Something liberals and conservatives can agree on -- health reform bills won't help keep costs down for middle class families.

The more one learns about the health reform bills the more concern one should become concerned.

A review of the House health care bill finds a massive marriage penalty for middle and upper middle income families. The result? An incentive not to get married in order to obtain health insurance. One observer said this will destroy marriage in the middle class just as welfare did for the poor.

Then there are analyses by a University of Minnesota economist and others that the health bills will not drive costs down for middle income families.

While both bills guarantee access to health insurance regardless of pre-existing conditions, neither one will do much to improve the affordability of health coverage for moderate to middle-income Americans in the individual market, according to wonks and critics across the political spectrum.

In fact, some Americans eligible for proposed federal subsidies may fall into the category of "under-insured" because they would spend more than 10 percent of their income — a widely used affordability standard — for premiums and out-of-pocket costs.

So, despite all the historic efforts to clean up the individual health-insurance market, consumers could continue to be priced out of the market — and they could be penalized for not having insurance, potentially adding insult to injury.

"All that guaranteed issue is, by definition — and people forget this — is you are given a price for the insurance policy," said Stephen Parente, a University of Minnesota health economist who helped develop health policy for Republican Sen. John McCain's presidential campaign. "It doesn't change the fact that you might not be able to afford an insurance policy, at which point you are effectively denied."

Liberal analysts also worry about the question of affordability for moderate to middle-income people.

"Some people will be helped but there are going to be some people that fall just out of the benchmarks," said policy analyst Lynn Blewett, director of the State Health Access Data Assistance Center at the U of M.

Economists, policy analysts and congressional aides are still sorting through the details of the new 2,074-page Senate bill, but bills from the Senate Finance Committee and Health, Education, Labor and Pensions (HELP) Committee were similar in laying out how subsidies or credits would work. Both bills call for subsidies for folks earning up to 400 percent of Federal Poverty Guidelines, although they vary on percentages of cost-sharing.

"Today we're carefully considering the provisions outlined in the bill that was introduced last night [Wednesday]," said Jess McIntosh, a spokeswoman for Sen. Al Franken, D-Minn., who is a member of the HELP committee. "We're pleased that the merged bill has some marked improvements compared to the Senate Finance bill, including coverage for an additional 2 million people and lower premiums for families above 150 percent of the poverty level. Unfortunately, the bill has higher premiums than the Senate Finance bill for families between 133-150 percent of the poverty level."

Subsidies and caps
A Congressional Budget Office's analysis of subsidies [PDF] in the House's Affordable Health Care for America Act breaks down the share of premiums and out-of-pocket costs per income level. Higher-income individuals would pay no more than $5,000 in out-of-pocket costs (in addition to premiums) while families would pay no more than $10,000.

At the low end, a family of four with annual household income of $30,000 would on average spend no more than 4 percent of income on the insurance premium and out-of-pocket costs, and 97 percent of the premium would be subsidized. But once household income for a family of four reaches $54,000, the family's premium and cost-sharing would be 11 percent of income — exceeding the point where many analysts consider a moderate-income family to be under-insured. The total share climbs to as much as 18 percent for families of four making $78,000 to $90,100. (See chart below.)

In fact, what we have is a worsening of the health care crisis. For what purpose? One could say naivete or maybe a desire to create the circumstances where the government steps in and takes over the entire health care system. The push for socialism via the health care system is on.