Health Reform Winners and Losers by David Himmelstein, MD

This article is more than 14 years old.

Health Reform Winners and Losers

A year into health reform, its starting to become clear who the winners and losers will be.


1- Health insurance firms hit the jackpot. The state is set to force hundreds of thousands of people – mostly near-poor and lower-middle class – to pony up for private coverage. The $1 billion or more in new business – and the promised end to private insurers’ indirect contribution to the Free Care Pool - virtually assures healthy profit growth.
2- Very poor citizens get upgraded and expanded coverage. Though all of them were previously eligible for Free Care, some will find the new coverage more flexible and easier to use. But for some, the copayments for drugs and emergency visits in their new plans will mean even worse care than before.
3- Hospitals that serve few of the uninsured. They’ve gained higher reimbursement rates from Medicaid, and big savings from the phaseout of their contributions to the Free Care Pool.
4- Politicians who are posing as innovative leaders in solving the health coverage crisis.


1- Uninsured immigrants. This group – especially immigrant children - already gets shockingly little care (about half as much as the native-born uninsured). They’re ineligible for the new subsidized coverage, and will find care harder to get as the demise of the Free Care Pool squeezes safety-net providers.
2- Safety net hospitals and clinics. With the end of the Free Care Pool, these institutions will be in deep trouble. It is now clear that many patients will remain uninsured despite Chapter 58, but private insurers and affluent hospitals are soaking up the funds that previously paid for the uninsured.
3- Low income patients forced to empty their pockets paying for defective insurance policies. High deductibles and co-insurance mean that many will pay hundreds or even thousands on premiums, and yet be unable to afford care if they get sick. For the many who were previously eligible for fully or partially free care, the new coverage means worse financial problems and, in many cases, less access to care.
4- The American public who are once again being taken down a health reform blind alley. Costs are still rising, insurance plans are getting skimpier and politicians use Chapter 58 to avoid discussing the only real solution – national health insurance .

David Himmelstein is an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program

This program aired on March 28, 2007. The audio for this program is not available.