukemia. Just days before health care reform became a reality.
And I kept Natoma's story with me as we fought to pass this law, and I hung her letter on one of my walls in the Oval Office. And while she couldn't be there the day I signed the Affordable Care Act into law, Natoma is here today. And because of this law -- here's Natoma right here. Give her a big round of applause. Because of this law, there are millions of other Americans -- moms and dads, and daughters and sons -- who no longer have to hang their fortunes on chance.
Because we are not going to inflict that hardship on the American people again. The United States of America does not sentence its people to suffering just because they don't make enough to buy insurance on the private market. Just because their work doesn't provide health insurance. Just because they fall sick or suffer an accident -- that could happen to anybody. And regular access to a doctor or medicine or preventive care -- that's not some earned privilege, it is a right.
So I understand the politics of this stuff sometimes, but there are times when I just want people to step back and say, are you really prepared to say that 30 million Americans out there shouldn't have health insurance? Are you really prepared to say that's not a worthy goal? Because of politics?
That's why we're going to keep fighting with everything we've got to secure that right, to make sure that every American gets the care that they need when they need it at a price that they can afford. That's what our families deserve. That's what the vast majority of Americans believe in. That's what we're going to make sure that we deliver. And we're going to do it with your help.
Thank you very much, everybody. God bless you. Thank you.
© 2013 Henry J. Kaiser Family Foundation. All rights reserved.