About 228,000 Kansans would gain health coverage by 2019 under the Senate reform bill being debated in Congress.

If the bill fails to pass, it is estimated that 59,000 more Kansans would lose coverage in the next 10 years, increasing the number of uninsured residents by 17 percent from an average of 338,000 in 2007 and 2008 to 397,000.

The figures were released Wednesday in a report by Families USA, a national nonprofit, nonpartisan organization that advocates for health care consumers.

“The consequences of inaction are very severe for people across the country,” said Ron Pollack, executive director of Families USA. “If the Senate fails to act, Americans will continue to struggle and a growing number of them will face the devastating effects of going without coverage. The Senate has an opportunity to provide peace of mind to families by providing and extending health coverage to virtually everyone.”

The report “At a Crossroads: Is Health Coverage Ahead for America?” used figures provided by the Congressional Budget Office.

Nationally, the report estimates that 31 million people would gain health coverage under the bill by 2019, and if the bill doesn’t pass, another 8 million individuals would lose coverage. Currently, it is estimated that 46 million Americans are without health coverage.

Research shows that each year, the deaths of at least 22,000 people between the ages of 25 and 64 can be attributed to lack of health insurance. The uninsured also are more likely to live sicker and die earlier than those with coverage.

Extending coverage

Pollack said there are three ways that health care reform would extend coverage to more people. Those are:

• The Senate bill would prohibit insurance companies from denying coverage for people with pre-existing conditions and would prohibit them from charging higher premiums based on health status.

“Insurance companies charge discriminatory premiums and that will come to an end. It also means for women who have to pay considerable more in premiums, they no longer will be faced with discrimination in the premium cost.”

• The bill would expand eligibility for Medicaid. Federal law requires states to cover all low-income children; however, eligibilty levels for parents vary widely across the nation. The national median eligibility for parents is 67 percent of the federal poverty guideline or $14,770 in annual income for a family of four.

“For people who do not have dependent children, in 43 states, you can literally be penniless and you are ineligible for the Medicaid safety net.”

The Senate bill would make all individuals who have incomes below 133 percent of the poverty guideline — or $29,330 for a family of four — eligible for Medicaid.

• For middle-class families who can’t afford premiums but don’t qualify for Medicaid, the bill creates a new health marketplace, also known as a health insurance exchange, where people can purchase more affordable insurance. In addition, subsidies will be available to families with incomes up to 400 percent of the federal poverty level or $88,200 for a family of four.

“For many people who are shut out of the system, it is going to mean that they are no longer shut out of the system, and through these subsidies I think it will make it more attractive for people to buy in,” Pollack said.

He said many states are concerned about how the Medicaid increase would affect budgets. But, Pollack said the funding formula would be different under the Senate bill.

Today, he said the federal government pays an average of 56 cents per dollar and states kick in the remaining 44 cents. These percentages vary state to state.

Under the bill, the federal government would pick up 100 percent of the costs for the first few years and then states would pick up a “much lower” portion of the bill than they are paying now.

Cost-cutting measures

Pollack said health reform also would benefit those who already have health coverage through lower premiums.

He said the insured are paying “hidden health taxes” that are passed along by hospitals who are forced to care for the uninsured.

“When you have lots of people who are uninsured and when they go to a hospital and get care, often they can’t pay the full bill and of course, the hospital has to get its costs covered,” Pollack said. “So, what do they do? They shift costs to all of us who have health insurance and that results in higher premiums that all of us have to pay.”

According to a report released by Families USA in September, the “hidden health” tax increased premiums for family health coverage by an average of $1,017.

So far, Pollack said Congressional Budget Office estimates are showing that the Senate bill would reduce the federal deficit during the next 10 years.

He said such a reduction is possible mainly because of a more efficient Medicare system.

For example, he said the bill would eliminate the windfall payments that are provided to private insurance companies in the Medicare Advantage program. The program has been reviewed by the Medicare Payment Advisory Commission, which found the plan was overpaid by 14 percent.

Families USA projects that new payment systems for hospitals will save $150 billion over 10 years.

“There are a lot of times that people go to a hospital and then they have to be readmitted at a later time because they didn’t get the appropriate care,” Pollack said. “The payment systems for hospitals will reward quality and not quantity.”

Pollack said the report’s figures wouldn’t change under any of the controversial issues, such as the public option plan, abortion issue or Medicare expansion, being debated in Congress.

He strongly hopes that the debates don’t deter legislators from passing health care reform.

“It is enormously beneficial,” he said.