About This Series
Barack Obama's first term as president begins three Tuesdays from today. On every Tuesday between now and his inauguration, this series will look at a particular issue and expectations for Obama's first term.
Dec. 30: Energy and the environment
MONROE - President-elect Barack Obama recognized during his campaign that revamping the health care system in the United States is not going to be an easy task.
Karen Mau-Boll, an American Family insurance agent in Monroe, believes attaining the health care level in the Obama-Biden plan would be a "miracle."
In June 2003, Obama said he was a proponent of "a single-payer health care pan, a universal health care plan."
By May 7, 2007, he had qualified that position.
"If you're starting from scratch, then a single-payer system ... would probably make sense. But we've got all these legacy systems in place, and managing the transition ... would be difficult to pull off. So we may need a system that's not so disruptive," he said in an interview with The New Yorker.
But even with the multi-layered health care plan Obama is proposing, he is promising to implement universal health care by the end of his first term.
"We'll guarantee health care for anyone who needs it, make it affordable for anyone who wants it, and ensure that the quality of your health care does not depend on the color of your skin. And we're not going to do it 20 years from now or 10 years from now, we're going to do it by the end of my first term as president," he said at the 99th NAACP Convention on July 12, 2008.
Mau-Boll has been in the insurance business for 34 years and says "some things never change."
"The change as they describe, it cannot come overnight, nor can it probably come during the next four years. This plan calls for many, many people pulling together and changing the entire system. Is it possible? Doubtful. Is it probable? No..." she said.
Obama is guaranteeing "affordable, accessible health care coverage for all Americans."
At the core of his plan is guaranteed eligibility for all health insurance plans and a National Health Insurance Exchange to help purchase private health insurance.
How would that affect insurance agents like Mau-Boll?
"I sell individual health plans as well as Medicare supplements. I would be extremely pleased to see everyone in the USA with affordable health insurance and not only affordable but also quality care. I actually don't believe that this will happen during my career as an insurance agent, so I don't think Obama-Biden's plan will change my business," Mau-Boll said.
"If this were a perfect world and if all of this happened and all companies accepted everyone with all pre-existing conditions, THEN, my job would be much easier. I would simply fill out an enrollment form with a name, and address and the insurance would be issued.
"As it is now on individual plans (not including Medicare), I fill out several pages of health questions and spend the next 30 to 60 days waiting for a policy to come through issued standard and with no riders excluding health conditions that the applicant has.
"Medicare apps are streamlined and do not require the underwriting as long as they are applied for during the open enrollment time, and everyone is accepted regardless of pre-existing conditions."
Other parts of the Obama plan include new tax credits to families and small businesses; requirement for all large employers to contribute toward health coverage for their employees or toward the cost of the public plan; required health care coverage for all children; expanded eligibility for the Medicaid and SCHIP programs; and flexibility for state health reform plans.
Obama claims Americans will be able to maintain their current coverage, have access to new affordable options, and see the quality of their health care improve and their costs go down.
Mau-Boll had one major concern with the entire plan.
"Where will the money come from?" she asked.
"The idea of working with money within the USA makes me excited, rather than sending all of the help abroad, but what will they sacrifice to get the billions of dollars that are needed to ensure that every person has insurance?" she said.
To help pay for the plan, Obama is reaching for cost savings by reducing inefficiency and waste and by improving health care quality, which could drive down costs for families and individuals.
Obama says his plan will produce about $120 billion a year, or $2,500 per family, in savings, with more than half, about $77 billion, coming from a drive to adopt state-of-the-art health information technology systems.
"Even in a perfect world, this plan would be next to impossible," Mau-Boll said. "How long will it take for all medical facilities to become electronic? I see many clinics working on that, but unless they require it by a certain date, will it get done? And how many small clinics will it force out of business? Will we then see monopolies?"
The Obama plan references a RAND study that found the use of electronic health records by most facilities could save up to $77 billion a year in overall health care spending. But the study says that level of savings won't be reached until 2019, when it projects 90 percent of hospitals and doctors would be using electronic records systems.
The plan calls for an investment of $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records.
Other savings in the Obama plan are expected to come from required access to preventive care and chronic disease management programs; the required collection and reporting of cost and quality data by hospitals; reformed market structure to increase competition in the insurance and drug markets; and lowered drug costs by allowing importation of safe medicines and increasing use of generics.
Obama also has said the plan will "lower premiums by up to $2,500 for a typical family per year."
But the $2,500 figure includes savings to government and employers, and could lead to lower taxes or higher wages for families.
Obama claims his plan "strengthens employer-based coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference."
Under the plan, "if you like your current health insurance, nothing changes."
But employers are going to have to "pay or play," Obama said Mar. 24, 2007, at the Service Employees International Union (SEIU) Democratic Health Care Forum in Las Vegas.
"I think that employers either have to provide health care coverage for their employees or they've got to make a decision that they're going to help pay for those who don't have coverage outside the employer system. So I think that's one important principle, and the second important principle is that we're going to have to put more money into prevention, chronic care management, and medical technology, because that is how we're going to accrue the needed savings," he said.
Now, more than a year later, Mau-Boll sees economic conditions are playing a major role in employers' decisions even to stay in business.
"The more that I read of the plan, the more I asked myself, where will the money come from? This is only one of the many, many problems that Obama and Biden need to fix," she said.
"This plan will cost us as taxpayers billions of dollars. They are going to require large employers to contribute toward health coverage or toward the cost of the public plan - that is good, but where are the large employers going to get the money? Look at GM and the other major car companies that have been paying for the health benefits ... Where are they today?" she said.
Health insurance premiums have doubled, rising 3.7 times faster than wages, in the past eight years. Increasing co-pays and deductibles threaten access to care.
Calls to Mau-Boll's office verify that statistic.
"Actually, I just got off of the phone with a prospective client and her health insurance jumped 35 percent," Mau-Boll said. "But I know her wages did not go up that much."
More than 45 million Americans, including more than 8 million children, lack health insurance. Eighty percent of the uninsured are in working families.
Obama finds those statistics are caused, in part, by "anti-competitive actions in the drug and insurance companies" which benefit most from the status quo.
There were more than 400 health care mergers from 2000-2006. WellPoint and United (United Group Health) control 33 percent of the U.S. commercial health insurance market. WellPoint covers approximately 34 million Americans. By 2005, United's membership had grown to 32 million.
"Obama and Biden say they will require insurance companies to cover pre-existing conditions. Who will finance such a program? Small health insurance companies as well as some of the larger ones that sell individual plans for general health insurance (not including Medicare) are losing money as it is on health claims," Mau-Boll said.
"When they are forced to take people with pre-existing conditions, there would have to be a lot of subsidizing of the premium from the government or it will force many companies out of the business," she said.
Obama intends to pay for his $50-$65 billion health care reform effort by rolling back the Bush tax cuts for Americans earning more than $250,000 per year and retaining the estate tax at its 2009 level.
"The self-employed, the farmers, the elderly on a fixed income and those who do not have employee-sponsored programs struggle, just as they have throughout my entire career," Mau-Boll said. "I would be thrilled if I woke up tomorrow and everyone had health insurance and it was affordable and quality care, but as I said, if ever, it will take much time, knowledge, and money."
Karen Mau-Boll, an American Family insurance agent in Monroe, believes attaining the health care level in the Obama-Biden plan would be a "miracle."
In June 2003, Obama said he was a proponent of "a single-payer health care pan, a universal health care plan."
By May 7, 2007, he had qualified that position.
"If you're starting from scratch, then a single-payer system ... would probably make sense. But we've got all these legacy systems in place, and managing the transition ... would be difficult to pull off. So we may need a system that's not so disruptive," he said in an interview with The New Yorker.
But even with the multi-layered health care plan Obama is proposing, he is promising to implement universal health care by the end of his first term.
"We'll guarantee health care for anyone who needs it, make it affordable for anyone who wants it, and ensure that the quality of your health care does not depend on the color of your skin. And we're not going to do it 20 years from now or 10 years from now, we're going to do it by the end of my first term as president," he said at the 99th NAACP Convention on July 12, 2008.
Mau-Boll has been in the insurance business for 34 years and says "some things never change."
"The change as they describe, it cannot come overnight, nor can it probably come during the next four years. This plan calls for many, many people pulling together and changing the entire system. Is it possible? Doubtful. Is it probable? No..." she said.
Obama is guaranteeing "affordable, accessible health care coverage for all Americans."
At the core of his plan is guaranteed eligibility for all health insurance plans and a National Health Insurance Exchange to help purchase private health insurance.
How would that affect insurance agents like Mau-Boll?
"I sell individual health plans as well as Medicare supplements. I would be extremely pleased to see everyone in the USA with affordable health insurance and not only affordable but also quality care. I actually don't believe that this will happen during my career as an insurance agent, so I don't think Obama-Biden's plan will change my business," Mau-Boll said.
"If this were a perfect world and if all of this happened and all companies accepted everyone with all pre-existing conditions, THEN, my job would be much easier. I would simply fill out an enrollment form with a name, and address and the insurance would be issued.
"As it is now on individual plans (not including Medicare), I fill out several pages of health questions and spend the next 30 to 60 days waiting for a policy to come through issued standard and with no riders excluding health conditions that the applicant has.
"Medicare apps are streamlined and do not require the underwriting as long as they are applied for during the open enrollment time, and everyone is accepted regardless of pre-existing conditions."
Other parts of the Obama plan include new tax credits to families and small businesses; requirement for all large employers to contribute toward health coverage for their employees or toward the cost of the public plan; required health care coverage for all children; expanded eligibility for the Medicaid and SCHIP programs; and flexibility for state health reform plans.
Obama claims Americans will be able to maintain their current coverage, have access to new affordable options, and see the quality of their health care improve and their costs go down.
Mau-Boll had one major concern with the entire plan.
"Where will the money come from?" she asked.
"The idea of working with money within the USA makes me excited, rather than sending all of the help abroad, but what will they sacrifice to get the billions of dollars that are needed to ensure that every person has insurance?" she said.
To help pay for the plan, Obama is reaching for cost savings by reducing inefficiency and waste and by improving health care quality, which could drive down costs for families and individuals.
Obama says his plan will produce about $120 billion a year, or $2,500 per family, in savings, with more than half, about $77 billion, coming from a drive to adopt state-of-the-art health information technology systems.
"Even in a perfect world, this plan would be next to impossible," Mau-Boll said. "How long will it take for all medical facilities to become electronic? I see many clinics working on that, but unless they require it by a certain date, will it get done? And how many small clinics will it force out of business? Will we then see monopolies?"
The Obama plan references a RAND study that found the use of electronic health records by most facilities could save up to $77 billion a year in overall health care spending. But the study says that level of savings won't be reached until 2019, when it projects 90 percent of hospitals and doctors would be using electronic records systems.
The plan calls for an investment of $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records.
Other savings in the Obama plan are expected to come from required access to preventive care and chronic disease management programs; the required collection and reporting of cost and quality data by hospitals; reformed market structure to increase competition in the insurance and drug markets; and lowered drug costs by allowing importation of safe medicines and increasing use of generics.
Obama also has said the plan will "lower premiums by up to $2,500 for a typical family per year."
But the $2,500 figure includes savings to government and employers, and could lead to lower taxes or higher wages for families.
Obama claims his plan "strengthens employer-based coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference."
Under the plan, "if you like your current health insurance, nothing changes."
But employers are going to have to "pay or play," Obama said Mar. 24, 2007, at the Service Employees International Union (SEIU) Democratic Health Care Forum in Las Vegas.
"I think that employers either have to provide health care coverage for their employees or they've got to make a decision that they're going to help pay for those who don't have coverage outside the employer system. So I think that's one important principle, and the second important principle is that we're going to have to put more money into prevention, chronic care management, and medical technology, because that is how we're going to accrue the needed savings," he said.
Now, more than a year later, Mau-Boll sees economic conditions are playing a major role in employers' decisions even to stay in business.
"The more that I read of the plan, the more I asked myself, where will the money come from? This is only one of the many, many problems that Obama and Biden need to fix," she said.
"This plan will cost us as taxpayers billions of dollars. They are going to require large employers to contribute toward health coverage or toward the cost of the public plan - that is good, but where are the large employers going to get the money? Look at GM and the other major car companies that have been paying for the health benefits ... Where are they today?" she said.
Health insurance premiums have doubled, rising 3.7 times faster than wages, in the past eight years. Increasing co-pays and deductibles threaten access to care.
Calls to Mau-Boll's office verify that statistic.
"Actually, I just got off of the phone with a prospective client and her health insurance jumped 35 percent," Mau-Boll said. "But I know her wages did not go up that much."
More than 45 million Americans, including more than 8 million children, lack health insurance. Eighty percent of the uninsured are in working families.
Obama finds those statistics are caused, in part, by "anti-competitive actions in the drug and insurance companies" which benefit most from the status quo.
There were more than 400 health care mergers from 2000-2006. WellPoint and United (United Group Health) control 33 percent of the U.S. commercial health insurance market. WellPoint covers approximately 34 million Americans. By 2005, United's membership had grown to 32 million.
"Obama and Biden say they will require insurance companies to cover pre-existing conditions. Who will finance such a program? Small health insurance companies as well as some of the larger ones that sell individual plans for general health insurance (not including Medicare) are losing money as it is on health claims," Mau-Boll said.
"When they are forced to take people with pre-existing conditions, there would have to be a lot of subsidizing of the premium from the government or it will force many companies out of the business," she said.
Obama intends to pay for his $50-$65 billion health care reform effort by rolling back the Bush tax cuts for Americans earning more than $250,000 per year and retaining the estate tax at its 2009 level.
"The self-employed, the farmers, the elderly on a fixed income and those who do not have employee-sponsored programs struggle, just as they have throughout my entire career," Mau-Boll said. "I would be thrilled if I woke up tomorrow and everyone had health insurance and it was affordable and quality care, but as I said, if ever, it will take much time, knowledge, and money."