What Is In This Healthcare Bill Anyway?
The Overture
White House spokesperson Robert Gibbs was right to compare the recent mob scenes outside health care town hall meetings across the country to the Brooks Brothers Brigade that stormed the vote count in Miami in the 2000 Presidential Election. Of course in 2000 the angry white mob got its way, and now it will be interesting to see if it gets its way again. It’s not to say it’s just conservatives who are angry.
Over the last few months on Capitol Hill progressive activists angry that a single-payer model is not being considered disrupted a series of Senate Finance committee hearings on health care reform.
Lets say this for President Obama: if this bill passes, no one will like it; if this bill fails, no one will like it. Either way he loses.
“I’m just trying to give everyone health care, and now everyone is mad,” I imagine him saying. “Now I’m the bad guy!”
But if the measure is passed and if by 2015 more people have health insurance, perhaps history will be kinder to Obama the way it has been to Lyndon Johnson over Medicare (…and hopefully Afghanistan won’t
dominate his legacy the way Vietnam has for Johnson).
The public debate, though ferocious, is as silly and full of misinformation as was the health care debate in 1994. With the current President being compared to Hitler and claims that the health care bill is part of a larger scheme to institute a fascist government, it’s easy to see why it had taken 15 years before the country seriously breached the issue again. And it’s one thing to hear ‘Ted the tractor driver’ say it outside one of those town-hall meetings, but for our former Republican Vice Presidential candidate Sarah Palin? (This a person who, if the angry mob had its way would be VP.) This is what she had to say on her new PR apparatus, Facebook:
“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.”
Time for some facts.
I will do my best to give a rudimentary explanation of some of the more significant details of the health care bill being considered in the House of Representatives.
In a nutshell: the measure would require everyone to have health care and prohibit insurance companies to deny coverage to people with preexisting conditions. Companies with payroll over $250,000 will be required to provide health insurance to their employees or face a tax penalty. Existing employer based insurance can be grand-fathered into the new system and must meet minimum federal requirements.
People who do not have employer health care, and do not qualify for Medicaid, will be required to purchase it from a pool of providers regulated by the Health Insurance Exchange that will include private plans and potentially a government run program. People who are not insured will also face a tax penalty. The whole plan, if passed, will begin in year 2013. There is no guarantee of it passing.
The health care reform bill is not President Obama’s bill nor is it “Obama Care.” It is a bill in Congress sponsored by several Democratic Congressional members and is called “America’s Affordable Health Choices Act of 2009.”, or by its bill number HR 3200. The House is expected to vote on it in the early fall.
The Senate has yet to unveil it’s final measure, though it is expected to look much like the House bill. There will likely be some important differences though, including the much maligned government run public option. (Described in more detail below.) Differences between a House and Senate bill will have to be worked out in a conference committee before being sent to the President’s desk for his signature.
The bill will cover most people, not including undocumented immigrants—meaning we’ll still have millions of people without health care. The White House and Democratic Congressional leaders are hoping to be done with it all by the end of the year. Most Republicans are trying to derail it.
The Death Panel
So what is H.R. 3200? Let’s begin with Palin’s ‘death panel’:
Oddly enough the bill does not call it a ‘death panel’ but an “Advance Care Planning Consultation.” According to the bill, it will pay a medical practitioners to discuss advance care planning with their patients. This means a practitioner explains what advance care planning is, including such things as the role and responsibilities of a health care proxy, options of federal and state programs meant for elder and disabled care, and the continuum of end-of-life services and supports available, including palliative care and hospice. This is already actually happening, the only change is that doctors will get paid for it.
Disputing the euthanasia claim, factcheck.org had this to say: “The accepted definition of end-of-life planning means thinking ahead about the care you would like to receive at the end of your life – which may include the choice to reject extraordinary measures of life support, or the choice to embrace them.”
Public Option
Another controversial aspect of H.R. 3200 is the Public Health Insurance Program. This is the proposed government run public option that competes with the private health care insurance plans offered by the Health Insurance Exchange. A Health Insurance Exchange is a marketplace where people choose an insurance option. Currently, Massachusetts has such an exchange where people and small businesses choose among policies offered by six different companies. The public option would be one choice competing with the private plans offered by the Health Insurance Exchange.
While conservatives and business interests are alarmed that the public option is a first step towards a single-payer socialized medicine model, the actual language of the bill appears to put safeguards keeping any such transformation from occurring. According to the bill, the public option has to meet the same benefit requirements and comply with the same insurance market reforms as private plans. The public option is also required to become financially self-sustaining and build up its own start up costs and contingency funds into its premium rates. In other words, while Medicare funds will likely help launch this program,the public option won’t be Medicare, and, to the chagrin of some on the left, won’t be able to use Medicare’s purchasing power with prescription drugs and other health care products to bring down costs.
While the public option is included in the House bill, it’s possible it will be cut out of the Senate bill. In an interview on CNN the second highest ranking Democrat in the Senate Richard Durbin of Illinois said that he was open to alternatives. “…I don’t want the process to be filibustered to failure, which unfortunately, many senators are trying to do.”
While centrist Democrats in the Senate threaten to oppose a bill that includes the public option, progressive Democrats in the House threaten to oppose the bill if it doesn’t.
The co-chair of the Congressional Progressive Caucus Democratic Representative Lynn Woolsey of California wrote an op-ed piece in the Press Democrat that she would vote against a health care bill if it excludes a public option.
“Along with most of my colleagues in the 83-member Congressional Progressive Caucus,” wrote Woolsey. “I’m expecting that the final legislation will retain a robust public option linked to Medicare. If it does not, it will not be meaningful health care reform. If it does not, it will not get my vote.”
If some 80 members of the House voted against the bill, along with Republican opposition, it would fail. Supporters of the public option contend that a government run not for profit plan would compete with private plans, and thus keep private plans honest. Opponents say that a government run program has advantages that private companies do not have, and thus creates unfair competition that could drive private companies out of business.
The real legislative fight over the bill won’t even include Republicans or the socialist fearing wackos outside of the town-halls shown on Youtube, but will be between centrist and progressive Democrats…and that fight will flare up during the House-Senate conference committee—if it gets that far—when lawmakers have the task of reconciling the House and Senate bills.
Affordability of the plan
H.R. 3200 mandates that employers provide a certain level of benefits established by a Health Benefits Advisory Committee, created by the bill, or be subject to a tax of up to 8% of payroll. All employers with payroll over $250,000 will be required to offer health care insurance to their workers. Also, employers that offer health care but fail to meet minimum health coverage requirements would be subject to a tax of $100 per day for each employee to whom the failure applied. Employers with payroll below $250,000 will be exempt from health care requirements.
A worker does have the option to reject employer provided health care and instead can purchase a plan provided by the Insurance Exchange Program.
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Individuals, regardless of income or employment, would be required to have health care or face a financial penalty of 2.5% of their annual income. The penalty, proponents argue, is to discourage mostly healthy and young folks from going without a plan. The idea behind it is that the more people who buy into the plan, especially healthier people, the more prices will be driven down for everyone.
People earning under 133% of the poverty rate, or under $14,400 a year for an individual, will become eligible for their state run Medicaid system—which is free.
For people earning between 133% and 400% of the federal poverty line (400% is 43,320 for an individual or $88,200 for a family of four) will be eligible for “affordability credits” offered at a sliding scale rate based on income. While exact numbers still need to be worked out, an individual earning 133% of the federal poverty level will pay 1.5 percent of their income for health care: about $216 a year. An individual earning near 400% of the federal poverty line will pay 11% of their income for health care: $4,765 a year.
Once earning over 400% of the federal poverty line, people will be ineligible for affordability credits and will have to pay regular prices that will be determined by the market.
There it is. Some things to like and something to dislike for everyone. If approved, it will likely dramatically increase the number of insured, but it will come with a price. An individual earning 400% of the federal poverty level, or $43,000 a year, will have to pay 11% of their income on health care. That’s about $400 a month. I’m in that bracket and if I had to pay $400 a month I would have to quit drinking and smoking. Perhaps that’s part of the government’s health care preventative plan.
Mitch Jeserich is a seasoned political journalist who has reported from Sacramento and from the U.S. Capitol for Pacifica Radio. Currently, he is the Executive Producer of KPFA’s Morning Show in the Bay area.
The runaway premium similar to the peak fuel price last year and left so many folks in despair insists on staying the course with the attitude ‘unchanged’, clearly this trend could bankrupt individual, business, and government. Now the government subsequently is tasked with these two main assignments, first, to address premium inflation, second, to expand coverage to all in urgent need.
In order to cover all and not to add to the deficit, the public option can not set the same rates of private market, rather, it needs to have the function to keep it in check in terms of inflation, too. Unfortunately, this ‘unavoidable’ direction is aggressively being accused by the runaway premium, citing government ‘take-over’ .
Under the circumstances the energy bill to determine human future and the other major issues is presently piled up, who wants to waste time making enemies ?, which also does not benefit the forthcoming election.
On the other hand, to make things worse, critics say the savings from the proposed public option is not enough to meet the revenue goal. Furthermore, on another hand, some say ‘hands off’ . Where do these No tax, No saving and the like intend to force this reform to go ? The conclusion by ‘just-say-no’ is no doubt. Ironically, the Deficit-sensitive groups have a distinctive common ground, they all have a Deficit-driven background out of question.
Of all choices, the best thing would be savings through efficiency. Considering the wasteful structure, the highest premium in the world, and the most expensive part of medicare, with the prevention / wellness program in place, an American style innovation, an ‘outcome’-based payment founded upon IT system may be enough to save more than 50 billions per year (500 / decade), both ‘improving quality’ and removing the unnecessary procedures (as pay is dependent on patient’s outcome). Young folks and advocates need to explain the notion of a pay for outcome agreement to the elderly misled by the disinformation.
Unlike private market, this public option includes large-scale investments, these large investments still does not get the fair score, instead seem to become a source of acute conflict, even so, this common sense-based program needs to develop further as early detection goes beyond monetary value.
In short, with the heartbreaking tears in mind (Nearly 11 Million Cancer Patients Without Health Insurance), private market also needs change and should join together to complete this reform , as promised, if not, the runaway premium only has itself to blame. Job-based coverage (indirect payment), mandate code, and ample capital might be favorable to the private market. And It can be said that fair competition starts with fair market value.
Over time, supposedly, the public plan will concentrate more on basic, primary cares, and the private insurers will provide their clients with differentiated services.
Thank You !
There is a reason you hear so many rags to riches stories in this country. Some of them from naturalized citizens but many from immigrants that came here for the freedom of opportunity.
The success of this ideal has been based on the full freedom of all of us to make choices. Our free market system has grown and is envied and copied by most of the world because of its success. That is what makes us different and attractive as a country.
It’s not a perfect model, but free markets survive by providing the best product at the best price to the nation and the world. If they don’t do this, they are replaced by their competition. The alternative is to have a government based business which is guided by market indices, legislators or an individual or group of people that believe they have the answer. No one is that smart. The best private companies can fail….but in a free market, there are other companies to take their place. In a government, they find new taxes to fund shortfalls. It is the opposite of efficiency. Don’t blame the government, it was intended to legislate and protect……not create and run business. So don’t set them up to fail.
Let government govern and business run business.
Health insurance (aka prepaid health care) is a luxury that has become common place over the last 30 years. When I was raised in the sixties, very few people had health insurance including my family. Through private companies alone, health insurance became an industry providing security to over 80 percent of the country today. Out of the 15 or 20 percent that are uninsured, only a small percent will have a catastrophic issue which will become an unbearable financial problem. Health care is an important problem, but it is not an epidemic that will undermine our way of life. It is not a problem for the government to fix. In fact it may be a problem that cannot be resolved.
If we believe we can solve all our issues through government, then we end up burdening individuals and companies with taxes that brings our economy to a halt. If we put too much burden on business then we can no longer compete with our rapidly growing foreign competitors. We need those businesses so that we can have jobs and raise families. Don’t force health care on individuals or companies. Let them choose as they do today. If we focus our efforts on how to make U.S. companies compete effectively in the world, the jobs and benefits created and kept in this country will far outweigh our temptation to directly fix all these issues with government. This is the fundamental principle that makes our country strong.
Contrary to belief, the health insurance companies fight endlessly to lower costs. If they don’t, their competitors put them out of business. Ironically, one of the statements was if we cover more people with health care, it will create efficiencies and lower the cost. Over time, that is a true statement. But follow this point.
The same period that health care insurance grew rapidly, so did health care costs. Is that a problem with free enterprise? No, health care insurance encourages people to get medical help. Health insurance with all its competitiveness inadvertently created a huge inflow of cash to the health care industry causing it to expand and raise costs. Once enough companies enter the field and the entry of new individuals with health care slows down, this rapid growth will cease and costs will settle. This is a natural cycle in every industry. I believe we are on the verge of that now. Today the rigorous competition between insurance companies has health care providers accepting roughly 50 percent of their charge as payment in full. My health care insurance is offering lower cost packages which many people will take even though they provide less service. These changes will slow the rapid growth of the medical industry and we will reach an equilibrium on costs.
All of this without a government sponsored option. Free markets do work, but don’t panic when an industry that is near and dear to your heart goes up in costs, have patience. The costs will come down.
The simple answer is let the free market decide our choices. It’s never perfect, but it’s always better than the government choice.
Let our legislators focus on laws and fair trade. We can better solve issues like this ourselves.
Brilliant. This is exactly what I’ve been trying to tell people– you’ve just put it in an organized, accessible entry. Gov’t healthcare will be great for the short term, but harmful in the long term. I do not get how people don’t see this fact. Health insurance companies will compete with each other, continually lowering prices and keeping a check on the market; Gov’t insurance won’t. Taxes will continually rise to afford the over-priced insurance, and so will our debt.
It’s happened to every country that has implemented universal healthcare– they always underestimate the cost.
“Health insurance companies will compete with each other, continually lowering prices and keeping a check on the market”
Really? Because last time I checked, my insurance cost was rising.
You clearly didn’t read the post I replied. He detailed WHY it’s rising now. I also stated that, in the short term, Gov’t healthcare is better, because it prevents these temporary rises. Project that, however, and you get entirely different results.
I wouldn’t expect an insurance-money bubble to keep going for 30 years. What will be left of the healthcare industry when the bubble pops?
crazy society I must say, from the outside : the most important democracy in the world >>>…being ahead – far behind. °!°
what astonishes me the most is the question everyone is yelling about “the affordability of the plan” ? : as anyone asked the same question according to the huge amounts of money loaned to the banks in the next past months ?
I do not remember >>> everything was soo necessary, important…vital…
“mainly money issues” will kill humanity, in the long term
americans, you are in the avant guard, on this particular aspect
good night
sleep well
Whose organizing to disrupt – looks like we can add HCAN to ACORN and SEIU –
See how they say to disrupt people who question the reps that don’t agree with healthcare – they come complete with a script!
http://tpmdc.talkingpointsmemo.com/2009/08/hcan-prepares-pro-health-care-reform-activists-for-responding-to-town-hall-disruptions-plans-to-disr.php
Something in it for EVERYONE????
What is in it for me? I am in perfect health and do not feel like I need any insurance other than cadastrophic. I do not drink or smoke. I exercise 3-4 times a week. I eat healthy and am not obese. So because I have some restraint and self discipline I now have to pay for those that make poor choices? I also make a good living because I worked hard and went to school for eight + years and will have to pay more than most to the program. To top it off I will be forced to offer ins. to the eight people I gainfully employ. I have worked hard all my life because I believe in the American Dream. Now that I am finally realizing my dream the Obama regime is going to rip it away. Oh, and it is not all about me… I donate over $20,000 of my hard earned money each year to help others, but that is by CHOICE, not force.
@richard dennis..
what benefits do you currently offer your employees ??
the $400 a month must be cheaper for your insurance than you’re paying now.. mine is much higher..
the crazy part is, you’re fit and healthy, i am too.. if you get hit by a bus, your insurance can decide to stop your coverage !! is that enough to infuriate you ?? you pay in for years and then get denied coverage .. it’s time for reform .. the ins companies are stealing.
Richard misses the point that most others are missing as well!
You DO NOT need to go with the public option!!! That is why it is called an OPTION!!!!!
the private companies will still have their plans, – and in your income bracket, it will most likely be more cost effective for you to go with a private company!!
If you went to school for 8 + years, i would think you would be able to make that deduction from all the facts….
and more over, if the $400 is too expensive, don’t you think the private companies will think that as well, and in turn offer a competitive rate??? Isn’t that the definition of a FREE MARKET?????
i’ll spare you the response – i realize the term “free market” is more about non-regulation – but tied into that is the notion of competitive pricing -
and I guarantee that companies will still be able to tailor plans to the specific needs of individuals and/or companies to offer, what they feel, is good or the right coverage for their price structure.
Yes, the gov’t will be instituting some guidelines as too what is needed as far a “basic” coverage, but it’s more like a patients bill of rights….
I’m sure Richard, and people like him will be screaming up a storm if / when the time comes that when they need their insurance to kick in and work for them, if the ins. co. turn around and denies them coverage for any number of reasons that they do currently….
It’s not in the Ins Co interest to pay for Anything at all, this is why they deny so many people….. this is part of what needs to come to an end…..
Remove the tax penalty for not signing on. THEN you can call it an option. Seriously, there should be an opt-out clause for the employee (but not the employer).
You know how businesses run- if the government sets the price at $400, they’ll offer it for $399. Whoop ti do.
By their estimates, I’d be paying $550/month for what is likely to be very basic health care. There is no way in hell I can afford to do that now- I’m paying out the nose on my college loans. When my employer offers me a health care option, it always comes with a pay cut (on top of the monthly charge). Everything flows downhill.
Trust me, I’d love to have some health, dental, and vision. Hell, my glasses prescription is 5 years old. I can afford ~$200/month, though, not $550.
so if i hear you correctly J, you don’t make above a certain income, and therefore would qualify for a lower rate…
I still don’t see where the problem is –
you just proved that what they are proposing will help people like you?
Richard Dennis.
I’m in the same exact position as you. 7 employees, good health, now may have to pay for others making a poor choice.
Mark
All i can say is I strongly oppose this plan. I would like to make my own choices and make my own future. I also can not afford $400 a month… I don’t know how anyone at $42,400 could…
$400/person? $1200 for a family of 4? Not sure how anyone could afford that, if that is how this works? Sorry in advance for not understanding the Bill. It’s got a LOT of double-speak, and overall is a terrible plan for the US. if we were a country like England or Canada, then OK… but we are NOT like any other Country and that is what makes us the Best Country in the World!
I agree with you, Brandon. I oppose this bill for many other reasons than the overall cost. My BC/BS is cheaper than this!
To Richard Dennis.
You won’t be young and healthy forever. Kids seem to forget that. Gonna get old like the rest of us. Everything changes.
Let’s Respect others and discussion, not violence.
‘What’s in it’ ? or ‘violence and disruption’, which one is the reason of slow-down ?
This article does not describe what will be covered by the health plan. If a middle income person making $43K a year has to pay $100 per week for coverage, is that all we’d have to cover? Are there co-pays, deductibles, additional fees? Does this come from pre-tax or post-tax dollars? Does this cover dental and vision which are also very expensive and treated by most employers and heatlh insurance providers as seperate benefits that many don’t currently offer? Also, will all doctors, hospitals, etc. be forced to accept all kinds of insurance, including the public option … or can they continue to pick and choose as they do now? If my $100 per week covers me in full, then I think its reasonable and actually less than what most people currently pay. If not, this plan does nothing for the middle class who are the majority of the voters. I hope someone can answer this please.
In other words, we are all going to take a bighit!
RT
http://www.anon-web-tools.net.tc
Listen people!
no one is being forced to use the public option!
It would be there for those who want it!!!
If you earn a lot a decent amount of money – and the public option seems too expensive – then stick with your private insurance!!!
Why can’t people understand this???
Why on earth would people choose the private option? Tax paying citizens would already be paying 30% of the gov’t option. It’d be silly to spend more money on a private insurance company.
Even if you find the concept to be wrong and choose to stay with private insurance, eventually these companies will go out of business– the only option left would be the public “option”. It’s a blatant, unfair monopoly.
Can anyone supporting the fact that this is an “option” explain how on earth private companies could compete with tax-assisted gov’t healthcare?
If my employer chooses to drop our current private plan because it is cheaper than private plan, wouldn’t I then be “forced to use the public option”?
In other words, we are all going to take a bighit
Obama is on record as saying that this Heallth Care Reform Bill is the first step to a single payer health care system for all Americans. This health care bill is a transition to socialized medicine. Make no mistake about it. Proof: In this bill, you can keep the private healthcare plan you have currently BUT if you change jobs (which the majority of American’s eventually do) you MUST choose the government option. This idea that everything will remain the same with your current health care is perhaps the biggest lie of them all. What are the public health care systems like around the world? In Canada, if you want a primary care family doctor, you must enter your name in a lottery. They pull names out of hat each week. If you are extremely lucky, you might get a family doctor. And the watinig lists—-the waiting lists. Here is the average wait for the citizens of Calgary.
- 62 weeks for general surgery at Rocky- view General Hospital;
- 30 weeks for MRI scans at Foothills Medical Centre;
- 54 weeks for knee replacement surgery at Rockyview General Hospital;
- 11 weeks for cardiac surgery at Foothills Medical Centre.
Did you see that last one? Over two months for cardiac surgery. Many people die on those waiting lists. That is what we ultimately have to look forward to. And don’t get me started on the biased activitst liberal press who are marginalizing average Americans who dare to question Saint Obama.
The only concern I have about the public option is that it will create an unfair advantage and then inevitably will become the “only” option. I agree that scenario is probably better that what we currently have, however I think instead that a little regulation could go a long way.
As long as the public option doesn’t foster an unfair situation, I say let’s give it a shot, because fair competition in the marketplace is only a good thing.
I Need The Help Of All Health Care Reform Supporters
There are a few things about this health care reform debate I don’t understand, and I am hoping some Obama supporters can clear things up for me:
http://freedomedium.com/2009/08/i-need-the-help-of
-all-health-care-reform-supporters/
Stockholm syndrome = is a psychological response sometimes seen in abducted hostages, in which the hostage shows signs of loyalty to the hostage-taker, regardless of the danger or risk in which they have been placed.
These protesters, insisting they have the right to speak their minds (which are being fed lies by the many insurance special interest groups), are the very same people who, during protests of Bush, were claiming that the protesters were being un-american, and should be put in jail…
Say nothing of the fact that, during the Bush Regime, the laws of the people, regarding the right to protest, and “gather” were seriously infringed in an effort to squash dissent – in cities, and especially in Bush televised meetings…. And people are calling Obama a Nazi? people need to go to school and learn some history….
I’d be willing to bet that these SHEEP have had major complaints in the last decade with the healthcare run-around, and HMO’s and “primary providers” or referrals, and not being able to get one…… “pre-existing conditions” –
THis is why i brought up Stockholm Syndrome – because NOW they are sticking up for their abusers…..
I am over their 400% line and there is no way in hell I could afford 400$ a month…..