DeParle: GOP plan doesn't 'make sense'
Health-care reform begins today. At least, some of it does. As of today, health insurers must extend dependent coverage for children up to age 26. They also can't discriminate against children based on preexisting conditions. Coverage can no longer be rescinded except in cases of fraud, and lifetime limits on care are outlawed. But insurers are saying that all this will raise costs, and the GOP renewed its promise to repeal the bill. Earlier this afternoon, I interviewed Nancy-Ann DeParle, director of the White House's Office of Health Policy, to get the administration's perspective on this. An edited transcript follows.
Ezra Klein: What actually changes for people today?
Nancy-Ann DeParle: Kids up to 26 years old get to stay on their parents’ plans. We ban insurance companies from dropping coverage after people get sick. We ban lifetime limits on coverage. Anyone who has had a serious condition or chronic condition or thinks they might ever -- and that's all of us -- should welcome that one.
And then there are the pieces of the patient’s bill of rights. Insurance companies now can’t limit your choice of doctor in the network. Insurers can no longer restrict emergency room care, you can’t get a huge bill because you went to the closest emergency room rather than some other one. Covering preventive care with no cost is a big foundational piece to changing the cost curve. It begins moving insurance from helping when you get sick to helping you stay well.
And what about the plan that Republicans put out today? They said they'd repeal the bill but keep some of its more popular provisions, like the ban on preexisting conditions.
I think they would’ve done better to just say repeal rather than say they’ll replace it with these things that don’t make sense. We’re trying to figure out what they mean when they say they’ll continue to ban preexisting coverage exclusions. Their language there says that insurers can't discriminate against people who had "prior coverage." That's the existing law in COBRA. If it’s that, then it does nothing. But if they mean they’ll ban preexisting conditions without asking everyone to get covered, CBO says that’ll raise costs by 20 percent.
Realistically, Republicans won't be able to repeal the bill. They don't hold the White House and they're not likely to get 60 votes in the Senate. But they've been talking about strategically starving it of funding. Does that worry you?
It poses a lot of danger. If they go to the appropriations committees and say no funds can be used to enforce the ban on preexisting conditions, no money can be given to get healthreform.gov up and running in October, no more seniors getting discounts on their prescription drugs in the donut hole, no trillion dollars in deficit reduction, they can do damage.
Is the White House willing to fight that out to the end with them? The plan's poll numbers aren't great. If the Republicans are threatening to shut down the government, could there be some deal where certain parts don't get funded and others do? Or is the White House determined to stand on this?
Of course. We’d be happy to fight with them about defunding any of this. But I’m not sitting around thinking about defunding this bill. I’m thinking about how we move forward and implement it in a smart and intentional way.
Then on implementation, the insurers are saying look, these new regulations might be great, but since they don't have some of the cost controls that the bill is bringing in later, we're going to have to raise costs or stop offering certain plans. The White House has reacted angrily to this, but why are they wrong?
Well, the law is very clear. Children can’t be discriminated against for preexisting conditions. And the insurers say they will abide by that with family policies, but they say that this niche product they’ve developed, these child-only policies, will be affected. That market is very profitable for them now, They underwrite these kids, check them out, and then decide whether to insure them.
When we were writing this regulation, they came to us and said children need to come in right at the beginning, they can’t just come when they get sick. We checked with the actuaries and said fine, you can have an open enrollment period. And then they said they wanted to underwrite all year. They can’t do that. We don’t restrict them from raising their rates. But they don’t seem to want to do that. So I don’t know what to believe. I'm very cynical on this.
But when you put all this together, it will raise some of their costs, right? I mean, that's why you have things like the individual mandate coming in later. But for now, isn't it likely that we'll see a bump?
At the margins, yes. But a tiny bit. We did a cost analysis. We had actuaries and economists look at it. And at most, all of this together will be up to one or two percent. So yes, some of these benefits do have a slight cost. We also believe things like prevention benefits will save money over the long-term. But that’s why we’re not banning preexisting condition discrimination for everyone right now -- which looks like what the Republican plan purports to do. So yes, there’s a tension, but you can work through, in a deliberate way, which things can be done now and which have to wait for the new markets.
Finally, the bill isn't popular, and it looks to have slipped a bit further in the last month. Why do you think that is?
I don’t look at polls that much but to the extent I have, it looks pretty stable. There’s a certain number of people who’ve never liked it and their intensity has remained about the same. There’ve been people who’ve always loved it and they’ve been stable. And then there are people in he middle, who’ve been pretty stable. But there was a great story yesterday. A lady from Florida was telling the president how her son had had an operation and she had to switch insurers and she was surprised by how low the quote was. So she said to her broker that there has to be a catch. Are they going to refuse to cover everything related to the operation? And her broker said, no, the law says they have to cover your child. And she said she just thought, wow, my government is really helping me. I think people are going to have more of those wow moments going forward.
Photo credit: White House
| September 23, 2010; 2:16 PM ET
Categories: Health Reform, Interviews
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