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What would happen if you broke your leg tomorrow?
by

Maxine Lo

on 22 December 2009

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Transcript of

how would health care reform
affect these people? maureen book, nurse, 59 jesse brooks,
patient, 48 sadri madjlessi,
business owner, 45 micah circe,
uninsured worker, 29 Age: 48
Health condition: HIV-positive
Unemployed, on disability
Location: Oakland, CA

Current healthcare coverage:
He receives Medicare and MediCal and pays a $200 annual deductible. There is no monthly cost. Most co-payments or other medical expenses he might encounter are covered by California’s Ryan White Act, a special program using federal funds to pay for AIDS patient services.

"His situation is almost certainly not going to change. MediCal for HIV patients is not going to change under the House bill.

"Waiting rooms are going to be crowded, but there is no short-term solution. The long-term solution is more clinics, doctors, electronic medical records.

"Even people with money will bump into more demand for physician services. Everyone who now has health insurance is going to face a delivery system that will now have to cover or deal with at least 30 million more people. Therefore, access may indeed be affected, because so many more people will be insured, and the number of doctors will not double overnight.” “Congress now has access to a mini-health exchange run by the federal government. Federal employees- including the President – can choose a plan. It’s a health exchange. The Office of Personnel Management negotiates with health plans concerning premiums and benefits. That’s exactly what the health exchange in the House bill would do for everybody.

"Whether the health exchange for everybody would do this as effectively, though, remains to be seen – it has to do with how much power and money is given to the exchange. Right now, Congress appropriates what it wants for good health insurance for federal employees, even while some members object to the cost of providing this kind of coverage for others.”
Age: 59
Employer: Sutter Hospice, Oakland
Occupation: nurse
Income: less than $100,000 per year
Current health coverage: She pays $6,000 a year toward health insurance provided by her employer. This covers Book, her husband and their 22-year-old daughter.


There has become an emphasis on perfect documentation, sometimes at the expense of having less time with patients. It can take me 15 to 20 minutes to collect information about a new patient, and then spend three-and-a-half to four hours documenting, coordinating, communicating.” "Most providers are still using paper documents. We have a medieval documentation system. That is going to change, regardless of what happens to the House bill. They want to put another 35 million people in the system. Health reform will not work unless delivery is computerized." Age: 29
Employer: The East Bay Depot for Creative Reuse, Oakland
Income: $1,200/month
Current health care coverage: none
“This person is exactly who the House bill targets because his income is less than 150% of the Federal Poverty Line. This person would definitely be eligible for Medicaid coverage under the House bill.” Age: 45
Owner, Hudson Bay Cafe and I Squared restaurant, Oakland
21 full and part-time employees
Current health care coverage: Kaiser

Madjlessi, his wife, and their three children, along with the seven full-time employees of the restaurant and cafe the family owns, are covered under the same group plan for small business. The family pays $700 per month for its own health insurance, with a total yearly deductible of $1,500 per person, or $3,000 for the family. Madjlessi pays $2,500 per month to cover his full-time employees. He says he would cover part-time employees as well if he could, but that it's too costly to cover everyone. He would go to Kaiser. All costs above his yearly deductible are covered. "But I think there are a lot of businesses out there that are just hanging by a thread to survive.

"Say it’s a small café that only has 2 or 3 employees, and you’re going to mandate they have to give health insurance, and its going to be another 700-800 bucks a month for them? That’s going to put them under.

"Or if they’re smart enough, they’ll be creative. They don’t hire anybody full-time, which is a shame. They’ll hire more people at part-time. So instead of having 3 people who could make a living, they’ll hire 6 part-timers that won’t qualify for health insurance. So what did they accomplish? Not a whole lot." “It’s a policy tradeoff. It all starts with the social value placed on employer-based insurance. If we agree that there should be an employer mandate, those have – forever – only involved full-time employees. If employers fire all full-timers, then you have consequences in the labor force."
Maureen Book,
nurse What if you broke your leg tomorrow? She'd go the Alta Bates emergency room,
and be charged a co-payment. Maureen says: “One thing I'm concerned about is more paperwork. Health policy expert
Lucy Johns responds: "As the president has said all year, the House bill does not change anything with regard to this well-insured family's existing health policy. Under the bill, Maureen's family would still be able to choose the policy they now have." "There is a huge push from both the House and Senate to transform our medical records. Another bill, part of the stimulus package that already passed, has allocated $44 billion over three years to computerize the medical records system." Micah Circe,
clerk
Lucy Johns responds: Jesse Brooks, HIV/AIDS activist What would you do if your leg broke tomorrow? Jesse says: "My concern is the quality. Will people have access to specialists?”
Lucy Johns responds:
Lucy Johns
responds: Sadri Madjlessi,
business owner What if your leg broke tomorrow? Madjlessi says: “We’re in a very fortunate situation, where we can afford to do what we are doing.
Lucy Johns responds: Jesse would go to emergency room. He thinks the co-pay, if there was any,
would covered by the Ryan White act, but he's “not concerned.” Jesse asks: “Would the public option be comparable to the Congress’ coverage? My hope is that they pass a bill that they would use.” “The House bill would mandate that part-time workers not covered by their employer’s insurance would have to buy their own health insurance. Unless we don't know their incomes, we don't know whether they might qualify under the House bill for Medical. But since most restaurant workers receive fairly low pay, they might." “Under the health insurance exchange, this business owner might find a better deal for both his family and his employees. That’s what the President believes. The exchange is a mechanism for promoting competition between private insurers. We’ll see if that will work.” “Employers will say, ‘I’m going to shut down, or I’m only going to hire part-time people.' At the state level, they say, ‘I’m going to leave the state.’ But few really do. "The tradeoff is the expense and inconvenience of having a temporary workforce. I think hiring part-timers generates enormous new administrative duties for employers. Supervising a lot more individuals, your payroll, tax processes, FICA withholdings all become more complicated. Plus, the temporary employee market is much more volatile." "We have to remember that the cost of insuring employees is a tax deduction for employers. Small employers’ main problem with providing employees with insurance is the paperwork – it’s complicated. The insurance exchange will take over all of that… one hopes.” What if your leg broke tomorrow? "I'm really not worried. I really don't do the activities I used to do [rock climb and bike for fun] when I had insurance." " "
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