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The Expert View
Expert View - Winter 2012 - Karen Pollitz
Karen Pollitz, MPP
Senior fellow
The Henry J. Kaiser
Family Foundation


Karen Pollitz, MPP
For Your Health's Sake, Become an Expert on Reform

By Sandy Graham

EDITOR'S NOTE: Karen Pollitz, MPP, is a senior fellow at The Henry J. Kaiser Family Foundation where she directs and sponsors research related to consumer protections and transparency in private health insurance. Previously, Pollitz was a director in the federal government's Center for Consumer Information and Insurance Oversight, which was created to implement Affordable Care Act (ACA) provisions related to private insurance. She also has worked for the Health Policy Institute at Georgetown University, as a deputy assistant secretary in the U.S. Department of Health and Human Services and as a health care policy advisor to members of Congress.

What's the biggest change you see coming in private health insurance that people should be aware of?

We already have seen some big changes. The provision of the Affordable Care Act [ACA] that allows parents to keep their adult children on their policies until the children turn 26 took effect in 2010. In the Kaiser Family Foundation's "2011 Employer Health Benefits Survey," we found that meant 2.3 million young adults were added back to their parents' policies. That's a huge change! This is the age group that has long been a driver for the number of uninsured people in this country. Another change due to the new law that's also taken place is that health insurance plans must cover preventive services.

But this is all really building toward 2014 when the ACA will make insurance markets easier to navigate, create a subsidy system so lower-income people can buy insurance, set standards for what new policies have to cover and create exchanges where people can find coverage if they have no other insurance.

How aware is the average person of this change and others that are about to occur?

An August 2011 poll by the Kaiser Family Foundation found that only about half of nonelderly Americans currently without insurance coverage say they are familiar with the chief components of the ACA. And 47 percent of uninsured people surveyed said they did not expect to be affected at all by federal health care reform.

The poll indicates to me that if you're not an avid reader of the Federal Register, you don't know what's coming in 2014. That's a challenge for public education.

Is there a way to get around the emotion that has clouded the debate over health reform so we can get to the facts?

Certainly if people are looking for facts there are great places to find them. Two of them are our website, www.kff.org, which has a whole section on the ACA, [and] the federal government also has a website on reform, www.healthcare.gov. The site is part of what I worked on while I was at the Center for Consumer Information.

The harder part is if people aren't actively looking for information and they're just being bathed in the information that's coming out of cable television or radio or wherever. It has been the case for a long time – since the time of Theodore Roosevelt, really – that health care issues, while fundamentally important to people, are easy to demagogue. Over the decades, attempts to change the health care system have been labeled Bolshevist, Communist, German – whoever was evil at the time.

Such rhetoric is difficult to overcome. Here at Kaiser, we try to focus on the facts. My own inclination, since I am a two-time cancer survivor and have been on the other side as a patient, is to try to frame the issues and what's going on from the perspective of people who need health care. This makes it real to people.

If a person expects to continue to have insurance through an employer or through an existing individual plan, should he or she be following what's happening in health reform?

It always makes sense to study up on your health insurance and what's being offered. But there's always been a cliff between employer-sponsored coverage and what you can buy on your own. There are many more protections for you when you're covered by an employer's plan. For example, I cannot be excluded from an employer's group plan, but I am definitely uninsurable [because of the cancer diagnoses] if I tried to purchase an individual plan. An individual insurance plan has no premium subsidies [from an employer] and individual policies typically offer less coverage. For example, you're much less likely to find an individual plan with comprehensive coverage for mental health services, prescription drug coverage or pregnancy coverage. That also will change in 2014. So you really do need to keep an eye on what's happening.

Do you see a need for educating people to be informed users of health care, not just informed users of their health insurance coverage?

People should always be savvy consumers of anything they spend money on. In health care, they have to understand it's a business and there's a whole lot of marketing going on. Unfortunately, when you're very sick or hurt and consuming a lot of health care, it's hard to be an informed purchaser.

Accountability to make health care more affordable and efficient cannot just rest with the consumer. There needs to be accountability built into the system and there are elements of that in the ACA – such as the medical loss ratio, which requires insurance companies to spend roughly 80 percent of what they collect in premiums on claims. The act also drives the quality of care by including efforts to reduce hospital readmissions or errors at the bedside. There also will be new measures of doctors' and health plans' quality of care.

So, yes, it's important for individuals to ask questions and be good consumers of health care, but because of the nature of the system, we also need to engage hospitals, doctors and insurance companies so they're also held accountable.

Is it time to get on with it and actually reform American health care?

I think it would be lovely if the rhetoric would just stop and implementation would just proceed. This has been a politically charged issue for about a century, though, so that's not something that will likely go away. Still, I do think that it's significant that about 50 million Americans have no health insurance and many, many millions more have inadequate coverage so that they end up saddled with medical debt or going into bankruptcy. I'm hopeful that those problems will also remain prominent in the public discussion and will be addressed meaningfully as health reform is implemented.