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Ron Pollack explains how the bill might cover even more than 95% of the country

ron_pollack_145.jpgRon 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.

By Ezra Klein  |  March 22, 2010; 5:36 PM ET
Categories:  Explaining health-care reform , Interviews  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati   Google Buzz   Previous: An interview with Kaiser's Drew Altman
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The Anthem rate increase is unchanged, raising my rapidly disappearing CALCOBRA by another $150/mo. As soon as that runs out I'm completely screwed to 2014 because of pre-existing conditions. This bill does NOTHING for me and I cannot believe that there aren't millions of others getting screwed much worse. I'm not even sick. My "pre-existing condition" is a bogus excuse made up to avoid insuring a 55 year old. And that's something else that bill does NOTHING to fix.

I'm tellin' you, Ezra - you can sit in your 20-something ivory tower and blather away but the real people in this country are getting SCREWED by this bill.

Posted by: akmakm | March 22, 2010 6:01 PM | Report abuse

All this substantive stuff is nice, Ezra... but don't you want to gloat just a little bit?

A leeetle little bit, maybe? I have to confess, as my favorite health care blogger, I was looking forward to your gloating especially.

Posted by: roquelaure_79 | March 22, 2010 6:02 PM | Report abuse

With all due respect, Mr. Pollack, maybe you are not worried about this bill; but 55% of the public is very worried! This is a HUGE entitlement program rewarding the far left for their support of Obama's presidency. Stupak betrayed his principles and caved in to the pressure. He will be forever remembered as the person that brought this bad legislation to America. I hope his constituents reward him with another job opportunity in November.


Posted by: my4653 | March 22, 2010 6:03 PM | Report abuse

Excellent Post - thanks Ezra.

And especially thank you Mr. Pollack for all of your incredible work helping to craft and pass this historic legislation.

I'm heartened to hear that you plan to stay involved with implementation, including through Enroll America.

I encourage all fellow citizens to support Mr. Pollack's important organization.

Posted by: paul65 | March 22, 2010 6:25 PM | Report abuse

Hey my4653: With all due respect to you, it sounds like you've been "drinking the tea," brother! :)

MYTH: 55% of American's opposed the President's health care reform plans.

TRUTH: 40% opposed, 40% supported and 15 percent like the plans but wanted to go further (about 15% were undecided)

BOTTOM LINE: 55% of American loved or like the President's plans -- and that number is going up fast as people learn what the plan really entailed.

Posted by: paul65 | March 22, 2010 6:28 PM | Report abuse

@my4653:rewarding the far left for their support of Obama's presidency.

I want some of what you are smoking. The left got screwed in this debate.
-No VA style real socialized medicine
-No single payer
-No robust public option
-no weak public option
-no medicare buy in for 55-65 people
-small subsidies
-private insurers controlling the market,
-state based exchanges instead of a national exchange.
-no mechanism to stop medical bankruptcies (something almost unknown in Europe, Japan, Canada, Australia, etc) even if one has insurance

This is a centrist bill similar to what repubs proposed in 1993, Romneycare in MA, and similar to the dole/baker/daschle (all flaming socialist, fascists) proposal from last year.

Face it, the idea that this plan is a socialist, fascist, Marxist, communist, far left wing plot to destroy America is a dog that just won't hunt.

Posted by: srw3 | March 22, 2010 7:07 PM | Report abuse

"but don't you want to gloat just a little bit?"

This is what's worrying me today. My Facebook friends are putting out a non-stop stream of Glenn Beck-like rantings about how the country has changed forever. I've done my part to throw in some facts (CBO stuff, for example) but this doesn't do much when the CBO is so obviously in league with this "conspiracy against taxpayers."

I think that all HCR supporters should start normalizing how our new health care system works and now. This should not continue to be a political football; it's part of our daily life and *needs* to be supported (at least explicitly) by Democrats AND Republicans in the long run. I'm just not sure how we do that when the midterms are around the corner.


I'm extremely happy it passed, but HCR will never be insanely popular with the American people because the public is not directly tied to its outcome. There's no broad-based buy-in (as there would eventually be with a strong public option). The public's just sorta confused by it all (partly because we kept our confusing system in place).

The Democrats should stop their celebrating immediately and react to GOP talk of rollbacks not by gloating but with a sense of exhaustion: "why do you want to keep talking about reform when we already addressed the problem?" This attitude helps to change "ObamaCare" to "our health care system" and allows it to survive until all its policy pieces start working.

The Dems would do well to reflect the public's exhaustion as the GOP tries to keep this a controversial issue as long as they can. By framing this as the "law of the land," GOP criticism will sound outdated and irrelevant to jobs and the economy. It'll help make this less politically useful for the GOP in the mid-terms, and hopefully less volatile in the long run.

Posted by: Chris_ | March 22, 2010 7:08 PM | Report abuse

HCR will never be insanely popular? Hmm, let's revisit that in a decade or so, k? As coverage becomes widespread, reliable and available, HCR will come to be thought of as a right, same as with SS benefits and Medicare. Anyone who tries to take it away will get an earful - and I flatly disagree we'll be talking about something invisible to Americans. Subsidies, guaranteed issue, etc... those will all be plenty visible as soon as they're under threat.

Further, I think a little gloating necessarily 1) emboldens the HCR troops, 2) demoralizes the opponents and 3) by definition means focusing on the positive. That last point alone should satisfy you since the positive is what we HAVEN'T been hearing about all this time: the substance of the thing.

Further, I'm sorry but anyone that can't understand the impulse to spray a little champagne on your pals after a long sought victory is just insufferably drear. This was a long, hard fight. There's nothing wrong with savoring the moment for a freaking day. Lighten up.

Posted by: roquelaure_79 | March 22, 2010 8:23 PM | Report abuse

Mr Pollack deserves much credit for once the moment seemed reform would happen putting the systems into place to make sure the right things were done and included all players.

he's like the unions but without the heavy handed tactics and their own special deals they're keeping themselves safe from.

Good for him. He deserves a lot of credit for helping this all to happen and he doesn't get enough of it.

I don't know that there was a Ron Pollack in 1994. They could have used him.

Posted by: visionbrkr | March 22, 2010 8:26 PM | Report abuse

I applaud the ambition but there is no way to get 95% coverage with this for-profit system because of short term coverage gaps. Also the mandate penalty is too low. Also there is no penalty for people less than 100% FPL. Also religous exemptions. And of course that 95% excludes 12-20 million illegals.

Posted by: bmull | March 22, 2010 8:44 PM | Report abuse

@akmakm: "the Anthem rate increase is unchanged, raising my rapidly disappearing CALCOBRA by another $150/mo. As soon as that runs out I'm completely screwed to 2014 because of pre-existing conditions."

You are mistaken. After exhausting COBRA you are eligible for guaranteed-issue coverage through any of the insurers selling individual insurance in the state. They are required to sell you one of the two most popular plans that they sell without any pre-existing condition exclusions.

It amazes me how uninformed people are, and how they'll use that ignorance to demonize someone else.

You're right, akakm, this bill does nothing to fix your situation, because your situation IS ALREADY FIXED by existing laws. How about getting informed before you go on a "woe is me" lament and insult Ezra.

Posted by: ab13 | March 22, 2010 9:28 PM | Report abuse

ab13 - That's a good point. A lot of people don't know that. This is why I don't like sob stories as an argument for reform. When you delve into the details they usually don't hold up.

Posted by: bmull | March 22, 2010 9:52 PM | Report abuse

"I flatly disagree we'll be talking about something invisible to Americans. Subsidies, guaranteed issue, etc... those will all be plenty visible as soon as they're under threat."

No. They'd be invisible because the people getting them are largely invisible. It's the whole "programs for the poor doing poorly" thing. People don't understand that those folks need to be included in the insurance pool, and I'm afraid subsidies will be cut in the name of deficit reduction (which wouldn't have happened if we did this using a Public Option...)

It will be a whole lot easier to cut subsidies if this thing's still a thing labeled Obamacare in 5 years. Obama may do a lot of things wrong, but he's GREAT at making divisive things sound like they're both popular and believed by both Democrats and Republicans. That sort of attitude will pay off, not humiliating the opposition with the win for the next couple years.

"There's nothing wrong with savoring the moment for a freaking day. Lighten up."

Yeah I knowww... It's just tough to enjoy when there's so much bad info out there. I wrote that earlier comment after hearing a group of otherwise educated people at a top law school talk about this being "health care for the lazy and poor." Depressing. With people so willingly dumb on this issue, I worry about the political prospects for the thing when the deficit's huge and the time frame on implementation is really long.

Posted by: Chris_ | March 22, 2010 10:05 PM | Report abuse


yes another uninformed american who doesn't realize he or she is eligible for guaranteed issue coverage.

Most don't understand the rules of HIPAA either.

Ezra does a great job of trying to inform those who come around here but if its something they don't want to believe, don't want to hear sometimes its easier to blame someone else.

Posted by: visionbrkr | March 22, 2010 10:29 PM | Report abuse

Eh, well... here's my philosophy: screw the uninformed. They're a pre-existing condition that can't be helped. Take your enjoyment where you can, especially when it's hard won.

Posted by: roquelaure_79 | March 23, 2010 12:38 AM | Report abuse

Premiums for HIPAA guaranteed coverage plans may be triple the premiums for comparable individual coverage. The Blue Cross and Aetna plans I've seen for California either don't provide any coverage if you leave the state; or, don't provide any in-network coverage out of state. Either way, you have exactly one shot to enter one of these plans. Once in, you are now in an individual (but overpriced) plan and have no more options to switch to any other guaranteed issue plan. So if you move to a new state, with most of these you are either uninsured, or badly insured. Blue Shield may not be as severely restricted - still looking into it.

My point is, yes there is guaranteed coverage, but at an enormous price and with great limitations. And if you take these plans, then you are insured - and won't be able to get into the new high risk pools that are going to be set up, because they will require that you be uninsured for a considerable period (6 months) to be eligible. So choose your poison - enormous premiums to stay insured, or gamble for 6 months without any insurance.

Now - anyone here still want to say this is a lovely existing safety net? Anyone want to call this ignorant?

The only thing I'm aware of in HCR that is of immediate help to the middle-aged is the lifting of lifetime maximums. As far as I can tell, there is NOTHING ELSE until 2014, unless you are willing to go uninsured for 6 months, and can then get into a high risk pool (of which we know next to nothing - what benefits? what premiums? waiting lists? Most states with high risk pools today have long waiting lists and provide lousy benefits).

Posted by: idf2 | March 23, 2010 9:44 AM | Report abuse

Hmmm, not much discussion. Feh.

Posted by: idf2 | March 25, 2010 1:22 AM | Report abuse

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