Who will be winners, losers in overhaul of health care? Some groups profit; most taxpayers lose

Detroit Free Press

WASHINGTON — Picking winners and losers among the proposals for health care overhaul before Congress is like predicting who’ll win the Super Bowl before training camp starts: too many variables.

Still, you can make an educated guess.

Say your income is less than three times the federal poverty level — $66,150 for a family of four — you’re probably a winner: The federal government likely will help pay your monthly premium. Or say you’ve been denied coverage because of a congenital heart condition — denial of coverage because of preexisting conditions almost certainly will end.

On the other hand, if you’re young, healthy and don’t want to pay for health care, you likely will have no choice. And people who have gold-plated policies likely will pay much more to keep their coverage.

Those are a few of the logical outcomes, say health care analysts, experts and economists.

But the big question remains: Can changes to cut waste in Medicare, reduce uncompensated hospital care and discourage unnecessary bloat in the system slow the skyrocketing cost of health care coverage in the United States, save Medicare and pay for reform — estimated between $850 billion and $1 trillion — without leaving taxpayers holding the bill?

Premiums have jumped 131 percent in the last decade, according to the independent Kaiser Family Foundation. During the same 10 years, wages have increased 38 percent and inflation has been 28 percent.

“The big losers are taxpayers,” said Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan policy research organization in Washington, D.C.

And possibly, in more ways than one: President Barack Obama has said that if savings don’t materialize, he’ll make cuts elsewhere. Medicare, the government safety net for people older than 65, could be insolvent in a decade otherwise.

Meanwhile, the Business Roundtable — representing chief executive officers of the nation’s biggest companies — released a report this week saying that without change, employer costs will rise 166 percent in the next 10 years. It would push total health care spending to $4.4 trillion — 20 percent of the gross domestic product — and threaten the system that provides coverage to 150 million people.

Big firms already meet most of the standards for employee insurance that would be required under the reform measures . On the surface, that coverage is not expected to change much. But it costs both them and their workers more each year.

Joe Antos, an expert in health care at the Washington, D.C.-based American Enterprise Institute, said if just one prominent company dropped coverage to gain a competitive edge, many others could follow.

“Then,” he said, “you’re going to have a flood.”

Matt Wickey, 45, of Royal Oak, Mich., has a pretty good idea who might be a winner in the health care debate after the year he’s been through.

Laid off as an IT consultant for a Detroit area company, he started paying the full tab of $1,214 a month to continue his ex-company’s health insurance earlier this year.

His wife has multiple sclerosis; he needs coverage for the two of them and their daughters. But with her preexisting condition, it would be too pricey to buy on the open market, if he could find it at all.

Through the stimulus bill, 60 percent of his insurance is paid for through the end of the year. After that, he’ll have to decide if the coverage at his new job works for his family.

But he’d be glad to know that under various congressional proposals, he could get affordable insurance through a public exchange should he lose his job again.

“When you lose your job, you lose your health care,” he said. “It’s a double whammy.”

That is the message proponents have locked onto — that reform will bring stability to a system of coverage that can disappear with your job .

Curiously, experts say, most of the higher costs of health care change aren’t linked to forcing insurers to offer better, more affordable coverage.

Sen. Debbie Stabenow, D-Mich., said it’s a “tradeoff with the insurance industry” — they offer more, but in return, they get 40 million new customers, those now uninsured. Many of them are young and relatively healthy and cheaper to insure.

The bigger expense is in expanding Medicaid — the government program for poor people — and providing subsidies for lower- and middle-income Americans to afford coverage.