Senate HC bill

[teejayevans]

Here is some info, include health care bill full text, but the summary pdfs
are helpful: The Patient Protection and Affordable Care Act
Note the one about how this will benefit early retirees.
I understand this is a moving target, but if you ignore the public option
and abortion stuff, most of the other stuff still applies.
TJ

 

[REWahoo]

I don't think anything in this sales brochure should be relied upon until the senate and house bills are reconciled.

 

[Gone4Good]

I don't think anything in this sales brochure should be relied upon until the senate and house bills are reconciled.

True, but the Senate version is probably going to survive reconciliation mostly intact. Getting 60 votes was such an [-]expensive[/-] painstaking and delicate process that any major changes away from the Senate's version will likely result in failure.

 

[Gone4Good]

If you ignore the larger ideological issues that ordinarily surround this bill, the net impact for most individual early retirees getting insurance from the private market is likely to be positive (IMHO).

Positives include:
1) Coverage of pre-existing conditions
2) Community ratings
3) National scope
4) Ban on rescissions
5) No asset test
6) Subsidies based on income

Negatives include:
1) Likely increased premiums (pre-subsidy) for healthy people in low cost states . . . premiums could go up before the subsidies start in 2014.

 

[mountaintosea]

Thanks TJ. And thanks for the summary.

 

[samclem]

Negatives include:
1) Likely increased premiums (pre-subsidy) for healthy people in low cost states . . . premiums could go up before the subsidies start in 2014.

I would add:
2) Increased potential for loss of any private insurance coverage presently offered.

Best hopes now (for those who oppose this thing)
- Elected reps back home get an earful and get cold feet. Many are not in "safe" districts and might not be able to afford to follow Speaker Pelosi off the cliff.
- The deals struck by Senators Nelson and Landrieu will rightly serve to motivate other senators and Congressmen to seek their own special carve-outs--or they will not vote for the bill. Everyone who gave away their vote without getting a slice or pork should feel like a chump. At some point the monstrosity collapses of it's own fat.
- The abortion issue kills it
- The Supreme Court drives a stake through it. There's no precedent for the federal government forcing all citizens, as a condition of citizenship, to buy any product from a private company. Some more on the constitutional issues (warning-Heritage Foundation link, so some will take issue with its impartiality). I favor a personal mandate as a practical matter, but I think the constitutional issues are real.

 

[Martha]

I really hope it doesn't die, as problematic as it is. But odds are we end up with a bill that looks like the senate bill. Work on the issues later, at least we have something to work from.

If there is a constitutional issue (which I haven't thought about much), add back in a public option later.

 

[nwsteve]

We can also forget having much in the way of choice when it comes to how you want to manage your healthcare cost. As this article points out, once fully implemented everyone will be limited to using coverage from one of four plans that Feds decree as adequate. Like medicare, you wil not be allow to pay for additional services not covered out of pocket. No matter what your personal priorities and needs are, we are all to be treated the same
ObamaCare: No exit - NYPOST.com
The article also points that even those getting coverage from employers will ultimately not have any additional choices no matter what they may have now.
Personally I find it offensive there are governmental subsidies for families with 400% of poverty level($86K) of income. This has got to be one of the biggest transfer payment shams of the century.
If anyone is on the fence about converting their IRA to Roth, it might be good to reflect just how high our tax rates will be to pay for this 'slight-of-hand"
Nwsteve

 

[ERD50]

As problematic as it is, I really hope it DOES die - samclem points out the reasons that it just might.

And if it does die, maybe Congress will wake up and start taking some small steps to actually address some of the issues. I'd bet the public could actually get behind some small, understandable bill that clearly did some good and didn't need "compromises" (the new word for pork) to get it passed. Get that one passed, see the benefits and them take another small step. Keep going until we have actually solved have a good portion of the problem.


-ERD50

 

[Bikerchick]

I think we'll be stuck with it this year - ensuring the administration's place in history. Many others tried and failed... clear back to the Nixon years. From what I've experienced in large private and public institutions I expect to see many people thrown at the problem and not necessarily in the most efficient way.

 

[frayne]

Does anyone have any idea how HSAs are going to be affected by the bill ?

 

[Martha]

Does anyone have any idea how HSAs are going to be affected by the bill ?

IIRC, HSAs will still be around but if you use the money for non-healthcare expenses the tax on that money will be incurred at a special high rate. Also, I think all heath savings accounts are going to be restricted on use for non-prescription drugs.

 

[easysurfer]

Views whether for or against the bill, do you think any chance lets say a new administration comes in office the health care overhaul will be overhauled again. I won't want a Lily Tomlin, all these changes, then a "oh well, never mind..."

 

[Gone4Good]

We can also forget having much in the way of choice when it comes to how you want to manage your healthcare cost. As this article points out, once fully implemented everyone will be limited to using coverage from one of four plans that Feds decree as adequate.

Ok. But right now I'm limited to the three plans my employer offers. I don't believe I have the ability to "opt out" of my employer provided coverage and get something else on the private market or go with no coverage at all (probably to protect the firm from healthy people ditching their plans for lower cost ones).

So I'm not really sure why I'm supposed to get upset about losing a choice I don't currently have. (Assuming I even lose that choice as most of the NY Post article is highly speculative).

All of which brings us to the question of whether you'll be able to spend extra money to add benefits that exceed the government's basic package or opt out of that plan entirely. The bill doesn't address this question directly — but . . .

 

[samclem]

Views whether for or against the bill, do you think any chance lets say a new administration comes in office the health care overhaul will be overhauled again. I won't want a Lily Tomlin, all these changes, then a "oh well, never mind..."

Not Lily Tomlin but Gilda Radner as Emily Litella--right?

It's highly likely there will be major changes or even a scuttling of the plan as the Congress and/or Senate changes control. Every other major entitlement expansion (Medicare, Social Security, etc) enjoyed more support across both parties than this effort has received--this looks to be a straight party line vote and that's not a good foundation for permanent change. The proposed Senate bill is unpopular already, and the taxes start soon while the big "free goodies" which might sway votes don't begin to flow until 2014, so there will be two elections between now and then in which people can vote for change. Unless the public falls in love with this plan once it gets a good airing, the new legislators will come with a strong mandate to fix this.

It would be a lot cheaper and better for everyone to do something closer to right the first time, but there's just a lot of desire in some circles to get something, anything, passed. And it is gonna be a doozy.

 

[REWahoo]

Not Lily Tomlin but Gilda Radner as Emily Litella--right?

YouTube - Gilda Radner Nevermind

 

[ERD50]

The proposed Senate bill is unpopular already,

Thanks for that link. What really struck me, is not that the average of all those polls shows 51% against, 38.4% for (12.6% spread), but that EVERY ONE of the nine polls in their average has more opposed than for. Seems rather decisive.

-ERD50

 

[teejayevans]

You need two willing parties to negotiate. The Dems gave up things that were important to them (most notably single payer or even a "public option"). They gave up so much so that the leftwing base is calling the bill a "sell out". (Part of the reason the bill's unfavorable rating is so high in opinion polls is because liberals don't think the bill is strong enough). So now that the public option is gone, where is support from all of the Republicans who said that was a deal breaker?

The biggest problem is the timeline, the heart of the reforms don't take
effect until 2014. I can't understand why this is the case.
TJ

 

[REWahoo]

The biggest problem is the timeline, the heart of the reforms don't take
effect until 2014. I can't understand why this is the case.
TJ

As I understand it, the delay was a way to make the cost numbers look more palatable. The funding mechanisms go into effect three or more years prior to the benefits kicking in to allow the build up of a "bank account" for the programs. Without this, the advertised ~$900B cost of the program over the next ten years would be substantially over one trillion, making the bill even more difficult to sell to the public and unacceptable to Obama.

 

[easysurfer]

Not Lily Tomlin but Gilda Radner as Emily Litella--right?...

Yeah, that's right. Gilda Radner. I got the two confused

 

[Trek]

Wonder how they'll deal with Americans retired abroad who have health care already. I assume (probably shouldn't) that if you're not a resident and don't have to pay US income tax, you won't have to buy US health insurance.

But more interesting would be folks (retired or otherwise) that have foreign healthcare but are US resident for tax purposes. For example, say you spend part of the year in Mexico at your condo and pay into the Mexican healthcare system and have all your medical problems treated there. However most of the year you live at your permanent residence in the US. Will you have to buy expensive US healthcare by law? Or would proof of foreign health insurance satisfy the mandate?

 

[teejayevans]

As I understand it, the delay was a way to make the cost numbers look more palatable. The funding mechanisms go into effect three or more years prior to the benefits kicking in to allow the build up of a "bank account" for the programs. Without this, the advertised ~$900B cost of the program over the next ten years would be substantially over one trillion, making the bill even more difficult to sell to the public and unacceptable to Obama.

But the reforms: no longer excluding coverage based on pre-existing conditions, premium limitations of 3:1 based on age, health insurance
exchanges for individuals doesn't cost any money??
If it passes as is, wait for sometime before 2012 election when you'll
see stories of people unable to get health insurance.
TJ

 

[ziggy29]

I just hope all those [-]bribes[/-] special promises to secure sweetheart deals to get those last few votes are burned at the stake in conference. That wasn't one of the finer moments of the sausage-making process.

 

[oliverdickens]

Can someone please explain what the Re-insurance for Retiree Health Insurance Plans provision means? States that early retirees will be provided immediate re-insurance access to employers health plans that provide coverage for early retirees.

We are currently covered by my former employers self insured plan which offers some but very limited coverage at a high price. ie $650/mo for both of us with no coverage for doctors visits, $2000 ded, no drug coverage, $1mm limit. Premiums increase about 10% each year.

Will this provision improve anything. Makes no sense to me, but sure someone can explain.

Thanks

 

[M Paquette]

Can someone please explain what the Re-insurance for Retiree Health Insurance Plans provision means? States that early retirees will be provided immediate re-insurance access to employers health plans that provide coverage for early retirees.

We are currently covered by my former employers self insured plan which offers some but very limited coverage at a high price. ie $650/mo for both of us with no coverage for doctors visits, $2000 ded, no drug coverage, $1mm limit. Premiums increase about 10% each year.

Will this provision improve anything. Makes no sense to me, but sure someone can explain.

Thanks

The 'self-insured' employers providing retiree insurance normally carry all of the risk themselves. That is, if a retiree comes down with a really expensive medical problem, the self-insured employer has to come up with the cash to cover the insured portion of the bill.

The proposed legislation allows for something called re-insurance, which lets the employer buy insurance against an unexpected expense in the employers own coverage of retirees. This Re-insurance for Retiree Health Insurance Plans provision is transparent to retirees. The biggest effect is that it would make the former employer much less likely to cancel retiree coverage, as the employer could participate in a larger risk pool, the re-insurance pool, to reduce their risk and make the financing of retiree insurance more predictable.