ECM'S HEALTHCARE REFORM BILL ANALYSIS : WHO WILL BE COVERED--AND HOW WLL IT IMPACT YOU?

COSTS, DIFFERENCES BETWEEN KEY REPUBLICAN AND DEMOCRATIC PLANS ALSO WEIGHED
 

November 8, 2009 (Washington D.C.) –H.R. 3962, The Affordable Health Care for America Act approved Saturday by the House of Representatives is widely deemed the most significant social reform since the enactment of Social Security and Medicaid. The bill will next be considered by the Senate. While much media coverage has focused on a public option (i.e., giving qualifying consumers a choice between private healthcare and a government-run system) the bill in fact has many other provisions that, if enacted, will impact nearly everyone in America.

Last-minute amendments, media spin (and in some cases, outright fibs) have many confused about what’s actually in the bill. How will it affect you, what will it cost, and how does the Democratic-backed bill passed by the House compare with alternatives proposed by Republicans? East County Magazine has consulted a wide variety of sources on the left and right as well as nonpartisan fact-checking outlets, government analysts, and major media outlets to provide you with as many answers as we could find.

Near-Term Impacts for all Americans

If enacted, the bill would prohibit all health insurance companies from denying coverage to anyone based on pre-existing conditions –starting next year. 

Since one third of young adults have no insurance currently, the bill would allow adult children to be covered under their parents’ policies up to age 27. Insurers would be banned from dropping people when they become ill and could no longer impose lifetime limits on coverage. Insurance companies would also have to justify proposed premium increases to regulators. You will no longer have to pay a co-pay for preventive care, enabling people to to obtain early diagnosis and treatment of serious illnesses.

Women could no longer be charged higher premiums than men under the measure passed by the House. The bill also bans insurance companies from discriminating against women based on pre-existing conditions which some insurers have defined to include domestic violence, C-sections, and pregnancy. Pregnant women will not be able to obtain funds for abortions under the public option, however, except in cases of rape, incest, or when a mother’s life is in danger.

The bill also moves toward closing the “doughnut hole” for prescription drug coverage under Medicare starting with discounts on prescription drugs immediately, closing the cap entirely over the next ten years.

It also bans insurers from charging higher rates to women than men and bans discrimination against women for pre-existing conditions, which some insurers have defined to include domestic violence and pregnancy.  The Washington Post offers in-depth details on many of the bill's key features.  You can also view a summary of the bill's key points from the House Speaker's office.

Can you keep your private insurance--and can you qualify for the public option? 

If you have health insurance, you can keep your plan and your doctor.

If you are presently uninsured and can’t get coverage, you will be able to join a temporary high-risk insurance pool, making it easier for you to obtain coverage under a private insurer or a public option.

If you’re unemployed, you will be able to keep your COBRA benefits until the public lan and insurance exchanges start in 2013.

The bill, if passed by the Senate and signed by the President, would establish a new public option insurance system starting in 2013.

Who will pay—and what's the cost to businesses and individuals?

Currently less than half of all small businesses offer healthcare to employees. The House bill gives employers access to less costly group rates and provides a tax credit to help businesses that provide insurance to their employees.

Businesses with payrolls over $500,000 will be required to either provide insurance for their workers, or pay a fine of up to 8% of payroll. However 86% of all businesses in the U.S. have payrolls under $500,000 and would be completely exempt from those requirements.

The U.S. Chamber of Commerce has staunchly opposed the measure, however.  At it's website, the Chamber states: "Friday's news that unemployment has reached double digits for the first time in 26 years should have been a wake-up call for those considering job-stifling tax increases and employer mandates included in the House health care bill. Expanding coverage is an imperative; it is also imperative that the nation is moving on a credible and sustainable fiscal path."

For the first time, individuals would be required to obtain insurance or pay a fine of up to 2.5% of their income.

The bill also imposes a 5.4% income tax surcharge on individuals earning more than $500,000 and on households with incomes over $1 million a year.

What if I can't afford or don't want to buy insurance?

Claims by critics that people who can’t afford insurance would serve time in jail are false, according to www.MediaMatters.org, a fact-checking website. In fact, the bill imposes no criminal penalties for people who fail to buy health insurance. However those who willfully refuse to pay a tax imposed for not buying insurance could face civil or criminal penalties.

States will be required to extend Medicaid coverage to more people. Low and moderate income individuals who still can’t afford coverage will be able to apply for federal subsidies through an insurance marketplace that would negotiate with private insurance companies to provide comprehensive policies as options to a government-run public option.

How does the Democratic plan compare with alternatives proposed by Republicans?

According to the nonpartisan Congressional Budget Office (CBO), the Democratic bill would cost $1.06 trillion, far more than the $61 billion cost of the Republican proposal over the next decade. However, the Democratic proposal would actually reduce the deficit by $104 billion over the next decade, compared with just a $68 billion savings in the Republican bill.

The Democratic bill would also cover more people – 96% of all Americans, according to the CB0. The Democratic plan would reduce the number of uninsured Americans from 46 million to 18 million (including about 6 million illegal immigrants who would not be covered). The Republican bill, by contrast, would reduce the number of uninsured by only 3 million, leaving 52 million Americans still uninsured, according to the nonpartisan fact-checking site www.PolitiFact.com “truth-o-meter.”

The Republican plan would lower health insurance premiums by capping medical malpractice awards. Democrats aim to save money on costly emergency room treatments by funding preventive care to keep people healthy. Republicans would offer incentives to states that reduce premiums and lower the total number of uninsured, while Democrats would require that everyone buy insurance or pay a penalty. Requiring large businesses to provide insurance would also reduce costs to the government.

Republicans want to allow people to buy health insurance across state lines, which is currently prohibited by law. Small businesses could pool resources to buy insurance through trade associations, which only big companies and labor unions can do presently.

However PolitiFact warns, “The flip side of several of the Republicans’ new consumer options is a decrease in regulation. If insurance policies are sold across state lines, critics say, there could be an incentive for insurers to loate in the least-regulated states, allowing them to scale back coverage.” Republicans’ bill, unlike the Democratic proposal, does not prohibit insurers from discriminating against patients with pre-existing conditions. PolitiCheck also faults the GOP proposal as not providing enough money for high-risk pools to be effective in helping sicker patients obtain insurance.

Democrats also propose trimming Medicare Advantage and implementing reforms they say would trim waste, fraud and overpayments to private insurers that drain resources from the Medicare system.  Republicans have claimed such cuts could hurt seniors.

How has the bill changed during the final negotiations in the House?

Numerous amendments have been added.  For full text of these and others, click here.

One controversial piece has been stripped from the version of the bill passed by the House. Funds for patient counseling in the last stages of life on options such as hospice care have been cut after some critics incorrectly labeled panels as “death squads.”

Another amendment adopted prohibits any government plan from funding abortion, except in cases of rape, incest, or a mother’s life in danger. The measure drew praise from pro-life groups but condemnation from women’s reproductive rights advocates.

Yet a third amendment reinstates antitrust laws from which health insurance companies have been exempted, opening the possibility that the federal government could seek to break up health insurance monopolies.

The House version of the bill had support from major organizations including the American Association of Retired Persons (AARP), which represents older Americans, and the American Medical Assocation (AMA), which represents doctors.

Leaders react to passage of landmark measure in House

President Obama hailed passage of the bill as “historic,” adding that he is confident the Senate will pass a similar version of the legislation soon. Senate Majority Leader Harry Reid has said he aims to have a floor vote by Thanksgiving.

In the House, all but one Republican (New Orleans representative Joseph Cao) voted against the measure. In addition, 39 Democrats voted no, including some conservative Democrats as well as liberals such as Dennis Kucinich (D-Ohio). Among local Congressional representatives, Democrats Bob Filner and Susan Davis voted for the landmark measure, while Republicans Duncan Hunter, Brian Bilbray and Darrell Issa voted against it.

Kucinich called the bill a “bail out under a blue cross” and argued that by forcing Americans to buy insurance, the bill is a move toward privatization of the healthcare system. He also objected to removal of an amendment that protected states’ right to opt out or enact a single-payer system if they choose.

California Nurses Association criticized Congressional leaders for not allowing a vote on another bill that would have set up a single-payer system, virtually eliminating private insurance under a healthcare-for-all government run system The group hopes to see the states’ rights option for single payer reinstated when the Senate considers the bill.

Democrats control 60 of 100 seats in the Senate-barely enough to halt procedural delays including a filibuster, with no defections. But Senator Joseph Lieberman of Connecticut, who won reelection as an Independent but caucuses with Democrats, has said he will stand with Republicans to try and strip the bill of the public option. Ultimately, differences in House and Senate versions must be resolved in a conference committee with a final version reconsidered by both houses before going to President Obama for signature.

House Minority Leader John Boehmer (R-Ohio) denounced the House bill as a “$1.3 trillion government takeover of healthcare” which he said would “dim the light of freedom and diminish opportunity for future generations.”

But for John Dingell (D-Michigan), who has been fighting for healthcare reform for over 50 years, the measure is long overdue. Dingell praised passage of the bill, which he concludes “offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable healthcare when they need it.”