WASHINGTON -- The older you are, the more you usually pay for health coverage, and that's a difference likely to persist under the sweeping health care legislation that Congress is now considering.
The House of Representatives would permit insurers to charge older Americans twice what younger people pay. The bill that passed the Senate Finance Committee would allow premiums four times as high.
Yet the major House and Senate measures would end what many consider another longstanding, discriminatory practice -- basing rates on gender, which is now allowed in most states.
Some wonder, are middle-aged and older consumers victims of age discrimination?
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Senate Finance Committee member John Kerry, D-Mass., said, "Allowing insurers to charge older Americans vastly higher premiums simply because of their age is discrimination, pure and simple."
Sen. Ron Wyden, D-Oregon, also a committee member, added: "It's a question you'll have senior citizens asking all over the country."
On the issue of gender variations, the National Women's Law Center sees substantial differences in rates.
In a 2008 survey, the center found that in 47 states and the District of Columbia where insurers used gender ratings the premiums charged 40-year-old women were between 4 percent and 48 percent more than men of the same age.
Women tend to pay more for health coverage because insurers find they use more health care services than men -- and because any women of childbearing age could become pregnant.
Lawmakers explained that charging older people more, though, also could be justified with data.
"As you get older, you start consume more health care," explained House Education and Labor Committee Chairman George Miller, D-Calif. "Age rating is a common practice in insurance underwriting," added Sen. Jeff Bingaman, D-N.M., a member of the Senate Health and Finance Committees
So are gender differentials, he was told. Why are they being eliminated?
"I don't know all the answers," Bingaman said. "You'll have to ask someone else," said Miller.
Senate staffers explained one reason for the difference this way: Age-based premiums can be justified by consumers' experience, while gender-based differentials relying somewhat on potential pregnancy has the look of being blatantly discriminatory.
Experts have determined that age-based premiums can be justified as six to seven times as high as those charged the lowest risks.
America's Health Insurance Plans, the industry trade group, would prefer a 5-to-1 ratio. In a letter last month, Karen Ignagni, AHIP president, and Scott Serota, Blue Cross and Blue Shield Association president, warned that a 4-to-1 ratio "would increase premiums for Americans in nearly every age cohort."
Supporters of lower ratios argue that the health care overhaul legislation requires most people to buy coverage and would provide other incentives, notably government subsidies, to encourage consumers to buy policies.
The new laws should expand the risk pools, and as those pools expand, particularly with younger, healthier people, rates should stabilize for everyone.
Last year, according to Census Bureau data, 30 percent of people 19 to 24 were uninsured, compared to 12.5 percent in the 55- to 64-year-old age group. Most people over 65 rely on Medicare for coverage.
But at what point do policies become so expensive that young people won't buy them? Conversely, at what point do premiums become so expensive that they become a major burden for older people who need care the most?
Congress is struggling to figure that out.
"The people that are getting hammered the hardest in America are the people between 55 and 64," Wyden said. "These are folks that are essentially a decade away from Medicare, and they also are in a bad economy feeling some of the direct pain in getting laid off, because they are not in a position to get additional economic opportunities."
But lowering the allowable ratio to 2-to-1 has other risks, said Sen. Jon Kyl, R-Ariz. "Without young people in the pool, premiums will go up for us all," he said.
And there is a sense that older people will buy coverage, even if it's more expensive, and it hurts them.
At AARP, a Washington activist and research group that supports the 2-to-1 ratio, legislative policy director David Certner noted that even with a bigger premium gap, older people "may be able to afford these policies but give up something else in return. If you're talking about a 4-to-1 ratio, you're talking about pretty hefty costs."
Data from the Kaiser Family Foundation illustrate the dilemma.
A 55-year-old with a $60,000 income heading a family of four, with no employer coverage available, would have a total premium of $15,361 under the Finance Committee bill. The person would pay $6,363 and government aid would provide $8,998.
But under the House Ways and Means and Education and Labor bills, that same person would pay $4,731.
A 25-year-old single person earning $60,000 would pay $3,169 under the House version, but $2,258 in the Senate bill.
The nonpartisan Congressional Budget Office sees the House measure, which provides more government help as incomes drop, as having the potential to insure more people -- 97 percent of the eligible population, compared with 94 percent for the Senate measure. Currently about 83 percent are insured.
Senate Democratic leaders are now trying to merge provisions of the Senate Health and Finance Committee bills into one, and House leaders are also working on combining three committees' work into one bill. Each House will then consider legislation, probably next month.
The age issue is sure to come up at that time, said Wyden, and "there's going to be some very vigorous debate."
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