About 50,000 Americans joined an AARP national town hall meeting by phone yesterday to hear Nancy-Ann DeParle, director of the White House Office for Health Reform, address their questions and concerns about the future of U.S. health care.

Through more than 1,000 questions submitted live or online, AARP members and activists sought answers about the lack of affordable health insurance, skyrocketing medication costs and coverage of preexisting conditions.

AARP health policy experts also addressed worries that reform efforts could adversely affect Medicare coverage and costs. New AARP CEO A. Barry Rand said seeking affordable, quality health care for all Americans was a top issue for the association.

Nancy LeaMond, an AARP executive vice president, pointed out that families’ health premiums are slated to nearly double in the next 10 years and people on Medicare are spending 30 percent of their income on out-of-pocket costs. She added that up to 28 percent of people ages 50 to 64 are being denied coverage because of a preexisting condition and nearly 20 percent of Medicare Part D beneficiaries are delaying or not filling prescriptions because of cost.

Although LeaMond said many think the current economic crisis means we can’t afford to fix health care, “we can’t afford not to address this issue.”

DeParle, the White House czar for health care reform, said that Congress has set a timetable of passing reform legislation by August and that President Obama is committed to “enacting a plan that will give consumers more choice of doctors and plans and that will ensure that every American, regardless of their health, can be assured quality and affordable health care.”

Here are excerpts of DeParle’s answers to questions from participants.

Q. Is it true that the Medicare reserve is going to be used to provide universal health care?

A. The answer to that is no. The president is calling for a reserve fund to be created in his budget of $634 billion, and that money will be used to help cover more people and the investments that we need to make in health care reform. As a matter of fact, the changes would extend the solvency of the Medicare Trust Fund by two years. We’re not tapping into the Medicare Trust Fund.

Q. My husband is 56, unemployed, uninsured and has advanced prostate cancer. Will there be an insurance program in place that will allow enrollment for a patient with a preexisting condition like cancer by the end of this year? If not, when do you anticipate this being available?

A. This is part of why the president says we have to get health care reform enacted now. In the health care reform legislation that the Congress is working to pass, we hope that those kinds of [preexisting] conditions will no longer exist. The law will tell insurance companies, no, you have to cover people with preexisting conditions. We hope the bill will pass by the end of this year and I believe that it will, but I don’t think the coverage will be available until probably next year or even beyond that.

Q. I lost most of my 401(k), my job, my health insurance and soon my home. I’m 60 years old, with no place to turn when unemployment runs out. What are we going to do for the most severely affected senior citizens who have little hope of working again and years to go before they gain Medicare?

A. Again, this case illustrates so clearly why we need health care reform. What the president is working with the Congress right now to get done is a new plan where there would be something called an insurance exchange. It would be a simple way of purchasing insurance, and people who didn’t have the income to afford it would be given subsidies. Because they’d be in a larger pool, people who are already sick would be covered from the beginning and their costs should be lower than they would be under the current system. So for people who don’t have insurance and don’t have any way of getting it, this would be a way to help them get insurance. And we want to get that enacted before the end of the year.

Q. Will health care reform address the problem of people who use the emergency rooms for nonemergency treatment? We’ve had situations here where emergency rooms have had to close to other cases because there are so many people trying to use them.

A. That problem is happening nationwide. I’ve seen numbers [showing] that most families who have health care coverage are paying $1,000 a year or more in additional premiums, just to cover the cost of people who show up in emergency rooms and don’t have the money to pay for it. So yes, the idea [of the president’s proposals] is that if these people have a way of getting insurance, then they will be covered, or they’ll have subsidies to afford the insurance, and then they’ll be able to get treatment so they don’t have to turn to the emergency room.

Q. My husband now has very good medical insurance that we’re completely satisfied with. I’m covered under this policy too. How will any new program that the federal government institutes affect us?

A. It shouldn’t affect you at all, except that your costs should be lower over time. What we’re trying to do here is build on the existing system. So for those of us who are fortunate enough to have employer-sponsored insurance that we’re satisfied with, nothing should change. Because of some of the other investments we’ll be making, such as computerizing the records of clinical information at hospitals and doctors’ offices, your costs should be lower over time.

Q. A concern of those of us who are retired and disabled is that our sources of income are not keeping up with the exorbitant cost of health care and prescribed medications. As an example, one of my wife’s multiple sclerosis prescription drugs costs over $2,000 a month. What can we expect to hope for in the future with regard to relief from ultra-high health care costs?

A. The president has said that fixing our health care system and trying to do something about these exorbitant costs is not only a moral imperative, which he believes it is, but also a fiscal imperative. The same costs that you and your family are experiencing and the increases you just find breathtaking and can’t keep up with, that’s what we’re facing at a federal level as well. The way to do something about them is to find ways of treating people earlier, to prevent disease from getting worse, from [using] computerized medical records so there’s not so much administrative cost in the system. We have to make some investments up front to do those things. And then I believe we’ll get to see the costs going down, so that the rate of growth that you’re experiencing as a family trying to afford your premiums should slow down.

Q. Can you set a date when you can begin to enact health reform and get a bill through Congress?

A. That part’s already started. The president is working with both the House and Senate right now in earnest toward enacting bills. They’ve given themselves a deadline of having them done by August. And then there’ll probably be a conference committee that will work out the differences between the two houses. The president’s goal is that Congress enact legislation that he can sign—that meets his principles of lowering costs for American business and families and getting us on a path to covering all the uninsured—by the end of the year. As he says, it cannot wait, it must not wait, it will not wait another year. He wants to have it done this year.

Q. I’m a former insurance executive. My question is why a bipartisan solution? The only thing I ever hear from the [political] right is that they want a market-driven system and they’re afraid of offering a public plan.

A. There’s a lot of agreement around the importance of lowering costs for businesses and families and getting all Americans covered. And that part doesn’t seem to be a partisan issue. I think Republicans and Democrats can agree with that. And when you look at what the president has done since he got to Washington, already we’re making progress on issues that people said were intractable a couple of years ago. The president wants to try to do this in a bipartisan way, and I think we’ll be able to do that.

Q. In the cost-saving proposals of the new administration to help reduce health care costs, can we expect to see a “smart card” that provides all medical and appropriate personal information so that form-filling requirements in the present cumbersome health care system is replaced by a more modern, efficient system?

A. Wow, that’s a great idea! I think you probably will see that. In the Recovery Act in early February, there was a $19 billion commitment to wiring the health care system—and doing it the smart way by giving physicians and hospitals additional funding if they show they’re meaningfully using health care information technology. This is not just putting a computer in doctors' offices. This is actually encouraging them to go further and really use the technology that’s available to manage people’s medical information in a smarter way and, obviously, to protect their privacy. The idea of a smart card is one [that] I believe some health systems already have. We believe and hope that this additional funding that the Congress and the president have enacted will make that a reality in the future. It’s a great vision. 

Elizabeth Agnvall is a contributing editor and Patricia Barry is a senior editor at the AARP Bulletin.