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Health Care Bill - Opinions & Reactions - Page 2

post #31 of 34
4/1/10 at 9:32am
http://www.american.com/archive/2007...pays-the-taxes

Quote:
2. What income group pays the most federal income taxes today?

The latest data show that a big portion of the federal income tax burden is shouldered by a small group of the very richest Americans. The wealthiest 1 percent of the population earn 19 percent of the income but pay 37 percent of the income tax. The top 10 percent pay 68 percent of the tab. Meanwhile, the bottom 50 percent—those below the median income level—now earn 13 percent of the income but pay just 3 percent of the taxes. These are proportions of the income tax alone and don’t include payroll taxes for Social Security and Medicare.
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post #32 of 34
4/1/10 at 3:41pm
Maybe this is going to be a lesson in futility on my part. I hope someone actually reads it here and thinks enough of it to comment. My sincerest hope is that it sparks more conversation. Civil conversation about why people support some things I don’t, or why they oppose some things I like. It isn’t short – it was 7 pages, single spaced. Needless to say, I spent a whole lot of time on this, mostly because I wanted a better understanding of what is (and is not) included in this “Health (Insurance) Care Bill†that has been signed into law.

This was based on the document from KLL, linked to on the first page of this thread which has the basic details of the House Reconciliation Bill. The Senate changed a couple of things and sent it back, but I assumed that the vast majority of it wasn’t changed. I went through point by point and the things I thought stood out as positives and negatives were noted. Things that were neither, or were “meh†pro or con I just didn’t comment on. Although my eyes feel like it, I didn’t read the entire legal wording. I also assumed that the interpretation by KLL of the legalese was accurate.

For where I stand politically on Health Care specifically: I wouldn’t go so far as saying that it is a “right†to have health insurance or make the health care that is available to the top paying patients available to all. While I think that having food is a right, I don’t think that the top restaurants in the US should lower their prices or have a government subsidy to make their menu available to everyone. Just the same as while I think that having money shouldn’t put someone on top of the transplant list, I don’t think less of Steve Jobs for using his money to get a liver transplant ahead of others by finding a private donor.

This is based on a conservative standpoint, or at least my standpoint which isn’t 100% “right wing conservative†since I am, generally speaking, conservative in matters of government and socially libertarian. Governmentally, that means I prefer a small federal government except as needed, i.e. for necessary regulatory issues and the military. I would prefer to keep the rest as local as possible, although I recognize that isn’t always practical or feasible. I am also a strong believer in capitalism and believe that a free market, with a few exceptions, will regulate itself via supply and demand. Socially I mean that when it comes to my personal freedoms I want the government out of my business – stay out of my bedroom, stay out of my kitchen, and stay out of my body. Frankly, I wish this particular Bill hadn’t passed but since it has here are my thoughts on it.
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post #33 of 34
4/1/10 at 3:47pm
Pros:
There are definitely some positive points about this legislature. There are parts that will definitely help a tremendous amount of people.

Bill Basics
  • Military health benefits are NOT affected.
  • Members of Congress and their staffs will be required to take part in their State run Exchanges by 2014 – just like the rest of us. YES!
Individual Requirements: See Cons.

Employer Requirements:
  • Employers are required to offer insurance to everyone employed full time.
  • Offer Free Choice Voucher to employees who wish of opt out of insurance offered by the company. BUT (and it’s a big one!) I don’t like the clauses – if employee makes less than 400% FPL whose contribution is between 8-9.8% of their income.
Expansion of Public Programs:
  • Medicaid available to people even if they don’t have dependent children, based solely on income. What a concept! Level the playing field for people who aren’t popping out kids when they can’t afford them!
  • Medicaid funding assistance by the federal government to states who will have to implement the new guidelines. Too many bills in general only tell the states what to do, and even though there will be large increases in costs there isn’t one cent from the feds to assist (i.e. No Child Left Behind).
  • Requiring verification of both income and citizenship status to receive subsidies. I’m sure there will be some who figure out how to bilk the system, but the more checks the better. It won’t be a hardship for the honest, but may be a deterrent for the dishonest.
  • Medicaid will be available to LEGAL immigrants for the first 5 years before they are eligible for subsidies. If they are here legally, they should receive Medicaid if they are unable to afford other health insurance.
Creation of insurance pooling mechanisms
  • Creating a system that levels the playing field for small businesses vs. large corporations to be able to purchase health insurance for or on behalf of their employees. Currently it is very much biased toward
  • Subsidies to those who cannot otherwise afford insurance, so that everyone can buy health insurance of some kind to ensure access to some health care
  • Co-ops are not to be government run (+) but not an existing insurer (- ) formed at least one in every state.
  • Catastrophic plans still available to those under 30 with less risk.
  • This is where the guarantee issue and renewability clause is at. So pre-existing conditions, etc. are done away with only if you get into a public plan, or possibly group plan?
  • “Out of Pocket Limit†has limits. (Don’t bank on that being the total that you’ll spend, though. My current plan has those “out of pocket limits†too. I’ve never reached that, but I have gone well above the 7.6% of my income to have it count as a deduction on my taxes.)
  • Allows states to determine if they will allow abortions to be included in the Exchange plans.
  • Which then begs the question…if these Exchanges are granted funds from the Federal government, whether in the form of funding to start up or accepting Subsidies, then would the Federal government actually be funding abortions, which is illegal due to the Hyde Amendment in 1976, that has been an amendment to appropriations bills and passed with either party in control. While Obama didn’t have the actual authority to ensure this with his Executive Order, it certainly is a written statement that he would abide by the Hyde Amendment with this legislation. Campaign promises may be easily forgotten, but that won’t be.
Changes to Private Insurance
  • Adopt standards for financial and administrative transactions to promote administrative simplification. Should help reduce overhead costs on both sides, the physicians and the insurers!
  • Allowing a child to stay on parent’s insurance up to age 26. I’d prefer it if there were a stipulation about the child continuing their education, but it’s OK as it is. Hey – it’s hard getting yourself established!
  • Establish an internet website to help residents identify health coverage options (effective July 1, 2010) and develop a standard format for presenting information on coverage options (effective 60 days following enactment). – Sure will be nice for the patients; sure will be a pain for the providers, though.
  • Prohibits lifetime limits on the dollar value of coverage. :yay:
  • After 2014, prohibits yearly limits on the dollar value of coverage.
  • Fixed the child-pre-existing condition clause so it does go into effect 6 months following enactment in the Reconciliation.
  • Limit deductibles.
  • Limit waiting periods to 90 days. (2014)
  • o Permit states to form health care choice compacts and allow insurers to sell policies in any state participating in the compact. – it’s closer to interstate sales of insurance than we’ve ever had…but – there are CONS to this clause too.
Cost Containment:
  • Authorize the Food and Drug Administration to approve generic versions of biologic drugs and grant biologics manufacturers 12 years of exclusive use before generics can be developed. (Effective upon enactment) – Generally a good thing since patent currently last 20 years, which is the earliest time that Generics can be offered.
Long-Term Care:
  • I like that it is a consideration, through voluntary payroll deductions. I don’t like that “voluntary†means that you are automatically enrolled unless you opt out.
Other Investments - Medicare:
  • The “Drug Gap†is finally being closed, to an extent. People will still have to pay 25% of the drug cost which is much better than 100% currently!
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post #34 of 34
4/1/10 at 3:55pm
Cons:
While there are good points to this bill, I personally still think the bad parts far outweigh the good.


Bill Basics
  • If funding the bill with increased taxes and fees for 4 years before implementing the main parts is the only way to make it “balance†for the 10 year report by the CBO, then it’s not a budget neutral bill. For anyone who bought that load, I think there’s some ocean front property in Arizona that’s for sale…
  • There is a LOT of new government bureaucracy, government committees, and governmental rules in areas where I don’t think the government has any business. I have only seen committees, especially government committees, muck things up instead of “fixing†a system with problems already. Bureaucracy does not make anything run smoother, cheaper, more efficiently, or more effectively. Period.
Individual Requirements:
  • Requiring an individual to purchase anything that they feel is necessary or face penalties if one chooses not to. I’m not a Constitutional lawyer or expert, but I don’t think that is Constitutional.
    • If you are going to make it stick, then making the amount you’re supposed to pay for insurance at least 8% of gross income and then the penalty maximum 2.5% sure doesn’t make sense to me.
  • Some (not all!) of the exemptions detailed below: Exemptions will be granted for financial hardship, religious objections (click for explanation), American Indians, those without coverage for less than three months, undocumented immigrants, incarcerated individuals, if the lowest cost plan option exceeds 8% of an individual’s income, and if the individual has income below 100% of the poverty level.
    • Financial Hardship – Would need to read up on this one. If this is an exception from insurance, what happens if someone under this exemption needs medical care? How long does “financial hardship†last? What circumstances does “financial hardship†apply? If these aren’t spelled out, it’s written badly.
    • Undocumented immigrants. Nope, don’t agree with this one at all. No subsidies, yes. I’m quite sure that they cannot be denied treatment, and in most cases I completely agree with that (as long as they aren’t using the ER as their family physicians). But then who picks up the tab if they skip out on the bill, because they aren’t required to have insurance? If it’s OK to require American citizens to purchase health insurance, it’s good enough for anyone living in the U.S.
    • If the individual has income below 100% of the poverty level. If this is the case they should qualify for Medicaid, which would grant them state supplied insurance. No need for an exemption.
Employer Requirements:
  • Require employers that offer coverage to their employees to provide a free choice voucher to employees with incomes less than 400% FPL whose share of the premium exceeds 8% but is less than 9.8% of their income and who choose to enroll in a plan in the Exchange.
    • Offer Free Choice Voucher to employees who wish of opt out of insurance offered by the company is a Pro. BUT (and it’s a big one!) I don’t like the clauses – if employee makes less than 400% FPL whose contribution is between 8-9.8% of their income. Pretty easy to make the numbers work out in your advantage. I’m sure the Dems didn’t mean for this “out†to be in the bill – they certainly wouldn’t side with the employers on purpose!
Expansion of Public Programs:
  • Medicaid available to people even if they don’t have dependent children, based solely on income (Pro). BUT this isn’t available until 2014 either. I guess according to current Government doctrine you aren’t worthy of jack unless you have a kid or six. And then we wonder why some people keep popping them out to stay on the Government payroll.
Premium subsidies to employers
  • Provide small employers with no more than 25 employees and average annual wages of less than $50,000 that purchase health insurance for employees with a tax credit. The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $25,000.
    • Seriously??? This is what the Democrats call “assistance for small businessesâ€??? If the regulations for fines and such go up to 50 or 200 employees, then this should as well. And average annual wage of $50,000, or $25,000 for full credit? That’s an average wage of right around $12/hour, full time. That may sound like a lot to some (not sure who…I was making that as a receptionist 10 years ago…), but I guarantee that in California and other high cost-of-living states that isn’t diddly. So this is pretty much only for very, very small operations with no educated professionals on staff, right? :uhuh: WAY too small of a base number of businesses across the country to make a real difference in offsetting the cost for the vast majority of companies that will be taking a hit.
Tax changes (oh, you knew this one was coming, right? )
  • Impose a tax on individuals without qualifying coverage of the greater of $750 per year up to a maximum of three times that amount or 2% of household income to be phased-in beginning in 2014.
    • So much for “no new taxes on individuals making less than $250,000 a year†huh?
    • Obviously some of the Democrats who voted for the bill are grossly misinformed about this: http://www.foxnews.com/story/0,2933,589996,00.html
    • I do not believe that the IRS is able to assess punitive measures, except for due to not paying the taxes which they are assigned to collect. Maybe I’m wrong on this point, but I don’t think so.
  • “Cadillac†Plan tax (Effective January 1, 2018 under Reconciliation so that their buddies the Unions don't get dinged. Too much of a fuss was raised about the Unions getting the break when the rest of the people didn't, so they gave it to everyone.)
    • Penalizes *employers* who include good benefits packages for their employees, not to mention the employees.
    • Fixed numbers in the plan further penalize people living in high cost-of-living states, while the same plans in a lower cost-of-living state won’t be penalized at all.
  • Increase the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income for regular tax purposes. (Effective January 1, 2013)
    • Ouch. Guess that only affects some of us, but just ouch. Doesn’t end up helping with the taxes a whole lot, but it sure does help. Trust me, if you’re spending 7.5% of your adjusted gross income on medical expenses you’re spending a LOT. Most people don’t get there. You’re only there if you have a seriously bad health year, have a chronic condition, have to get very expensive treatments (i.e. chemo), or have a really high deductible. Or a combination of all of them.
  • Impose new fees on segments of the health care sector:
    • OK, I get this one, and I don’t necessarily have an issue with it on the basis of charging fees to the industry in general.
      • However the only sector that has % increases is the health care insurance sector. And the non-profit (i.e. non-profit or state run) fees will be based on 50% of their net premiums. This isn’t competition to lower the price of premiums across the board – it’s running the for-profit companies out on a rail.
      • Pharma manufacturers get a sweet deal under the Reconciliation: – $2.8 billion in 2012-2013; $3.0 billion in 2014-2016; $4.0 billion in 2017; $4.1 billion in 2018; and $2.8 billion in 2019 and later. I guess this is why the Pharma mfgs. switched sides to support the bill! Considering I read recently the ONE MS DRUG was netting the mfg. over a billion dollars per year in profit, this deal REEKS!
  • Fees on health care sector total $17.1 billion/year + the 2.3% tax on the medical devices. The other taxes will certainly diminish over time as individuals and companies figure this system out. The taxes and fees listed here are not a drop in the bucket if they are actually trying to pay for this monstrosity on a year to year basis. So really – who will end up paying for all of this and how???
Creation of insurance pooling mechanisms While overall I like this concept, the devil is in the details.
  • Permit states to allow businesses with no more than 100 employees to purchase coverage in the SHOP Exchange beginning in 2017.
    • So what are we supposed to do between 2014 and 2017? What about the companies with 101-199 employees? Seems like they are stuck in limbo.
  • Contract with insurers to offer at least 2 multistate plans in each Exchange.
    • So non-profits MUST have multi-state plans, but for-profit still can’t cross state lines? Again, unfair advantage to state/non-profit businesses.
  • Boatloads of red tape for “qualified health plans participating in the Exchangeâ€. As if insurance doesn’t have enough bureaucracy already!
Changes to Private Insurance
  • This entire bill seems to have an intentional “unintended consequence†of putting Private Insurance out of business. “You’ll be able to keep the insurance you have†as long as they can make these mountainous changes to their entire structure, and somehow compete against non-profits that can and are required to sell across state lines – but they still can’t.
  • Require reports (they already do this! Is this just a “feel good clauseâ€?) and rebates to planholders for premiums collected that exceed 85% for large group market and 80% for small group market of the “clinical expenditures and qualityâ€.
    • Did you know that there is already a government mandated “ratio†that the insurance companies must meet? That number is 64%. The remaining 36% currently and 15-20% beginning 1/1/2011 isn’t just for the bigwig’s salaries. It’s for overhead costs. I’m not sure how much “quality†accounts for, but I’m sure it doesn’t cover all of the administrative staff, office supplies, office equipment (i.e. computers, proprietary software, printers, copiers, phones, etc.), customer service reps, claims adjusters, claims overseers (the people who make sure you aren’t trying to submit stuff you aren’t supposed to, and minimally check for In-Network vs. Out-Of-Network providers), etc. Yes, I do hope that it makes the companies assess how they can be more efficient but that won’t get them to cut ½ of those costs in 1 year. That will have to be done with salary cuts, as in layoffs.
  • Permit states to form health care choice compacts and allow insurers to sell policies in any state participating in the compact. – Seems good, but the cons are that the States determine where they will agree to a compact and most of all – not allowable until 2016. They are at a 2 year disadvantage to the state/non-profit co-ops.
Cost Containment
  • Medicare waste, fraud and abuse: I agree this is a problem (!!!), and hopefully these measures will cut these. The problem I have with it is:
    • If it was this “simple†that legislators could figure it out, why hasn’t it been done long before now by Medicare itself, whoever in the government oversees Medicare, or by prior legislative bodies?
    • The dollar amount they have given to this solution is way out of the ballpark, IMO. They have figured it as a homerun when I see it more as a ground single.
Improving Quality/Health System Performance
  • Support comparative effectiveness research by establishing a non-profit Patient-Centered Outcomes Research Institute to identify research priorities and conduct research that compares the clinical effectiveness of medical treatments.
    • And they think no one has been looking at this before? Insurance companies haven’t been quantifying the cost effectiveness vs. clinical effectiveness?
    • It worries me beyond belief that they will start limiting access to testing, i.e. mammograms, due to bureaucrats looking at statistics rather than healthcare professionals.
Medical Malpractice
  • Only authorizes “demonstration grantsâ€, i.e. studies. It’s been studied. It’s been enacted in some states and proven effective.
Medicare, Medicaid, Primary Care, “National Quality Strategyâ€
  • Problem with this is that they are entrusting the improvement of everything to newly formed government entities. When has the government ever been able to make anything run smoother than the public sector?
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