Better Know a Health Care Bill

[Startraveler]

Welcome to the second part of our [unknown]—part series (Part I, What's IN this health care bill?, is still floating around). You've browsed What's IN this health care bill?, you've got a decent idea of the general shape reform has been taking, now you're interested in what's happening during the final stretch.

Big legislation like this starts off with a good deal of palace intrigue and a healthy back-and-forth. But that’s all over now; if you want to follow the twists and turns that happened to health care reform during the committee process, you can track it by reading through Part I. But we’ve reached the second-to-last part of the process: at last, the House of Representatives has one final bill that it intends to vote on (probably late next week) and the Senate has one final--but different!--bill that it intends to vote on.

The final Senate bill—while done—hasn’t been put online yet so we're not going to discuss it much here but the final House bill has been put online. It came out Thursday morning: H.R. 3942. This is the final incarnation of the original House bill that diehard political junkies will remember as H.R. 3200.

Some of you said you wanted the text of this bill posted 72 hours before it's voted on: they released it around 8 days before it'll be voted on (note that there will be one more health care bill to vote on after this: the House-Senate hybrid bill that comes out of the conference committee). So what's new with this final incarnation of the House bill?

What's Different?

Unlike the previous incarnation of the House health care bill, this final bill puts a great deal of focus on immediate changes to the health care system (as opposed to changes that don’t happen until 2013). Here’s a list of the Top 14 Provisions That Take Effect Immediately:

1. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE — Reduces the donut hole by $500 and institutes a 50%discount on brand-name drugs, effective January 1, 2010.
   
2. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) — Creates a temporary insurance program until the Exchange is available for individuals who have been uninsured for several months or have been denied a policy because of pre-existing conditions.
   
3. BANS LIFETIME LIMITS ON COVERAGE—Prohibits health insurance companies from placing lifetime caps on coverage.
   
4. ENDS RESCISSIONS—Prohibits insurers from nullifying or rescinding a patient’s policy when they file a claim for benefits, except in the case of fraud.
   
5. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 27TH BIRTHDAY THROUGH PARENTS’ INSURANCE— Requires health plans to allow young people through age 26 to remain on their parents’ insurance policy, at the parents’ choice.
   
6. ELIMINATES COST-SHARING FOR PREVENTIVE SERVICES IN MEDICARE—Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program.
   
7. IMPROVES HELP FOR LOW-INCOME MEDICARE BENEFICIARIES—Improves the low-income protection programs in Medicare to assure more individuals are able to access this vital help.
   
8. PROVIDES NEW CONSUMER PROTECTIONS IN MEDICARE ADVANTAGE— Prohibits Medicare Advantage plans from charging enrollees higher cost-sharing for services in their private plan than what is charged in traditional Medicare.
   
9. IMMEDIATE SUNSHINE ON PRICE GOUGING—Discourages excessive price increases by insurance companies through review and disclosure of insurance rate increases.
   
10. CONTINUITY FOR DISPLACED WORKERS—Allows Americans to keep their COBRA coverage until the Exchange is in place and they can access affordable coverage.
    
11. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled.
    
12. HELP FOR EARLY RETIREES—Creates a $10 billon fund to finance a temporary reinsurance program to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64.
    
13. COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for a doubling of the number of patients seen by the centers over the next 5 years.
    
14. INCREASING NUMBER OF PRIMARY CARE DOCTORS — Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals.

In addition to moving up the dates when some of the consumer protections kick in and adding some nice little features like letting people stay on their parents' insurance until they turn 27, some other big changes were made:

Medicaid is expanded even more under this version of the bill than the prior version: originally the House wanted to make everyone under 133% of the federal poverty line eligible for Medicaid. Under this final bill, everyone under 150% of the poverty line is eligible.

The public option was altered (weakened). Instead of reimbursing like Medicare (i.e. paying for services according to a set fee schedule), the public option will negotiate rates with health care providers just like private insurance companies do.

This thread is a work in progress so I'll throw in more things as I find more information.

The effects of it?

According to the Congressional Budget Office, it costs $894 billion over the next ten years (as you may recall, this is down from over $1 trillion for the original bill). But it pays for itself and then some:

According to CBO and JCT’s assessment, enacting H.R. 3962 would result in a net reduction in federal budget deficits of $104 billion over the 2010–2019 period. In the subsequent decade, the collective effect of its provisions would probably be slight reductions in federal budget deficits. Those estimates are all subject to substantial uncertainty.

That means the federal deficit actually goes down by a over $100 billion over the next decade if this bill passes. Moreover, 96% of Americans would have health insurance in ten years. The CBO estimates that in 2019, about 18 million people will still be uninsured, though about one-third of them would be illegal immigrants.

Special concerns?

The good people over at Think Progress have noted some of the of complaints that opponents (read "Republicans") have made that have been addressed (follow the link if you want the links that they included):

1. REPUBLICANS ASKED FOR – DEFICIT NEUTRAL BILL: “Do the American people believe that this almost 2,000 page bill won’t add to the deficit?” [Rep. Eric Cantor, 10/29/2009]

HOUSE BILL – DEFICIT NEUTRAL BILL:

According to the Congressional Budget Office, the House bill costs $894 billion over 10 years and actually reduces the deficit by $30 billion and continues to reduce the deficit over the second 10 years.

2. REPUBLICANS ASKED FOR – REDUCE COSTS OVER LONG TERM: “Nevertheless, House Republicans recognize the need to lower health care costs.” [Rep. Mike Pence (R-IN), 9/9/09]

HOUSE BILL – REDUCES COSTS OVER LONG TERM:

Encourages payment reforms that can help lower costs. Requires the Department of Health and Human Services to establish specific benchmarks for expansion of the Accountable Care Organization, Payment Bundling, and Medical Home pilot programs. The bill will also slow the rate of growth of the Medicare program from 6.6% annually to 5.3%.

3. REPUBLICANS ASKED FOR – POLICIES ACROSS STATE LINES: “Interstate competition allowing people to buy insurance across state lines.” [sen. John Thune (R-SD), 9/8/2009]

HOUSE BILL – POLICIES ACROSS STATE LINES:

Allows for the creation of State Health Insurance Compacts – permits states to enter into agreements to allow for the sale of insurance across state lines.

4. REPUBLICANS ASKED FOR – MEDICAL MALPRACTICE REFORM: “Why not bring about reasonable restrictions and limits on medical malpractice claims to end the era of defensive medicine?” [Rep. Mike Pence (R-IA), 9/9/2009]

HOUSE BILL – ENCOURAGES MALPRACTICE REFORM:

The bill establishes a voluntary state incentives grant program to encourage states to implement “certificate of merit” and “early offer” alternatives to traditional medical malpractice litigation.

5. REPUBLICANS ASKED FOR – HIGH RISK POOLS: “Senator McCain has a proposal sometimes called high-risk pools at the state level…These are efforts I think we can have bipartisan agreement on and deal with the question of pre-existing conditions.” [Rep. Eric Cantor (R-VA), 9/10/2009]

HOUSE BILL – HIGH RISK POOLS:

To fill the gap before the Exchange becomes available in 2013, the bill creates an insurance program with financial assistance for those uninsured for several months or denied policy due to preexisting conditions.

6. REPUBLICANS ASKED FOR – ALLOW YOUNG PEOPLE TO STAY ON PARENTS’ POLICIES: “Recognizes that not all high school and college graduates are able to find a job that offers health care coverage after graduation. By allowing dependents to remain on their parents’ health policies up to the age of 25, the number of uninsured Americans could be reduced by up to 7 million.” [Republican Health Solutions Group]

HOUSE BILL – ALLOW YOUNG PEOPLE TO STAY ON PARENTS’ POLICIES:

The bill requires health plans to allow young people to remain on their parents’ insurance policy until they turn 27.

7. REPUBLICANS ASKED FOR – NO PUBLIC MONEY FOR ABORTION: “The American people will not stand for government-run insurance that uses taxpayer money to fund abortions in this country.” [Rep. Mike Pence (R-IN), 10/16/2009]

HOUSE BILL – NO PUBLIC MONEY FOR ABORTION:

The bill prohibits abortion services from being made part of essential benefits package and prohibits federal funds from being used to pay for abortion (except in cases of rape, incest, and to save life of the woman).

8. REPUBLICANS ASKED FOR – PROTECT SMALL BUSINESSES: “Helps employers offer health care coverage to their workers by reducing their administrative costs through a new small business tax credit.” [Republican Health Solutions Group]

HOUSE BILL – PROTECTS SMALL BUSINESSES:

The bill exempts 86% of businesses from the requirement to provide coverage. Businesses with payrolls below $500,000 are exempt while firms with payrolls between $500,000 and $750,000 would pay a graduated penalty. Small businesses would also receive a tax credit that helps cover 50% of their health care expenses.

9. REPUBLICANS ASKED FOR – PROMOTE JOB WELLNESS PROGRAMS: “Promotes prevention and wellness by giving employers and insurers greater flexibility to financially reward employees who seek to achieve or maintain a healthy weight, quit smoking, and manage chronic illnesses like diabetes.” [Republican Health Solutions Group]

HOUSE BILL – PROMOTE JOB WELLNESS PROGRAMS:

The bill establishes a grant program to help small employers create or strengthen workplace wellness programs.

10. REPUBLICANS ASKED FOR – DELIVERY SYSTEM REFORM: “Uses new and innovative treatment programs to better coordinate care between health care providers, ensuring that those with chronic disease receive the care they need and do not continue to fall through the cracks.” [Republican Health Solutions Group]

HOUSE BILL – DELIVERY SYSTEM REFORM:

The bill requires the Department of Health and Human Services to establish specific benchmarks for the expansion of the Accountable Care Organization, Payment Bundling, and Medical Home pilot programs.

11. REPUBLICANS ASKED FOR - HELP AMERICANS 55-64: "To help those aged 55 to 64, the plan increases support for pre- and early-retirees with low- and modest-incomes." [Republican Health Solutions Group]

HOUSE BILL – HELPS AMERICANS 55-64:

Creates a reinsurance program to help cover expensive health claims for employers that provide coverage to Americans 55-64.

To that I would add that several pages were added to the bill to address the verification of citizenship of people applying for affordability credits to help them buy insurance (if you recall there was a big stink about that a few weeks ago).

Here's the text of the final bill: H.R. 3962 - Affordable Health Care for America Act (PDF)

But as I said, more information (maybe some nice visuals) should be coming in the near future as people digest this. In the meantime: thoughts, reactions, questions?

[Pseudo Intellectual]

Get ready to start paying more taxes, America!

Edited October 31, 2009 by Pseudo Intellectual

[Startraveler]

That reminds me of a change I meant to mention in the original post. The House bill raises revenue primarily by a surcharge on high-income individuals--effectively a small income tax release. Originally this would have kicked in at $280,000 for an individual or $500,000 for a family. In this final bill, the tax doesn't kick in until you're over $500,000 for an individual or $1 million for a family. So they've raised the threshold at which the surcharge kicks in.

[ninjadude]

It's obvious then that PI is a high-income American - just like Aroces.

[+Sherapy]

That reminds me of a change I meant to mention in the original post. The House bill raises revenue primarily by a surcharge on high-income individuals--effectively a small income tax release. Originally this would have kicked in at $280,000 for an individual or $500,000 for a family. In this final bill, the tax doesn't kick in until you're over $500,000 for an individual or $1 million for a family. So they've raised the threshold at which the surcharge kicks in.

thank you for all your efforts on this, very informative....

[Caesar]

But it includes the public option so its not going to be easy getting all democrats not to mention Republicans.

[Fluffybunny]

I know you put a lot of work into that post Star, thank you

Edited November 3, 2009 by Fluffybunny

[Startraveler]

No problem, even if people aren't on the same page politically there's no reason we can't all be on the same page when it comes to the facts. In that vein, here's some good summaries of this final House bill:

• Affordable Health Care for America Act, Detailed Summary. This is a 10-page summary that explains in plain English virtually everything you want (or need) to know about this bill. Definitely worth taking a few minutes to read it.
  
• Affordable Health Care for America Act, Section by Section. This one is a bit longer (61 pages) but it goes section by section and briefly describes the contents.

Hat tip to OpenCongress for the links.

[+DieChecker]

The final Senate bill—while done—hasn’t been put online yet so we're not going to discuss it much here but the final House bill has been put online. It came out Thursday morning: H.R. 3942. This is the final incarnation of the original House bill that diehard political junkies will remember as H.R. 3200.

I just read this article:

http://online.wsj.com/article/BT-CO-20091103-721579.html

Seems the Senate Bill unveil is still delayed.

Asked whether Congress may not be able to pass health-care legislation this year, Senate Majority Leader Harry Reid (D., Nev.) said Democrats would "do this the right way, not the fast way."

"We're not going to be bound by any timelines," Reid said. "We want quality legislation, and we're going to do that."

Even as a strict Republican I have to admire that.

[Pseudo Intellectual]

Heh. Looks like the majority of Americans oppose the House bill. Tough, statists. Better luck in... shall we say 20 years?

[danielost]

That reminds me of a change I meant to mention in the original post. The House bill raises revenue primarily by a surcharge on high-income individuals--effectively a small income tax release. Originally this would have kicked in at $280,000 for an individual or $500,000 for a family. In this final bill, the tax doesn't kick in until you're over $500,000 for an individual or $1 million for a family. So they've raised the threshold at which the surcharge kicks in.

get ready for higher prices america

[danielost]

It's obvious then that PI is a high-income American - just like Aroces.

im not.

[Pseudo Intellectual]

It's obvious then that PI is a high-income American - just like Aroces.

Yep. Because anyone who opposes the government controlling our health care is obviously an evil, rich Rethuglican who hates poor people and wants them to die.

[+DieChecker]

get ready for higher prices america

Umm.... The Congressional Budget Office has clearly said that even they can not say that this health care reform bill will save any money. So pass or fail, taxes and expenses are going up. The bill is just a expensive way for the government to get in on a good racket and help out the uninsured at the same time.

[danielost]

Umm.... The Congressional Budget Office has clearly said that even they can not say that this health care reform bill will save any money. So pass or fail, taxes and expenses are going up. The bill is just a expensive way for the government to get in on a good racket and help out the uninsured at the same time.

a good racket is right. another reason for the government to raise taxes. if they just came out and raised income taxes there might be a revolt. but doing it this way it makes them look like they care. just like raising minimum wage.

[Perdition]

Really do like that parental coverage till 27. God knows I won't be able to afford health insurance until I'm at least 28 or even more topped off with 100 thousand dollars in debt

[SQLserver]

It's obvious then that PI is a high-income American - just like Aroces.

This stereotype is over-done. I have a high income, and I have my own healthcare that works fine for me. Yet, I still support this bill fully.

get ready for higher prices america

Consistently, we see the same thing: Rational, calm, in depth discussions from health-care proponents, and quick, witless one-liners from the anti-health care folks.

if they just came out and raised income taxes there might be a revolt.

The chances of this happening are very close to nil.

[preacherman76]

Consistently, we see the same thing: Rational, calm, in depth discussions from health-care proponents, and quick, witless one-liners from the anti-health care folks.

Yea, right up till you start talking about the quater of a million dollar fine for people who cant afford it. Or the 5 years they will do for not paying the fine.

[Siara]

Welcome to the second part of our [unknown]—part series (Part I, What's IN this health care bill?, is still floating around).

Edited November 8, 2009 by Siara

[danielost]

This stereotype is over-done. I have a high income, and I have my own healthcare that works fine for me. Yet, I still support this bill fully.

Consistently, we see the same thing: Rational, calm, in depth discussions from health-care proponents, and quick, witless one-liners from the anti-health care folks.

The chances of this happening are very close to nil.

consistently, we see the same thing. rational calm in depth deiscussions on any subject that involves the government quickly derailed by those who think the government/democrats can do no wrong.

the cbo says prices are going to go up. so they must be anti-health care too.

which has no chanceof happening them raising taxes to pay for this or a revolt.

Edited November 8, 2009 by danielost

[Siara]

This stereotype is over-done. I have a high income, and I have my own healthcare that works fine for me. Yet, I still support this bill fully.

The same is true of me. I can afford any procedure I want and can have it done anywhere in the world. I support the bill because America's health care system is broken. It's a matter of wanting my country (the people in my country)to do well.

[preacherman76]

The same is true of me. I can afford any procedure I want and can have it done anywhere in the world. I support the bill because America's health care system is broken. It's a matter of wanting my country (the people in my country)to do well.

So your cool with people GOING TO JAIL over not having health care?? Health care at gun point, I love the smell of freedom in the afternoon.

[Siara]

So your cool with people GOING TO JAIL over not having health care?? Health care at gun point, I love the smell of freedom in the afternoon.

The problem is that if you got sick other people would be hit with the moral dilemma of whether to let you die or not. In many ways I think you should have the right to not pay in and then simply die if you have the misfortune to get sick. I definitely don't think that would be appropriate for kids who are too young to make an intelligent decision about this and are sometimes at the mercy of crackpot parents. I think the norm should be that if you contribute to society and pay into the system you are part of the American family and you get health care.

There are a lot of people with your attitude who say, "Hey it's my life and I have a right to risk it" but then switch over to, "Please, please. please don't let me die" when they get sick. I'm not saying that YOU would say that, but I'm sure you'll agree it's a common pattern. The systems of other countries protect their citizens from these nightmare moral dilemmas.

Edited November 8, 2009 by Siara

[seax]

So your cool with people GOING TO JAIL over not having health care?? Health care at gun point, I love the smell of freedom in the afternoon.

Preacherman they are going to support any bill the Dems throw out. It does not matter if you get sent to the gulag. Blind trust...marching in lock step...but they are going to be the first ones crying bloody murder things start going terribly wrong..and they will..if this plan gets passed...(it hasn't gone through the senate yet) with our economy on the rocks...some people are going to eat a lot of crow. Trouble is...those of us that know better will suffer also. Believe me...anything is 'not' better than nothing.

best regards,

seax

[danielost]

The problem is that if you got sick other people would be hit with the moral dilemma of whether to let you die or not. In many ways I think you should have the right to not pay in and then simply die if you have the misfortune to get sick. I definitely don't think that would be appropriate for kids who are too young to make an intelligent decision about this and are sometimes at the mercy of crackpot parents. I think the norm should be that if you contribute to society and pay into the system you are part of the American family and you get health care.There are a lot of people with your attitude who say, "Hey it's my life and I have a right to risk it" but then switch over to, "Please, please. please don't let me die" when they get sick. I'm not saying that YOU would say that, but I'm sure you'll agree it's a common pattern. The systems of other countries protect their citizens from these nightmare moral dilemmas.

nothing about this will give the government the right to decide who can or cannot get help. yea right.