Health-care plan leaves some gaps in coverage

By Ricardo Alonso-Zaldivar • ASSOCIATED PRESS • September 17, 2009 WASHINGTON — You're a 51-year-old single mother raising two kids and juggling a mortgage and a car loan. Because you're self-employed, getting health insurance has always been a problem. Under the new Senate plan, you still might have to stretch your budget to pay premiums even if the coverage is more secure. The health-care plan unveiled Wednesday by Finance Committee Chairman Max Baucus, D-Mont., strives to contain costs for taxpayers, reducing the risk that covering the uninsured will blow the federal deficit wide open. But that means benefits are not as generous as in competing plans from Senate and House Democrats. "We've done everything imaginable to get the most generous, most affordable coverage we can within President Obama's target of $900 billion," Baucus said, referring to the president's 10-year estimate of what the legislation should cost. A free lunch it's not. For consumers, the Baucus plan comes with costs and benefits, rights and responsibilities. Though people with employer-provided health care would not see dramatic changes, the plan is broad enough that it would touch every American family in some way. Here's a look at how consumers in different circumstances would be affected: • Self-employed head of household.If anyone is meant to benefit from the plan, it's people who have to scramble to find and keep coverage because they work for themselves, not a large employer.Baucus would eliminate onerous insurance practices, such as denial of coverage due to a pre-existing health problem. But subsidies in the plan may not be enough to make coverage affordable for all middle-class families, who would be required under the bill to carry insurance. The Washington-based Center on Budget and Policy Priorities, which advocates for low-income people, compared the Baucus plan to two other major proposals — the House Democratic plan and the Senate health committee bill. A family of three earning about $55,000 — three times the federal poverty level — would have to pay 13 percent of its income. That's roughly $7,100 a year. It compares with costs of about $5,500 under the House bill, and $4,300 in the Senate health committee bill. The three-person family earning about $27,500 would have to pay 5.5 percent of its income, a premium of about $1,570. That compares with $824 a year in the House legislation, and $275 under the Senate health committee proposal. "They're getting subsidies, but the question is, do those subsidies go far enough both for the premiums they have to pay, as well as the cost-sharing charged under the plan," said Edwin Park, a health- care analyst with the center. The numbers used in the examples are based on 2009 incomes. The dollar figures would likely be higher — to account for inflation _ when subsidies take affect under the plan in 2013. • Senior covered by Medicare. Seniors would get a 50 percent discount on medications if they fall into the "doughnut hole" coverage gap in the Medicare prescription drug benefits. At least 3 million a year get caught in the gap. Medicare recipients also would get a free annual wellness visit with their doctor, to focus on ways to stay healthier. Coverage for end-of-life counseling, which caused an uproar when it was included in the House bill, isn't part of the Baucus plan. Coverage for preventive care would be expanded. "Most Medicare beneficiaries will feel like they have gotten something very tangible," said John Rother, the top policy strategist for AARP. Baucus has proposed scores of changes in Medicare to make the program more efficient. Medicare accounts for most of his proposed cuts of $500 billion over 10 years in federal health-care spending. The reductions would affect managed-care plans, hospitals and other medical providers, but Rother said that should not erode the benefits seniors receive. • Single woman in her 20s. People in their 20s account for a sizable share of the uninsured. Under the Baucus plan, they'd be required to get coverage and pay into the pool. But depending on income, they'd be eligible for subsidies they can't get now. They'd also have the option of buying a lower-cost plan, tailored to those 25 and under, which would cover mainly preventive care and catastrophic medical costs. Insurers would not be allowed to charge women more because of gender, a practice that is now common. And health-care plans would have to cover prenatal care and pregnancy. Coverage for abortion continues to be controversial. Baucus said his plan would not allow federal funds to be used to pay for the procedure, except in cases of rape, incest or to save the life of the mother. Abortion opponents say loopholes in the proposal would allow subsidies to health plans that cover abortions. Abortion rights supporters say they will oppose any effort to restrict coverage of the procedure by private insurance plans. • Immigrants. Immigrants are more likely to be uninsured than the U.S. population as a whole. The Baucus plan would let legal immigrants get federal subsidies for health insurance but would bar benefits for those here illegally. U.S.-born children of illegal immigrants _ who are considered citizens under the law — would be eligible for benefits. Baucus has called for a verification system to make sure that no subsidies go to illegal immigrants.