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Eight Questions About Health-Care Reform

Ceci Connolly and Alec McGillis have an article outlining eight common questions about health-care reform. Importantly, they also provide the answers. It's the sort of article that people sometimes say the media don't publish, but the actual problem is that it doesn't get republished. If you miss it in today's Post, you've simply missed it. Which is a shame, because this article is probably the most useful thing we'll publish for the people who doesn't read every newspaper every day.

But even if newspapers don't do reruns, the internet does archives. This article could be expanded as new questions arise, and it could be prominently included in the link box accompanying future health-care articles The Washington Post publishes. It need not disappear into the ether.

By Ezra Klein  |  September 8, 2009; 8:35 AM ET
Categories:  Health Reform , Health Reform For Beginners  
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while Ceci and Alec do attempt to and do as good a job as they can to explain this what they don't seem to specify is that every state in the union is different. In some states the phrase below is completely incorrect or could be incorrect:

#5 What will happen to small businesses under health-care reform?
Small businesses now have a difficult time buying coverage for employees. They have a smaller pool of people to cover than large companies do, so coverage costs can soar if the workers tend to be older or if even one person happens to get very sick.

In my state of NJ for example (and I expect many others work very similar) rates for a small employer are not based on the claims experience of that one employee or even that entire company of say 20 employees. They are based upon everyone within the 2-50 market. In our market if workers are older then yes their rates are normally higher as we have modified community rating but there are plenty of "larger size" employers that pay higher rates than smaller size employers basically because in many states once you reach a certain size your claims experience becomes your own meaning you're not seperately pooled with everyone else and if your claims are high then your rates are higher based upon those claims.

Again I really wish the Washington Post would get an actuary to write a column about how this all works because the large majority of either the writers or the posters don't have the foggiest idea.

Posted by: visionbrkr | September 8, 2009 9:40 AM | Report abuse

Great link! I have a question related to the number of uninsured they show for the two plans. If both bills have an individual mandate, what is driving the difference in the uninsured estimate?

Posted by: pedro_mn | September 8, 2009 9:52 AM | Report abuse

A pretty good serviceable article summarizing the situation. I would have expanded the answer to question #2 though. If we can get everyone insured, and thus eliminate the cost shift from providers from those that don't pay to those that do (ie, those with coverage now), this will cause much less pressure on the rates for coverage. In the worst cases (TX, NM) you have 25% of the population uninsured. The deferred care emergency type expenses they incur are shifted onto those that pay.

Posted by: scott1959 | September 8, 2009 11:29 AM | Report abuse

visionbrkr is correct in that claims experience in the small (<50) market is not a factor in rating....but demographics are (maybe not in NJ but in most states). So if you hire an older employee, that can make a difference in your premiums. Likewise, as we are now seeing in the downturn, you layoff some younger employees and the remaining group is therefore older and you get a sizeable increase. Had a small group here (40 employees) lay off 5 or so younger workers and they ended up with a 40% increase.

Posted by: scott1959 | September 8, 2009 11:32 AM | Report abuse


they are in NJ as well but I didn't want to get into an age bias issue but statistics show that older AMericans utilize more care and more expensive care than younger ones. Each state deals with that issue differently. Pre-reform in NJ (pre-1993) they used to give age based rates so you could have single young employees that were charged $50 for a month's coverage and families of older employees much more than that. It was determined that it was better to put the group together, get the average age and demographic and rate it accordingly so smaller groups are more affected by an age shift than larger ones. There are pluses and minuses to both ways of doing it.

Posted by: visionbrkr | September 8, 2009 11:48 AM | Report abuse

How about one of those little beige boxes at the side of every front-page health care article (in the print edition, I mean) including a short URL for the big health care overview article? That way even people who usually don't read the paper online will know where to look for the backgrounders.

Posted by: mellifluent | September 8, 2009 2:13 PM | Report abuse

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