"A premium is $15,000 per family or $12,000 per family, regardless of income," he said. "The subsidies are a big issue, first, because so many people can't afford insurance because it's a bigger percentage of their income. And second, because U.S. health care costs are twice as great as the average wealthy country."
But Sager cautioned against Beilenson's doomsday scenario. For starters, Healthy Howard is not the same as comprehensive health insurance, which covers everything from primary care and surgeries to medical equipment and mental health services, so it makes little sense to compare the two, he said.
In addition, the federal subsidies being proposed are similar to those offered in Massachusetts, where a health care makeover in 2006 mandated insurance for all state residents and has managed to expand insurance to an estimated 400,000 people, bringing down the state's uninsured rate from 10 percent to about 3 percent, Sager said.
"It's affordable enough," he said. "People have enrolled and maintained coverage."
Massachusetts also offers lessons for a nation grappling with how to pay for health care reform. That state did not devise any cost controls when it mandated universal coverage. Now, with tax revenue down and high subsidies, the state is struggling financially, said Sager.
Sager agreed that substantial subsidies will be necessary for the federal plans to keep insurance affordable, but lawmakers face a delicate balancing act.
"There will only be so much available to subsidize insurance premiums," he said. "There will be trade-offs: bigger subsidies for fewer people or smaller subsidies to stretch the finite new federal dollars to try to cover as many of the 50 million uninsured" as possible.
Trimming Medicare payments to hospitals and other providers, adding new taxes and reducing expensive procedures are among the many ideas for cutting costs and raising money to pay for health care reform. But Sager said it's unclear if proposed reforms will achieve major cost savings.
Advocates for the uninsured have suggested other taxes, including an alcohol tax, to raise money, said Vincent DeMarco, president of Maryland Citizens Health Initiative. He notes that while subsidies will be important, federal reformers also propose expanding Medicaid, which would offer coverage to millions of low-income people - including as many as 200,000 Marylanders.
Still, interest groups such as AARP fear that many of its members may not qualify for subsidies or federal programs.
Nora Super, chief health lobbyist with AARP, said the organization is worried about people 50 years old to 64 years old, about 13 percent of whom (7 million) are uninsured and too young to be covered by Medicare. She said only 1.2 million people in that group earn between 300 percent and 400 percent of the poverty level, the two thresholds for subsidies being negotiated by lawmakers.
"That would be a lot of people who wouldn't be covered," Super said. "These are the folks we think could really lose out."
Health care
Related articles,
PGS 9, 10
