Open for Questions: Health Care

Dr. Kristy Hammam: Hello, everyone.
Thank you for joining us.
I'm Kristy Hammam from WebMD.
We're here at the White House today with Health and Human
Services Secretary Kathleen Sebelius.
Secretary Sebelius will be answering your questions about
the Affordable Care Act, a topic also of great interest to the
WebMD community.
The questions I'll be asking Secretary Sebelius come from
people across the country who have been submitting them on
the White House YouTube channel where you can
also vote on questions.
The questions we'll be talking about today have received the
most number of votes.
We've received about 3,000 votes over the past day and a half.
And we encourage you to continue submitting questions throughout
the course of the conversation.
Let's get started.
The bill provides new coverage options starting this year for
people with preexisting conditions who have been
uninsured for at least six months.
We've had many questions about this topic.
LS in Portland, Oregon, asks: How do I apply for the
preexisting condition pool and what am I supposed to do?
What are my options for that six months of being rejected before
I can get into that pool?
And how expensive will that coverage be?
Secretary Sebelius: Well, all good questions.
First of all, Kristy, I'm really glad that you're here and glad
to have the opportunity to talk about the features of
the Affordable Care Act which really impacts
Americans across the country.
This is a great opportunity.
Every state will have a preexisting condition pool
set up and running by August.
And some states are running their own pools.
And in other states that Department of Health and Human
Services is actually providing the National Fallback Pool.
So the law says that individuals have to be uninsured for six
months and have a preexisting condition determination that
has prevented them from having affordable health insurance.
So a turndown letter or a quote that is just wildly
impossible to meet.
Or what a lot of insurance plans do is say we'll insure you but
we won't cover the condition that you need coverage for.
The best place to start is really, for the Oregon question,
is to call the insurance department in Oregon and
get the information about the application and the
website out of Oregon.
The price is determined by the price in Oregon.
So a standard rate in Oregon will set the
price for the pool in Oregon.
A standard rate in California will set the price for the
pool in California.
So the price is going to vary across the country.
And frankly, we are anticipating that most of the people who are
applying have already tried to get coverage and just haven't
been able to either get affordable coverage or
get a coverage at all during the six months.
We don't anticipate that people will be dropping their coverage
in order to get into the pool.
Dr. Kristy Hammam: Okay.
And then many people, including Reilly from Texas asked:
Why six months?
Secretary Sebelius: Six months was seen by Congress, again,
as the appropriate amount of time to make sure that
coverage was not available.
So they weren't just holding out for another option.
Or that, you know, people had been turned down,
which is one of the criteria.
We don't want people dropping their existing
coverage and shifting plans.
The whole idea was one more alternative available to
people who really were locked out of the market.
And again I want to point out this is not seen as the option
that is going to be available for long-term.
This is kind of a bridge strategy.
It's one more piece of the puzzle to get to 2014.
In 2014 there will be new insurance markets for everyone
including everyone with a preexisting condition.
They'll be able to come into the exchanges and
have affordable coverage.
So this is just a temporary bridge to
get people to that point.
Dr. Kristy Hammam: And then just one more related question.
This is from Jules from the WebMD community posting on
YouTube and she says: I'm concerned about
preexisting conditions.
I have several and I have my trusted doctors.
With the new Health Care Reform, will I have to change doctors or
can I continue to see the ones who know me?
Secretary Sebelius: Well, again, for Jules it depends on what her
options are between now and the time that we have these
new exchanges in 2014.
I think the preexisting condition plan coverage that
we're talking about should allow her to see her own doctors.
Should have a network of providers that have the
kind of medical care that she is used to.
The exchanges will certainly have a network that will allow
you to see your own doctors.
And a couple of other points about preexisting conditions.
One of the things that the law says is this year all health
insurance plans will have to insure children
with preexisting conditions.
So in a family plan their kids can no longer be locked out.
Starting in September of this year,
all the new policies that are issued have to involve children.
That's not going to happen for all adults until 2014,
so we have got kind of a phased-in strategy for
preexisting conditions.
Dr. Kristy Hammam: Okay, thank you.
Violet Reynolds in Clarksburg, West Virginia,
wants to know why it will take until 2014 for some of the
provisions to go into effect?
Why so long?
Secretary Sebelius: Well, Violet, that's a great question,
and it kind of relates to the question Jules just asked.
In order to set up new marketplaces everywhere
in the country, a couple of things have to happen.
I mean, first of all, you have to make sure that you have
providers in the network.
You can't really set up a plan, a health plan,
unless you make sure you have enough OB/GYN's to deliver
babies, you have got mental health professionals,
you have specialty care, you have got primary care,
and that really takes some period of time.
We want every consumer to have at least two choices.
So again, you are setting up kind of two new plans
in most markets.
Some may have three or four or five.
And the states will be running these exchanges.
And they need some time to make sure we get it right.
So we have got some bridge strategies: The preexisting
condition pool that will go into effect;
some new rules about help for small business owners to get
tax credits so they can begin to afford coverage;
some stabilization of the plans that are in place.
But we know that for a lot of people it isn't until you get
to 2014 until you see a brand new marketplace.
Dr. Kristy Hammam: Right.
We've had many questions from people who are concerned about
insurance companies raising premiums.
For instance, Carol in Colorado asks: What laws have you put
into place to prevent health insurance companies from raising
their rates because of having to insure all risks?
Secretary Sebelius: Well, that's a great question.
Again, companies are going to be phased in to this just the
way that individuals are.
But a couple of new rate authorities exist right away.
First of all, state insurance departments regulate the
companies in that state.
And we have asked all the insurance commissioners
-- and I used to be an insurance commissioner,
so I know these folks pretty well -- to look at their rate
authority and to actually go to their legislatures
to get broader authority.
To make sure that they get to check the rates before
they go into effect.
Check the numbers.
Look at the health trends.
And a lot of the states are doing that right now.
And secondly, we have got a new website up and running,
Healthcare.gov.
And right now, it combines all the plans that someone
has available, all the public plans, all the private plans,
and gives it in one easy-to-see comparison.
By October that will have price data on it.
I know from experience that putting prices side
by side is often a good strategy for competition.
It has -- companies don't like to be the most expensive
plan in the market.
We also have authority now at Health and Human Services to
look at excessive rates and we'll be doing that.
And finally there's a new piece of the Bill that starts in 2011
will require companies to spend at least 80 percent
of their premium dollars on medical losses.
It's the medical loss ratio.
So they have to make sure that they're returning good value
to consumers and not in CEO salaries and advertising and
paying agents, but really on paying health costs.
And again if they don't meet that threshold they will have
to rebate money back to consumers.
And I think all of those put together are again good
strategies until we get to the new marketplace in 2014.
Dr. Kristy Hammam: Okay.
Many people have expressed concerns that increased access
to care will come at the cost of quality of care.
Could you respond to that?
Secretary Sebelius: Well, actually I think that we are concerned about three
features and that's really what the Affordable Care Act
looks at: Access to care.
We, right now, have 40 million Americans with no real access.
That's going to change over time with this Bill.
But quality and cost are the other two important features.
What we know right now in America is that we spend almost
twice as much as any developed country per capita but our
health results are not as good.
So we're spending a lot more but not getting the
bang for our buck.
So part of what the President and Congress directed us to do
is really look at what are those issues which can improve the
quality of people's care, save lives,
and lower cost at the same time.
And there is a lot of effort.
Preventive care, for instance.
We know that having a mammogram, finding breast cancer early on,
increases a patient's likelihood of survival to 98%.
If breast cancer, on the other hand, is found late,
if it has been able to travel around your body for a while,
it's about 24% survival rate.
So the early mammogram really helps.
It helps save lives.
It helps lower costs.
It helps people get better in the long run.
The Affordable Care Act will get rid of the financial co-pay with
preventative care.
So there are strategies like that throughout the Bill that
are actually going to lower costs but also improve the
quality of people's care.
Dr. Kristy Hammam: Okay.
Starting September 23rd of this year, children under 26 will be
allowed to stay on their parents or family policy or be added to
it with some exceptions.
We had a lot of questions about this topic.
Here is one from Chase in New Jersey who says: How can I get
the fine print details for the new rule that allows a child to
stay on his or her parents' health coverage through age 26?
And then: Can a child stay on the parents' policy even though
the child's employer offers more costly and
less comprehensive coverage?
Secretary Sebelius: Good questions.
And the best way to get the fine print is really go to
the insurance company that your parents have.
It's almost impossible to tell you policy by policy.
But what the new federal law basically says is that
all plans will have to allow the opportunity for adult children
to re-enroll after the 23rd of September,
which is six months after the President signed the Bill,
so that option will be available and could provide
a cost-effective option.
If your adult child has employer-based coverage,
it is one of the only times that they are probably not going to
be allowed to re-enroll because it's assumed that they have
credible coverage, they have affordable coverage.
If they aren't working.
If they don't have coverage at all through their employer.
If, you know, they're married.
If any number of things don't provide barriers to come back
into the plan.
But if they have employer-based coverage,
that may eliminate the possibility of re-enrolling
on your parents' plan.
Dr. Kristy Hammam: Okay. Thank you.
And then a follow-up question comes from
Contenta in Galveston, Texas.
She says: We are on a very limited income and can't
afford health insurance.
Our college-aged daughter has serious health issues but was
dropped from the Medicaid Kids Program due to her age.
What can she do since we don't have insurance?
Secretary Sebelius: Well, I don't know how old the daughter is.
It's possible that she could qualify for Medicaid on her own.
Dr. Kristy Hammam: Okay.
Secretary Sebelius: Particularly given health conditions.
That's one option that the parents could look at,
not enrolling her as a child, but actually enrolling her
as a single adult is possible depending on
where that state is.
And unfortunately, in the intervening time,
the daughter may also qualify for the preexisting condition
pool that will be set up in every state around the country.
And that should be looked at.
For the parents, I think the best strategy is going to be in
2014 there will be a new market and there will be tax credits
available for families to purchase affordable coverage.
So there is some help from the government to come into those
insurance markets that probably at that point could insure the
whole family.
But in the short-term the daughter may be able to enroll
in Medicaid or may qualify for the preexisting condition plan
in that state.
Dr. Kristy Hammam: Okay. Okay. Great, thank you.
So on a different topic, this is a question from a citizen in
Oregon who says: Does anything in your plan act to control
prescription costs?
It's true that people need to be able to see a doctor,
but sometimes if a prescription is very expensive,
even if there is coverage, the price is still out of reach.
Secretary Sebelius: Well, again, the federal law doesn't really deal
with specifics of what's called the formulary.
You know, how many drugs are there,
whether you would substitute a generic drug
for a brand-named drug.
But most health plans do.
And those strategies will still be in place.
What's been very successful in lots of places around the
country is to actually encourage and sometimes even provide
financial incentives for a patient and a provider to switch
to a generic drug that may have exactly the same health benefits
but be at a half or a third of the cost.
That's often a part of the health plan and we're going
to certainly encourage that kind of cost savings.
We also had a pretty significant negotiation with Pharma,
the big group who manages a lot of the drug manufacturers,
in terms of cost savings over time.
A lot of the cost savings will come into the Medicare program
so that seniors who currently hit the so-called "doughnut
hole," the gap in drug coverage, will start to see some real
relief from that.
Now this year they get a $258 rebate check.
Starting next year there will be a 50% discount on brand name
drugs in the doughnut hole and that will gradually,
the doughnut hole will gradually be phased out
over the course of the plan.
Dr. Kristy Hammam: Okay. And then this comes from Vicky in Montana.
This will be our last question today.
Vicky asks: Will insurance companies be required to cover
alternative medicine such as chiropractic and acupuncture as
a form of preventative medicine?
Secretary Sebelius: Well, I think, Vicky,
it's likely that insurance plans will offer those alternatives.
First of all, they are very popular with consumers and a
lot of them have a lot of very good health benefits.
So right now a lot of plans offer nontraditional providers
or providers of a variety of fields.
And I think that's likely to continue in the future.
Again, we're not taking over the private market.
This is more the private plans becoming more competitive,
becoming more inclusive and operating finally under a new
set of rules which says they can't pick and choose any longer
who gets coverage and who doesn't.
Dr. Kristy Hammam: Okay. Thank you.
Thank you, everyone, so much for your questions today.
And thank you, Secretary Sebelius.
Secretary Sebelius: Sure. Great to be with you.
Dr. Kristy Hammam: It was very informative. Thank you.
If you missed part of the conversation,
you'll be able to see the video in about 24 hours on
the WhiteHouse.gov website.
We'll also be answering a few more of the questions that we
didn't get to today.
They'll also be available at WhiteHouse.gov or you can go
to WebMD.com and search "Health Care Reform."
Thank you.