Healthcare Reform in Congress

Updated July 28, 2009  

NETWORK is carefully reviewing the various healthcare proposals as they move through Congress. Information about them can be found here.

Here are some sample questions you may want to ask as you review them as well:  

On Access

According to Catholic Social Teaching, healthcare reform needs to provide access to needed healthcare for all.

Does the proposed reform make healthcare available to lower-income people?

Many of the reform proposals assume a population with a steady income, a relatively stable address, and the ability to read through complicated coverage options in order to choose the most appropriate one for their family. Many people fall into these categories, but there are also people who need healthcare who don’t have incomes steady enough to make regular premium payments, or who are not in a position to make informed choices about competing coverage options. Does the proposed reform provide a way for these people to have access to appropriate healthcare services? Does the proposed reform make healthcare available to people at prices they can afford?

Does the proposed reform make healthcare available to people with pre-existing conditions?

If you had diabetes, or high blood pressure, or cancer, you can see that reform that says that “we will provide coverage for everything EXCEPT for the health issues you have and the conditions that result from them” is not truly providing the coverage you need.

On Quality and Cost

Catholic Social Teaching requires access to healthcare that will do each person the most good (i.e., high quality care). Mercifully, recent published articles have documented that high quality care does not have to be more expensive than lower quality care; indeed, there is some evidence that higher quality care is less expensive.

Does the proposed reform suggest effective ways to encourage the provision of better care, and not just more care?

Does the proposed reform provide a means to assess alternate treatments so that treatments with the best value are the ones that are covered?

Newer, more expensive treatments tend to be in demand simply because they are new. However, newer or more expensive doesn’t necessarily mean that they are any more effective than treatments already in use. Before requiring payment for a new or expensive treatment, there should be careful study of how well it compares with less expensive treatments.

Does the proposed reform encourage people to stay well and to effectively manage their existing conditions, rather than kick into gear only when someone becomes sick or has an acute episode?

On Funding

While Catholic Social Teaching does require universal access to needed quality care, it does NOT require that such care cost more than absolutely necessary.

Does the proposed reform have a means to eliminate healthcare fraud and abuse?

Does the proposed reform have effective ways of eliminating unnecessary expense, whether medical expense or administrative expense?

Does the proposed reform maintain the current level of private funding for healthcare? Are employers encouraged to maintain their current level of funding or to provide at least a threshold level of funding if not currently sponsoring a healthcare plan?

Are private individuals encouraged to contribute their fair share toward their healthcare expenses? Are private individuals also encouraged to meet their responsibilities to stay healthy?

The questions outlined above provide a useful general overview for healthcare reform. But how do we get there from here? The answers to questions below show NETWORK’s position on some of the methods under consideration in the current healthcare reform discussion

Should there be an individual mandate?

Yes. Mercifully, there seems to be near universal agreement that everyone should be required to enroll in coverage.

How will people find coverage to enroll in?

We back the proposal to have health insurance exchanges set up as a kind of one-stop-shopping where people can find information about the coverage that is available to them, including what’s covered and how much it costs. People who already have coverage through their employers will be encouraged to keep it.

What if there isn’t any insurance available in the private market?

We support the development of a government plan so that there will always be affordable, comprehensive coverage available.

What if people can’t afford the premiums?

There are those who have so little income that any amount for health insurance premiums would be unthinkable. We believe that Medicaid eligibility should be expanded to cover more people – one current proposal is that people with incomes at or below 150% of the federal poverty level should be enrolled in Medicaid. Medicaid is already in place in all states and is experienced in meeting the special healthcare needs of our low-income population.

We believe there should be a cap on the percentage of income that anybody would have to pay for health insurance; this percentage would be set according to how much income people have, so that people with less income would pay a lesser percentage and people with more income would pay more. Government subsidies should be available to make up the difference between the cap and the amount of the premium on the health insurance exchange for the basic coverage plans. (Individuals will be free to pay Cadillac prices for Cadillac plans if they so choose.)

What if people don’t enroll in coverage?

They would receive care as if they had enrolled in the government plan, but they would have to pay back premiums and may also be charged a tax penalty. The monies they pay as a penalty would go back into the government “kitty” for funding healthcare.

What responsibilities would employers have for coverage?

We support the “pay or play” system – employers should either provide coverage for their full-time employees or pay a percentage (possibly 8%) of employee/executive compensation to the government to fund healthcare.

How can we save money while improving the quality of care?

Who really controls both the quality of care and the amount spent for healthcare? The doctors are the ones who order tests, hospital stays, medication, follow-up visits and other services. We can at least have a payment system that doesn’t make it harder for physicians to practice in a high quality, low cost way. Paying physicians fee-for-service makes it harder. Cutting the fees in a fee-for-service system makes it even harder. We support the development of payment systems (such as salary with incentive payments for good outcomes) that will encourage and support physicians in their personal commitment to provide high quality care.

Can we convince people who already have health coverage to support reform because they, too, will benefit?

Yes, because it is true! These are just some of the ways:

• Health insurance premiums, along with co-pays and other out-of-pocket payments, have been rising dramatically. Many people with insurance also find that their policies leave some of their medical expenses uncovered, and many postpone medical treatment or don’t buy prescribed medications because of cost. A health insurance exchange would make coverage more affordable for many because premiums would resemble current group rates rather than much higher rates paid for individual coverage. There would also be more regulation of insurance companies that would prohibit discriminating people with pre-existing conditions or those who become seriously ill. Also prohibited: annual or lifetime limits on the amount that policies would pay.

• Healthy young adults who currently choose not to be insured drive up costs in two ways: by increasing premiums for older, less healthy adults and by forcing the rest of us to cover their medical costs when they have an accident or become seriously ill. If they join the insurance pool, costs go down for those already insured.

• People who have insurance through their work would not have to pay exorbitant rates for individual coverage should they lose their jobs. Instead, they could get more reasonably priced coverage through the insurance exchanges.

• If most or all currently uninsured people receive healthcare coverage, hospitals will not have to provide as much “charity” care, the costs of which are passed on to those with insurance. That should help hold down or reduce premiums.

• By addressing escalating costs through regulations and other means and through more competition brought about by increased competition (insurance exchanges), healthcare reform would lower the rate of premium increases.

• Medicare recipients who rely on many costly medications and must currently pay the full cost would pay less with reform.