iVillage:
Secretary, thank you for joining us. iVillage users have posted a number of questions about health reform, and we have selected a few of them today. Our first questions come from Lisa and Karen. Lisa asks, “Are there going to be measures built into the bill that prevent skyrocketing premiums for preexisting conditions?” And along the same lines, Karen asks, “What about those who have insurance, but the coverage is inadequate or the out-of-pocket expenses are so high it bankrupts the consumer? What is being done to reform the way insurance companies do business?”

Secretary Sebelius:
Well Karen and Lisa, those are great questions. And one of the things that happens to folks in the insurance market today is that companies get to pick and choose who gets coverage and who doesn’t. They can lock people out of the market based on a pre-existing condition. If you are sick or your child is sick, they can say basically, “We don’t want to offer you coverage,” or offer it at such a high rate that it’s totally unaffordable.

They can drop people who have used their policies because they’ve gotten sick—refuse to renew them the following year, or, have the out-of-pocket costs and copay costs so high that if you get sick and use your policy, you end up in personal or family bankruptcy. All those situations happen every day to American families, and to women particularly because they’re often in the individual market where they don’t have any kind of rules protecting them.

So one of the new features of [the] new insurance marketplace, new health exchange, is that those rules will change forever. Insurance companies will no longer be able to eliminate folks based on a pre-existing condition; there will be a limit for how much they can charge in terms of out-of-pocket costs. There will be no caps on how much you get in terms of drawing down your benefits at the end of year, so if you end up with cancer or some kind of condition that requires expensive treatments—the reason you bought insurance in the first place—you actually will be able to use it during the course of your illness. Those rules that punish Americans, punish women, who pay more and get less out of the insurance market will be changed with health reform.

iVillage:
Thank you. Another iVillage user asks, “How will U.S. companies continue to offer the benefit to their employees? If they drop health benefits, how will employees pay for insurance out-of-pocket without an increase in pay?”

Secretary Sebelius:
Well again, a great question. Often times, women are in jobs where employers don’t offer coverage. So they’re often in the market by themselves. But the president wanted to make sure with health reform that the 180 million Americans who have employer-based coverage don’t lose it as part of [the] new health reform. So there are some features in the bill that provide tax credits for small employers who often are dropping out because of the increase in rates; provide some help for low-wage workers to pay for subsidies. But, the bills also have a feature of the responsibility for employers to provide coverage, so either employers will have to offer coverage, pay a share of that coverage for their employees, or pay into a fund so the employees can better afford to buy coverage on their own. Nothing in today’s market prevents an employer from dropping coverage, unfortunately, and it happens each and every day. But we think that the features that protect employer coverage will actually help stabilize that market for future employees.