"Why is FCNL supporting the House and Senate health care reform bills instead of a single payer plan?"

Jul 20, 2009

Since we announced our support of the House and Senate health care reform bills last week, many of our constituents have asked: "Why is FCNL supporting these bills instead of a single player plan?"

FCNL's policy doesn't point us toward any particular funding scheme for health care; the central concern is that everyone should have access to comprehensive care:

"We affirm health care as a right, regardless of employment or ability to pay. We support universal access to timely health care. ... We advocate [for] systems that provide for the fair distribution of health care resources." -- FCNL Statement of Legislative Policy

So as Congress takes up a health care debate that does not focus on a single payer option, we have a couple of choices: We can stand on the outside of the debate, and insist that single payer is the only way to go, or we can get into the debate and try to move the huge and complex U.S. health care system toward something that would work better than what we have now. The debate, and the implementation of a public plan, might prove a giant step toward a single-payer system.

This was not an easy or binary question. Sometimes, as on climate change, we stand outside the prevailing process, insist that it is going in the wrong direction, and demonstrate that adoption of a bogus bill will hamper our chances for real change. Other times, even though our policy calls clearly for a broad objective such as nuclear disarmament, we do not hesitate to work for treaties, agreements, and budget cuts that might lead the nation in the direction of our vision.

We see the health care debate as more like the disarmament debate than the climate change debate. The elements of change in the bills being debated are mostly good. If a couple of them were adopted, we'd be better off than we were last year. If all of them were adopted, we'd be several huge steps down the road toward truly universal health care.

Do insurance companies make too much profit? The bills have some fairly strict controls on that, and require that private insurance companies offer a higher quality product to the entire population -- not just to their preferred healthy elite. This scenario is not as good as having no insurance companies involved in health care finance, but is a significant positive step along the way.

Some observe that insurance companies will always race to the bottom -- offering a weak product to as few people as possible for as high a premium as possible. In the new health care system, insurance companies would only be allowed to offer individual plans that match a nationwide standard that includes coverage of basic care; they would be required to include no annual or lifetime limits on coverage, no exclusions for pre-existing conditions, no different rates by gender, geography, or plan usage, and capped out-pocket-expenses. Employers would be required to offer health care insurance to employees and dependents, and that insurance would have to match the same standards. There would be no market for sub-standard insurance products.

And what if anyone and everyone could choose the public insurance option? If the public insurance option can offer better service for less money, insurance plans that want to stay in business will have to keep up.

Many are concerned that this cobbled-together plan won't cover everyone. That's a good thing to worry about and we’ve been looking at that issue very carefully. If the plan being considered is not a universal plan, the drafters have to be very careful to ensure that everyone is covered.

Here are the pieces of that puzzle:

• People with incomes up to 133 percent (or in the Senate 150 percent) of the poverty line will have Medicaid -- including childless adults. That’s a big step forward all by itself. Many states don't even cover everyone below the poverty line in their Medicaid programs.


• At up to 400 percent of the poverty level, people will receive premium subsidies to ensure that their health care costs do not exceed a certain percentage of their income. At 200 percent of the poverty level, for example, (about $37,000 for a family of three), the cap would be at 5 percent of income. The premium would be about $154/ month for the whole family. Health care would still be a heavy lift, but doable for many more people than now.


• Many fewer people would be forced to provide their own insurance, because employers will be required to offer it to workers and dependents.

These are good things. They mean that about 97 percent of the population would have health care within their reach. That beats the current 85 percent any day.

There is a mandatory provision for people too, not just employers. In order for this to work -- in order for everyone to have access to primary care and not have to depend on emergency rooms for expensive urgent care (with the cost added onto the premiums of people who are insured) there needs to be some kind of mechanism to require participation. If people don't sign up, two things will happen:

1. When they go for some kind of emergency care, or another service that would have been covered under the health care system, they'll be asked whether they knew they could sign up. If they're eligible for Medicaid, they'll be given Medicaid. If they're eligible for a subsidy, they'll be given a subsidy.


2. If they decline to sign up (and there are exemptions for hardship or religious objections) they will be charged an extra 1.5 percent on their income tax. At the low income levels, this will be truly minor, but it is enough of an incentive to get people to think about signing up, if they can manage it. (Remember, single payer is the ultimate mandatory system. All taxpayers will be charged for that, and whether or not they use it, everyone will be signed up).

FCNL is not opposed to a single payer plan. We're working with what Congress has presented -- and doing our best to shape it to meet our shared goal: that everyone have access to high quality, comprehensive health care, regardless of income.