What's IN this health care bill?

[Startraveler]

I started a thread like this not too long ago but it was lost during the great purge that sent us all back in time two days. So I'll try again. It's important that people understand what the reform plan before Congress actually is, particularly since so many false claims have been made about it. So I'm going to put in some useful links below that give a good overview of what's in there (without having to wade through a thousand pages of legislation).

I should note that at this time there are a few different plans: one in the House of Representatives called H.R. 3200 (which I consider the gold standard of plans--when I reform to "the plan," I'm generally talking about the House plan) and two in the Senate. One of the links below will make the distinctions between these plans clear.

First, my brief spiel (copied and pasted from other threads where I've said this): In general, the proposed health care reform plan is a pretty incremental change. Our health care system will remain dominated by employer-based coverage with a smaller individual health care market, just as it is now. There are only three major structural changes to our health care system (which themselves are not particularly radical):

1. Mandates will encourage all citizens to enter the health care system (larger insurance pools spread out the risks and costs more, generating a much more optimal insurance system and allowing access to those who want to get in now but are expensive to treat) with affordability credits being offered to help families buy coverage,
   
2. The individual insurance markets (and, gradually, employer-based plans) will be regulated to prevent discrimination against people based on medical history, pre-existing conditions, gender, etc and a panel of health care experts will be allowed to design standards for a basic minimum benefit plan
   
3. A public option will be allowed to participate in the individual insurance market to increase competition and encourage more aggressive bargaining with provider networks.

Someone has ingeniously designed a graphic to explain what the health care system looks like under the reform plan (notice its very similar to the shape of the system now):

(If you can't see it just follow that link above.)

Ok, now some links for people who want to learn a bit more:

• CRS summary. This is the short (but comprehensive) summary of the House bill provided on the Library of Congress's THOMAS website (i.e. the site where all bills introduced in Congress are uploaded) by the Congressional Research Service. If you read anything, read this. It's short but sweet.
  
• More in-depth summary of the House bill. This is a little longer than the last summary but it's extremely good. In fact, if you have a few minutes to spend on this, make sure you read this one. It's far more in-depth than the CRS summary.
  
• Section-by-section summary (PDF). This summary was prepared by the three House committees that came up with H.R. 3200 and walks through the bill section-by-section, giving a brief summary of what's in each one. It's 35 pages.
  
• Summary of Senate HELP Committee bill. (PDF). So far these summaries have all been of the House plan. This is a section-by-section summary of the bill that passed out of the Senate Health, Education, Labor and Pensions Committee (this is Senator Kennedy's committee). It's 20 pages.
  
• Side-by-side comparisons of different plans (PDF). This table compares four "plans": the House bill, the Senate HELP committee bill, the Senate Finance bill (which hasn't been completed yet--this is based on the information we have about it), and the President's stated principles for health reform. Actually, it does a lot more than that. Starting on page 26 it starts considering alternative health care plans that have been introduced in Congress this year. These bills aren't really part of the massive current health reform effort but they are other ideas and you might find perusing them interesting.

And for those who want to check something they read in a summary of the bill (or just peruse it), here's the actual House bill:

• OpenCongress version. This is the format I generally prefer--the whole bill is there on one page.
  
• PDF version. Since people insist on referring to things in the bill in terms of page numbers (which aren't really official since the Library of Congress version doesn't register page numbers), it might be handy to have the page-numbered PDF version handy. Notice how I just sneaked in a third version with that link to the THOMAS website.

And one final source of information: this thread. If anyone wants to talk about it, sort through it, vent, voice concerns, ask questions, or whatever, this is the place to do it. All I ask is that you don't knowingly or intentionally distort what's in this bill in an attempt to further obfuscate this topic. The more people understand it (not necessarily agree with it), the better off the national debate will be.

Edited August 25, 2009 by Startraveler

[Startraveler]

A very important oversight: District-by-district estimates of the House bill's impact. One of the House committees that helped write the House health care bill did heroic work in figuring out what the bill would mean for each congressional district in the country. Find your district and have a look. For example, the sheet for my home district tells me that, among other things (there are a few more things in the sheet, I'm picking a few), these impacts would be felt in my district:

• Relieving the burden of uncompensated care for hospitals and health care providers. In 2008, health care providers in the district provided $27 million worth of uncompensated care, care that was provided to individuals who lacked insurance coverage and were unable to pay their bills. Under the legislation, these costs of uncompensated care would be virtually eliminated.
  
• Coverage of the uninsured. There are 71,000 uninsured individuals in the district, 11% of the district. The Congressional Budget Office estimates that nationwide, 97% of all Americans will have insurance coverage when the bill takes effect. If this benchmark is reached in the district, 51,000 people who currently do not have health insurance will receive coverage.
  
• No deficit spending. The cost of health care reform under the legislation is fully paid for: half through making the Medicare and Medicaid program more efficient and half through a surtax on the income of the wealthiest individuals. This surtax would affect only 4,470 households in the district. The surtax would not affect 98.6% of taxpayers in the district.

Have a look at yours.

[SQLserver]

Wow, that was really, really helpful. Thanks.

This really puts the healthcare debate into perspective. I do not seriously think someone can look at what you've posted here(especially the graphic) and disagree with it.

It's absolutely unbelievable how much Republicans have lied, cheated, and stole their way into blocking this. They've pretty much painted the entire thing as a radical, completely new change.

Instead, it's simply a rational, incremental improvement that will fix the holes in the system today.

Cheers,

SQLserver

[Mattshark]

Got to say though, you know the argument against can be bad when you see this.

"People such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless."

Well done on looking stupid Investor's Business Daily. You have to wonder when such lies are made up.

[Caesar]

The problem I have with the plan is that I believe it will cause rationing and it will hurt the quality we have now.

Great post Startraveler

[ninjadude]

The problem I have with the plan is that I believe it will cause rationing and it will hurt the quality we have now.

MYTH 2: Health care reform will impose rationing CLAIM: Progressive health care reform proposals will introduce a system of "rationing" into American medicine.

REALITY: Insurance companies already ration care. Insurance companies acknowledge that they ration care, restricting coverage of procedures and tests like MRIs and CAT scans and denying coverage for pre-existing medical conditions.

Sanjay Gupta: "I can tell you, as a practicing physician ... who deals with this on a daily basis, rationing does occur all the time." As Dr. Sanjay Gupta, CNN's chief medical correspondent, explained: "[P]eople always say, 'Is there going to be rationed care?' And I can tell you, as a practicing physician, as someone who deals with this on a daily basis, rationing does occur all the time. I mean, I was in the clinic this past week. And I -- you know, at the end of clinic, I get all this paperwork that basically says, 'Justify why you're doing such and such procedure. Justify why you're ordering such and such test.' And if the justification is inadequate, the answer comes back, 'Well, that's not going to be covered.' Which basically is saying that the patient is going to have to pay for it on their own, which is, in essence, is what rationing is, in so many ways." [CNN's Anderson Cooper 360, 8/12/09]

Insurance companies ration care by rescinding coverage. As former senior executive at CIGNA health insurance company Wendell Potter explained in June 24 Senate testimony, insurance companies restrict or deny coverage by rescinding health insurance policies on the grounds that people had undisclosed pre-existing conditions. President Obama recently cited one such example, noting that "[a] woman from Texas was diagnosed with an aggressive form of breast cancer, was scheduled for a double mastectomy. Three days before surgery ... the insurance company canceled the policy, in part because she forgot to declare a case of acne. ... By the time she had her insurance reinstated, the cancer had more than doubled in size."

source

[SQLserver]

Well done on looking stupid Investor's Business Daily. You have to wonder when such lies are made up.

This source should have instantly lost all credibility with that. Seriously, that's something you expect from a youtube comment, not a professional source.

[Wickian]

If they didn't intend to tax, or punish, those who choose not to participate, I wouldn't even care about that bill.

[Startraveler]

Can I ask if you're currently uninsured?

[Startraveler]

The problem I have with the plan is that I believe it will cause rationing and it will hurt the quality we have now.

Ezra Klein had a great post today entitled "We Ration. We Ration. We Ration. We Ration." It's worth repeating:

"Look at Canada," says Charles Krauthammer. "Look at Britain. They got hooked; now they ration. So will we."

So do we. This is not an arguable proposition. It is not a difference of opinion, or a conversation about semantics. We ration. We ration without discussion, remorse or concern. We ration health care the way we ration other goods: We make it too expensive for everyone to afford.

I've used these numbers before, but let's repeat them. A 2001 survey by the policy journal Health Affairs found that 38 percent of Britons and 27 percent of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5 percent. This, Americans will tell you, is the true measure of our system's performance. We have our problems. But at least we don't sit in some European purgatory languishing without our treatments. That's rationing.

There is, however, a flip side to that. The very same survey also looked at cost problems among residents of different countries: 24 percent of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn't fill a prescription. And 22 percent said they didn't get a test or treatment. In Britain and Canada, only about 6 percent of respondents reported that costs had limited their access to care.

The numbers are almost mirror images of each other. Twenty-seven percent of Canadians wait more than four months for treatment, versus only four percent of Americans. Twenty-four percent of Americans can't afford medical care at all, versus only 6 percent of Canadians. And the American numbers are understated because if you can't afford your first appointment, you never learn you couldn't afford the medicine or test that the doctor would have prescribed.

We ration. And if the numbers and the surveys don't convince you of the point, this is what it looks like when we ration.

This is spot on.

[Caesar]

I see we do have some rationing but not at the levels in Canada and England. we simply don't have enough doctors and hospitals.

[Wickian]

Can I ask if you're currently uninsured?

Yes I am. Although national healthcare would probably help me, I'm still opposed to the concept of being forced to pay whether I want to(if I decide to sign up for it and get taxed accordingly) or not(if I choose not to involve myself with it and get punished accordingly).

I could be wrong with the above statement seeing as how every other healthcare article says something different, but all I've read about the bill suggests that even those who don't want to be involved will be forced to pay for everyone else. I disagree with that.

[Startraveler]

You're correct that you'll face a mandate to get health insurance coverage. If your income is below 133 1/3% of the federal poverty line, you'll be eligible for Medicaid coverage (since Medicaid is administered at the state-level, what, if anything, you'd pay for that in premiums would depend on the rules of your state and your particular financial situation).

On the other hand--assuming you don't have (and don't get, once the provisions of the bill kick in) an offer of health insurance through your employer--if your income is higher (or you just feel like shopping for private coverage) you'll have to get something through the individual insurance market, which will be called the Health Insurance Exchange and will be federally regulated. However, if your income is below 400% of the poverty line, you'll be eligible for affordability credits to help pay your premiums; these credits kick in after you've paid a certain percentage of your monthly income on premiums (exactly how much will be determined by a certain scale).

The other option is to not get health insurance and pay a tax of 2.5% of your taxable income (not to exceed the average annual national cost of health care premiums).

I realize this is a sticking point for some but if you step back for a second and take a global view of our health care system I think you'll see the necessity of it. The system we have--one of pooled resources/insurance--requires virtually everyone to be in it if it is to work effectively. The negative effects for public health and the financing of our system of having a large uninsured population are pretty clear. Solving these issues is going to require action on the part of both employers and individuals, as well as government, which is tasked with installing a sheriff to tame the Wild West of the individual insurance markets, pushing consumer protection measures, and assisting people with the costs of their health insurance premiums. I'll admit that--if a robust public option isn't included in the final bill--I have my own reservations about the individual mandate. I fear that without a relatively low-premium government competitor to private insurance companies, the individual mandate and the affordability credits could simply amount to a government subsidy for private insurance companies that lack additional incentives to control spending. The increased regulation of the product that these companies offer is some comfort but, at present, I tend to think my own support for this bill is contingent on it containing a strong public option. So, yes, I understand your reservations about the individual mandate.

Edited August 29, 2009 by Startraveler

[churchanddestroy]

So I have a question about this bill, and hopefully someone more knowledgeable in its contents than I am can help me out. So I'm a college student, and currently on my parents healthcare plan. However, when I'm out of college, I suspect I will have to find healthcare for myself. If such is the case, will the portion of the bill that says something about people who leave their current healthcare coverage must enroll in the public option affect me? Will my being on my parents health care plan previously affect me being able to find a new source of health care coverage outside of the public option?

Or do I have this concept completely *** backwards?

[Startraveler]

So I have a question about this bill, and hopefully someone more knowledgeable in its contents than I am can help me out. So I'm a college student, and currently on my parents healthcare plan. However, when I'm out of college, I suspect I will have to find healthcare for myself. If such is the case, will the portion of the bill that says something about people who leave their current healthcare coverage must enroll in the public option affect me? Will my being on my parents health care plan previously affect me being able to find a new source of health care coverage outside of the public option?

Or do I have this concept completely *** backwards?

You have it a little bit backwards. But you've brought up a very key point that I wanted to address at some point--namely, a popular piece of misinformation that's been going around. So if you'll indulge me, instead of just answering your question, I want to take advantage of a teachable moment (though I will answer your question). First, though, I want to say that in the Senate HELP committee bill, you'd be allowed to stay on your parents' insurance until you're 26 if you choose to. Whether that will be in the final bill, I can't say--but as Senator Kennedy explained this provision of his bill: "The bill drafted by the Senate health committee will let children be covered by their parents' policy until the age of 26, since first jobs after high school or college often don't offer health benefits."

But on to the main point. In an effort to make the transition to the new, reformed iteration of the health care system as painless as possible (and fulfill campaign promises), the House bill grandfathers in existing health insurance plans. One of the main goals of the reform effort is to more tightly regulate insurance which, as I noted in the original post, involves designing a minimum benefits plan that insurance companies have to offer and ensuring the plans don't discriminate (or offer spotty coverage because of something in your background). But if you like the coverage you have now, you can keep it, even if it somehow fails to meet the standards that newly-created plans will have to meet. But the text of this legislation has been twisted, particularly this bit:

SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE.

(a) Grandfathered Health Insurance Coverage Defined- Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term ‘grandfathered health insurance coverage’ means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:

(1) LIMITATION ON NEW ENROLLMENT

(A) IN GENERAL- Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.

So what some foes of the bill have done is point to this section and claim that H.R. 3200 eliminates private insurance by forbidding anyone who changes health plans from enrolling in a new private plan. "Limitations on new enrollment [in private plans]!" they cry. Thus everyone is slowly but surely forced into the public option, right? Well, no. All this says is that once the reform plan goes into effect you can't enroll in a grandfathered health plan. If you're not getting health insurance through your employer, you'll have to shop for it in the Health Insurance Exchange, a creation of H.R. 3200. But most of the plans offered in the Exchange will be private--only one (the public option) will be administered by the government but it is absolutely, as the name suggests, an option (I can go into a bit more detail about the Exchange if that would be helpful). Private insurance will be alive and well under the new plan. So the provision "that says something about people who leave their current healthcare coverage must enroll in the public option" won't affect you because no such provision exists. Everyone can choose a private plan if they wish. Hopefully they'll also have the option of a government-administered plan, as well.

The real lesson to take away here is that much of what you've heard about this bill is probably distorted in some way (especially those extensive lists of little "facts" about the horrifying contents of this bill). And part of the purpose of this thread is to help clear up those issues so thanks for bringing that one up. Does that help?

[Lord Umbarger]

Instead, it's simply a rational, incremental improvement that will fix the holes in the system today.

It's teh "incremental" part that has a lot of folks worried. I mean, when does "incremental" become "mission creep"? Where does it stop? The same place that Social Security will? The same place that government housing will? The same place that our involvement in the U.N. will? How about Gun control?

Incremental could eventually become forced innoculations, limited care for the "less productive", etc.

What seems like a good idea in the vision of one President could evolve into a nightmare under another one four years down the road. What if they decided that there aren't enough doctors in one part of the country? Could they one day say that it's "common sense" to limit the number of folks that move into that part of the country to insure that those there will have a decent access to health care providers? Sound scary? It was part of what the Clinton version of Health care included.

[ninjadude]

It's teh "incremental" part that has a lot of folks worried. I mean, when does "incremental" become "mission creep"?

I'll accept that. But then democracy (or represenative democracy if you prefer) is an active participation event. You have to continue in future years to keep what you call "scope creep" out of it. Scope creep does not eliminate the need for the programs you mentioned in any way shape or form. If the scope of these programs is beyond what the public wants, then the public has to have the government change them. This happens periodically. What the public wants is not what a fringe element whines about on Fox news or town hall meetings. It's a simple majority.

[ninjadude]

So I have a question about this bill, and hopefully someone more knowledgeable in its contents than I am can help me out. So I'm a college student, and currently on my parents healthcare plan. However, when I'm out of college, I suspect I will have to find healthcare for myself.

Churchandestroy, my son has this very problem. In our mutual state (IL), the law was recently changed that students can be on their parents insurance until age 26. However my companies national healthcare plan was written in some other state (New Jersey I think). So the answer from them was "So sorry but at age 23 you can't be on your parents plan". I have a few choice words for that. FU.

So choices are 1) pay the individual COBRA amount - an amount nearly equal to what I pay for the entire family (because companies don't give you the company discount with COBRA) FYI this is a boatload of money for a young person in school with two part time jobs 2) find an individual plan with an insurance company. This would also be very expensive and not cover pre-existing conditions.

Have you tried to buy health insurance? Not the standard stuff your job offers. I claim to be fairly intelligent, but the whole thing is incredibly insane. Try it with Google. The rates are apparently controlled by government but in the end, it seems the insurance companies are going to screw you over no matter what you do. The sliding scales of coinsurace, deductibles, in-patient, out-patient, etc etc is IMO simply crap. Sure my son will eventually get a better job with insurance when he's out of school but there is this time - in between. He, of course, doesn't want to pay for any of it. When you're young, you think you're invulnerable. We have to do something soon, but the options are less than useful.

In the Reform bills, forcing all insurance companies to cover students on their parents plan to age 26 will be a very good thing. Covering pre-existing conditions will be a very good thing. Adding more people to the pool will result in the rates going down and that would be a very good thing. Years too late, but a good thing.

[Startraveler]

It's teh "incremental" part that has a lot of folks worried.

The alternative to incremental change is pretty clear: major change or no change at all. I prefer major change myself but I don't think it would be adopted. And so here we are. If you have an alternative, feel free to put it in this thread.

What if they decided that there aren't enough doctors in one part of the country? Could they one day say that it's "common sense" to limit the number of folks that move into that part of the country to insure that those there will have a decent access to health care providers? Sound scary? It was part of what the Clinton version of Health care included.

I'm not sure where you believe that authority would be derived from--certainly not a bill applying consumer protections to the sale of health insurance. What you're doing is engaging in alarmism that has no basis in reality. You're certainly not the first; Ronald Reagan made almost exactly the same argument as you almost 50 years ago:

The doctor begins to lose freedom. . . . First you decide that the doctor can have so many patients. They are equally divided among the various doctors by the government. But then doctors aren’t equally divided geographically. So a doctor decides he wants to practice in one town and the government has to say to him, you can't live in that town. They already have enough doctors. You have to go someplace else. And from here it's only a short step to dictating where he will go. . . . All of us can see what happens once you establish the precedent that the government can determine a man's working place and his working methods, determine his employment. From here it's a short step to all the rest of socialism, to determining his pay. And pretty soon your son won't decide, when he's in school, where he will go or what he will do for a living. He will wait for the government to tell him where he will go to work and what he will do. -- Ronald Reagan on the dangers of Medicare, 1961

You know what never happened? That. Medicare didn't limit someone's ability to move wherever they wanted and neither will this bill. Reagan promised that if Medicare passed "you and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free." Maybe someone should do a poll of AARP members--do they wish someone would repeal Medicare so they no longer have to tell their grandchildren about what it was like when men were free or should we go ahead and keep it? It's easy to come up with a thousand "what-if" scenarios that have no basis in reality.

[ninjadude]

What if they decided that there aren't enough doctors in one part of the country? Could they one day say that it's "common sense" to limit the number of folks that move into that part of the country to insure that those there will have a decent access to health care providers?

Who would they be? The private insurance companies?!! (they probably already do) Under no bill that I'm aware of, is national healthcare being setup as you describe - since the majority of health insurance will continue to be PRIVATE. And all private healthCARE will continue to be private. The current health care reform is not single payer. It also does not take over the healthCARE industry. Somethings I suspect from your comments, you do not understand. Single payer is like Medicare or Englands NHS. Something many of us would like but have ALREADY compromised on for the sake of conservatives who now claim they they will not support any reform. Please read the posts by Startraveler and the links he provided. Otherwise, if you really already know these things, you are trolling and fearmongering to stop healthcare reform without facts.

Edited August 30, 2009 by ninjadude

[Startraveler]

As part of my bid to make this thread something of a mothership for all useful health care reform-related information, I'll be adding useful links from time to time as I come across new resources.

Today I'm putting in something that doesn't really offer much information about the reform plans on the table but instead goes into the background of the issue. If you've followed the issue you'll probably be familiar with most of what's in here (issues of coverage, quality, affordability, etc) but if you're new to health care issues this is a great introduction with a few handy tables at the end. It answers a basic question that you might have: why do we need to reform the U.S. health care system?

Health Care Reform: An Introduction.

This comes from Open CRS, a project that attempts to haphazardly collect as many reports issued by the Congressional Research Service (a think tank that provides policy research for members of Congress) as it can. OpenCRS notes that "CRS Reports do not become public until a member of Congress releases the report" because "The Congressional Research Service strongly believes that its sole purpose is to directly serve Congress and not the public." Well, this report has been released and provides some handy to-the-point background on health care in the U.S.

Several of you have brought up good points and good questions so far in this thread but we've only scratched the surface. Let's keep the discussion going.

[Dredimus]

You still don't get it startraveler... WHY is it the governments job to provide health care? ITS NOT. It is not the governments job to dictate what we do, people seem to forget that the citizens are supposed to be in control, not the government.

[Mattshark]

You still don't get it startraveler... WHY is it the governments job to provide health care? ITS NOT. It is not the governments job to dictate what we do, people seem to forget that the citizens are supposed to be in control, not the government.

Because there are people who need healthcare and their is limited option for them. Because the charges are ridiculous and because the insurance companies will do anything they can to avoid payment. It is a governments job to help, protect and aid its citizens too. This is not the government dictating what you do, that is a unbelievably ridiculous statement, this is the government offering health care to people who need but cannot afford it. How is that a bad thing.

[Startraveler]

You still don't get it startraveler... WHY is it the governments job to provide health care? ITS NOT. It is not the governments job to dictate what we do, people seem to forget that the citizens are supposed to be in control, not the government.

Well, if one considers a basic level of health care an undeniable human need--and thus views a basic level of health care as something to which a person has a right--then it certainly is the government's job to protect that right.

But even if you consider being healthy or staying alive a privilege to be treated as a commodity, it undeniably is the government's job to regulate the insurance markets. And that's what this bill does. It sounds like you take issue with the affordability credits and the individual mandate, since the government doesn't really "provide health care" under this bill. It just says "go buy insurance" and helps you pay for it if your income is low enough (and your premiums are high enough). The imperative for this is logical: if we intend to retain the current insurance-based system and address the defects that make it more expensive (as well as ensure that less healthy people can enter insurance pools), we're going to need to ensure that risk pools are as large as possible.

But your comment is framed in somewhat abstract terms (though you do channel the incorrect "government takeover" meme). You mentioned in the other thread you wanted to specifically discuss the policies in the bill and this is the thread for it.

Also, if you're primarily interested in discussing the questions of "why are we doing this?" and "what else could we be doing?" I have another thread devoted to those sorts of discussions: Health Care Reform: Alternatives? This thread is simply for people who have questions to come and get a clear, undistorted picture of what's in H.R. 3200 (and the Senate bills)--and, of course, people who want to argue against certain provisions of those bills. But larger, system-wide concerns are better put in that other thread.

Edited September 3, 2009 by Startraveler

[Dredimus]

It is not the governments job to regulate anything in the free market. But thats the point now... its not free anymore...