House "Affordable Health Care for America Act"

[FUEGO]

Nothing wrong with that. Should be the same with tax exempt interest.

What, are you trying to get back into practice?!?! This is proposing an alternative alternative minimum tax...

 

[M Paquette]

Republican proposal available

A draft of the Republican proposal is now available. I can't find it on the House web sites, but NPR, of all places, is hosting it.

http://media.npr.org/assets/blogs/health/images/2009/11/GOPhealthbill.pdf

Note that this bill is offered as an amendment to HR 3962, and as a reform bill, amends a number of pre-existing pieces of legislation, all of which are referenced in the bill.

Items of note include "association health plans", a way for business groups and professional organizations to offer group coverage, limits on malpractice claims, and essentially unrestricted sales across state lines.

Unlike the Democrats plan, sales across state lines are not restricted to states that agree to participate in a specific group, but instead allow sales across all states. The insurer must select one state as it's Primary, and operate under the rules of that state. This allows state regulatory authorities to be gamed against each other,with national policy sellers selecting the most favorable state to use as Primary. (This may be the big gotcha in the bill.)

Compliant policies will no longer have lifetime caps, and policies may be rescinded only for unrevealed preexisting conditions that are relevant to a condition being claimed. (No more denying cancer treatment for unreported acne.) Starting 1 April 1014 plans not in compliance, or uncertified, will be fined in the amount of $1 per covered person per day until certification is complete.

A special re-insurance program is established for association health plans.

Association health plans are open to trades, businesses, or industries which has been indicated as having average or above-average risk or health claims experience by reason of State rate filings, denials of coverage, proposed premium rate levels, or other means demonstrated by such plan in accordance with regulations. In addition, the following trades, businesses, and industries may form associations:
* agriculture
* equipment and automobile dealerships
* barbering and cosmetology
* certified public accounting practices
* child care
* construction
* dance
* theatrical and orchestra productions
* disinfecting and pest control
* financial services
* fishing
* food service establishments
* hospitals
* labor organizations
* logging
* manufacturing (metals)
* mining
* medical and dental practices
* medical laboratories
* professional consulting services
* sanitary services
* transportation (local and freight)
* warehousing
* wholesaling/distributing

An association plan under which the sponsor does not restrict membership to one or more trades and businesses or industries and whose eligible participating employes represent a broad cross-section of trades and businesses or industries may also be formed. (COSTCO Medical Association, anyone?)

 

[Stevewc]

Nice to see a lot of interest in the health care issues.
As I've stated several times on the forum, my ER (Go or No go) kind of hangs in the balance. I read on Tuesday (yesterday) that the the powers that be are not sure they will get the legislation passed before the end of the year. That's disappointing to me since I'll probably wait to see what goes into the proposed Law before I sign any ER papers. So may put me into 2010 waiting, but I need to make as good and wise a decision as I can possibly make.
My question to all of you is: If and when a bill/law is actually signed by the president. If we/I see beneficial things toward an ER person (that hopefully would be me). Could I retire and take advantage of any and all loop holes before my employer has time to change benefits that could be locked down at the time I walk through the gate? Does the laws/rules lock down and take effect immediately, even though they are saying it might take several years to implement some things?
An example for my question would be: If the new law states a person that leaves his/her job that is 55 or over can stay on cobra until the new competitive insurance plans are in place? Could I jump out and jump on this immediately? Even Cobra is much better than my current State high risk pool. I am truly watching this thing that closely believe it or not? It means that much to me !!!
Any Thoughts on, is it law immediately?
Steve

 

[ziggy29]

I agree, the way to play this game under the current versions is to live simply, own your home and have no debt. This may put an end to the pay off mortgage early debate. For moderate income folks, the premiums you pay may end up being capped at 9-11% of your income, which is an effective tax. Add that to a 15% federal tax and possibly 7-8% state tax for some, and you have a very hefty marginal tax burden even for rather low income individuals.

And don't forget the phaseout of the health insurance subsidy which firmly and completely falls within the middle class tax brackets. While technically not a tax, when I looked at some of the tables for (say) a married couple on a $60,000 income, it looked like every dollar they earned -- above and beyond existing taxes -- would cause something like a 15-20 cent loss of subsidy; i.e. they'd have to pay another 15-20 cents for their coverage.

Though technically not a tax, it has the same impact on the bottom line as if it were a tax. This is, to me, one of the most problematic specifics of the plans.

Some analyses -- and not just the ultraconservative ones -- have figured that a married couple with a $70,000 taxable income could wind up keeping less than 40 cents per dollar earned on the margin in states with an income tax if you factor in the loss of subsidized care. In fact, the phaseout of the subsidy creates a "bubble" in effective marginal rates that sticks it to the middle class. (Again, yes, I know this phaseout of a subsidy is not a tax, but I would be interested to hear someone claim it doesn't have the same effect as a tax on incremental dollars earned.)

That would be another incentive to "engineer" a retirement with as low an income as one could comfortably manage. And as long as we asset-rich, income-poor FIRE types remain a small minority it might not bust the Treasury and people may not notice the deal we're getting, but if too many people catch on to this, we'll increasingly become a nation of grasshoppers who realized being an ant just wasn't worth the effort any more. And that's when I'd bet we start taxation based on assets and net worth.

 

[FUEGO]

And don't forget the phaseout of the health insurance subsidy which firmly and completely falls within the middle class tax brackets. While technically not a tax, when I looked at some of the tables for (say) a married couple on a $60,000 income, it looked like every dollar they earned -- above and beyond existing taxes -- would cause something like a 15-20 cent loss of subsidy; i.e. they'd have to pay another 15-20 cents for their coverage.

Though technically not a tax, it has the same impact on the bottom line as if it were a tax. This is, to me, one of the most problematic specifics of the plans.

Some analyses -- and not just the ultraconservative ones -- have figured that a married couple with a $70,000 taxable income could wind up keeping less than 40 cents per dollar earned on the margin in states with an income tax if you factor in the loss of subsidized care. In fact, the phaseout of the subsidy creates a "bubble" in effective marginal rates that sticks it to the middle class. (Again, yes, I know this phaseout of a subsidy is not a tax, but I would be interested to hear someone claim it doesn't have the same effect as a tax on incremental dollars earned.)

That would be another incentive to "engineer" a retirement with as low an income as one could comfortably manage. And as long as we asset-rich, income-poor FIRE types remain a small minority it might not bust the Treasury and people may not notice the deal we're getting, but if too many people catch on to this, we'll increasingly become a nation of grasshoppers who realized being an ant just wasn't worth the effort any more. And that's when I'd bet we start taxation based on assets and net worth.

You are talking about the phase out of subsidy, as in those earning 20,000 pay 2% of income, those earning 40000 pay 6% of income, and those earning 65000 pay 10% of income? Yes, that adds another layer of progressiveness to the "tax". And there is the additional layer of all the phaseouts based on AGI (IRA contributions, retirement tax credits, earned income credit, etc).

Yes, it will probably be even more lucrative to early semi-retire if one can. As in we may be well served in our family to have one person quit, and the other cut back to 3/4 or 1/2 time, and collect a lot of govt benefits and pay no tax or possibly negative tax. I don't really like the idea of working for 40 cents on the dollar. This would also encourage more grey market employment, under the table, cash basis, etc. Hmmm... earn $40 an hour at a w-2 and take home $16 of it? Or find a side biz and take home $20+? I could mow grass on the side and probably do better after tax than working!

 

[ERD50]

My question to all of you is: ... Does the laws/rules lock down and take effect immediately, even though they are saying it might take several years to implement some things?

Any Thoughts on, is it law immediately?
Steve

I think that depends on the exact wording of (if) whatever bill gets signed. Pretty sure they can do whatever they agree on. Devil's in the details.

And don't forget the phaseout of the health insurance subsidy which firmly and completely falls within the middle class tax brackets. While technically not a tax, ....

When the Pres was on the Sunday talk show round a while back, I was surprised to hear George Stephanopoulos challenge Obama on this. According to George (and Merriam-Webster), technically, it *is* a tax:

Stephanopoulos takes issue with a mandate that obligates Americans to purchase health insurance, or risk being fined as much as $900. "How is that not a tax?"

"A responsibility to get health insurance is not a tax increase," Obama said.

Stephanopoulos then tells Obama that he looked up the definition of "tax" in Merriam Webster's dictionary.

"The fact that you looked up... the definition of tax increase indicates that you're stretching a little bit right now," Obama responded.

see here at the 5 minute mark:

YouTube - Obama Goes Toe-To-Toe With Stephanopoulos On "Tax Increases"

Wow, using a dictionary definition is "stretching "? Shades of Orwellian Double-Speak (war is peace, freedom is slavery, dictionaries do not have definitions)?

And I liked this one - apparently a High School debate team member's take on it:

YouTube - Stephanopoulos vs. Obama - The definition of "Tax"

I just love the emotion and logic at 0:45 - 1:15. Cracked me up (but also so sad).

-ERD50

 

[DeborahB]

I think whatever they pass, if it has a couple of key provisions, will be better than the employer-based coverage we have today. We need reliable coverage, and people who can't get it through an employer (ERs for example) need affordable coverage.

There's a term in the insurance industry, "adverse selection," which means that only people who are sick (or expect to be) get insurance. The pool of insureds is less healthy because of this.

Having coverage for all, coverage that can't be cancelled if you become ill, will benefit everyone. The healthy people will pay into the system and so will the less healthy. The hospitals won't be burdened with uninsured (and unable to pay) extremely ill people in the Emergency Room and ICU who should have seen a doctor long before their illnesses became so acute.

The issue of taxation... we will have to see what the final bill looks like (or what it looks like when it starts to BE a "final bill". At the moment there are so many competing bills that it's hard to know where the compromise points are.

I'm in favor of universal coverage but that's not going to happen. For whatever reasons (politics, anyone?) we want to keep the current insurance companies, and keep them happy. IMHO keeping the insured happy is a lot more critical.

NO ONE I know likes their insurance. Everyone has stories of long calls to get payments figured out or straightened out. The paperwork has become a nightmare.

So I'm waiting to see what happens. The real issues I see are (1) the assumption that everyone works (and CAN work) until 65/Medicare, (2) the assumption that everyone can get health insurance. Very puritanical, this stuff. The reality is that lots of us get older and have trouble working as hard as we did at 45 and older people almost always have pre-existing conditions.

The concept that people could save enough to retire modestly before age 65...? Hard for people who have no health issues to imagine, hard for younger people to imagine, etc. The only thing keeping me from retiring right now is health insurance (well, it would be good to have a little more in investments, too). But if I get sick again? I really could afford to stop.

 

[teejayevans]

Maybe I missed it, but I remember them talking about when leaving your job you should be able to take your HI with you. I was thinking, how the heck will they do that?
Leave megacorp with gold plan->small business ??
Leave megacorp to ER (either by choice or forced out)??
Did not see that in the nice summary...

Also, the help for early retirees section, from my perspective, can you make that 50-64 in case I EER
TJ

 

[DeborahB]

An association plan under which the sponsor does not restrict membership to one or more trades and businesses or industries and whose eligible participating employes represent a broad cross-section of trades and businesses or industries may also be formed. (COSTCO Medical Association, anyone?)

Oh, I LOVE the thought of a COSTCO Medical Association! And why not...?

 

[Stevewc]

Maybe I missed it, but I remember them talking about when leaving your job you should be able to take your HI with you. I was thinking, how the heck will they do that?
Leave megacorp with gold plan->small business ??
Leave megacorp to ER (either by choice or forced out)??
Did not see that in the nice summary...

Also, the help for early retirees section, from my perspective, can you make that 50-64 in case I EER
TJ

I just made the age thing up as part of my example.
Not sure if any kind of age is mentioned in the bill? But may be?
I'm not even sure the stay on cobra would help me at all since my state does have a high risk pool already. The problem with our risk pool is it stinks so bad that cobra would be less expensive for me and I would have better coverage with a mega corp. plan. Its possible mega corp. might force me out at 18 months due to the fact there would be a state option in place already, even though it smells really bad .
My hope is any law that goes in, will force my state/area to get more competitive on pricing. That's all I'm really looking for. My state has been used as a poster child for terrible access to insurance and pricing on national TV in the recent past.
Steve

 

[lets-retire]

Age is listed in the retirement section of the bill. It lists the lower limit as 55 years old.

I find it interesting that many on here say the devil is in the details and still support the bill. I find the bill incredibly lacking in details. Many of the details that were hammered in the last bill are now passed on to an as of yet unappointed committee of unknown people.

I have more to say on this topic, but will refrain because I know it is wasted breath on this forum.

 

[Stevewc]

Age is listed in the retirement section of the bill. It lists the lower limit as 55 years old.

I find it interesting that many on here say the devil is in the details and still support the bill. I find the bill incredibly lacking in details. Many of the details that were hammered in the last bill are now passed on to an as of yet appointed committee of unknown people.

I have more to say on this topic, but will refrain because I know it is wasted breath on this forum.

There has been so many things taken out of and changed in the bill at this point I'm not seeing much benefit for the average retiree or dreamer. Seems most potential benefits are aimed at lower income folks.
When this thing was first talked about, I thought the idea was to lower everybody's premiums. I don't see much of that now.
I guess the dream was to good to be true as usual.
Steve

 

[JustNtime]

My twenty-somethin' daughter was shocked and appalled by the [health care proposals]. She's been unable to find health insurance for 'reasonable rates', so she was looking forward to the 'promised' free lunch of health care coverage. Finding out she was going to have to buy health insurance OR else be fined for NOT having it - did NOT make her a happy camper. The CBO is estimating about $157 Billion in coerced fines to help pay for this ugly baby. So a whole lot of people are expected to choose NO insurance and a fine versus what will be available to them following this legislation! OUCH not only to have the risk of being uninsured, but to further subsidize the health coverage of others. I've heard the current number of uninsured is 57million, but I've never seen a break down of how many can't get insurance at any price versus how many have done their own cost benefit analysis and decided to risk being uninsured rather than to pay bloated premiums... To reduce those numbers by coercion seems rather heavy handed, but hopefully those being coerced will remember the next time they vote [moderator edit]

 

[JustNtime]

There has been so many things taken out of and changed in the bill at this point I'm not seeing much benefit for the average retiree or dreamer. Seems most potential benefits are aimed at lower income folks.
When this thing was first talked about, I thought the idea was to lower everybody's premiums. I don't see much of that now.
I guess the dream was to good to be true as usual.
Steve

IT seems rather naive economically speaking to increase demand and expect prices to drop. Increase demand => increase price. We could use a bill to increase supply - more health care folks and facilities, perhaps some real control on malpractice costs.

 

[ziggy29]

IT seems rather naive economically speaking to increase demand and expect prices to drop. Increase demand => increase price.

That's not how it works with public monopolies like public utilities and transit agencies. In that economics-defying world, revenue shortfalls caused by reduced demand usually lead to price increases, not decreases as would be the normal response to reduced demand.

Of course, outside the world of essential monopolies, the usual laws of economics may well apply. So maybe it's important to make sure that the delivery of health care doesn't ever resemble a public monopoly.

 

[JustNtime]

That's not how it works with public monopolies like public utilities and transit agencies. In that economics-defying world, revenue shortfalls caused by reduced demand usually lead to price increases, not decreases as would be the normal response to reduced demand.

Of course, outside the world of essential monopolies, the usual laws of economics may well apply. So maybe it's important to make sure that the delivery of health care doesn't ever resemble a public monopoly.

That just puts some smoke and mirrors to the increase in costs - the gov't pays the increase costs and wallah no increase - but eventually the 'free lunch' has a cost involved and someone pays(OPM?) -- Bottom line: increasing price to make up for a reduced demand will tend to further reduce demand and create a downward spiral. Bucking the curve has consequences. Giving 'free' health care to all(as some advocate) will substantially increase costs w/o some serious expansion of supply will lead to higher costs and greater difficulty obtaining timely treatment. Simple economics.

 

[Martha]

I have never heard anyone advocate for free health care for all. Not logically possible.

 

[JustNtime]

I have never heard anyone advocate for free health care for all. Not logically possible.

I would tend to agree on the logic, but many in favor of socialized medicine would disagree and those countries with 'free health care' usually have hefty taxes to pay the bill.

Soo anyways back to currently proposed health care legislation in this country (which is definitely NOT free health care for all), but does appear to increase demand and thus add further pressure to further increase cost.

 

[DeborahB]

IT seems rather naive economically speaking to increase demand and expect prices to drop. Increase demand => increase price. We could use a bill to increase supply - more health care folks and facilities, perhaps some real control on malpractice costs.

Assuming everyone will have insurance, I think the expectation is that by adding in a lot of young, healthy new insureds (who are now not insured by choice), there will be a larger pool of both insureds and premiums. The pool of individual policies now would not only be people who are sick. This levels out the situation, and also allows people to seek medical care before they are extremely ill.

The premiums actually could go down in this scenario, if the legislation is done very carefully and the premiums are affordable.

 

[RonBoyd]

Side-by-Side Comparison of Health Reform Bills’ Impact on Medicare

 

[JustNtime]

Assuming everyone will have insurance, I think the expectation is that by adding in a lot of young, healthy new insureds (who are now not insured by choice), there will be a larger pool of both insureds and premiums. The pool of individual policies now would not only be people who are sick. This levels out the situation, and also allows people to seek medical care before they are extremely ill.

The premiums actually could go down in this scenario, if the legislation is done very carefully and the premiums are affordable.

Sure sounds like smoke and mirrors, more people seeking more medical care sounds like more demand. Someone might be suggesting an once of prevention is going to be equal to pound of cure or perhaps even a ton of cure.

I doubt 'careful' will have much to do with how the bill gets done and 1900+ pages of 'careful' boggles the mind.

IF the premiums do become more 'affordable' it will either be because of gov't subsidizing them or OPM.

 

[DeborahB]

Sure sounds like smoke and mirrors, more people seeking more medical care sounds like more demand. Someone might be suggesting an once of prevention is going to be equal to pound of cure or perhaps even a ton of cure.

I doubt 'careful' will have much to do with how the bill gets done and 1900+ pages of 'careful' boggles the mind.

IF the premiums do become more 'affordable' it will either be because of gov't subsidizing them or OPM.

I know it may sound like smoke and mirrors but it actually isn't. By increasing the pool of insureds and having a lot more of them be healthier, the increased demand doesn't exceed the increased premium pool.

How to get the costs down? I would so much prefer single payer... Even my internist would go for it (I asked him). No one except extremely highly paid specialists likes current system and its paperwork.

I work for a large healthcare system (but in IT) so I've been around this discussion for years. That doesn't make me an expert but gives me a perspective that may not be the norm.

Of course my employer is NOT for single payer and freaks out at the possibility of payments going down. I forget what the official position is, but I didn't agree with it.

I think there has been way too much consideration to the insurance companies' "plight"... There are many systems in place to cover people nationally (federal employees' insurance, Medicare, VA...). I know I'm a lone voice but why they couldn't just make the big move and expand one of those... it's so irritating.

Maybe at some point the bill(s) will be comprehensible.... Maybe...

 

[JustNtime]

I know it may sound like smoke and mirrors but it actually isn't. By increasing the pool of insureds and having a lot more of them be healthier, the increased demand doesn't exceed the increased premium pool.
....
Maybe at some point the bill(s) will be comprehensible.... Maybe...

I think that's counter-intuitive too -- Adding more to a 1900+ page bill is more likely to lead to the incomprehensible...

"Increasing the pool of insureds" by coercing those who do NOT want and hopefully(likely) will NOT need coverage is definitely using OPM (other people's money) to reduce premium costs... Using fines, taxes on cadillac plans, deficits, etc is just more of the same. It all looks smoky to me and it does no good to tell me, 'PAY NO attention to the man behind the curtains'. If you follow the yellow brick road to DC -- you'll find little magic beyond making our tax dollars disappear...

 

[Martha]

"Increasing the pool of insureds" by coercing those who do NOT want and hopefully(likely) will NOT need coverage is definitely using OPM (other people's money) to reduce premium costs... Using fines, taxes on cadillac plans, deficits, etc is just more of the same. It all looks smoky to me and it does no good to tell me, 'PAY NO attention to the man behind the curtains'. If you follow the yellow brick road to DC -- you'll find little magic beyond making our tax dollars disappear...

I have no problem with a requirement to buy insurance or posting a bond or something to prove that you can be self insured. Unless you are very wealthy you cannot say that you will not needinsurance. Accidents and illness happens. Even to young people. And those uninsured young people are going to be looking for care if they get hurt or ill and someone is going to have to pay for that care. Failure to have adequate insurance doesn't just effect the person without insurance. So, OPM is already in use. (Or, you could bar them from treatment without proof of ability to pay, but we don't do that in emergency situations).

The young person says "I will take the risk" but they don't mean it. If they have a serious car accident they will expect to be treated in a hospital. If they get cancer, they will be looking for treatment.

Plus, if there is a bar on underwriting then adverse selection will occur if people are not required to buy insurance. This is what happened in states like New Jersey, making non-group insurance unaffordable for most.

 

[DeborahB]

I think that's counter-intuitive too -- Adding more to a 1900+ page bill is more likely to lead to the incomprehensible...

"Increasing the pool of insureds" by coercing those who do NOT want and hopefully(likely) will NOT need coverage is definitely using OPM (other people's money) to reduce premium costs... Using fines, taxes on cadillac plans, deficits, etc is just more of the same. It all looks smoky to me and it does no good to tell me, 'PAY NO attention to the man behind the curtains'. If you follow the yellow brick road to DC -- you'll find little magic beyond making our tax dollars disappear...

We'll have to agree to disagree. I think everyone should have some level of health insurance, because there is no way to predict when or if a serious health problem will occur. It could be a car accident, it could be cancer.

If you don't have health insurance (these are those young healthy people?) you do one of two things: go bankrupt if you have assets, or get paid for by the government (Medicaid etc.). OR, the hospital (often) absorbs the costs, which raises their expenses and forces them to charge more for service to the paying customers.

I also think this should be a federal program paid for by taxes.

Interesting site: www.pnhp.org Physicians for a National Health Program