Expect more jousting, compromises and (yes) speeches, but here’s what’s been approved so far in Congress.
The approved stipulations — which came out of four congressional committees — are sure to be modified and blended with other bills being considered. Still, the current approvals show which way Congress is leaning on key pieces of the legislation:
- How much it’ll cost: $1.5 trillion spread over 10 years.
- How it’ll be paid for: $500 billion from cuts in Medicare and Medicaid, $580 billion in taxes, $200 billion in employer penalties for not providing coverage.
- Employer requirements: Except for small businesses — with annual payrolls of less than $500,00 — employers must provide health coverage.
- Employee requirements: Must have coverage or face a tax penalty, with exemptions for hardship.
- Who’s eligible for subsidies for coverage: Starting in 2013, those with incomes of up to 400% of the poverty level.
- What types of benefits coverage will provide: Hospitalization, doctor visits, prescriptions; no denials for preexisting conditions.
- How plans can be chosen: A National Health Insurance Exchange.
- Government plan: Available through the exchange.
- Uniform changes to Medicaid: The program will be available to all with incomes up to 133% of the poverty level, instead of leaving eligibility requirements up to the state.
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Tags: Congress, health, Medicaid
August 11th, 2009 at 4:01 pm
Why not give the health care tax break (or tax credit) to the individual instead of the employer and let employers get OUT of the health care insurance business. It is NOT their core competency. I would love to be able to just give my employees $8,500 cash and let them find their best deal. I am very tired of negotiating new one-size-fits-all plans for my workforce each year.
A “public option” will be a disastrous cash black hole. At no time in US history can one cite a Federal program that either reduced cost or increased efficiency. Only competition can do that. Release 150 million American shoppers into the health care market and stand back. You’ll see some REAL COST REDUCTIONS.
August 11th, 2009 at 4:22 pm
Here is why you don’t give your employees cash instead of coverage.
Years ago when I was a restaurant manager I had a young man working for me for minimum wage who used to be a chef. He was offered the cash or insurance and being 24 took the cash. He had an accident and sliced through his hand and couldn’t work as a true chef any longer.
August 11th, 2009 at 4:27 pm
To better paint the picture on just how disastrous the “public option” will be we can take a lesson from Medicaid. Medicaid has cost over 7 times what the CBO scored the program at when it was conceived. As John said, there is no history with government programs that indicates this one will be any different. Based upon the lesson of Medicaid we can realistically expect the “public option” to cost closer to $10.5 trillion dollars over the first 10 years. Almost last years entire GDP.
The government option isn’t about health care. It is clearly about control. Control of our lives and control of 17% of the economy.
August 11th, 2009 at 4:28 pm
Save $400+ billion annually on insurance and provider paperwork by providing a single payer system, e.g., Medicare coverage, to all. Follow the lead of other countries to define a “best practice”.
This would eliminate private insurance and should provide enough savings to cover the uninsured and plug the “doghnut hole” and other gaps in coverage for those with insurance. The insurance industry provides little or no value to health care.
August 11th, 2009 at 4:28 pm
Small businesses should be allowed to opt into the National Health Insurance program. A One – Two Million Dollar payroll is still a small company or business. Small business should not be subjected to dramatic annual increases in health insurance costs.
Further, the overall Health program should not allow hospitals, doctors and other health care providers to bill different amounts. Now significantly greater amounts are billed to individuals without health insurance coverage as well as for employer’s workers compensation claims.
Health Insurance companies are billed significantly lower amounts, and even lower amounts are billed to state or government funded programs such as Medicaid. The billings should be the same.
August 11th, 2009 at 4:32 pm
Jean, what does that have to do with any of this? John is right, leave the employers out of it. Give the tax credit on individual tax returns and let people shop for themselves. Allow groups to pool together. That is the only way to reduce cost, by competition. I also agree that a public option is probably the worst thing we could do. The government has proven time and again that they can’t run anything efficiently. It will drive insurance companies out of business and there will be no competition. Then watch the costs skyrocket!
August 11th, 2009 at 4:37 pm
I think the politicians and even the media are missing the point of all this. All the Obama administration and Congress are addressing is the symptoms of the problem, not the root causes and the media is not doing any better. Ever here of ISO 9000. It stresses finding the root causes of the problem and then correcting and solving them. So, here are some questions to answer to get to the root causes of overpriced healthcare – why is it so costly? Why not available to everyone? Maybe if we reduce the costs for doctors and hospitals to do business. Most doctors and hospitals will tell you that the cost of malpractice and liability insurance costs more than payroll/benefits/rent and utilities combined. So, get rid of or limit law suits and insurance costs go way down. Why not available to everyone. Let government subsidize hospitals and clinics for those that do not have insurance and control the costs like insurance companies do. MAybe you can provide some more examples, but the way government is going is just bandaging a really bad infection and covering it up and we will all lose a limb going their way.
August 11th, 2009 at 4:47 pm
Jean says “He had an accident and sliced through his hand and couldn’t work as a true chef any longer.”
And?
He paid a price for short term thinking. Life (just like elections) has consequences. Reasonably intelligent people learn from those experiences and it (usually) makes them grow into more mature people.
I guarantee you that presented with the same choice today he would:
a) take the cash and buy insurance, probably shopping around to find the best plan for that money, or
b) would take the insurance offered by his employer.
Because of the experience learned the hard way as a young man, he would almost certainly not repeat the same behavior.
If he did, he would be a dumb*ss and deserve whatever happened to him.
August 11th, 2009 at 4:54 pm
Jeff hit it right on the nose. We need to put a cap on malpractice claims and we will see medical cost come down and unnecessary test end or limited. When doctors don’t have to focus on covering themselves they will be able to go back to taking care of their patients.
August 11th, 2009 at 5:04 pm
I agree with Jeff and Jean. Cap malpractice suits so doctors can focus on what tests are necessary and to drive down docs’ liability insurance cost.
August 11th, 2009 at 5:21 pm
Maybe we need a little bit of regulation here (only a little). It is illegal to drive a vehicle, at least in my state, without car insurance. Let’s make it illegal to work without personal health insurance. Now businesses can rid itself of workers comp and send that money along with our current health insurance costs directly to the employee. If you don’t work, and don’t choose to have health insurance, the world does not owe you. If you are not working because of an accident, you were working, and as such have health insurance. If you are incapable of work, some relative is likely all ready taking care of you. If not, let’s allow Americans to be charitable; we typically are.
August 11th, 2009 at 5:23 pm
Tort reform is first. My wife is a Registered Nurse in a Doctor’s Office. She just handles paperwork. We still carry a 1 million dollar malpractice insurance policy. This is a litigation crazed culture. Start here. Next, fix Medicare. It will be bankrupt in the next 5-7 years. If this can’t be fixed, Why should we be letting our elected nitwits spend more trillions when they have this disaster right under their noses? After they fix these two issues, THEN we can start looking into adding more people to the system with the resources to properly serve them. Add 47 million folks overnight and you have instant rationed care.
August 11th, 2009 at 5:26 pm
The shortage of general practitioners could be solved by funding more pre med students. There should be more qualified doctors with no barriers to qualified people becoming doctors. They should not have those really high school loans to pay, which causes their costs to be high.
August 11th, 2009 at 5:34 pm
John and Steve have it correct. Any government program will not work, will cost 10X more and not be effective. They have proven this on every program they have ever touched. Please contact your representive and tell them to slow down and think this over. We are moving way too fast and I believe for reasons that are not valid.
August 11th, 2009 at 5:46 pm
I agree with Jeff and Jean, but you will never see tort reform in this country, when the majority of our politicians are lawyers. This is the most self serving industry in the world.
August 11th, 2009 at 5:50 pm
Why do we seem to ignore the fact that Americans without question live the most unhealthy lifestyle of any country on earth. My work takes me to both cities & rural areas of the Americas, Europe, the Mideast, the Far East and nowhere do I see the excesses that are common in the US. This has a huge impact on our health care system.
August 11th, 2009 at 6:31 pm
Stan, In Arkansas it is aginst regulations to bill patients different amounts based on their payor source. There are contract negotiations with insurance companies and providers and insurance companies may actually pay less based on those negotiations but they are billed the same. With Medicare and Medicaid (federal programs) they too are billed just like a private pay patient. However, the government regulates what they pay based on what is considered usual and customary. I am a hospital administrator and you can pull any patient account and find that all are charged the same price.
August 11th, 2009 at 6:58 pm
Your state probably does not require everyone to have full comprehensive collision coverage with a $100 deductible for each car. Typically the minimum required coverage is some limited liability coverage, due to damage you could cause to someone else or their property.
There are many people who carry high-deductible “major medical” policies. Perhaps this is more akin to a liability car insurance policy – in that some catastrophic event is when an individual becomes a drain on the system.
The proposed legislative reform would effectively eliminate this minimum level of catastrophic coverage, and force everyone to have comprehensive coverage. While some may say that bringing these generally healthy people with “major medical” coverage into comprehensive coverage will increase the pool of money available to pay for those who need more complex procedures, it is likely that these people will take higher deductibles so that their premiums are lower. Therefore, there may not be enough anticipated “stimulus” funds into the plan’s pool.
August 11th, 2009 at 8:06 pm
Lawyers are our biggest problem in everything we do. It has to be the most lucrative profession and partly because they create their own business and charge as much as they can get away with. They have their noses stuck in everyone’s business just waiting for some little mistake. And, if there is no mistake, they seem to be able to create one.
Jeff has some great ideas and seems to make good sense to me. The one thing I do know is “Obama Care” will never work and we have to do everything we can to keep congress from passing legislation for it. I wish they would work as hard fixing our current healthcare system. Hmmm, maybe it is because they are all a bunch of lawyers.
August 11th, 2009 at 8:32 pm
Nothing will change until our elected officials have to live under the laws that they pass. They have their own retirement and health care plans that we pay for. We must make them accountable for their actions. I own a small business that pays for the employees and family coverage. I have worked since the age of eighteen(I am now a few months from 60) and do not expect to see any social security because our government has seen fit to misspend the money that I have contributed over the years and now they think they can provide better health coverage?
We need to elect people that truly care for us rather protecting themselves and their special interest groups and contributors.
We do not work for them, they work for us.
August 12th, 2009 at 8:24 am
They say we can keep our coverage if we want, and call the government run program an option, but I am not comfortable just being told all is safe without reading the fine print regarding how that is being done.
Here’s the fine print:
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.
(B) DEPENDENT COVERAGE PERMITTED- Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.
(2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS- Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.
(3) RESTRICTIONS ON PREMIUM INCREASES- The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.
(b) Grace Period for Current Employment-based Health Plans-
(1) GRACE PERIOD-
(A) IN GENERAL- The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121.
(B) EXCEPTION FOR LIMITED BENEFITS PLANS- Subparagraph (A) shall not apply to an employment-based health plan in which the coverage consists only of one or more of the following:
(i) Any coverage described in section 3001(a)(1)(B)(ii)(IV) of division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111-5).
(ii) Excepted benefits (as defined in section 733(c) of the Employee Retirement Income Security Act of 1974), including coverage under a specified disease or illness policy described in paragraph (3)(A) of such section.
(iii) Such other limited benefits as the Commissioner may specify.
In no case shall an employment-based health plan in which the coverage consists only of one or more of the coverage or benefits described in clauses (i) through (iii) be treated as acceptable coverage under this division
(2) TRANSITIONAL TREATMENT AS ACCEPTABLE COVERAGE- During the grace period specified in paragraph (1)(A), an employment-based health plan that is described in such paragraph shall be treated as acceptable coverage under this division.
(c) Limitation on Individual Health Insurance Coverage-
(1) IN GENERAL- Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.
(2) SEPARATE, EXCEPTED COVERAGE PERMITTED- Excepted benefits (as defined in section 2791(c) of the Public Health Service Act) are not included within the definition of health insurance coverage. Nothing in paragraph (1) shall prevent the offering, other than through the Health Insurance Exchange, of excepted benefits so long as it is offered and priced separately from health insurance coverage.
————————————————————————————————–
Here is what they call protecting your choice!
No new enrollments! Whether this means new “policies” or the actual word used “enrollments” the result is devastating. If the traditional insurance industry term is applied, no existing plan (policy) can add new members except as dependents of existing members. If it means policies, then present employers without policies, will not be able to get one. How does either of these help the uninsured get coverage?
No updating of plan is like saying no oil changes or fill ups for your car. This will prevent inclusion of new coverages or types of care no presently covered. It prevents cost changes to deductibles and copays for inflation purposes. If your deductible is $500 per year now, it must remain the same forever. Any change to the policy in restricted areas as mentioned results in loss of the grandfathered status; which means the policy is unlawful.
In quick summary, you can keep your coverage if you want, but there will be #$@$# to pay if you do.
Just because the fox is going to watch the hen house, no one should be concerned, right?
August 12th, 2009 at 8:24 am
So many factors work together to create the negatives (problems) driving a need for ‘reform.’ {I prefer to say improvement.}
The introduction of insurance lessened the cost burden on individuals with coverage, increasing individual buying power and subsequently the demand for services; economics dictates where demand increases, prices do also. As prices creep up, the disparity felt by the uninsured increases. Introduction of no cost care for low-income individuals fosters more increased demand.
Subsidized premiums (by government or employer) and the pricing influence gained thru group policies, particularly a large group, increases the cost to individual disparity for the uninsured.
Our health care industry has flourished with improved methods and means for improved health. We do not want to undermine this great feature of our system. But the absence of access to affordable health insurance is crippling to the uninsured. The cost of social medicine is crippling to our nation’s finances.
To address both of these concerns, we need more access to affordable insurance. How do we get there?
1) Alter the insurance model away from employer based groups. I did not say eliminate them, but foster development of group plans based on other entities. Any association of persons, church, clubs, memberships, community organizations, etc. Allow grouping of smaller employers and self-employed thru associations or chambers of commerce. Do not provide government subsidies to these entities. Let them force competition in the industry.
>This will foster broad access to larger group policies and multiple choices for a group plan for all individuals. If my employer offers the best option fine, if it is my local credit union, NAACP, NRA, ACORN, AARP, church, alumni association, or whatever, I have options each possessing the strength and benefits of group policy status.
2) Require all medical insurance policies to cover all care associated with the physical well being at some level. Do not specify the level; let competition drive this. Do not require coverage for nonessential care – non-essential meaning it does not alter the general health of the individual. Do not force coverage of care not specifically for the direct improvement or preservation of the patient’s physical health. Allow plans to offer add-on coverage for anything they wish, but do not require the group to provide nonessential care coverage, which is cost-shared by all group members. These items should be, pay if you want it, but not if you don’t. Similar to I can buy a car a basic warranty, but if I want the enhanced warranty, I pay for it separately.
3) Set a deadline to phase out government programs; Medicare, Medicaid (as individuals become insured thru other plans, we will not need these any more) and the redirect individual taxes for them to HSAs type funds, which can be used for premiums or coinsurance/copays. Employer contributions (50% share) will encourage employment in some capacity thru a viable employer, and also help assure all income is subject to proper taxation. (Could somewhat reduce the cost of unemployment, food stamps, welfare, etc., which is not a negative.)
4) Lastly, tort reform. Why do we have so much “malpractice” by licensed physicians? If they cannot practice soundly, take away their license. It lowers cost of health associated with unnecessary repeat treatment and preserves life and limb suffering due to these incompetent or negligent practitioners. This measure will likely force a healthier definition of malpractice as well. Limit damages to real costs. Existing worker’s compensation models could be used to establish the quantification of such losses. Eliminate cash settlements for these claims. Too often in the past, when a settlement occurred, it was followed by a spending spree, and then government programs got stuck with the future treatment and unemployment bills.
I am not a guru of all of life’s wisdoms on these matters, but my exposure to health insurance as a group plan administrator, a covered individual, a veteran subject to that system, and a recipient of the welfare system as a youth, I do have exposure to varied perspectives.
If we take the best of where we have been and hone it, we can have an even greater health care system. The rest of the world may not like that, as we already have the best system in the world. Why is that, I would say it is because we have birthed or naturalized into us a yearning for excellence. We favor no obstacle to achieving it. In this our forefathers were ingenious. The ‘pursuit of happiness’ drives us to want the best for ourselves and our fellow man. This inner will has afforded this nation the greatness we enjoy, the innovations that enrich our lives, and the liberties we cannot imagine the absence of. Let us and our leaders not settle for the way of other nations, we were not therein created, but find the resolve and wisdom to craft a better more refined mechanism to ensue our goal, the general welfare of all American citizens. Our forefathers founded the greatest nation on earth, not through the notion of the strength of a government, but the unimaginable strength found in the power of the people, as the preamble notes, “We the people,” not we the leaders. Let’s not lose this power by thinking the government has a strength greater than the people. Leave choice where it belongs, with the people.
August 12th, 2009 at 9:21 am
The two biggest problems in healthcare right now…lawyers and insurance companies, lawyers in congress and senate and insurance companies the biggest lobbyists in Washington its no wonder nothing gets done…everyone is in the CYA mode.
August 12th, 2009 at 9:25 am
What did the Pres say at the town hall meeting…. Look at Fedex and UPS they are doing fine. They are keeping their doors open but the US Post Office is closing locations and minimizing hours.
Somehow he thought this was a good argument for having the government run our health care too???
The way they will save money is have us all (so far it’s just the seniors) sign living wills so there is less end life care. Again, we are ALL in trouble if government takes over healthcare.
August 12th, 2009 at 9:57 am
It sure sounds like NO ONE is for the President’s Healthcare Reform. However, it sure is moving like wild fire throught the Congress. The really important questions right now are, What can we do to stop it, or at the very least slow it down? How many of us are really willing to take the time to contact our elected officials and voice our opinions as American citizens. The population at large needs to educate themselves and make a stand!!
August 12th, 2009 at 10:18 am
You should not be so hard on attorneys…..they are not all bad.
95% ruin it for the rest of them!
August 12th, 2009 at 10:37 am
Here is my experience with government insurance i.e. Medicaid: I work in a primary care facility, it seems that people on Medicaid will come to the doctor for the simplest things like believe it or not a blister on their toe or upset stomach before ever trying any home remedy. People with commercial insurance will come only when necessary. The difference is Medicaid people have no investment in their insurance, they pay nothing when they come for a doctor visit unlike commerical insurance patients who generally have a co-pay or deductable. If something comes out of your pocket you think twice. Let the Medicaid people be required to pay something whether it be $2 or $5, then you would see silly doctor office visits decrease. I think everyone should pay something, when you have to spend your money you think twice. This could save millions in tax payers money and is such a simple solution.
August 12th, 2009 at 11:37 am
Terri you are right what you say, I work in the EMS field and what you say is the truth, we are called for some of the simplest things minor nose bleeds, stubbed toes, upset stomachs, and those who want free drugs and/or attention. These people are not paying for they’re care we are, so they have a tendency to abuse the system. Trivial ER visit would decline if they had to pay a little something out of pocket. I had heard (the location slips my mind) that a locale hospital started charging people who walk through the door a $10 fee to be seen, unless it is a true emergency. The frivolous visits dropped 30% at that hospital reason; walk in patients did not want to hand over money they use to buy booze, cigarettes or drugs with. Savings enormous, freeing up hospital staff fro true emergencies: priceless.
August 12th, 2009 at 11:41 am
Claudia makes a couple of interesting points. Health care reform is moving through Congress like wild fire — must be a really slow burn as it has been moving for over 40 years with no measurable progress. But she is quite right that the public needs to be better educated about this debate. Then, perhaps, we would not be hearing about such nonsense as “death panels”, euthanasia” and “soylent green”. The truth is that very few people really have taken time to read through all the proposals and that is all they are, proposals. It is draft legislation that includes many items that will be deleted as the process continues. Do we need substantial health care reform? Absolutely! As a senior, I hope my children and grandchildren will have a more comprehensive program than we have today. Last week, my doctor, whom I have known for years, told me it costs his small office $100,000 annually just to do insurance paperwork, much of which he describes as totally unnecessary and duplicative. As for those who rail against government health care, Medicare is a federal program that, for the most part, manages to be efficient, reasonable and not arbitrary. None of those attributes can be found in much of the private insurance programs. In addition, government employees, including members of Congress and the president, have excellent health care programs. Perhaps the simplest and best approach might well be to extend their excellent care system to all Americans, eliminate multiple, time consuming, contentious Congressional hearings, cut the hundreds of pages of proposed legislation down to the language that covers members of Congress, etc. and let everyone benefit.
August 12th, 2009 at 1:00 pm
Giving life and form to the new health plan is like the founding fathers framing the United States Constitution, it must be built on fairness, limited excesses and moral controls with checks and balances. Is this possible with our current representatives in Congress? I pray that it is. The Constitution was not framed in a day! This process will take time and a lot of effort.
August 12th, 2009 at 1:27 pm
mkh, your comments are the best overview and proposed solutions that I have read yet. I would like to get your permission to use them in a letter to the editor of our local paper, and send them to my representatives.
I may be breaking the rules, but could you contact me at 801-622-4587.
February 11th, 2010 at 5:13 pm
I agree with Bob Fowlkes. He has the right idea! Make the government officials live with what they make us live with. WE don’t get to vote ourselves raises every year either! I think we have too much government, and they are not serving the people, but rather their own best interests. We are mortgaging our grandchildren’s futures here, for yet another government program that does not work, and costs a fortune above what they say it will.
I am 62 and have no plans to retire. I can’t afford to. I have to hope that what they do won’t ruin the small, family-owned business I work for too. There are too many people in this country who really believe that the world – especially this country – owes them a living, health care, and the RIGHT to never work at a job. One lady on TV was bragging that her family had been living in the projects and on welfare for five generations! She said her greatest fear was that one of her children might someday have to get a job. Who does she think is paying for all her benefits that she considers a RIGHT???