Beth's Health Care Reform Blog

A humorously serious look at life’s trials & tribulations,
American politics, religion, and other social madnesses by Beth Isbell.

Moderator: roxybeast

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 19th, 2010, 5:49 am

AFL-CIO President Richard Trumka issued the following statement in favor of passing the health care reform bill:
"After a lot of deliberation by our national unions, the AFL-CIO has decided today to put our strong, active support behind the president's health care bill. After 60 years of fighting for health care reform, we are convinced that now is the time to say "Yes." This health care bill is good for working families--now and even more in the future.

It is not a perfect bill. But we are realistic enough to know it's time for the deliberations to stop and for progress to begin. And we are idealistic enough to believe this is an opportunity to change history we can't afford to miss.

That's not what you'll hear from the insurance industry. They've plastered their money and lobbyists across Capitol Hill to try to stop this bill because it's a game-changer for them. It ends what is literally a reign of insurance company terror. Rising health care costs are crushing families and businesses. Middle class families are losing health care coverage faster than any other group today.

This bill is a solid first step in changing that. It will make health care more secure for all Americans. It stops insurance companies from denying care based on pre-existing conditions and blocks the worst insurance company abuses. It stops the relentless rise in health care costs and expands coverage and care for everyone. It reduces prescription drug costs for seniors and saves money for small businesses. And because of the work we've done, the penalties on employers who try to run from their responsibilities are tougher - and health care reform will not be paid for on the backs of working people.

The activism of millions of working people has made the health care bill stronger, and that doesn't stop now. We are mobilizing at the grassroots, marshalling state and local leaders and putting everything we have into passage of this landmark legislation--and it will pass. And we will continue working to improve health care for all Americans. That is our goal, and this legislation moves us closer to achieving it."
Source: ... 04424.html

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 19th, 2010, 5:56 am

<center>Democrats Say Health Bill Will Pay for Itself in the Long Run
New York Times, March 18, 2010

WASHINGTON — House Democrats initiated a 72-hour countdown Thursday on their yearlong effort to overhaul the health care system, unveiling a nearly final version of the legislation that promptly won additional support with a promise that the bill would more than pay for itself over the next decade.

Armed with detailed legislative language and a report on the bill’s costs from the Congressional Budget Office, Democratic leaders and White House officials kicked off a new round of arm-twisting to line up the votes they will need to pass the legislation when it comes to the House floor in the face of intense Republican opposition on Sunday.

House Democratic leaders were still struggling Thursday to lock in the 216 votes they need to pass the bill. They are believed to be at least a half-dozen votes short, but say they are confident they can secure the needed votes.

With the fate of his top domestic priority still up in the air, President Obama postponed a foreign trip that he had been scheduled to start Sunday to be on hand for the final House vote and a subsequent round of voting that would begin in the Senate next week to complete work on the bill.

The legislation’s chances seemed to be improved by the budget office report, which estimated that it would reduce projected federal budget deficits by $138 billion over the next decade, with additional tax revenue and Medicare savings. Many of the House Democrats who have continued to waver over the bill had been concerned about its long-term costs. The bill would provide insurance coverage to most of the uninsured, put new restrictions on insurers and seek to lower rising health care costs.

The version of the bill unveiled on Thursday is based on the bill passed by the Senate in December, but it incorporates a package of changes that would address concerns raised by House Democrats. Under the timetable outlined by Democratic leaders, the House on Sunday would pass the Senate bill and then immediately approve a package of changes. If signed by Mr. Obama, the first bill would become the law of the land, but the second one would go to the Senate, where it could be approved by a simple majority, using a procedure intended to avoid the threat of Republican filibuster.

Representative Bart Gordon, Democrat of Tennessee, cited the deficit-reduction figure in announcing Thursday that he would switch his vote and support the new bill. Mr. Gordon, a member of the fiscally conservative Blue Dog Coalition, voted against the House bill in November.

Another Blue Dog Democrat who voted no in November, Representative Betsy Markey of Colorado, said she too would support the new measure.

But a few House Democrats, including Representatives Michael Arcuri of New York and Stephen F. Lynch of Massachusetts, said they were moving in the opposite direction.

Mr. Arcuri, who supported the bill in November, said he would vote against the new package because it did not do enough to lower insurance costs.

Mr. Lynch issued a statement saying he was opposed to the Senate bill — and to a plan being considered by Democratic leaders to pass it without explicitly voting for it. The House should take “a straightforward up-or-down vote on a bill of this magnitude,” he said.

The No. 3 Democrat in the House, Representative James E. Clyburn of South Carolina, said, “We are absolutely giddy” over the report from the budget office.

Republicans minimized the significance of the latest cost estimate, deriding the 10-year budget savings as paltry compared with what they called the staggering scale of the government’s debt.

Democrats see no prospect of obtaining any Republican votes for the bill, a top priority for Mr. Obama and Speaker Nancy Pelosi of California.

“Passage of health care reform is of paramount importance, and the president is determined to see this battle through,” Robert Gibbs, the White House press secretary, said in announcing that Mr. Obama had postponed until June his plan to travel to Indonesia and Australia.

Officials said that Senate leaders would spend Friday conferring with the Senate parliamentarian over the specific legislative language to determine if any provisions may be struck out for failing to meet the requirements of the complex process being used to alter the Senate bill, known as budget reconciliation.

Senior House Democratic aides said the decisions by the Senate parliamentarian could result in a final package of amendments, in the hope that the House could approve a bill on Sunday that would not require any further changes in the Senate.

Under the bill, the budget office said, the federal government would spend $940 billion over the next 10 years to provide coverage to 32 million people who would otherwise be uninsured.

The price tag, though higher than $875 billion cost of the Senate bill, is lower than the limit of $950 billion suggested by Mr. Obama.

The cost of the bill results from a significant expansion of Medicaid, to cover 16 million more low-income people, and the payment of federal subsidies to help moderate-income people buy health insurance on their own.

House Democrats said they had reduced the impact of a proposed tax on high-cost employer-sponsored health plans. White House officials have described the tax, included in the Senate bill, as a way to slow the growth of health spending.

Labor unions dislike the tax, but the A.F.L.-C.I.O. endorsed the overall legislation on Thursday.

Richard L. Trumka, the group’s president, said unions would “do everything we can” to lobby Congress on the bill.

Under the Senate bill, the tax on high-cost health plans would have raised $149 billion over 10 years. The new legislation delays and reduces the tax, slashing expected revenues to $32 billion.

Democrats would make up for some of the lost revenue by increasing the Medicare payroll tax and extending it to capital gains, dividends, interest and other “unearned income” of people with adjusted gross incomes over $250,000 for married couples and $200,000 for individuals.

The new Medicare tax would raise $210 billion over 10 years, more than twice as much as the $87 billion generated by the comparable provision of the Senate bill, according to the Congressional Joint Committee on Taxation. Fees and taxes under the new bill would total $438 billion over 10 years, up from $399 billion in the Senate bill.

Representative Luis V. Gutierrez, Democrat of Illinois, said he decided to vote for the health care bill on Thursday after receiving assurances from Mr. Obama that the White House would press forward with an immigration overhaul this year.

“I feel that what I have from the White House is a commitment to bring more enthusiasm, to make it a great priority to get immigration reform done this year,” said Mr. Gutierrez, who voted for the House bill in November but was noncommittal in recent days.

Ms. Pelosi said she was ready for a fierce fight. Insurance companies “will do anything to stop this legislation,” she said, asserting, “They have made a fortune off of the misfortune of the American people.”

The Senate Republican leader, Mitch McConnell of Kentucky, said the new legislation was “worse than the Senate bill.” Republicans said the new numbers should not provide any comfort to people worried about the deficit. In the first decade, they said, the picture is too rosy because many of the taxes and fees would start immediately, while the major costs would not show up for several years.

Source: ... ealth.html

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 19th, 2010, 11:28 am

<center>The Top Ten Immediate Benefits You'll Get When Health Care Reform Passes
by Rep. John B. Larson - Chairman of the Democratic Caucus U.S. House</center>

As soon as health care passes, the American people will see immediate benefits. The legislation will:

1)Prohibit pre-existing condition exclusions for children in all new plans;

2)Provide immediate access to insurance for uninsured Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool;

3)Prohibit dropping people from coverage when they get sick in all individual plans;

4)Lower seniors prescription drug prices by beginning to close the donut hole;

5)Offer tax credits to small businesses to purchase coverage;

6)Eliminate lifetime limits and restrictive annual limits on benefits in all plans;

7)Require plans to cover an enrollee's dependent children until age 26;

8)Require new plans to cover preventive services and immunizations without cost-sharing;

9)Ensure consumers have access to an effective internal and external appeals process to appeal new insurance plan decisions;

10)Require premium rebates to enrollees from insurers with high administrative expenditures and require public disclosure of the percent of premiums applied to overhead costs.

By enacting these provisions right away, and others over time, we will be able to lower costs for everyone and give all Americans and small businesses more control over their health care choices.

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 21st, 2010, 10:53 pm

Sunday ... March 21st ... 9:30pm ...

219 - 212 ... the House just passed the historic health reform legislation! No Republicans voted for the bill.

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 22nd, 2010, 2:28 am

The house just passed the exact unedited senate bill (the one the Senate passed with 60 votes on Christmas Eve) - they sold it to reluctant house Dems by also passing a reconciliation bill with amendments to financing provisions that will now go to the Senate for vote, but will only need 51 votes to pass ... so the Senate bill that was just approved/passed by the House now goes straight to the President for signature & will become law! Health Care Reform has passed!!!

Further, it is not possible for the Republicans to derail the reconciliation bill now going to the Senate, and though they will try and delay, there is a 100% chance they will fail according to long time Senate insiders, and that reconciliation bill will then also go to the President for signature ...

Sources: NPR ... =124993274
-and- ... =124999058

and New York Times ... ealth.html

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 22nd, 2010, 2:36 am

<center>What Are The Immediate Effects Of Health Bill Passing?

March 21, 2010

Obama administration officials and wonks call them "early deliverables." They're the benefits of the health legislation that would kick in this election year.

The provisions, which could just as easily be called the Democrats' "Incumbents' Protection Plan," suddenly are everywhere—touted on liberal blogs, on the Rachel Maddow Show, in talking points by Health and Human Services Secretary Kathleen Sebelius.

They're designed to counter Republican denunciations that the legislation is a government takeover of the health care system that will drain the federal treasury.

But the question for Democrats is whether promoting the early changes will be more persuasive with voters than the Republican arguments. The answer may determine whether the Democrats retain their congressional majority.

James Capretta, a top budget official in the George W. Bush administration, is skeptical. He says he assumes the people who would benefit by the changes before November are in the "single-digit millions," not enough to have a big impact. "There aren't enough people in those categories to say, 'Yes, the increased taxes are worth it.'"

But Chris Jennings, a consultant who was the Clinton administration's senior health policy advisor, says the legislation includes "many important, immediately available policies that people will care about." He adds: "If we can’t market them well, then we will have deserved to fail."

Changes that would occur this year include:

- Dependent children could remain on their parents' health insurance plans until age 26.

- Senior citizens would get more help paying for drugs in Medicare.

- People with health problems that left them uninsurable could qualify for coverage through a federal program.

These are among the more than a dozen features of the new health care overhaul law that would take effect in 2010 under the measure passed Sunday. (Although the Senate bill approved Sunday by the House would become law with President Barack Obama's signature, Senate action is needed on the separately-passed House measure that would amend that law.) Other first-year items include a ban on lifetime limits on medical coverage, more oversight of premium increases and tax credits for some small businesses.

The big changes in the law – the ones that could affect tens of millions of people – don't kick in until at least 2014. Those include insurance marketplaces called “exchanges"; rules requiring insurers to accept all applicants, even those with health problems, and an expansion of state Medicaid programs.

Capretta says that the legislation has big downsides for Democrats, including the sharp cuts to Medicare Advantage. Benefits in this private-plan part of Medicare likely will be pared because the bill includes payment reductions intended to make the program similar to traditional Medicare. Medicare Advantage, Capretta says, "is going to get hammered, and it's hard to see how they avoid taking the blame."

Stuart Rothenberg, editor of the The Rothenberg Political Report, a nonpartisan newsletter, has some sympathy for Capretta's argument. "The public is unhappy," he says. "The idea that suddenly after the bill passes that Democratic leaders could start talking about it and people would be happy strikes me as Pollyannaish at best."

Americans have been sharply divided over the legislation – Democrats hope attitudes toward it will swing in their favor as people focus on the details. While some of the more popular elements of the legislation go into effect quickly, some less popular items – such as the requirement that nearly all Americans carry insurance or face a fine – won’t occur until well after the election.

Meanwhile, Republicans are keeping up a steady drumbeat of their concerns, saying the legislation will harm more Americans than it helps by raising government spending in a time of record deficits. Many in the GOP want to build support for repealing the law.

Public opinion of Congress – aimed at both partie—-- and the legislative process is low. The deal-making to garner votes during the year-long health care debate, such as special payments to specific states, coupled with last-minute maneuvering after Democrats lost their filibuster-proof majority in the Senate, soured voters.

Some of the items that go into effect in the first year include:

New help for some uninsured: People with a medical condition that has left them uninsurable may be able to enroll in a new federally subsidized insurance program that is to be established within 90 days. The legislation appropriates $5 billion for this, although that may not be enough to cover all who apply; it's not clear how much consumers would pay as their share of the cost. About 200,000 people are covered in similar state programs currently, at an estimated cost of $1 billion a year, says Karen Pollitz, a research professor at Georgetown University.

Discounts and free care in Medicare: The approximately 4 million Medicare beneficiaries who hit the so-called "doughnut hole" in the program’s drug plan will get a $250 rebate this year. Next year, their cost of drugs in the coverage gap will go down by 50 percent. Preventive care, such as some types of cancer screening, will be free of co-payments or deductibles starting in 2010.

Coverage of kids: Parents will be allowed to keep their children on their health insurance plan until age 26, unless the child is eligible for coverage through a job. Insurance plans cannot exclude pre-existing medical conditions from coverage for children under age 19, although insurers could still reject those children outright for coverage in the individual market until 2014.

Tax credits for businesses: Businesses with fewer than 25 employees and average wages of less than $50,000 could qualify for a tax credit of up to 35 percent of the cost of their premiums.

Changes to insurance: All existing insurance plans will be barred from imposing lifetime caps on coverage. Restrictions will also be placed on annual limits on coverage. Insurers can no longer cancel insurance retroactively for things other than outright fraud.

Government oversight: Insurers must report how much they spend on medical care versus administrative costs, a step that later will be followed by tighter government review of premium increases.

Source: ... =124999058

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 22nd, 2010, 2:40 am

<center>Get Ready For The Senate's Health Vote Slog

March 21, 2010
Action on health care legislation now shifts to the Senate, where the process is expected to be slow and frustrating. In other words, business as usual in that chamber.

But experts on congressional process predict that the Senate will ultimately clear the health reconciliation bill that the House passed Sunday: Senate Republicans have the tools to slow the bill's progress, but not block it.

The Senate will take up the bill within days, at which point Republicans will try any and all strategies to delay and, if possible, derail this legislation. For anyone who follows the Senate on a regular basis, the process is going to feel familiar.

"In the Senate, all legislation is a mess. It's just that most people don't pay attention to it," says Donald Ritchie, the Senate's in-house historian. "This is a much larger case with more at stake on both sides, so everybody is going to use every tactic possible."

What Reconciliation Is About

The progress of health legislation looks particularly messy because it's turning out to be a multistep process. Shortly after passing the Senate's version of the health bill — clearing it for President Obama's signature — the House also passed a reconciliation bill that was, in essence, a package of amendments to the main bill.

The reconciliation process is used when Congress needs to make policy changes that affect spending or taxation in order to meet budgetary goals. Only items that directly affect either revenues or spending can be part of a reconciliation package. That's why there was no attempt to rewrite language in the main health bill having to do with the availability of insurance for illegal immigrants, for example.

The reconciliation bill does have several major tweaks on the earlier Senate bill, such as changing the penalties both for individuals who don't purchase health insurance and for companies that don't provide coverage to employees. It would delay the implementation of the so-called Cadillac tax on generous health care plans an additional five years, until 2018. And it seeks to answer complaints from states about Medicaid costs by increasing the federal share of coverage for those who enroll under the new law.

As everyone following the health debate knows by now, there's a big advantage for Senate Democrats in using reconciliation to move this legislation. It requires only 51 votes for passage, in contrast with the 60 votes required to bring filibusters to an end. Reconciliation measures are "privileged" and can't be filibustered.

A De Facto Filibuster

Senate debate on reconciliation will be limited to 20 hours. But that's sort of like reaching the two-minute warning in football. Real time is going to pass a lot more slowly because there will be plenty of timeouts called.

Votes don't count against the time limit, and there will be no limit on amendments. Republicans will be offering amendments by the dozens, if not hundreds. And reading the amendments out loud — something the GOP might insist on — doesn't count against the time limit, either.

A Test For The Democrats

From the Democratic perspective, the key thing is to stick together against any and all changes. If Republicans alter a single word, the bill would be sent back to the House for another vote — something House Democrats desperately want to avoid.

"Given the difficulty of crafting 216 votes for the first version, I'm sure leaders don't want to do that again," says Sarah A. Binder, a senior fellow in governance studies at the Brookings Institution.

That's why senators and aides from both sides of the aisle have been trooping in and out of the parliamentarian's office in recent days, double-checking which provisions will pass muster.

Senate Republicans know that if the parliamentarian upholds any of their challenges, Democrats would need 60 votes to overrule him — which they won't have.

But with 59 votes, Senate Majority Leader Harry Reid (D-NV) should be able to keep enough of his troops in line to prevail on votes against amendments. On Saturday, Reid presented a pledge from "more than 50" Democratic senators to his House counterparts that they will clear the House version for President Obama's signature.

So the test is really whether congressional Democrats have sufficiently scrubbed the measure to survive any procedural challenges.

Vote-Arama To Follow

The reconciliation process ends with what is lovingly referred to on Capitol Hill as a "vote-arama." The GOP will not be interested in reaching agreement on limiting the number of amendments that require a roll-call vote. Senate Republicans are not likely to offer their consent to anything that smooths this bill's process.

"The Senate does a huge percentage of its business by unanimous consent, and obviously there's not going to be unanimous consent for anything," says Ritchie, the Senate historian. "That's going to slow things down."

The End Of The Dance

All that delay will ultimately be for naught, predicts Bob Dove, who served as Senate parliamentarian for a dozen years under Republican majorities.

"You can expect a long, grueling process of amendments, but at some point that will stop," Dove says. "At some point, I think the Senate will pass the bill and send that bill to the president."

Source: ... =124993274

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 22nd, 2010, 2:43 am

<center>House Approves Health Overhaul, Sending Landmark Bill to Obama
New York Times, March 21, 2010

WASHINGTON — House Democrats approved a far-reaching overhaul of the nation’s health system on Sunday, voting over unanimous Republican opposition to provide medical coverage to tens of millions of uninsured Americans after an epic political battle that could define the differences between the parties for years.

With the 219-to-212 vote, the House gave final approval to legislation passed by the Senate on Christmas Eve. Thirty-four Democrats joined Republicans in voting against the bill. The vote sent the measure to President Obama, whose yearlong push for the legislation has been the centerpiece of his agenda and a test of his political power.

After approving the bill, the House adopted a package of changes to it by a vote of 220 to 211. That package — agreed to in negotiations among House and Senate Democrats and the White House — now goes to the Senate for action as soon as this week. It would be the final step in a bitter legislative fight that has highlighted the nation’s deep partisan and ideological divisions.

On a sun-splashed day outside the Capitol, protesters, urged on by House Republicans, chanted “Kill the bill” and waved yellow flags declaring “Don’t Tread on Me.” They carried signs saying “Doctors, Not Dictators.”

Inside, Democrats hailed the votes as a historic advance in social justice, comparable to the establishment of Medicare and Social Security. They said the bill would also put pressure on rising health care costs and rein in federal budget deficits.

“This is the Civil Rights Act of the 21st century,” said Representative James E. Clyburn of South Carolina, the No. 3 Democrat in the House.

Mr. Obama celebrated the House action in remarks at the White House.

“We pushed back on the undue influence of special interests,” Mr. Obama said. “We didn’t give in to mistrust or to cynicism or to fear. Instead, we proved that we are still a people capable of doing big things.”

“This isn’t radical reform,” he added, “but it is major reform.”

After a year of combat and weeks of legislative brinksmanship, House Democrats and the White House clinched their victory only hours before the voting started on Sunday. They agreed to a deal with opponents of abortion rights within their party to reiterate in an executive order that federal money provided by the bill could not be used for abortions, securing for Democrats the final handful of votes they needed to assure passage.

Winding up the debate, Speaker Nancy Pelosi said: “After a year of debate and hearing the calls of millions of Americans, we have come to this historic moment. Today we have the opportunity to complete the great unfinished business of our society and pass health insurance reform for all Americans that is a right and not a privilege.”

The House Republican leader, Representative John A. Boehner of Ohio, said lawmakers were defying the wishes of their constituents. “The American people are angry,” Mr. Boehner said. “This body moves forward against their will. Shame on us.”

Republicans said the plan would saddle the nation with unaffordable levels of debt, leave states with expensive new obligations, weaken Medicare and give the government a huge new role in the health care system.

The debate on the legislation set up a bitter midterm campaign season, with Republicans promising an effort to repeal the legislation, challenge its constitutionality or block its provisions in the states.

Representative Paul D. Ryan, Republican of Wisconsin, denounced the bill as “a fiscal Frankenstein.” Representative Lincoln Diaz-Balart, Republican of Florida, called it “a decisive step in the weakening of the United States.” Representative Virginia Foxx, Republican of North Carolina, said it was “one of the most offensive pieces of social engineering legislation in the history of the United States.”

But Representative Marcy Kaptur, Democrat of Ohio, said the bill heralded “a new day in America.” Representative Doris Matsui, Democrat of California, said it would “improve the quality of life for millions of American families.”

The health care bill would require most Americans to have health insurance, would add 16 million people to the Medicaid rolls and would subsidize private coverage for low- and middle-income people, at a cost to the government of $938 billion over 10 years, the Congressional Budget Office said.

The bill would require many employers to offer coverage to employees or pay a penalty. Each state would set up a marketplace, or exchange, where consumers without such coverage could shop for insurance meeting federal standards.

The budget office estimates that the bill would provide coverage to 32 million uninsured people, but still leave 23 million uninsured in 2019. One-third of those remaining uninsured would be illegal immigrants.

The new costs, according to the budget office, would be more than offset by savings in Medicare and by new taxes and fees, including a tax on high-cost employer-sponsored health plans and a tax on the investment income of the most affluent Americans.

Cost estimates by the budget office, showing that the bill would reduce federal budget deficits by $143 billion in the next 10 years, persuaded some fiscally conservative Democrats to vote for the bill.

Democrats said Americans would embrace the bill when they saw its benefits, including some provisions that take effect later this year.

Health insurers, for example, could not deny coverage to children with medical problems or suddenly drop coverage for people who become ill. Insurers must allow children to stay on their parents’ policies until they turn 26. Small businesses could obtain tax credits to help them buy insurance.

The Democratic effort to secure the 216 votes needed for passage of the legislation came together only after last-minute negotiations involving the White House, the House leadership and a group of Democratic opponents of abortion rights, led by Representative Bart Stupak of Michigan. On Sunday afternoon, members of the group announced that they would support the legislation after Mr. Obama promised to issue an executive order to “ensure that federal funds are not used for abortion services.”

Mr. Stupak described the order as a significant guarantee that would “protect the sanctity of life in health care reform.” But supporters of abortion rights — and some opponents — said the order merely reaffirmed what was in the bill.

The vote to pass the Senate version of the bill means that it will become the law of the land as soon as Mr. Obama signs it, regardless of when — or even whether — the Senate acts on the package of changes the House also passed.

In his remarks, shortly before midnight in the East Room, Mr. Obama urged the Senate to complete the final pieces of the legislation. “Some have predicted another siege of parliamentary maneuvering in order to delay it,” he said. “I hope that’s not the case.”

He continued, “It’s time to bring this debate to a close and begin the hard work of implementing this reform properly on behalf of the American people.”

Mr. Obama watched the roll call with Vice President Joseph R. Biden Jr. in the Roosevelt Room in the White House.

The House galleries were full, and the floor was unusually crowded, for the historic debate on health care.

Working together, Mr. Obama and Ms. Pelosi revived the legislation when it appeared dead after Democrats lost their 60th vote in the Senate and with it their ability to shut off Republican filibusters.

Republicans said they would use the outcome to bludgeon Democrats in this year’s Congressional elections. The White House is planning an intensive effort to convince people of the bill’s benefits. But if Democrats suffer substantial losses in November, Mr. Obama could be stymied on other issues.

The campaign for a health care overhaul began as a way to help the uninsured. But it gained momentum when middle-class families with health insurance flooded Congress with their grievances. They complained of soaring premiums. They said their insurance had been canceled when they got sick.

“It’s not just the uninsured,” said Representative Jim McGovern, Democrat of Massachusetts. “We also have to worry about people with insurance who find, for crazy reasons, that they are somehow going to be denied coverage.”

In the end, groups like the United States Chamber of Commerce and the National Federation of Independent Business tried to stop the bill, saying it would increase the cost of doing business. But other groups, including the American Medical Association and AARP, backed it, as did the pharmaceutical industry.

Lawmakers agreed that Sunday’s debate was historic, but they were poles apart in assessing the legislation.

Representative Rodney Alexander, Republican of Louisiana, said, “You cannot expect to expand coverage to millions of individuals and to curb costs at the same time.”

Republicans said the picture painted by the budget office was too rosy, because the new taxes and fees would start immediately, while the major costs would not show up for four years.

Moreover, Republicans said Democrats would pay a price for defying public opinion on the bill.

“Are you so arrogant that you know what’s best for the American people?” Representative Paul Broun, Republican of Georgia, asked the Democrats. “Are you so ignorant to be oblivious to the wishes of the American people?”

Lawmakers spoke with deep conviction in explaining their votes.

“Health care is not only a civil right, it’s a moral issue,” said Representative Patrick J. Kennedy, Democrat of Rhode Island, who invoked the memory of his father, Senator Edward M. Kennedy, a Massachusetts Democrat and a lifelong champion of health care for all.

After the legislation passed, Mr. Obama sought to place the day in perspective.

“In the end what this day represents is another stone firmly laid in the foundation of the American dream,” the president said. “Tonight, we answered the call of history as so many generations of Americans have before us. When faced with crisis, we did not shrink from our challenges. We overcame them. We did not avoid our responsibilities, we embraced it. We did not fear our future, we shaped it.”

Source: ... ealth.html

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 22nd, 2010, 2:46 am

<center>For Consumers, Clarity on Health Care Changes
New York Times, March 21, 2010

American consumers, who spent a year watching Congress scratch and claw over sweeping health care legislation, can now try to figure out what the overhaul would mean for them.

The uninsured are clearly the biggest beneficiaries of the legislation, which would extend the health care safety net for the lowest-income Americans.

The legislation is meant to provide coverage for as many as 32 million people who have been shut out of the market — whether because insurers deem them too sick or because they cannot afford ever-rising insurance premiums.

For people already covered by a large employer — most Americans, in other words — the effect would not be as significant. And yet, just about everyone might benefit from tighter insurance regulations.

“We think it’s a big step forward,” said Bill Vaughan, a policy analyst at Consumers Union. “It’s going to provide a peace of mind that many Americans who really want or need health insurance will always be able to get a quality product at a reasonable price regardless of their health or financial situation.”

There would be costs to consumers, too. Affluent families would be required to pay additional taxes. Most Americans would be required to have health insurance and face federal penalties if they do not buy it. And it is still unclear what effect, if any, the legislation would have on rising out-of-pocket medical costs and premiums.

But there is no question that the legislation should benefit consumers in various ways. Beginning in 2014, for example, many employers — those with 50 or more workers — could face federal fines for not providing insurance coverage. Several of the other changes would take effect much sooner.

Six months after the legislation is enacted, many plans would be prohibited from placing lifetime limits on medical coverage, and they could not cancel the policies of people who fall ill. Children with pre-existing conditions could not be denied coverage.

And dependent children up to age 26 would be eligible for coverage under their parents’ plans — instead of the current state-by-state rules that often cut off coverage for children at 18 or 19.

And within three months of the law’s taking effect, people who have been locked out of the insurance market because of a pre-existing condition would be eligible for subsidized coverage through a new high-risk insurance program.

That special coverage would continue until the legislation’s engine kicks into a higher gear in 2014, when coverage would be extended to a wider part of the population through Medicaid and new state-run insurance exchanges.

Those exchanges, or marketplaces, are meant to provide much more competitive, consumer-friendly online shopping centers of private insurance for people who are not able to obtain coverage through an employer.

In 2014, people with pre-existing conditions could no longer be denied insurance, all lifetime and annual limits on coverage would be eliminated and new policies would be required to meet higher benefit standards.

Even sooner, in 2013, affluent families with annual income above $250,000 would be required to pay an additional 3.8 percent tax on their investment income, while contributing more to the Medicare program from their payroll taxes. And eventually, the most expensive insurance policies would be subject to a new tax.

Here is a look at some of the main ways the health care overhaul might affect household budgets.

The Uninsured

Although most Americans who do not obtain health insurance would face a federal penalty starting in 2014, many experts question how strict the enforcement of that penalty would actually be.

The first year, consumers who did not have insurance would owe $95, or 1 percent of income, whichever is greater. But the penalty would subsequently rise, reaching $695, or 2 percent of income.

Families who fall below the income-tax filing thresholds would not owe anything. Nor would people who cannot find a policy that costs less than 8 percent of their income, said Sara R. Collins, a vice president at the Commonwealth Fund, an independent nonprofit research group.

EXPANDED MEDICAID More lower-income individuals under the age of 65 would be covered by Medicaid, the federal health insurance plan for the poor. Under the new rules, households with income up to 133 percent of the federal poverty level, or about $29,327 for a family of four, would be eligible.

EXCHANGES AND SUBSIDIES Most other uninsured people would be required to buy insurance through one of the new state-run insurance exchanges. People with incomes of more than 133 percent of the poverty level but less than 400 percent (that’s $29,327 to $88,200 for a family of four) would be eligible for premium subsidies through the exchanges.

Premiums would also be capped at a percentage of income, ranging from 3 percent of income to as much as 9.5 percent.

EMPLOYMENT FLEXIBILITY The exchanges would also help people who lose their jobs, quit or decide to start their own businesses.

“If you lose your employer-related insurance, you will be able to move seamlessly into the exchange,” said Timothy Stoltzfus Jost, a professor at the Washington and Lee University School of Law.

Moreover, people of any age who cannot find a plan that costs less than 8 percent of their income would be allowed to buy a catastrophic policy otherwise intended for people under age 30.

Those With Insurance

EMPLOYER COVERAGE People who receive coverage through large employers would be unlikely to see any drastic changes, nor should premiums or coverage be affected. But almost everyone would benefit from new regulations, like the ban on pre-existing conditions that would apply to all policies come 2014.

There might even be cases where people would be eligible to buy insurance through an exchange instead of through their employer, Professor Jost said: those who must pay more than 9.5 percent of their income for premiums, or those whose plans do not cover more than 60 percent of the cost their benefits.

CHANGES IN MEDICARE One of the biggest changes involves the Medicare prescription drug program. Its unpopular “doughnut hole” — a big, expensive gap in coverage that affects millions — would be eliminated by 2020. Starting immediately, consumers who hit the gap would receive a $250 rebate. In 2011, they would receive a 50 percent discount on brand name drugs.

HIGH-COST INSURANCE Starting in 2018, employers that offer workers pricier plans — or those with total premiums of $10,200 or more for singles and $27,500 for families — would be subject to a 40 percent tax on the excess premium, said C. Clinton Stretch, managing principal of tax policy at Deloitte. Retirees and workers in high-risk professions like firefighting would have higher thresholds ($11,850 for singles, or $30,950 for families), pegged to inflation.

Although the taxes would be levied on the insurer, experts expect the assessment to be passed on to the consumer in the form of higher premiums or reduced benefits.

Source: ... sumer.html

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 22nd, 2010, 2:24 pm

<center>What Health Overhaul Will Mean For You

March 21, 2010

The health overhaul package passed by the House Sunday and sent to the Senate for final action is the most far-reaching health legislation since the creation of the Medicare and Medicaid programs.

While the underlying Senate bill will become law as soon as President Barack Obama signs it, additional changes will occur if the Senate passes the reconciliation-bill part of the package. The following is a look at the impact of the entire package, which would extend insurance coverage to 32 million additional Americans by 2019, but also have an an effect on almost every citizen.

Here's where things stand and how you might be affected:

Q: I don't have health insurance. Would I have to get it, and what happens if I don't?

A: Under the legislation, most Americans would have to have insurance by 2014 or pay a penalty. The penalty would start at $95, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016. This is an individual limit; families have a limit of $2,085. Some people would be exempted from the insurance requirement, called an individual mandate, because of financial hardship or religious beliefs or if they are American Indians, for example.

Q: I want health insurance, but I can't afford it. What do I do?

A: Depending on your income, you might be eligible for Medicaid, the state-federal program for the poor and disabled, which would be expanded sharply beginning in 2014. Low-income adults, including those without children, would be eligible, as long as their incomes didn't exceed 133 percent of the federal poverty level, or $14,404 for individuals and $29,326 for a family of four, according to current poverty guidelines.

Q: What if I make too much for Medicaid but still can't afford coverage?

A: You might be eligible for government subsidies to help you pay for private insurance that would be sold in the new state-based insurance marketplaces, called exchanges, slated to begin operation in 2014.

Premium subsidies would be available for individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,404 to $43,320 for individuals and $29,326 to $88,200 for a family of four.

The subsidies would be on a sliding scale. For example, a family of four earning 150 percent of the poverty level, or $33,075 a year, would have to pay 4 percent of its income, or $1,323, on premiums. A family with income of 400 percent of the poverty level would have to pay 9.5 percent, or $8,379.

In addition, if your income is below 400 percent of the poverty level, your out-of-pocket health expenses would be limited.

Q: How would the legislation affect the kind of insurance I could buy? Would it make it easier for me to get coverage, even if I have health problems?

A: If you have a medical condition, the bill would make it easier for you to get coverage; insurers would be barred from rejecting applicants based on health status once the exchanges are operating in 2014.

In the meantime, the bill would create a temporary high-risk insurance pool for people with medical problems who have been rejected by insurers and have been uninsured at least six months. That would occur this year.

And starting later this year, insurers could no longer exclude coverage for specific medical problems for children with pre-existing conditions. Nor could insurers set lifetime coverage limits for adults and kids.

In 2014, annual limits on coverage would be banned.

New policies sold on the exchanges would be required to cover a range of benefits, including hospitalizations, doctor visits, prescription drugs, maternity care and certain preventive tests.

Q: How would the legislation affect young adults?

A: If you're an unmarried adult younger than 26, you could stay on your parent's insurance coverage as long as you are not offered health coverage at work.

In addition, people in their 20s would be given the option of buying a "catastrophic" plan that would have lower premiums. The coverage would largely only kick in after the individual had $6,000 in out of pocket expenses.

Q: I own a small business. Would I have to buy insurance for my workers? What help could I get?

A: It depends on the size of your firm. Companies with fewer than 50 workers wouldn't face any penalties if they didn't offer insurance.

Companies could get tax credits to help buy insurance if they have 25 or fewer employees and a workforce with an average wage of up to $50,000. Tax credits of up to 35 percent of the cost of premiums would be available this year and would reach 50 percent in 2014. The full credits are for the smallest firms with low-wage workers; the subsidies shrink as companies' workforces and average wages rise.

Firms with more than 50 employees that do not offer coverage would have to pay a fee of up to $2,000 per full- time employee if any of their workers got government-subsidized insurance coverage in the exchanges. The first 30 workers would be excluded from the assessment.

Q: I'm over 65. How would the legislation affect seniors?

A: The Medicare prescription-drug benefit would be improved substantially. This year, seniors who enter the Part D coverage gap, known as the "doughnut hole," would get $250 to help pay for their medications.

Beyond that, drug company-discounts on brand-name drugs and federal subsidies and discounts for all drugs would gradually reduce the gap, eliminating it by 2020. That means that seniors, who now pay 100 percent of their drug costs once they hit the doughnut hole, would pay 25 percent.

And, as under current law, once seniors spend a certain amount on medications, they would get "catastrophic" coverage and pay only 5 percent of the cost of their medications.

Meanwhile, government payments to Medicare Advantage, the private-plan part of Medicare, would be cut sharply starting in 2011. If you're one of the 10 million enrollees, you could lose extra benefits that many of the plans offer, such as free eyeglasses, hearing aids and gym memberships. To cushion the blow to beneficiaries, the cuts to health plans in high-cost areas of the country such as New York City and South Florida – where seniors have enjoyed the richest benefit—-- would be phased in over as many as seven years.

Beginning this year, the bill would make all Medicare preventive services, such as screenings for colon, prostate and breast cancer, free to beneficiaries.

Q: How much is all this going to cost? Will it increase my taxes?

A: The bill is estimated to cost $940 billion over a decade. But because of higher taxes and fees and billions of dollars in Medicare payment cuts to providers, the bill would narrow the federal budget deficit by $138 billion over 10 years, according to the Congressional Budget Office.

If you have a high income, you face higher taxes. Starting in 2013, individuals would pay a higher Medicare payroll tax of 2.35 percent on earnings of more than $200,000 a year and couples earning more than $250,000, up from the current 1.45 percent. In addition, you'd face an additional 3.8 percent tax on unearned income such as dividends and interest over the threshold.

Starting in 2018, the bill would also impose a 40 percent excise tax on the portion of most employer-sponsored health coverage (excluding dental and vision) that exceeds $10,200 a year for individuals and $27,500 for families.

The bill also would raise the threshold for deducting unreimbursed medical expenses from 7.5 percent of adjusted gross income to 10 percent.

The bill also would limit the amount of money you can put in a flexible spending account to pay medical expenses to $2,500 starting in 2013. Those using an indoor tanning salon will pay a 10 percent tax starting this year.

Q: What will happen to my premiums?

A: That's hard to predict and the subject of much debate. People who are sick might face lower premiums than otherwise because insurers wouldn't be permitted to charge sick people more; healthier people might pay more. Older people could still be charged more than younger people, but the gap couldn't be as large.

The bigger question is what happens to rising medical costs, which drive up premiums. Even proponents acknowledge that efforts in the legislation to control health costs, such as a new board to oversee Medicare spending, wouldn't have much of an effect for several years.

In November, a CBO report on how the legislation – which at that point had a tougher Cadillac tax – would affect premiums said big employers would see premiums stay flat or drop 3 percent compared to today's rates. It also noted that employees with small-group coverage might see their premiums stay the same. And Americans who received subsidies would see their premiums decline by up to 11 percent, according to the CBO.

Source: ... =124998781

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 22nd, 2010, 2:32 pm

Here's a quick question & answer guide put together by the Washington Post ... answer a few simple questions & it will tell you specifically how the health bill will affect you ... ... s-for-you/

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 22nd, 2010, 3:28 pm

March 21st, 2010 by DAVID FRUM
Republican - Former Bush speechwriter

Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.

It’s hard to exaggerate the magnitude of the disaster. Conservatives may cheer themselves that they’ll compensate for today’s expected vote with a big win in the November 2010 elections. But:

(1) It’s a good bet that conservatives are over-optimistic about November – by then the economy will have improved and the immediate goodies in the healthcare bill will be reaching key voting blocs.

(2) So what? Legislative majorities come and go. This healthcare bill is forever. A win in November is very poor compensation for this debacle now.

So far, I think a lot of conservatives will agree with me. Now comes the hard lesson:

A huge part of the blame for today’s disaster attaches to conservatives and Republicans ourselves.

At the beginning of this process we made a strategic decision: unlike, say, Democrats in 2001 when President Bush proposed his first tax cut, we would make no deal with the administration. No negotiations, no compromise, nothing. We were going for all the marbles. This would be Obama’s Waterloo – just as healthcare was Clinton’s in 1994.

Only, the hardliners overlooked a few key facts: Obama was elected with 53% of the vote, not Clinton’s 42%. The liberal block within the Democratic congressional caucus is bigger and stronger than it was in 1993-94. And of course the Democrats also remember their history, and also remember the consequences of their 1994 failure.

This time, when we went for all the marbles, we ended with none.

Could a deal have been reached? Who knows? But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.

Barack Obama badly wanted Republican votes for his plan. Could we have leveraged his desire to align the plan more closely with conservative views? To finance it without redistributive taxes on productive enterprise – without weighing so heavily on small business – without expanding Medicaid? Too late now. They are all the law.

No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?

We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.

There were leaders who knew better, who would have liked to deal. But they were trapped. Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible. How do you negotiate with somebody who wants to murder your grandmother? Or – more exactly – with somebody whom your voters have been persuaded to believe wants to murder their grandmother?

I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say – but what is equally true – is that he also wants Republicans to fail. If Republicans succeed – if they govern successfully in office and negotiate attractive compromises out of office – Rush’s listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.

So today’s defeat for free-market economics and Republican values is a huge win for the conservative entertainment industry. Their listeners and viewers will now be even more enraged, even more frustrated, even more disappointed in everybody except the responsibility-free talkers on television and radio. For them, it’s mission accomplished. For the cause they purport to represent, it’s Waterloo all right: ours.


User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 22nd, 2010, 4:46 pm

<center>11 States announce plan to launch lawsuits against healthcare plan
Reuters/Washington Post
Monday, March 22, 2010

CHICAGO (Reuters) - Less than 24 hours after the House of Representatives gave final approval to a sweeping overhaul of healthcare, attorneys general from several states on Monday said they will sue to block the plan on constitutional grounds.

Republican attorneys general in 11 states warned that lawsuits will be filed to stop the federal government overstepping its constitutional powers and usurping states' sovereignty.

States are concerned the burden of providing healthcare will fall on them without enough federal support.

Ten of the attorneys general plan to band together in a collective lawsuit on behalf of Alabama, Florida, Nebraska, North Dakota, Pennsylvania, South Carolina, South Dakota, Texas, Utah and Washington.

"To protect all Texans' constitutional rights, preserve the constitutional framework intended by our nation's founders, and defend our state from further infringement by the federal government, the State of Texas and other states will legally challenge the federal health care legislation," said Texas Attorney General Greg Abbott, in a statement.

The Republican attorney generals say the reforms infringe on state powers under the Constitution's Bill of Rights.

Virginia Attorney General Kenneth Cuccinelli, who plans to file a lawsuit in federal court in Richmond, Virginia, said Congress lacks authority under its constitutional power to regulate interstate commerce to force people to buy insurance. The bill also conflicts with a state law that says Virginians cannot be required to buy insurance, he added.

"If a person decides not to buy health insurance, that person by definition is not engaging in commerce," Cuccinelli said in recorded comments. "If you are not engaging in commerce, how can the federal government regulate you?"

In addition to the pending lawsuits, bills and resolutions have been introduced in at least 36 state legislatures seeking to limit or oppose various aspects of the reform plan through laws or state constitutional amendments, according to the National Conference of State Legislatures.

So far, only two states, Idaho and Virginia, have enacted laws, while an Arizona constitutional amendment is seeking voter approval on the November ballot. But the actual enactment of the bill by President Barack Obama could spur more movement on the measures by state lawmakers.

As is the case on the Congressional level, partisan politics is in play on the state level, where no anti-health care reform legislation has emerged in Democrat-dominated states like Illinois and New York, according to the NCSL.

Florida Attorney General Bill McCollum, a Republican candidate running for governor, said the mandate would cost Florida at least $1.6 billion in Medicaid alone.

All states would receive extra funding to cover Medicaid costs that are expected to rise under the reform, including 100 percent federal coverage for new enrollees under the plan through 2016.

Medicaid is the healthcare program for the poor jointly administered by the states and federal government.

Source: ... 01400.html
Breaking News - 3/22/2010 5:05pm EDT ... White House Spokesperson Robert Gibbs indicated that the White House does not believe any of these efforts will be successful.
Last edited by roxybeast on March 22nd, 2010, 5:10 pm, edited 2 times in total.

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 22nd, 2010, 4:50 pm

<center>The five most promising cost controls in the health-care bill
by Ezra Klein, Washington Post,
March 22, 2010

It's hard to overstate how important the Congressional Budget Office (CBO) -- which makes the official judgments on how much bills cost and save -- is in Washington. But the rest of the country doesn't know what the CBO is, and it doesn't care. "Washington may live and die by the pronouncements of the Congressional Budget Office," wrote pollsters Doug Schoen and Scott Rasmussen in the Wall Street Journal, "but 81 percent of voters say it's likely [health care reform] will end up costing more than projected."

That's left Democrats in a worst-of-both-worlds situation: They've built a bill that Washington's toughest scorekeeper says will cut the deficit by more than a trillion dollars over 20 years. They're getting attacked for the taxes and Medicare reforms that save all that money. But the country doesn't believe the savings are real.

One of the problems Democrats have had is that it's very easy to understand the one thing the bill does to spend money -- purchase insurance for people who can't afford it -- and considerably harder to explain the many things it does to save money. Another is that a lot of the savings have to do with changing how medicine is practiced, which people are less familiar with than how insurance is purchased.

But the fact that the cost controls are complicated and numerous doesn't mean they're absent, or that they won't work. So here are five of the bill's best ideas, and how they're meant to work:
(1) Create a competitive insurance market: This is the bill's first, and most important, step. Right now, the insurance market's version of competition is pretty brutal. Companies compete to avoid the sickest people and sign up the healthiest people. Offering the best coverage for the lowest cost isn't much of a priority, because most consumers don't know whose coverage is best, and the ones who really do know are probably sick customers who spend their days researching this stuff.

Outlawing the bad kind of competition while enabling the good kind, which the bill does, is more than just a humanitarian measure. It's a cost control. The insurance "exchanges" imitate the market in which federal employees (including congressmen) purchase their health insurance. In the exchanges, insurance products have to be above a minimum level of comprehensiveness (no more insurance that doesn't cover anything) and their benefits have to be presented in a standard, comprehensible way. The insurers themselves can't discriminate based on preexisting conditions, will have to answer to regulators if they attempt to jack up premiums, and will be rated by their customers -- a rating that everyone else will see when shopping for their insurance.

If all goes well, consumers will be able to log onto the exchange's Web site, compare insurance plans and choose their favorite. That means insurers will have to compete for customers in a more transparent market, where shoppers have more information, and where the relationship between price and quality is more obvious. As any free-market conservative will tell you, that should drive prices down and quality up. If it doesn't, insurers will have some annoyed legislators to answer to: The bill says congressmen and their staff members need to buy their insurance from these exchanges, too.

(2) The Medicare Commission: The next cost control worth mentioning is an effort by Congress to solve the problem of, well, Congress. Medicare's cost problem is, in many ways, a political problem: Saving money means cutting someone's profits or someone's benefits, and politicians are afraid to do either.

Enter the Independent Medicare Advisory Board. Modeled off of the highly respected (but totally toothless) Medicare Payment and Advisory Commission, IMAC is a 15-person board of independent experts chosen by the president, confirmed by the Senate and empowered to cut through congressional gridlock. IMAC will write reforms that bring Medicare into like with certain spending targets. Congress can't modify these proposals, it can't filibuster these proposals, and if it wants to reject them, it needs to find another way to save the same amount of money. Making the process of passing tough reforms easier is the single most important thing you can do to make sure tough reforms actually happen.

(3) A tax on "Cadillac plans": The least popular, but most direct, cost control is the tax on expensive, employer-provided coverage, which should really be thought of as a disincentive to buy insurance plans that don't control their costs.

Today, the average employer who offers insurance pays more than 70 percent of a worker's premiums, all of it tax-free. This amounts to an annual $250 billion subsidy for private insurance for people with good jobs. But it's not just the size of the subsidy; it's how we use it that matters. Because it's only good for insurance that employers buy for their workers, people have their employers buy their health-care insurance for them. But that means individuals don't know how much their insurance really costs and don't have as much incentive to keep those costs down. Imagine the pressure for cost control if the 70 percent that employers pay were coming out of our own pockets, instead of quietly coming out of our wages.

In 2018, the proposed excise tax on so-called "Cadillac plans" slaps a 40 percent tax on every dollar spent on an insurance plan above $27,500 annually. So if your plan costs $27,600, the final $100 bucks would be taxed (technically, the insurer pays the tax, but it'll pass that onto your employer). That's a very expensive plan, but over time, that $27,500 threshold grows by inflation, usually around 3 percent) rather than health-care inflation (closer to 7 percent). So if we don't get health-care inflation down, this will hit many more plans.

But the excise tax is part of getting that inflation down. The idea isn't that people will pay this tax. It's that they, or their employers, will evade it by choosing insurance that holds its costs down more aggressively. That gives insurers who hold costs down a competitive advantage against insurers who don't, because those who don't are not only offering pricier insurance, but are also passing along a hefty tax attached to their excess spending.

(4) Medicare "bundling" programs: The most obviously illogical part of our current health-care system is that we pay doctors the way we pay car dealers: They get more money for every item they sell. But while we aren't afraid to ignore a car dealer's recommendations, we are afraid to disagree with our doctors. As you'd expect, this pushes costs higher.

The health-care bill seeds Medicare with many experiments to change this status quo, the most immediately promising of which are the "bundling" programs. Instead of getting paid for everything they do to help a diabetic, hospitals will get paid once for treating that person's diabetes and all related conditions over a certain period of time. If this leads to lower costs and doesn't harm patients, it will be expanded. That would be the beginning of the end of paying for quantity of treatment, and the beginning of paying for quality of treatment.

(5) Changing the politics of reform: Republicans and Democrats both agree that we need more cost control in the health-care system. But politicians don't like to actually cut costs, because those votes reduce benefits and make people angry. So we've played a shameful game: We passively control costs by letting people become and stay uninsured, or by letting their insurance deteriorate and cover less, because those things don't require a vote in Congress.

But because the individual mandate in the bill brings everyone into the insurance market and the subsidies for those who can't afford insurance on their own put Washington on the hook for costs, Congress will have to get serious about holding costs down in the system. The alternatives, for lawmakers, are high costs infuriating constituents who're being forced to buy something they can't afford, or yawning deficits forcing them to vote to take subsidies -- and thus health-care coverage -- away from people who currently have it. The days of letting inertia win the day and watching the system fall apart on its own are over.

Thus ends the list. There are more cost control ideas in the bill, of course. Everything from modernizing the system's IT infrastructure to amassing and disseminating research on which treatments work and which don't to penalizing hospitals with the highest rates of infection. Five is just a good round number.

The bill's basic theory is to try pretty much everything in the hopes that some of it works out. The net effect is to make reform a continuous, rather than occasional, process, with different cost cops patrolling different beats. Insurers will have to work to stay a step ahead of the excise tax because employers won't want to buy plans that trigger it. The industries that provide medical care and technologies will have to hold their costs down because they don't want to become a target for the Medicare Commission. Hospitals will need to make sure they don't spend more than their competitors because they'll lose money under bundling. And if we want to try other things -- a public option, say, or incentives for insurers to abandon fee-for-service -- the exchanges give us an actual structure where we can make changes and test reforms.

Also important is that the various elements work together. For instance, the excise tax and the exchanges have an important interaction. Right now, there's a substantial amount of inertia among employers. They've got a contract with a health insurer and they don't want to waste time soliciting new bids and trying to figure out the relatively quality of different providers every year. In the exchanges, however, changing would be trivial: You'd see the prices (with the excise tax built in), and it would be a lot easier to see if cheaper plans were providing a good consumer experience.

Same goes for IT improvements and the comparative effectiveness research: As the data is crunched, it could be fed into software that'll help doctors choose the most effective treatment based on the latest evidence -- a far cry from them mainly knowing about new evidence because drug companies have spent money publicizing it. Or take the Medicare Commission, which will use a lot of the comparative effectiveness program's data when making its decisions.

Source: ... ost_c.html

User avatar
Posts: 720
Joined: November 28th, 2006, 1:00 am
Location: Oklahoma City, Oklahoma

Post by roxybeast » March 22nd, 2010, 5:12 pm

Breaking News - 3/22/10 5:07 pm per White House Spokesperson Robert Gibbs ... PRESIDENT OBAMA WILL SIGN THE HEALTH CARE BILL INTO LAW AT THE WHITE HOUSE TOMORROW MORNING (March 23, 2010)!!!

Post Reply

Return to “The Pregnant Pope”

Who is online

Users browsing this forum: No registered users and 1 guest