Health Care Bill - Opinions & Reactions

Yay for me - I actually found it again! Of course, it would have been a lot simpler if I were at work today (snow day!) where I found it since I knew it was a Kaiser something or other comparison. They have a bunch of resources, and here are links to a few.

Here is one of their PDFs that compares 3 bills - the first column is the combination of both bills that the House passed on Sunday (Senate + Reconciliation), the second column is just the Senate bill (in case the Reconciliation doesn't pass the Senate for some reason), the third is the House bill which means a whole lot of nothing since that didn't go anywhere legislatively. It isn't light reading; it's still 40 pages. But at least it isn't the legal language and over 2000 pages like the actual bill!

http://www.kff.org/healthreform/uplo...bill_final.pdf


Summary of Coverage of Legislation (Senate Bill) (2 pages): http://www.kff.org/healthreform/upload/8023-S.pdf

Summary of Coverage of Legislation and Reconciliation (3 pages): http://www.kff.org/healthreform/upload/8023-R.pdf

You can also do side by side comparisons of bunches of different options, most notably what was signed into law and the reconciliation, as well as various different committees or individuals proposed.

http://kff.org/healthreform/sidebyside.cfm

Here is also a calculator for figuring how much you would be required to pay for insurance and what type of subsidy you would be eligible for.

http://healthreform.kff.org/SubsidyCalculator.aspx

And just for fun they have a really cool timeline of the History of Health Reform in the U.S. It doesn't say anything about what party did what or anything like that. Just an interesting thing to look at.

http://healthreform.kff.org/flash/he...eform-new.html

I read the whole thing, and I like it a lot. I think that it is not perfect, but IMO we do have many choices here; actually, much more than before, when all we had was the BIG old insurance companies we could or NOT afford. many times we were not given an option either. Now it seems to me we will be able to actually make choices. Everybody will also have more resposibilities for the actual human life here - the government, the patient himself, the employer, the insurance companies... I truly see this as a win win situation for everybody.
I do think there was a lot of uproar done before, and I really can not understand why. I don't see how this bill is a bad thing. I really really don't. Another thing that was really apparent to me, is that we are protected in this bill.
Before, we were at complete mercy of the Insurance companies - if they wanted to drop us, they did. If they didn't want to cover us? They didn't.If they wanted to increase the price at anytime? They did. If they wanted to impose a cap in the middle of your cancer treatment? They did.
With this bill we are protected. If that is not important... I am not sure what is... Because that is even extremely important on my cats insurance... let alone MINE!
Thanks for posting the link...

Re premiums, one of the deals is that now proposed premiums would be reviewed by state insurance departments - people often don't realize that before insurance companies could basically change premiums at will.

Also, the whole idea of the 'forced' insurance is to build up the pool of insureds - all insurance is basically based on the idea that you have a large group of insureds - some will need coverage now, some may not need coverage til later, some lucky few may never need it - but if everyone pays in a certain amount, the risk is spread over the years and, assuming the companies' investments are ok, there should be funds to cover everything.

Otherwise, you have the classic 'young healthy people' opting out of insurance until they figure they need it - but they haven't been helping to build the balance, if you would, of the funds accumulating. My firm always requires insurance coverage for everyone - for many many years I never really needed it, but my money went in as premiums. Now, I do need some coverage. I figure it's a balance.

That's one of the things that drove so many people crazy about insurance - the concept of at will recission - companies happy to take your money but then being able to drop you the moment you actually start needing coverage, and your premiums now not covering the cost of care, so bye-bye.

Obviously, even the youngest healthiest person could be hit with health issues - leukemia, let's say, or perhaps a major accident. And some folks are blessed enough to hit their 90's with no major needs. Most of us fall in the middle if we're lucky.

Also, two things that should appeal to people, I think, is that pre-existing conditions will no longer be 'fatal', if you will, toward obtaining coverage. Many of you may know someone with Type 1 diabetes, for example - up to now, getting insurance as an individual was almost impossible, no matter how much you'd be willing to pay. Also, I believe the idea of de-coupling insurance coverage from the almost absolute need to work for a large company should be good in the long term - smaller companies would be able to compete on benefits available to potential employees, and people shouldn't feel trapped by needing insurance and not being able to change a job just because of that. Even when jobs were more plentiful, how many of us knew at least a few people who feared to change careers because they were worried about coverage.

Granted, a lot of people in their 20's don't think a lot about this - it only becomes urgent if you end up needing to pay large medical bills and realize you don't have the resources. There was a recent story in the Chicago Tribune about a young man, 35, diagnosed with leukemia - he worked at Menards and had selected insurance that paid out only $50,000 a year in benefits (he says he didn't realize that there was a cap - can't say for sure, but a lot of times those application forms can be confusing). Anyway, with that cap, he was denied admission by a local hospital - luckily, he found another doctor and hospital willing to admit him - although that hospital would be eating the excess costs. $50,000 may sound like a lot, but, believe me, it's nothing. Even a routine colonoscopy runs $10,000 to $15,000, so you can imagine how much effective leukemia treatment runs.

My best friend runs a small business (she couldn't afford health care for either herself or her employees) and her husband is a Type 1 diabetic. He's stuck in a large corporate firm because they must have health insurance. He's been wanting to quit his job to help his wife run her business but couldn't do it because no one would cover him. They are ecstatic over this bill.

My sister has a daughter that is about to turn 22 and in college. Her daughter works to pay for her college, but won't be through with school for a couple of years and can't find a job where she can work enough hours to get health coverage. She was going to have to drop out of college and get a full time job had she wished to be covered. My sister wanted to keep coverage for her but couldn't until this bill passed. My sister is very happy.

DH and I have been stuck in corporate jobs for years just so that we can have coverage. I was laid off last December (and decided to retire from a corporate job) but am still too young for medicare. DH is now stuck in a corporate job and we both wanted alternatives to where we chose to work. We now have that and we're happy.

The bill gives a lot of people the flexibility to pursue alternatives. To me, it's a civil right.

Absolutely - for me, I see nothing but added choices, and protection for US, the citizens... I think it is excellent - very happy with it.

Well it appears I would qualify for medicaid which for me would be a blessing as I have always forked out at minimum 20% of income to health insurence ... right now I pay out roughly 100% of what I bring in to my insurence company

I think we are going to see massive tweaks of it before it actually affects most people. Just as an example, it turns out that those who passed it THOUGHT it prohibited denying coverage to children with pre-existing conditions this year. Turns out it doesn't.

However, my personal bet is that 3 years from now, there will be as many people as ever without insurance. I can even imagine the number going up, due to people knowing that they can wait until they're sick to buy insurance. Maybe closing that loophole will be one of the many fixes.

I think there is much to like in the bill, but, like almost all such bills, the cost was way low-balled. For an example, the CBO at the time of the passage of Medicare estimated its cost as $8,000,000,000 in 1990. The actual cost in 1990 was $110,000,000,000, or almost 15 times the original estimate.

And there is a looming crisis. Medicare this year is going to be bringing in less than its spending, for the first time. That means the Social Security system is going to have to start cashing in its Treasury Department IOU's six years earlier than the most recent estimate.

Some believe that there will have to be a massive tax increase to fund the program, perhaps a national sales tax. That might not be too serious...although, can you stand to have 2% less income next year? If you made $20,000, that would be $400 less.

But all of it is speculation, because, as I said, there will undoubtedly be a lot of problems discovered as the regulators actually start to implement the bill as written.

I plugged in the survey too and I was also qualified for medicaid. Who knew I was THAT poor! My SIL thought it was funny and said that would also qualify me for food stamps. But she's probably right. Hmmm...can you use food stamps for pet food?

Maybe someone saw this, I haven't come across it yet. The only qualifiers I found were by annual income and age. Where does it address assets?

I thought it will be illegal not to have insurance???
The big problem that is a bit unfair when it comes to denying for pre existing conditions, as I understand it as that when you change insurance, or your insurance decides not to cover you at all anymore and you have to find a new one..
With my insurance the first year you're on it, only 60% of bills are covered, 2nd year it's 70 and then on the third year it's 80%..It's more complicated than that but this is the general idea...
So even if they don't deny you for pre existing conditions it's to your benefit to stay on the insurance because on the first year, they are making money and you're at a loss for having it.

You know, I saw that sales tax issue brought up elsewhere too. We've been fighting it in Oregon for decades since we already have a state income tax and property tax. The theory that everyone actually pays then makes good sense, but it's an additional tax that we would never see go away. I was surprized at the percentage of people who pay zero in federal taxes. (I'll try to track down the statistics) It stated that many low and lower middle income people were added to that percentage by George Bush's child credit. (vs those who just don't make enough) Apparently AMT was put in place to keep the wealthy from being able to completely offset their taxes? But with SS, Fannie, Freddie, USPS, Medicare, etc., all unable to keep their heads above water, I too would be surprised if they hit the nail on the head with the cost of healthcare reform.

utOpia, my dental insurance is like that. I didn't know health plans were set up that way too. Maybe with the reform you'll have something better to chose from. I may not have a correct understanding, but I thought there could be a cost involved with not carrying insurance, which might be less costly than paying for coverage. That would allow people to wait to get insurance until they had a problem and needed it. Mrblance will be able to explain it.

Speaking of dental... is it included at all in the reform package? I just worked 5 full days to pay for a crown, and I HAVE dental insurance.

Finally something I actually know an answer to....Nope cant use food stamps for pet food.....I asked when I got approved for mine...

It won't be "illegal" inasmuch as there is no judicial court, no criminal record, and no threat of jail time. But, the maximum fine you would have to pay is 2% of your income, but depending on your income insurance can be (must be? not sure...) 9.8% of your income. It doesn't take a rocket scientist to figure out which one comes out ahead, fiscally, if you're young and healthy and don't see the need. (Note: I have ALWAYS had insurance - the only time I was out of insurance was between jobs many years ago, but the last time I was between jobs (2001) I kept it with COBRA. I have never been one of those people who didn't see the need.)

As far as not covering with a pre-existing condition, in my experience and as I know the laws of Colorado, that can only happen as an individual buying insurance. If you enroll in a group plan, i.e. through an employer whether or not they cover any part of the premium, you cannot be denied nor can rates fluctuate individually. It also makes a difference if you are going from continuous coverage or a lapse in coverage. If you lapse even one day it's a whole new ballgame. I'm not sure how all of it works - it's very, very complicated.

I do think it was a sham to be saying all along that the pre-existing conditions clause for children, at least, was ended this year to get the votes and get support for the votes when that wasn't the case. Someone knew that wasn't in there before it was passed. Funny that it just comes out days after it's passed.

There are so many of those clauses that they pushed so hard that don't kick in until 2014 or later. I know it wasn't "lying" but it certainly was kind of an "error by omission" type of thing; like they were mumbling parts under their breath. In Amy's example of how people don't have to be scared to leave their jobs since the bill passed....well, yeah they still do for at least 3 more years. Maybe more, depending on how various things play out.

I'm trying to put together a list of things that I, personally, like and dislike as a conservative and as someone who does use insurance more than most. I'll get back atcha with that one.

Based on the reaction of the bill by many people, I would say that no one did a good job at advertising it's content prior to signing, and while available online, it was too big and under too many revisions to take the time for the general public to read it.

And just to clarify - I never implied that people could leave their jobs now. What I like is that I will get that option eventually. It is better to know that I'll have that flexibility in the next few years, rather than feeling trapped because nothing at all was done about health care.

What I don't like about the bill is that it didn't take a strong enough stand to regulate the insurance companies, nor did it contain a public option. I'm hoping to see these things addressed in future legislation. While I'm disappointed it's not in there now, the topic is so huge that I didn't expect a complete bill first time through.

I kind of figured that, but I would have asked too. OT I know, but I would imagine food stamp money does feed pets anyway, it's just not pet food. It's people food!

That sounds like how it works in Oregon too.

Amy, I knew that you completely understand that option isn't available right now. You are smarter than the average bear, and much better informed.

But the problem is exactly what you're referring to in the first paragraph there. Very few people had any idea what the bill actually included and didn't include, including the people who voted for or against it, before it was signed into law. They knew the talking points from both sides - best thing since slice bread/Armageddon-end of the country. I doubt the majority still do. I know I don't know for real what is and isn't in the bill. I know the big stuff, and I know some of the not so big stuff. But I don't think that anyone except the people who actually wrote the bills really know what's in it - and I doubt even they know the full extent because it wasn't just one or two people who wrote either the first bill or the reconciliation!

I'm sorry to hear your insurance didn't cover that. I asked this question several months ago on Yahoo and no one knew the answer. I can only guess dental is not included in the reform bills.

So I imagine whatever currently stands, stands. (?)

A great question worth repeating. And let's also remember there are super dentists (I don't know the official terminology, but I mean periodontists, orthognathic surgeons, etc., etc., etc.) not just the regular dentist.

I wonder how many people will say "Hey Obama, we need dental too!" (This last comment is not meant to be incendiary. I'm gonna hang out on the sidelines and listen for that type of national cry, if it comes. i.e., via a media story, etc. ...I don't mean cry-outs here on TCS - I mean on a national level)

I like how you say "only" as if the employer-based group plans are the standard by which all plans should be judged. I thought one of the goals of the reform was to bring the individuals and self-employed out of the cold. Sure group coverage is great - but who can count on it anymore these days?

It will be interesting to see that list, as I remember from previous discussions that you did think we needed a reform, just didn't agree with the proposed legislation (if I am remembering correctly)

It is unfortunate that there is this ambiguity in the bill with denying children for pre existing conditions, but as I understand it, it is only something they didn't think through correctly, and are planning on fixing it..
I found this article where they say what they plan to do to fix it:
I really hope they do fix it.
Apparently, after the bill passed, public opinion became more favorable, according to gallup poll 50% of Americans are happy with the bill as of March 22, as opposed to 34% that were reported before the bill passed..

Can I ask a question about the health care bill...Maybe one of you guys can help me figure this out.

So basically the ball is rolling on BF starting his own business. His brother will be investing in it basically taking care of the financial situation with them having partnership papers done. Regarding health care and this new bill because of him being self employed and running his own business how would this effect him getting health care for him and I? At some point in time (Id prefer sooner rather than later) we have talked about having a kid so of course insurance would be something we would need at that point in time. So basically my question is how would this bill effect him being self employed (not having other employees) with getting insurance and keeping insurance especially with my pre existing condition and his family history of heart problems????

I have no idea if I even worded that right and I dont even know where to begin looking for information on that kind of stuff...

And the problem there is that many doctors (perhaps MOST doctors) are not currently accepting new Medicaid patients, since they say they are losing money on every one of them who comes in the door.

Almost 50% of wage earners in the U.S. pay no Federal Income Tax, only SS and Medicare taxes.

And the top 1% of payers pay almost 50% of all Federal Income Taxes.

Well, you'll have to pay a fine. But it maxes out at 2.5% of your income. If you're making $30,000, that would be $750, or about what one month of health insurance actually costs. Therefore, it would be cheaper to pay the fine each year, and wait until you're in need of insurance to buy it.

It's a little like requiring life insurance companies to sell you life insurance after you've died.

Here's the short answer (we're heading out the door and DH is giving me the eye):

Short run - if you don't make much/any money in the first few years of business (typical of any start up), you'll be eligible for Medicaid.

Long run - after 2014 you can get any insurance, no pre-existing conditions apply.

But you'll have to pay for it, and it's not a case of "you CAN get it," it's a case of "you must get it, and be able to prove it to the IRS."

I usually fall into that category on my federal return, especially if I'm able to put something in my IRA. The state on the other hand is a whole different story. They only exempt $1945 in income and the tax credit is around $170. So, unless you have some two legged deductions, you're gonna pay.

It is odd that many people presume the rich pay no taxes.

So more people will qualify for Medicaid, but many doctors won't accept it? That must be one of those wrinkles that hasn't been ironed out yet.

just a "small" wrinkle there as in many to most places doctors limit or no longer take new medicaid patients

Superb point. Let's hope doctors and providers won't be forced to take Medicaid. That would be ugly (i.e., substandard care) and create bad feelings. But on a much less ugly note, i can envision a new market/new demand. ...or ...if that's too optimistic, then I guess community clinics will see a sharp rise in business.

Time's latest issue has an interesting article on the the health care reform which summarizes the changes and discusses potential benefits and problems: America's New Prescription