Ron Pollack explains how the bill might cover even more than 95% of the country
Ron Pollack heads Families USA, an influential health-care advocacy group that focuses on coverage and access issues. So he seemed like a good choice to explain those parts of the bill. A transcript of our interview follows.
Explain to me how the subsidies work.
It’s tied to income. At 100 to 133 percent of poverty – some of those folks might be in the exchange rather than Medicaid – they will pay up to 2 percent of income. From 133 percent to 150 percent, they’ll pay 3-4 percent. At the upper reaches, at 300 percent to 400 percent of poverty, it goes up to 9.5 percent of income.
And when you say this or that percent of income, what's it buying? Obviously a cheap plan and an expensive plan will cost different percents of someone's income.
One of the big improvements made in the reconciliation bill over the Senate bill is that the actuarial value of what you get in the plan was increased significantly for those nearer to poverty. At the lower end, it’s near 94 percent. It’s good coverage. And the cost depends on how significant the benefits are going to be. And the benefit plan now is much more helpful to people near poverty.
And how does Medicaid fit into all this?
Medicaid is huge in terms of the improvement. It now will establish income eligibility at 133 percent of poverty irrespective of family status. Right now, eligibility is predicated both on the state where you live and the family status. For adults who are not parents, in 43 states you literally can be penniless and you’re ineligible for Medicare. Period. End of subject. In those 43 states that do nothing, this is huge in terms of childless adults. For parents, the median income eligibility standard is 69 percent of poverty. In some states, it’s as low as 25 percent of poverty. If you make more than that, you are not eligible for Medicaid.
And you've mentioned to me before that the 95 percent coverage estimate leaves out a lot of folks who will be eligible for public programs or subsidies but CBO thinks won't enroll.
That’s right. The 95 percent coverage is predicated on CBO’s judgment about how many eligible people will be enrolled. I don’t know their exact assumptions. But there is a large number of people who will be eligible but they presume won’t enroll. We’re actually helping to found a new organization to work on this. Its placeholder name is Enroll America, and it will involve all the different interest groups, from supporters of reform like consumers groups to community health centers and doctors and insurers. And what we’ll do is raise tens of millions of dollars for state groups to work with the state to try to create the most effective systems to apply and enroll. You should be able to enroll with simple application forms at a doctor’s office or a pharmacy. You shouldn't have to take the day off of work. That sort of thing.
What are you most worried about in the bill?
At this point, I’m not worried about the bill. It has its imperfections and there are things we can build on in the future. The immediate concern is implementation. That’s where we decide whether the promise of the bill becomes a reality. This is hard work and it has to be done well because legislation only works if it gets implemented effectively. It's implementation that will translate this bill into real health-care reform.
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