New Members, New Look at Health Reform

Whatever lawmakers say they want or intend to do, they will first have to swallow 5 painful truths.

Video: Health Insurance Basics

Video: Health Insurance Basics

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Tuesday's election results giving Republicans control of the House and a stronger voice in the Senate virtually guarantee that something will be done to the new healthcare law before all Americans are required to purchase insurance in 2014. That is, if recent comments from our leaders are any indication. In a White House press conference Wednesday, President Obama stated, "If the Republicans have ideas for how to improve our healthcare system, if they want to suggest modifications that would deliver faster and more effective reform, I'm happy to consider some of those ideas." However, Washington Senate Minority Leader Mitch McConnell would just like to trash the whole law altogether; in a speech he gave Thursday at the Heritage Foundation in D.C. he said Republicans in Congress should aggressively seek votes to repeal Democrats' healthcare overhaul.

What should happen, if anything, to healthcare reform? Tweak, repeal, or leave well enough alone? When lawmakers reopen the debate, they will confront a set of uncomfortable realities they will have little choice but to acknowledge. Here are five of the most important:

1. Bringing more people under the insurance tent won't fix our chronic health problems. Because screening that picks up health problems early is encouraged, the American healthcare system enables us to live longer than the British despite the fact that we've got much higher rates of diabetes, cancer, and heart disease, according to a study released Thursday by the Rand Corporation, a nonprofit research group in Santa Monica, Calif. "We spend twice as much as the English do on medical care," says study coauthor James Smith, a senior economist at Rand. "It costs a fortune" to screen more aggressively for breast and prostate cancers, he says, but we "get extra years of life out of it." That's true, at least for those of us who have insurance; 95 percent of the study sample did. But we can't realistically keep this spending up as our population ages, he says. Nor will providing superb healthcare to all fix the fact that Americans develop chronic illnesses about 15 years earlier than our British counterparts, mostly due to poor lifestyle choices like lack of exercise. No amount of healthcare access will solve what Smith says is the real problem: Americans are loathe to walk or bike from place to place, and we've got bigger waistlines as a result.

[For Good Health, Watch Your Waistsize, Not Just Your Weight]

2. Many young, healthy folks will opt out of insurance and pay the penalty when coverage becomes mandatory in 2014. That would be bad news for insurance companies, which rely on a healthy, low-risk pool of people to keep costs down. And it would be bad news for policy holders, who would see a subsequent spike in premiums. The reason healthy individuals may opt to take the penalty is simple: The fines are "too small," says Phil Lebherz, founder and executive director of the Foundation for Health Coverage Education, a nonprofit. In California, which allows low-cost premiums for young folks, a healthy 25-year-old typically pays just $95 a month for a high-deductible plan; in 2014, when the insurance exchanges open, that 25-year-old's premiums will rise to about $500 a month—if he doesn't qualify for subsidized premiums—since the federal law says policy premiums can't differ by more than a certain ratio by age, says Lebherz. On the other hand, the penalty for not having insurance will be just $95 a year, rising to $395 the following year—still not even $33 a month. What's more, no one has to worry about being denied insurance because of illness, so why not wait for that rainy day? Raising the penalties, not a popular vote-getter, or lowering premiums for the young invincibles to entice them to buy insurance would help fix things, says Lebherz.

3. Newly free preventive care may make healthcare costs explode. "When people go in to get free weight-loss counseling or a cancer screening test, they usually have followup appointments and more tests," says Lebherz. "New individual and group plans will cost more because of these services," he says, although it will probably take a few years before they're factored into premiums. Some wonder why we should get mammograms, cholesterol checks, and vaccines for free when regular maintenance isn't included in, say, our car insurance. "If your car insurance covered oil changes and tune-ups, no one could afford it," says insurance broker and healthcare blogger Henry Stern in an interview with Kaiser Health News.