John Peeler, an unemployed computer technician in South Carolina, may soon get health insurance for his wife and three children. Four months after being laid off, he is one of the lucky jobless Americans who could receive thousands of dollars in government subsidies from the new stimulus plan.
Susan McKowen, a 62-year-old breast cancer survivor from Illinois, is not so fortunate. Though she too lost her job in the current economic crisis, she won't be getting help with health insurance under the new law.
When President Obama and his allies pulled together the $787-billion bill that he is to sign today, they talked about helping workers like Peeler, McKowen and others rapidly swelling the ranks of America's more than 46 million uninsured.
But in the scramble to pass a bill, lawmakers made changes that left out millions of middle-class Americans who have lost their jobs and are struggling to fill a prescription or pay for a visit to the doctor.
That reflected a frenzied process in which sometimes arbitrary decisions were made to speed agreements and satisfy a dizzying array of political interest groups working to influence the massive bill.
During last-minute negotiating, provisions were cut that would have opened the government-run Medicaid insurance program to the unemployed, a move opposed by more conservative lawmakers.
Another provision to allow older jobless workers like McKowen to keep their employer-based coverage until they qualified for Medicare was eliminated amid opposition from business groups.
Even the rules governing which workers were eligible for aid were picked on the fly, officials acknowledged. Sensitive to businesses' concerns, senior Democrats decided to give health insurance subsidies only to workers who lost their jobs after September, even though the recession began nearly a year earlier.
That means Peeler, who was laid off in November, is eligible for assistance; McKowen, laid off 13 months ago when the recession was starting, is not.
"It's just a matter of trying to balance interests and hold the line on spending," said Sen. Ben Nelson of Nebraska, a centrist Democrat who helped negotiate the compromise that narrowly cleared the Senate.
Despite the cuts, the aid package represents one of the largest federal investments in healthcare in history, totaling more than $147 billion, or nearly a fifth of the bill.
It includes $87 billion to help states shore up their Medicaid programs, which cover more than 55 million poor children, families and disabled people. States reeling from the economic downturn have been cutting services for months.
The legislation also commits $19 billion to increase the use of information technology in healthcare, a long-delayed objective that policymakers think is crucial to lowering costs and improving quality.
The National Institutes of Health will get nearly $10 billion for research into cancer, heart disease and other illnesses. And lawmakers directed more than $1 billion to boost government efforts to study the comparative effectiveness of medical procedures, pharmaceuticals and devices, another step deemed crucial to long-term health reform.
But the cuts in aid highlight one of the most vexing healthcare issues confronting Washington -- the growing number of middle-class workers who are losing health coverage as companies cut their payrolls.
An estimated 3.6 million jobs have been eliminated since the recession began at the end of 2007, the Department of Labor said.
Unlike the very poor who rely on Medicaid, most of these people had not looked to the government for healthcare, instead securing insurance through their employers or buying it themselves.
Now without incomes, some are faced with paying more than $1,000 a month to buy a new insurance policy or to keep the coverage they had at work under the federal COBRA law, which requires workers to pay the full cost of their premiums, picking up what their employers once paid.
Peeler, 39, looked at getting COBRA coverage when he was laid off in November from an apartment management firm. But he quickly calculated he couldn't afford the premium -- more than $1,300 a month.
He said his unemployment check of $326 a week barely covered the mortgage and the groceries. And his wife, who had been looking for a job since the beginning of last year, couldn't find full-time work.
Nor could Peeler find private insurance. Every insurer he consulted refused to cover treatment for his daughter's mild psoriasis and his son's asthma, both classified as preexisting conditions.
"Private insurance is a joke," said Peeler, who had never before sought public assistance.
The stimulus package may ease the burden for as many as 7 million people like Peeler who lose their jobs between September and the end of this year. Under the bill, the federal government will pick up 65% of COBRA premiums for nine months.
But the aid won't help McKowen. She lost her job outside Chicago in January 2008 when the greeting card company she had worked for since the late 1970s was restructured by new owners.
McKowen signed up for COBRA coverage, which was vital because getting a new policy would have been difficult with her history of cancer.
Now, she is nearing the end of the 18-month limit on COBRA with few options. Her husband, an accountant, is self-employed. And switching to a plan offered by the state of Illinois would cost her nearly $900 a month, compared with the $507 a month she pays now.
"I just don't know where to turn," McKowen said. "I don't like pity parties. I know there are a lot of people who are far, far worse than me . . . but I need my health insurance. It's like my lifeline."
Adam Ross, a 40-year-old San Francisco lawyer who lost his job in July, has another problem. He and his husband, who also was laid off last year, are paying $820 a month under COBRA for insurance that Ross gets through his former employer, a San Diego software firm.
The two are subletting a room in a friend's house, using Ross' severance and their savings to pay for food, rent and Ross' loans from law school. They won't get federal aid because Ross lost his job in July, two months too early to qualify.
"It's kind of getting down to the wire," Ross said last week. "I think we have a couple more months. . . . We try not to think about what happens after that."
Some lawmakers wanted to make the COBRA subsidies available to people who lost their jobs before September.
But such a move would have faced resistance from employers who have long been wary of the administrative burdens of keeping former employees on their health plans. Some companies already encourage employees and their families not to use the health plans they offer.
Business groups successfully beat back a proposal by House Democrats to allow unemployed workers over 55 to pay to keep their employer-based health insurance for up to 10 years until they qualify for Medicare.
"COBRA should not be regarded as a source of long-term coverage," Helen Darling, president of the National Business Group on Health, wrote lawmakers last month, warning it would push up healthcare costs for existing employees.
Republicans, meanwhile, rebelled at a proposal by House Democrats to open up Medicaid to those who have lost their jobs, a move conservatives worried would only further burden a government program already driving away many doctors because of the government's relatively low reimbursement rates.
Senate Democrats, who needed Republican votes to pass the stimulus legislation, did not include the Medicaid expansion in their version of the bill.
It was dropped in the final compromise, leaving an estimated 1.2 million people without assistance.
(BEGIN TEXT OF INFOBOX)
Congress appropriated nearly $25 billion in the economic stimulus package to help jobless Americans keep their health insurance after they are laid off. Here's how the subsidy works:
To qualify, workers must have lost jobs between Sept. 1, 2008, and Dec. 31, 2009, and had insurance through their employer.
Those who elect COBRA coverage will have to pay only 35% of the premium cost for up to nine months. (Employers will recoup the remaining 65% through a tax refund.) Workers who lost their jobs between Sept. 1 and now who did not sign up for COBRA because it was too expensive will have up to 60 days to sign up.
Those seeking aid will have to attest that their same-year income will not exceed $125,000 for individuals and $250,000 for families. They should contact their employers for further details.
Obama will sign the stimulus bill in Denver and announce a housing plan in Phoenix. NATION, A12