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With an estimated 1,200 in the audience and another 600-1,000 people unable to find seating in the auditorium of Niles West High School, Congresswoman Jan Schakowsky’s town hall meeting on Aug. 31 brought out some of the fears and hopes about national health-care reform.

Loud at times, raucous at a few points and given to responding with applause, groans, cheers and boos, audience members led the Congresswoman – after her introductory remarks – to several of the talking points about H.R. 3200, America’s Affordable Health Choices act.

“This is the great issue of my life – the chance of having affordable, quality heath care available to all Americans,” said Ms. Schakowsky. “The only thing holding it up is a vocal minority [and that] for one or two reasons: [Either] they have coverage or they have been scared by the health-insurance industry.”

“What we want tonight is real dialogue, conversation,” said Ms Schakowsky. “This is about answering questions and debunking some of the myths.”

She presented several statistics about the present state of health-care coverage: About 1 in 3 persons is uninsured – 50 million men, women and children; 14,000 persons per day lose their insurance coverage; 22,000 persons die each year because they are uninsured; 62 percent of personal bankruptcies have to do with medical bills, and of those, 78 percent were insured when they got sick.

Topics in the hour-and-a-half meeting included the reasons for health-care reform; some of the benefits in the proposed bill; the fate of Medicare, given the proposed cuts; and certain misperceptions about the bill.

Overview of H.R. 3200

Information provided by Congresswoman Schakowsky’s office emphasized two aspects of H.R. 3200, insurance reforms and access to affordable coverage. According to that information, insurance companies would not be able to deny coverage or refuse to renew coverage. They would not be permitted to deny payment for treatment of pre-existing conditions, to cancel policies retroactively except in cases of fraud or to “charge high premiums to women and people with a disability or ongoing health-care needs.” Increases of premiums would be limited, and annual and lifetime caps on benefits would be eliminated. Fair standards for marketing appeals and grievances would be required. Out-of-pocket expenses on covered services [co-payments] would be limited to $5,000 per individual and $10,000 per family per year.

The bill would not mandate any changes for those who are satisfied with their insurance coverage, Ms. Schakowsky said. It would, however, add to the array of insurance choices a federally managed insurance program called the “public option.” If this bill were passed by Congress, it would be implemented in stages, some immediately, and others incrementally until 2018.

Is the Health-Care System Broken?

“We should understand that, with all the problems in this system, we have the greatest system in the world,” said one audience member. “Eighty percent of the people are satisfied; the 20 percent vocal are not. Why do we have to change the system for 100 percent of the people?” she continued.

Ms. Schakowsky responded, “The World Health Organization ranks the United states at number 37, right below Costa Rica. Our health care and technology are advanced. Unfortunately not everyone has access to them. And even those who are satisfied could get sick, lose their jobs or have pre-existing conditions [that would bar coverage for treatment].”

Benefits

Information compiled from the Gallup-Healthways Survey, the United States Census, the Centers for Medicare and Medicaid Services and the House Committee on Ways and Means, and distributed by Ms. Schakowsky’s office states that under HR 3200, in  the “9th Congressional District of Illinois, 7,000 uninsured individuals would gain access to high-quality, affordable heath insurance; up to 13,600 small businesses would receive tax credits to provide coverage to their employees; 6,500 seniors would avoid the ‘donut hole’ in Medicare, which forces them to pay their full drug costs, despite having Part B drug coverage; and health-care providers would receive payment for $126 million in uncompensated care each year.”

In addition, coverage for mental-health services would be on an equal footing with coverage of other health services.

Whither Medicare?

One person said he worked in a retirement home and had asked several senior citizens what question they would like him to ask. Their question, he said, was, “If Medicare is working, why are you messing with it?” He added that President Barack Obama has said he supports cuts in Medicaid and Medicare.

Ms. Schakowsky said she was “really, really glad he asked about taking money out of Medicare. There will be no cuts in benefits or beneficiaries. We will be phasing seniors out of the ‘donut hole’ though an $80 billion contribution from the pharmaceutical companies. There will be free preventive care, resulting in a decrease in out-of-pocket [co-payments] and a two-year freeze on premiums.” Money to pay for much of these programs, she said, will come from greater oversight on Medicare fraud and abuse.

Fears and Falsehoods

Several strident questions about aspects of H.R. 3200 and “pork” projects prompted Ms. Schakowsky to say, “What I’m hearing is a deep-seated lack of trust in government.” She said she believes Congress should work on eliminating wasteful spending, but, she added, “One person’s ‘earmark’ may seem like ‘pork’ to others.”

In responding to some voiced concerns, Ms. Schakowsky said, the bill does not permit coverage for undocumented individuals (illegal aliens). Federal funds will not be used to pay for abortions, the Congresswoman said. Nor will there be rationing of services. As for “Let’s Kill Grandma” and the so-called “death panels,” the bill does not address end-of-life decisions, she said, but expands Medicare coverage to include the cost of voluntary consultation with a doctor about end-of-life care. Further, she said, since it builds on the present system, it does not force people into a public plan.

Affordability

“How can we afford this?” said Ms. Schakowsky. “At present 49 percent of health-care costs are already paid for by the government.”

She added, “There is certainly a practical aspect to this – practical, because costs are skyrocketing. But there is also a moral dimension.

“Health care ought to be a right. The insurance industry, railroads, major league baseball are all exempt from the McCarron-Ferguson [anti-monopoly] Act. Ninety-four percent of the markets for health insurance are non-competitive.” She said she believes competition in the health-care insurance area will lead to lowered costs.

Next Steps

“Imagine an America where, if you get sick, you only had to worry about getting well – not about paying your medical bills. Imagine an America

where, if you or your child had a disability, or you lost or changed your job, you didn’t lose your insurance or have to change your doctor. Imagine that you can get screened for cancer and can get insurance because [denial for coverage because of] ‘pre-existing conditions’ had become a thing of the past. …” Ms. Schakowsky said. “I’m going back to D.C. next week, where there are three bills in the House and two in Senate committees. I believe that by the end of 2009, we will have affordable quality health care with a public option,” she said.

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