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Examining Health Care Coverage Fears


So should Dave Koenig be worried? To help answer that question, I'm joined by Karen Pollitz. She's a research professor at Georgetown University's Health Policy Institute.

Welcome to the program.

Professor KAREN POLLITZ (Research, Health Policy Institute, Georgetown University): Thank you very much.

BLOCK: And how typical would you say Mr. Koenig's situation is? He says he's paying about $300 a month for his family under Blue Cross, that's through his employer. And he calls it wonderful. He says he's never paid a dime for his multiple surgeries.

Prof. POLLITZ: Well, $300 a month is actually quite typical for what people pay for their share of employer coverage today. But a typical employer plan has a lot higher cost-sharing than what Dave reported. So my guess would be he's in an above-average plan and his employer is contributing more toward the cost of that, so that he doesn't have to pay high deductibles and co-pays whenever he needs to make claims.

BLOCK: And you heard him there say that he is worried that with a complete overhaul, that things might change; that tomorrow it could all change, he says. Should he be worried?

Prof. POLLITZ: I think not, actually. I think as long as Dave stays working with his employer, it sounds like it's a high-tech firm, a profitable firm, and I would hazard a guess that he has specialized skills. And so employers like his would be happy to have him. So given all of that, he should feel pretty comfortable; that as long as he can stay in that job, he'll be able to keep that insurance. And that shouldn't change.

BLOCK: But the fear that's been expressed by him and many others is that if there is a complete overhaul, that health insurance companies will change the way they do business in order to stay profitable.

Prof. POLLITZ: There is no requirement that Dave has to change his coverage. There is a requirement that everybody has to have coverage that meets minimum standards. And it sounds like Dave's coverage - and his sister Jane's coverage -already is well above that minimum standard. So it's not a constraint that's going to move him anywhere. It is generally the case, and has been for a long time, that health insurance coverage kind of declines over time. We've seen a steady erosion in what health insurance covers and a steady increase in what it costs, both for people who buy on their own and for people who get coverage at work. So I think there's no guarantee that Dave's employer won't change his coverage over time, just in response to rising health care costs.

But under health reform, no matter which bill passes, there will be a requirement that health insurance policies that you get at work, that you buy on your own cover a minimum number of services and have a maximum level of cost-sharing. So that, I think, should be helpful for everybody, and it shouldn't change. It shouldn't change what Dave has because it sounds like he's on the high end of coverage right now. And if his employer feels pressure over time if health care costs continue to increase, even after health reform, then it's possible that his employer might back down toward that minimum. But I think that would happen in the absence of reform as well.

BLOCK: How important do you think it is for proponents of a health- care overhaul to get people like Dave Koenig to buy into the process, to shed their fears? And how would they do that?

Prof. POLLITZ: Well, I think it is important, and that is the reason why the proponents of health reform have stressed that you're not going to be required to change your policy; if you like what you have, you can keep it. There's a long history, almost a hundred-year-long history of health-care reform efforts where the opponents of reform have tried to scare people into thinking that change will make them worse off. And I think that is absolutely what is at the heart of this insistence by the advocates of reform on saying - again and again and again - if you like what you have you can keep it.

BLOCK: Karen Pollitz is a research professor at Georgetown University's Health Policy Institute.

Karen, thank you very much.

Prof. POLLITZ: Thank you, Melissa.

BLOCK: Our series "Are You Covered?" is produced in partnership with Kaiser Health News, that's a nonprofit news service. And at, you can explore the health insurance situations of other Americans, from the uninsured to those who have the same plan as Congress. Transcript provided by NPR, Copyright NPR.