Home » The Watercooler for 10/31/09 12:00 AM

The Watercooler for 10/31/09 12:00 AM

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- Howie's first!!

By puddle on Oct 31, 2009 12:32 AM EDT

House Health-Care Bill Unveiled Permalink

Yesterday House Speaker Nancy Pelosi rolled out a $896 billion dollar health-care reform bill (HR 3962) that will go to the House floor for an up-or-down vote within 2 weeks. A summary has been posted online. Some of the key features include:

Coverage

People who like their current plan may keep it.
Individuals not covered and some small business may buy insurance at new exchanges.
One of the offerings at these exchanges will be a nonprofit public plan.
A committee chaired by the Surgeon General will draw up a list of benefits all plans must include.
Insurance companies will no longer be allowed to discriminate against sick people.
Annual and lifetime limits on payments will be forbidden.
Children may be covered by their parents' plans until age 27.
All plans will have to offer preventative medicine for free.
About 96% of the population will be covered; most of the rest are illegal aliens (not covered)

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By puddle on Oct 31, 2009 12:33 AM EDT

Affordability

Families making up to 4x the poverty level ($88,000) will get federal subsidies.
The Medicaid income limit will be raised 50%, making more people eligible.
Patient out-of-pocket expenditures for health care will be capped at $10,000 per family.
Part of the Medicare "donut hole" will be plugged.
Medicare will be allowed to negotiate prices with drug companies.
Insurance companies will have to spend 85% of their premium income on medical care.

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By puddle on Oct 31, 2009 12:35 AM EDT

Shared Responsibility

Anyone who does not have insurance must pay a fine of 2.5% of their income.
Any large company not offering a health plan will be taxed at 8% of its payroll.
Insurance companies will no longer be exempt from the nation's antitrust laws.

In addition, there are a myriad of other provisions such as funding local health centers, doing prevention research, training more general practitioners, modernizing Medicare (including rooting out waste and fraud), and simplifying health-care paperwork. Also, the standard industry practice of denying health care to people who are victims of spousal abuse will be forbidden by law.

If you are a detail person and want to read the actual bill, here is a link. It is 1990 pages double spaced with a line length of about 45 characters. Despite its length, 8 million people downloaded it in the first 8 hours it was up there. Most bills are long, but bills like this are even worse because they have to be so precise. For example, insured people's children are covered in many policies. What is a child, anyway? Besides natural-born children, what about adopted children? Stepchildren? Foster children? Thousands of tiny points like this have to carefully defined. The Senate bill will be equally long but will differ in many ways that the conference committee will have to iron out.

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By puddle on Oct 31, 2009 12:35 AM EDT

The bill is weaker than what Pelosi wanted, but she didn't have the 218 votes for her version. What she and the Progressive Caucus favored was a bill that paid doctors, hospitals, and drug companies at Medicare rates plus 5%. But the 53-member Blue Dog caucus opposed that plan although it can live with Pelosi's second choice, a system in which the Secretary of Health and Human Services negotiates rates with doctors, hospitals, and drug companies. So we have a situation in which the Blue Dogs wanted the bill that will cost the government more money than Medicare+5. Why? The reality is that while the Blue Dogs say their main concern is spending less taxpayer money, in reality, their main concern is supporting business interests, especially hospitals and drug companies, but this is a harder sell to the public. But Pelosi should not be underestimated. She is one of the most powerful Speakers in decades. She has already said that this bill is merely the first step in reforming the health-care system.

Pelosi is not the only one unhappy with the bill. The insurance industry does not like it either. It does like getting tens of millions of new customers but it would prefer not to have new competition and lots of new rules (like not being alowed to cancel policies when someone gets sick). But at this point, the House bill is cast in stone and many Democratic senators are furious with the industry for releasing a report saying any reform would increase premiums.

- (the last)

By puddle on Oct 31, 2009 12:36 AM EDT

The bill will not increase the federal deficit. In fact, it will reduce it by $100 billion over 10 years. Financing for the subsidies comes from an income tax increase for couples making more than $1 million/year. It is not clear whether this form of financing will survive since the Senate bill will probably get its revenue from an excise tax on gold-plated health-care plans. Neither of these options is popular but the money has to come from somewhere. The conference committee might decide on a completely different financing method, though.

Very likely, no amendments will be permitted on the House bill. It will be yes or no. The decision to forbid amendments will (soon) be made by the Rules Committee, chaired by Rep. Louise Slaughter (D-NY). Slaughter and Pelosi are afraid of an amendment being vigorously pushed by Rep. Bart Stupak (D-MI) to prevent any government money being spent on abortions. The amendment, if offered, would probably pass and in doing so would so anger the progressive caucus that the entire bill would fail. So Slaughter and Pelosi want to prevent a vote and the only way they can do this is to forbid all amendments. It is probably this bill or nothing, folks. If it passes, this is the bill that will go to the conference. The bill's Senate counterpart will probably be released in a week or so. Then come the votes and the horse trading at the conference.