Out of touch: Conservative media argue insured don't need health care reform

Conservative media figures have echoed House Minority Leader John Boehner's statement that “93% of the American people have access to high-quality, affordable health insurance” by arguing that because most Americans purportedly have access to health insurance, health care reform constitutes, in Fox News host Steve Doocy's words, “blowing up the system for 5 percent” who don't. These media figures have ignored that tens of millions of Americans are underinsured and that the reform bills contain several provisions intended to benefit those currently insured.

From the July 30 edition of Fox News' Fox & Friends:

DOOCY: Currently, 90 percent of all Americans have got some sort of health care coverage, which means they are effectively blowing up the system for 5 percent. Now, the 5 percent, you gotta worry about them -- you gotta worry about everybody who doesn't have it. But is it worth all of this for 5 percent?

BRIAN KILMEADE (co-host): No, and Karl Rove wrote a great column today. The guy does so much research. How big is his staff? He says 91 percent of Americans have insurance; 84 percent are happy with it.

DOOCY: Right.

KILMEADE: When you start like that and work your way back, you wonder what the big deal is -- although I think health insurance is among the top five concerns for American people.

From the July 30 edition of Fox News' America's Newsroom:

STEPHEN MOORE (Wall Street Journal senior economics writer): And the other problem -- which I think is an even bigger one for the Obama administration and the Democrats right now, Bill -- is it turns out that the vast majority of Americans do have health insurance, and about three out of four people who have health insurance, you know what, Bill? They kinda like the insurance they have. They like their access to the medical system. And, you know, Megyn --

BILL HEMMER (co-host): So, what they're wondering is, why blow up the system for --

MOORE: Exactly.

HEMMER: -- a small number?

Contrary to GOP claim echoed by conservative media, millions are underinsured

Boehner claim: “93% of the American people have access to high-quality, affordable health insurance.” Conservative media figures have echoed Boehner's claim that “93% of the American people have access to high-quality, affordable health insurance.” For example, in response to Moore's assertion that “the vast majority of Americans do have health insurance” and that "[t]hey kinda like the insurance they have," Hemmer asserted, “So, what they're wondering is, why blow up the system for a small number?”

In fact, roughly 25 million Americans were underinsured in 2007. The underinsured are “the percent of adults between 19 and 64 whose out-of-pocket health care expenses (excluding premiums) are 10 percent or more of family income.” According to Cathy Schoen, senior vice president of The Commonwealth Fund, in 2007 “an estimated 25 million adults under age 65 were underinsured.” That figure represents a significant increase over the past several years. As Schoen explained, “From 2003 to 2007, the number of adults who were insured all year but were underinsured increased by 60 percent.” [Testimony before the Senate Health, Education, Labor, and Pensions (HELP) Committee from Gail Shearer, director of health policy analysis for Consumers Union, February 24; Schoen testimony before HELP Committee, February 24]

The underinsured do not receive adequate care and face financial hardship. As Shearer explained: “Underinsurance is a problem for two key reasons: Inadequate coverage results in the financial burden of uncovered health care. In our survey, for example, 30% of the underinsured had out-of-pocket costs of $3,000 or more for the previous 12 months. Underinsurance can lead to medical debt and even bankruptcy. The second problem posed by underinsurance is delayed or denied health care and poorer health outcomes, caused by the financial barrier to care.” Similarly, Schoen explained that the “experiences” of the underinsured were “similar” to those of the uninsured, noting that “over half of the underinsured and two thirds of the uninsured went without recommended treatment, follow-up care, medications or did not see a doctor when sick. Half of both groups faced financial stress, including medical debt.” [Shearer testimony before HELP Committee, February 24; Schoen testimony before HELP Committee, February 24]

Insurance companies often cancel policies or deny coverage

Insured currently subject to rescission if they become ill. Insurance companies restrict or deny coverage by rescinding health insurance policies on the grounds that customers had undisclosed pre-existing conditions. On June 16, a House Energy and Commerce subcommittee held a hearing exploring this practice, with the goal of examining “the practice of 'post-claims underwriting,' which occurs when insurance companies cancel individual health insurance policies after providers submit claims for medical services rendered.” The committee also released a memorandum finding that three major American insurance companies rescinded 19,776 policies for over $300 million in savings over five years, and that even that number “significantly undercounts the total number of rescissions” by the companies.

Currently, insurance companies deny coverage based on pre-existing conditions. CNN senior medical correspondent Elizabeth Cohen wrote in a May 14 CNN.com article, “According to the Kaiser Family Foundation, 21 percent of people who apply for health insurance on their own get turned down, charged a higher price or offered a plan that excludes coverage for their pre-existing condition.” Cohen added that "[t]he health insurance industry doesn't deny that people are rejected or charged higher premiums because of pre-existing conditions." Indeed, as Health and Human Services Secretary Kathleen Sebelius explained in May 6 testimony before the House Ways and Means Committee, a goal of health care reform is to “end barriers to coverage for people with pre-existing medical conditions.” She continued: “In Kansas and across the country, I have heard painful stories from families who have been denied basic care or offered insurance at astronomical rates because of a pre-existing condition. Insurance companies should no longer have the right to pick and choose. We will not allow these companies to insure only the healthy and leave the sick to suffer.”

Health care reform bills include provisions to address problems faced by the insured

Congressional bills ban recissions. According to a Ways and Means Committee staff description of the House bill, Section 112 "[r]equires ... renewal of insurance policies and prohibits the use of rescissions except in instances of fraud." And the HELP Committee bill similarly provides “guaranteed renewability of coverage,” stating that “if a health insurance issuer offers health insurance coverage in the individual or group market, the issuer must renew or continue in force such coverage at the option of the plan sponsor of the plan, or the individual, as applicable.”

House bill contains measure to control medical premium costs. The House bill as introduced requires qualified health insurance plans to meet a specified medical loss ratio, which is the part of revenue from premiums that actually pays for medical services. If insurers fail to meet this requirement, they are required to provide rebates to their enrollees.

Bills include provisions to help those who lose their insurance purchase new policies

Congressional bills prohibit the use of pre-existing conditions to deny coverage. According to a Ways and Means Committee staff description of the House bill, Section 111 "[p]rohibits the application of pre-existing condition exclusions," and Section 112 "[r]equires guaranteed issue (no one can be denied health insurance)." The Senate HELP bill similarly prohibits “discrimination based on health status,” stating that a “group health plan and a health insurance issuer offering group or individual health insurance coverage, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan or coverage based on [a number of] health status-related factors in relation to the individual or a dependent of the individual.”

House and Senate bills provide subsidies to buy individual insurance. The House bill provides “individual affordability credits” through a Health Insurance Exchange to individuals who meet certain criteria, including being “enrolled under an Exchange-participating health benefits plan,” not being “enrolled under such plan as an employee (or dependent of an employee) through an employer qualified health benefits plan,” and having a “family income below 400 percent of the Federal poverty level for a family of the size involved.” And according to a HELP Committee release, the Senate bill provides credits to “low-income” and “moderate-income” individuals “who enroll in plans through the Gateways” -- one term used to describe the exchanges. “Credits are provided on sliding scale, so that those with the lowest incomes receive the most help. Gateways, which will provide information on health insurance options, will administer these credits. The premium credits would be on a sliding scale up to 400% of the poverty line ($88,080 for a family of 4), with those at lower end receiving more.”