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As we approach the presidential election in November, Weekend Edition is seeking your questions about issues and candidates in a new segment called Reporter Hotline. This week, we answer inquiries about health care.
Why Is Insurance Employer-Based?
Question from Bob Dunne of Cedar Park, Texas: "Why do you have to work to maintain health insurance? In other words, I know many people who won't quit their jobs because they're not working for the salary; they're working for the health insurance."
Answer from NPR's Julie Rovner: "Well, you have to go back to World War II. The U.S. had wage and price controls, but also a labor shortage because so many men were part of the war effort. So one of the ways employers started to differentiate themselves was by boosting benefits, and health insurance was one of those benefits they started offering. After the war, there was a huge boom in hospital building, so it made sense for more people to have hospital insurance, and our system kind of grew up as an employer-based one.
"By the time health care got so expensive that insurance was a real necessity — rather than something that was just a nice fringe benefit, which was around the 1970s — really we as a country were sort of settled into the idea of having that employer-based system. In fact, it was President Richard Nixon who first proposed the idea of getting everyone covered by requiring all employers to provide health insurance to their workers. That came in response to the Democrats' proposal of that same era to have a tax-funded insurance plan for everyone.
"Later on, the Democrats would pick up Nixon's idea and propose that so-called employer mandate. In response, Republicans came up with the idea of requiring individuals to have their own coverage, which is of course what ended up passing first in Massachusetts under then-Gov. Mitt Romney, and then in the Affordable Care Act, which we have today."
Candidates' Plans For Women's Health Care
Question from Majal Perry of Monterey, Ky.: "I really want to know what each candidate's health care solution would specifically mean for me and other women like me, who are in their mid-20s, working, but low- to lower-mid-income and without insurance. How would their plans cover me should I ever choose to have children?"
Answer from Rovner: "Well, you're one of those people who would likely face a very stark difference between the two candidates' plans. Under the Affordable Care Act, starting in 2014, you'll likely be able to afford your own insurance through one of the health care exchanges, and you'll probably qualify for a subsidy. Insurance companies also won't be able to charge you more because you're a woman of child-bearing age, and they will have to cover maternity benefits. None of those things are true now.
"Gov. Romney hasn't told us enough about what he would do to replace the Affordable Care Act, which he wants to repeal, to know if he'd offer any of those same protections. He does have some proposals he said would improve competition and potentially lower prices for insurance for people like you, though."
Are Doctors Accepting Fewer Medicare Patients?
Question from Patrisha Thomson of Los Angeles: "A social worker I know who works in the medical field was telling me that many doctors are not accepting Medicare patients because they're not receiving the amount of money that really makes it a reasonable income. I would be interested to know how prevalent that is. And if that's true, what has changed?"
Answer from Rovner: "There's a continuing standoff in Congress about the way doctors are paid under Medicare. This predates the health law. This goes back to the late-1990s, and actually, if Congress doesn't do anything, doctors are going to see their pay cut by 27 percent more.
"So we are hearing more anecdotal evidence, at least, about doctors not taking new Medicare patients in particular. This is something that's going to come up again in the context of this fiscal cliff at the end of the year, something Congress has to deal with along with these expiring tax cuts and the potential for big budget cuts, and it is something that is definitely on policymakers' radar screens."
Weekend Edition host Scott Simon: "Let me understand this complaint — are doctors saying they're not getting reimbursed for the full value of the service they render?"
Rovner: "Mostly it's that they've not had any kind of real inflation increase really in a decade now. And that's because of this funding formula that is calling for cuts. Congress has mostly been cancelling the cuts, but they've not been giving them any increases.
"So they're getting less and less in the way of Medicare reimbursement compared to how much their cost of providing the care is going up. To be fair, most doctors continue to accept Medicare patients, to take Medicare, but it's getting more and more difficult for a lot of doctors to do that."