What’s Next For The Affordable Care Act?

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MICHEL MARTIN, HOST:

Finally tonight, we know that health care is a very complicated issue. We have many questions. We figured you do, too. So yesterday, we asked you to send us your questions about the health care debate. Today, we’re going to try to answer them with the help of Julie Rovner. She’s chief Washington correspondent with Kaiser Health News. Julie, thanks so much for joining us for this.

JULIE ROVNER: My pleasure.

MARTIN: So a popular comment on Facebook relates to the single-payer conversation we just heard. Keith Miller writes, I personally believe that everybody should have access to affordable health care and I don’t mind paying a bit more in taxes to make that happen. So he was talking broadly, Julie, but do you think that the tax issue is why single-payer hasn’t gained steam in this country when it is, in fact, the dominant model elsewhere in the world?

ROVNER: Well, of course, single-payer, as we just heard, means different things in different places. But I think in the U.S., it’s been slowly building steam. It’s always – it’s been around. It was a big issue during the Clinton health reform in the early ’90s. And the trouble is it would create different winners and losers as we’ve seen all year. Some people would pay more taxes. Some people, you know, would pay less than they pay now. Some people would pay more than they pay now. We saw two states – California and Vermont – try to do their own single-payer plans. They couldn’t do it. They mostly stumbled over this big tax issue. It would be just a huge redistribution of money in addition to a big change in the health care system. And we have trouble with change.

MARTIN: We have a lot of questions about the whole issue of pre-existing conditions. A lot of people want to know how the whole question of – the idea of converting much of the federal funding to block grants relates to pre-existing conditions. For example, Julie Wirt on Twitter asks – I’m curious what constitutes a pre-existing condition. I had cancer in 2006. I’m healthy now. Would that be considered pre-existing still? And others like CSchneider asks, what safeguards are there to protect pre-existing conditions? What happens to lifetime caps which are based on essential health benefits when some states can change it? What’s the answer to that?

ROVNER: OK. If you’ve ever been sick, that’s now a pre-existing condition. So the answer to the first one is yes. And that’s what – you didn’t used to be able to get insurance if you’d ever basically been sick or you couldn’t get insurance for that thing that you had been sick with. The – there are serious protections now in the Affordable Care Act. That was considered one of the big achievements, something Republicans say that they like. But in the new bill, you know, the bill that’s up now, states would have to say that they would – states would have to say how they intend to protect people with pre-existing conditions. But that’s not the same as states actually having to protect people with pre-existing conditions.

And, as you mentioned, it’s very complicated because there are these essential health benefits that you’re required to provide – that insurers are required to provide right now. States, again, would be able to waive those so they wouldn’t have to have those. If the states can waive the essential health benefits, there would not necessarily be any out-of-pocket caps because – over the lifetime limits because those are tied to coverage of the essential benefits. So no essential benefits, no lifetime caps.

MARTIN: A number of listeners asked about the ACA itself, the Affordable Care Act. It’s still the law of the land. If this bill is defeated, that will continue to be the case. But both sides agree that it needs fixing. For example, a Facebook user wrote to us to say that, quote, “it didn’t work for me. We had to switch doctors. And finding a doctor we liked that accepted that coverage was a challenge.” On Twitter, Jon Fowler asked – it seems likely the ACA could use overhauling but isn’t the uncertainty of legislation also causing massive instability in the market? So talk a little bit about the problems with the ACA.

ROVNER: There are problems with the ACA. Even Democrats acknowledge there are problems with the ACA. The biggest problems are people who aren’t getting help, this government helped to pay their premiums. They’re paying these huge enormous increases. There are, as one of the listeners said, narrower networks. It can be harder to find a doctor. There are a whole lot of issues. And the Republicans are very good at saying these are things that are wrong with the Affordable Care Act. But most of the things they’ve been proposing aren’t things that would fix the things that were wrong.

MARTIN: So that’s the last question. We have 30 seconds. So if this new iteration doesn’t pass, what’s next?

ROVNER: What’s next is they may go back to this bipartisan effort that was going on a couple of weeks ago that would stabilize it at least at the beginning. It might not fix everything, but it might fix it at least going forward into next year.

MARTIN: Well, that was a heroic effort, Julie, to answer all of these questions. We appreciate it. That was Julie Rovner, chief Washington correspondent with Kaiser Health News, here with me in our studios in Washington, D.C. Thank you so much.

ROVNER: You’re so welcome. Transcript provided by NPR, Copyright NPR.

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