McCain Vs. Obama on Health Care Reform: What About Those with Special Needs?

Our family's experience

Like Sarah Palin, I am the mother of a special-needs child, so I have a driving interest in this topic. According to both the McCain and Obama Web sites, 47 million Americans have no health insurance at all. And I can tell you from personal experience that even if you have good insurance through an employer, when someone in the family has a chronic condition the bills for "co-pays" and "co-insurance" are huge.

Our family's annual medical expenses, for a family of five including one special-needs child, average $427 a month or $5,124 a year in after-tax dollars. Health insurance premiums are $322.83 per month in pre-tax dollars, or $3,873.96 per year.

John McCain's proposal

McCain's plan, says his Web site, aims to make health insurance "innovative, portable, and affordable." Families and individuals will still have the option of employer-based coverage. But if they buy their own, they can receive a tax credit -- that's dollars straight off your tax bill -- of $2,500 for individuals and $5,000 for families, to offset the cost of buying their own insurance.

Insurance could be purchased "nationwide, across state lines" so that in theory, market forces will drive prices down and provide more choices. If you can find someone to sell you insurance for less than the price of the credit, you can put the difference in a Health Savings Account. And since your insurance isn't tied to your job, it's "portable."

McCain also offers a host of proposals to reduce the cost of health care overall -- everything from lowering drug prices to tort reform for medical liability lawsuits.

It all sounds good. But what about those with pre-existing conditions, or a child like mine who gets at least one MRI a year, sticker price $10,000? What insurance company with a profit motive, and who has the freedom to decline applicants, would take her on?

McCain's site attempts to address the issue with a special section, but most of it is so obfuscated by its language, I can't make heads or tails out of it. All I gathered was this (annoying capitalization removed): "As president, John McCain would work with governors to find the solutions necessary to ensure those with pre-existing conditions are able to easily access care."

When I surfed around a little, I found some articles saying that McCain is talking about "high risk pools" some states have, that limit premiums charged to people with pre-existing conditions and are a form of "guaranteed access." Hmm.

Barack Obama's proposal

Obama's proposal was a little harder for me to understand. His site says that his plan "strengthens employer coverage, makes insurance companies accountable and ensures patient choice." The site says that insurance companies would be required to cover pre-existing conditions at "fair and stable" premiums, and that after all of Obama's cost-saving reforms are phased in, the average family would save $2,500. The key to Obama's plan appears to be assisting more employers to offer insurance by having the government share some of the costs.

There would also be a "National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage."

Truly, I have no idea what that means, but I think he's getting at extending the insurance plan that the government offers itself, to everyone -- so they can buy their own insurance at a reasonable price if they cannot get it through an employer. Obama's site talks vaguely about a tax credit if you have to buy your own insurance, but doesn't say what the credit would be.

The $2,500 savings will come from many cost-saving reforms, such as allowing Americans to import medications from other countries where patients aren't gouged by the drug companies. (It's really criminal how much more Americans pay for the same drugs.) And, almost as a footnote on the page -- Obama will pay for his $50-$65 billion health care plan 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.

So what does this mean for me?

John McCain's plan, unless it's radically refined in a good way when the rubber meets the road, would probably be a disaster for my family. We already pay over $5,000 a year in after-tax health care costs, so the tax credit wouldn't even cover that.

I think most employers would probably dump their group healthcare plans and add the current premiums -- let's say $4K -- to the employee's salary. The employee then has to go shopping for their own insurance. Even if the employee is lucky enough to buy a family plan for that amount of money, what happens the following year when costs go up thirty percent and the insurance company passes them on to you? It is no longer the employer's problem, it's your problem. And you can bet the employer won't be handing out thirty percent raises, nor will the government be increasing the tax credit. Look how long it took them to raise the minimum wage.

All that doesn't even count the fact that no insurance company would take on a child like my daughter for $4K a year. She would be uninsurable on the open market, and I am not sure how she would fare in a "high risk pool." McCain's bullet point about "talking to the governors" probably amounts to adding thousands of children who are now covered by employer-sponsored insurance companies, onto the already sinking Medicaid ship.

The plan would likely cause a lot of divorces, too. Under current rules, to get my daughter on Medicaid I think we'd have to be living under the federal poverty level. The only way I can think of to do that is to divorce my husband and become an unemployed single mother. Then I could live with him in sin. Family values? Whatever.

Another big hole that I see in McCain's plan is the idea of personal responsibility. People would not be forced to buy coverage, so many would not -- they'd pass up the tax break and pocket the addition to their salary when their employers stop offering group health plans. And then when they get sick, off to the emergency room they go. How many would be able to afford the sticker price of health care? Obama's plan has this flaw too.

On the face of it, Obama's plan appears to be more favorable for us. We would still be able to insure our family through an employer, and our premium might go down if Obama succeeds in his cost-sharing plan for employers -- though I doubt we'd save $2,500 a year. Obama would require insurance companies to cover those with pre-existing conditions, like my daughter. But my family's share of the federal deficit would go sky high and our taxes would no doubt go up to pay for this mammoth program (and no, we are not among those who earn more than $250,00 a year.)

My biggest concern with the Obama plan is whether quality of care would go down. Look at the stellar -- sarcasm, anyone? -- health care that is provided to our veterans. Anybody want to send their child to a VA hospital? If parents of children like mine try to make up the difference in quality of care ourselves, we're likely to go bankrupt. In addition, the federal government is probably not capable of administering a national health care program without ridiculous waste, graft, and corruption. Look how they run a war.

In summary

I like to remind myself that anything a candidate spouts about health care reform still has to get through Congress. So with the economy tanking, it's unlikely anything as expensive as health care reform will happen in the next year or two. Which, I admit with some guilt, fills me with some measure of relief. Better the devil you know.

Interesting reading

In search of more information about this complex topic, I went to the Web site for Health Affairs: The Policy Journal of the Health Sphere. They published articles critiquing each candidates's plan. You can't read the full text of the articles online without a subscription, but the abstracts reduce some of your headache in trying to sort all this out. Links are on the home page, and there is a lot more information on this site if you're in the mood to dig.