Saturday, August 1, 2009

Final House Bill on Health Care, for now.

This is the plan I can endorse. I don’t like the 12 year lock on new drugs by big Pharma, or the HHS secretary negotiating prices instead of Medicare fees plus 5 percent, but that’s how it looks right now. The Republicans plan is irresponsible, the current private sector mess on steroids, with no ability to rein in prices. If there ever was a plan that would guarantee people losing their current insurance plans, it would be from the Republicans, where they would encourage businesses to "opt-out" of offering health coverage. No estimates, costs, new taxes and no mandates. That’s a plan?

Democrats narrowly, 31-28, pushed sweeping health care legislation and cleared the way for a September showdown in the House. From the Salt Lake Tribune, the House Democrat Proposal:

The committee agreed to cap increases in the cost of insurance sold under the bill, and also to give the federal government authority to negotiate directly with drug companies for lower prices under Medicare.

2. The panel handed the drug industry a victory, voting 47-11 to grant 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases.

3. Democrats also turned back a Republican bid to strip out a provision allowing the government to sell insurance in competition with private industry. Insurance companies would be required to sell coverage to all seeking it, without exclusions for pre-existing medical conditions.

4. The federal government would provide subsidies for lower-income families to help them afford policies that would otherwise be out of their reach. Individuals and families with annual income up to 400 percent of poverty level ($88,000 for a family of four) would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.

5. The bills would set up so-called exchanges, in effect national marketplaces where consumers both with and without subsidies could evaluate different policies and choose the one they wanted.

6. The main expansion of coverage would not come until 2013 -- after the next presidential election.

7. On a vote that crossed party lines, abortion opponents failed in an attempt to bar insurance plans that offer abortion services from accepting customers with government subsidies. The vote was 31-27. The government could neither require nor prohibit abortion services in insurance plans sold in the exchange.

8. Around 94 percent of non-elderly residents would be covered -- compared with 81 percent today. Nearly half the 17 million non-elderly residents who remain uninsured would be undocumented immigrants.

9. Cost : About $1.5 trillion over 10 years. Revenue-raisers would include $544 billion over the next decade from new income taxes on single people making more than $280,000 a year and couples making more than $350,000; $37 billion in business tax increases; about $500 billion in cuts to Medicare and Medicaid; sizable penalties paid by individuals and employers who don't obtain coverage. The penalty would be 2.5 percent of income.

10. Employers would have to provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payroll under $250,000 or $500,000 annually would be exempt. Employers could apply for a two-year exemption from the mandate if they can prove that the requirements would result in job losses that would negatively affect their communities.

11. A Health Insurance Exchange would be open to individuals and, initially, small employers; it could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules.

12. A committee would recommend an "essential benefits package" including preventive services, mental health services, oral heath and vision for children; out-of pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange and over time would become the minimum quality standard for employer plans. Insurers wouldn't be able to deny coverage based on pre-existing conditions.

13. Government-run plan: A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services. Democrats originally designed the plan to pay Medicare rates plus 5 percent to doctors, but under Wednesday's deal with the fiscal conservatives, the HHS secretary would instead negotiate rates with providers.

14. Changes to Medicaid: The federal-state insurance program for the poor would be expanded starting in 2013 to cover all non-elderly individuals with incomes up to 133 percent of the federal poverty level ($14,404).

House Republican Proposal

1. Who's covered: The House GOP's plan contains no estimates about how many additional people would be covered. Cost: Unknown. No new taxes are proposed, but Republicans say they want to reduce Medicare and Medicaid fraud.

2. Requirements for individuals: No mandates. Requirements for employers: No mandates; small business tax credits would be offered.

3. Employers would be encouraged to move to "opt-out" rather than "opt-in" rules for offering health coverage.

4. Subsidies: Tax credits would be offered to "low- and modest-income" Americans. People who aren't covered through their employers but buy their own insurance would be allowed to take a tax deduction. Low-income retirees under 65 (eligibility age for Medicare) would be offered assistance.

5. Benefits package: Insurers would have to allow children to stay on their parents' plan through age 25.

6. Government-run plan: No public plan.

7. How you choose your health insurance: No new purchasing exchange or marketplace is proposed. Health savings accounts and flexible spending plans would be strengthened.

8. Changes to Medicaid: People eligible for Medicaid would be allowed to use the value of their benefit to purchase a private plan.

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