Here's the New Senate Health Care Bill

Here's the text of the new Senate Health Care Reform Bill. The Washington Post reports here. Via Huffington Post:

Reid's bill includes a national, government-run insurance plan that would be available to consumers within the health insurance exchanges that the reform effort establishes. States could opt out of the plan.

On abortion: [More...]

The Senate bill does not go as far as the House bill does in restricting access to abortion. The House bill would block a woman's ability to purchase health insurance that covers abortion even with her own money in many instances. The Senate package, several senators said, makes crystal clear that no federal funds could be used to pay for abortion. But at least one plan within the exchange would have to offer abortion coverage -- and one plan would not.

On taxing the rich:

Instead of taxing the rich to pay for a significant piece of the bill, as the House does, the Senate plan would tax "Cadillac" health plans. But the value of plans that would be taxed is higher than in previous versions: $8,500 for an individual and $23,000 for a family of four. Even higher values are allowed in high-cost states and workers in high-risk jobs -- such as coal miners -- are given an exemption.

On cost and coverage:

Reid on Wednesday also presented to his colleagues a preliminary Congressional Budget Office analysis, which finds that the bill will cost $849 billion over the next decade. It would cover 94 percent of eligible Americans, including 31 million currently uninsured Americans. The bill would also lower the federal budget deficit by $127 billion over the next decade and by $650 billion during the decade after that. Kerry cautioned that the numbers were still being finalized and could change slightly.

Firedoglake has more on the public option component. The Wall St. Journal recap is here. The Senate may vote on the bill Saturday.

Update: The AP reports the bill would raise the Medicare payroll tax on those earning more than $200k a year.

Current law sets the Medicare payroll tax at 1.45 percent of income. Under the legislation, it would rise by half a percentage point on individual income over $200,000 a year and $250,000 for couples.
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    What about the 20,000,000... (5.00 / 1) (#7)
    by NealB on Wed Nov 18, 2009 at 10:33:07 PM EST
    ...Americans this bill won't cover? What about the promise of universal coverage?

    Everything Obama and the Democrats promised were lies. Lies pure and simple. Lies without excuse. Lies undeniable. Lies better than Republican lies, but lies nonetheless.

    People accessing the public option (5.00 / 1) (#30)
    by MO Blue on Thu Nov 19, 2009 at 09:52:26 AM EST
    Yes, there's still a public option, and the conservative Dems don't like the idea of public-private competition. But a little perspective is helpful -- Reid's version of the public option is a compromise of a compromise of a compromise. States that don't want to give residents a choice won't have to, and according to the CBO, only about 3 million to 4 million American consumers will end up choosing the public plan. link

    We are now down to 3 - 4 million in public plan in this version of the legislation.

    Implementation is 2014, not 2013 (none / 0) (#1)
    by lambert on Wed Nov 18, 2009 at 09:41:15 PM EST

    The bill is so damn bad that not only is Obama scared to run on it in 2012, they don't want to f*ck up the mid-terms in 2014!

    Hilarity ensues...

    Tell me again (5.00 / 1) (#12)
    by Socraticsilence on Wed Nov 18, 2009 at 11:19:28 PM EST
    how a massive transition affecting 1/6 of the nations economy would be easier if it was rushed through.

    Really (none / 0) (#16)
    by gyrfalcon on Wed Nov 18, 2009 at 11:53:20 PM EST
    Or how the bureacracy could possibly be in place to administer this with the care and exactness it needs to have.

    OTOH, you have to admit it is pretty conveeenient for it not to go into effect until after the 2012 elections.


    Less to do with creating (5.00 / 2) (#17)
    by caseyOR on Thu Nov 19, 2009 at 12:27:19 AM EST
    the proper bureaucratic structure.  Medicare was up and running in about a year. The reason for the delay is budgetary. The longer it takes to start this plan, the lower its impact on the deficit over the ten year window.

    Once again, it's about the money, not the people.


    This will not be that big a transition. (none / 0) (#18)
    by caseyOR on Thu Nov 19, 2009 at 12:32:03 AM EST
    Most people will continue to get insurance through their employer. And all the various health care bills were designed to keep the number eligible for the exchanges, and so the possible public option, very very low.

    This will not be anything resembling a massive transition of 1/6th of the economy.

    There is no good reason, unless you are a politician worried about re-election, to delay this so long.


    One very obvious way... (none / 0) (#24)
    by lambert on Thu Nov 19, 2009 at 08:36:29 AM EST
    ... would have been to adopt existing Medicare and/or VA infrastructure. That's how the original Kennedy Medicare for All bill phased in its coverage.

    And the original Medicare, IIRC, was adopted in less than a year, in the age before computers.

    In any case, if the administration, the Dems, and the progressive bloggers hadn't taken single payer off the table, we could have had implementation discussion a year ago, with, ya know, hearings n stuff, instead of having this blivet of a bill dropped on us. ....


    Look (none / 0) (#33)
    by Ga6thDem on Thu Nov 19, 2009 at 01:01:53 PM EST
    delaying this means it will probably never be implemented at all. The GOP can run against this bill in 2012 and win and scrap it. By not making it effective until 2014 Obama is pretty much saying that it's crap and he doesn't want to be held accountable for it but the irony is that he will be held accountable.

    In all his fear of losing in 2012 seems to be doing nothing but making it MORE likely that he'll lose in 2012.


    I will never understand how any of these (none / 0) (#2)
    by oculus on Wed Nov 18, 2009 at 09:50:25 PM EST
    bills will reduce the federal deficit.  Oh well.

    Cuts in care, obviously (5.00 / 1) (#25)
    by lambert on Thu Nov 19, 2009 at 08:37:25 AM EST
    That's what the Dartmouth study stuff is all about.

    Effectively, cuts in Social Security costs (5.00 / 1) (#28)
    by Cream City on Thu Nov 19, 2009 at 08:41:22 AM EST
    too, when we die sooner from lack of affordable, preventive health care.

    I read of Reid's tax on "Cadillac plans" (none / 0) (#3)
    by Cream City on Wed Nov 18, 2009 at 10:11:04 PM EST
    defined as health insurance plans so costly that they exceed $8500 per year.  But that jogs the memory, so I bring up today's local paper, which cited a study that found the average plan in this country costs almost $9000.  That means a lot of Americans paying a tax on health insurance.

    But that's just the average.  The study cited my state as averaging 22% higher than the national norm -- in part because my state also has worked hard at getting so many residents on health insurance that we are among the highest in that, too.

    In other words, I'm about to be punished by yet more federal taxes for my health insurance plan, in part because I pay such high state taxes for others' health insurance plans here.  And this on lower pay, owing to pay cuts for state employees in addition to no raise last year and no raises for the next two years.  And this while helping so many unemployed progeny laid off in this economy.

    Canada is looking better by the day, even with winter coming on. . . .

    I can't figure out how this is going to help (none / 0) (#6)
    by Anne on Wed Nov 18, 2009 at 10:28:52 PM EST

    The emphasis on, and the insistence that we preserve, the employer-based model for health insurance, is going to trap too many people into staying with jobs they don't like, and participating in insurance that isn't satisfactory, because they are barred from getting insurance on the exchange, and private plans may cost too much.

    Oh, happy, historic day-that-is-still-years-away!


    It's going to help the insurance companies (5.00 / 1) (#26)
    by lambert on Thu Nov 19, 2009 at 08:38:01 AM EST
    Why would you imagine that helping anybody else is on the agenda?

    Anne (none / 0) (#31)
    by coast on Thu Nov 19, 2009 at 09:53:53 AM EST
    Come on.  You know full well its not about passing something that is going to actually help people.  Its about just passing something at this point.

    When they say it will cost $XX.XX (none / 0) (#4)
    by Anne on Wed Nov 18, 2009 at 10:18:38 PM EST
    over the next decade, is that the decade that starts now, or the one that starts when implementation starts - over four years from now?

    Also, no one seems to want to answer the question as to why, if health care is in such a crisis, we can afford to wait over four years for this historic reform to get started.  You know there are people out there - a lot of them - who think that if Obama gets a bill to sign before the end of the year, these changes are going to start in January.  A lot of these people are desperate for help, and I just cannot imagine how angry and disappointed they are going to be when the truth is revealed.

    More people will have insurance, but what remains to be seen is whether they will have health care, and whether it will be more affordable in four years than it is now.

    Helpfully, (none / 0) (#5)
    by andgarden on Wed Nov 18, 2009 at 10:27:17 PM EST
    The Hill has a PDF from the Senate Dems showing what goes into effect immediately. I like item 5. That would directly benefit me if it goes into effect by June.

    #4 will make my boss happy (5.00 / 1) (#9)
    by ruffian on Wed Nov 18, 2009 at 10:49:01 PM EST
    and may help a lot of other small businesses, so i am glad it is going into effect sooner rather than later. #5 is good too. In fact it does seem to be that the 'consumer protection' part of the package is going into effect in the first year.

    Downside will be if premiums get raised so much in the next few years before the exchange and public option are available that the good from these protections is wiped out.  I suspect 'if' is not the right word there.


    I can't dismiss that possibility (5.00 / 1) (#11)
    by andgarden on Wed Nov 18, 2009 at 11:17:21 PM EST
    In fact, I think it's likely. Of course, I think the individual mandate has to wait for a while too, but for those paying for their own insurance, this could hurt before the subsidies come into effect. I think that's the biggest danger of implementing the reforms early.

    Uh, that is no change, after all (none / 0) (#13)
    by Cream City on Wed Nov 18, 2009 at 11:31:47 PM EST
    as coverage currently is through age 25.  Now, it is not rocket science to see that is no different from this on your PDF:

    The Patient Protection and Affordable Care Act will require insurers to permit children to
    stay on family policies until age 26.

    Or is my plan kind, offering another year (none / 0) (#14)
    by Cream City on Wed Nov 18, 2009 at 11:35:04 PM EST
    for my kids than your parents' plan?  Is that something different in your state?

    So far, nothing on this looks good for residents of my state, and much of it is going to hit us especially hard here.  


    I know of some places (none / 0) (#15)
    by andgarden on Wed Nov 18, 2009 at 11:39:21 PM EST
    where there is no such requirement. In any case, an extra year means something.

    Are you sure? Student insurance (none / 0) (#19)
    by Cream City on Thu Nov 19, 2009 at 12:32:27 AM EST
    can be cheaper at some campuses than another family member on a family plan, some plans, friends tell me -- so they paid their student's health insurance.

    I'm 95% sure (none / 0) (#21)
    by andgarden on Thu Nov 19, 2009 at 07:06:53 AM EST
    Two other issues:

    1. Student insurance is often junk. (A different issue that this doesn't seem to directly address. Bring on the public option!)

    2. Not everyone under 26 is still a student, but many people are either not yet employed or don't have a job that offers insurance.

    I'd be curious to (none / 0) (#22)
    by dk on Thu Nov 19, 2009 at 07:31:45 AM EST
    know how many states don't already require private insurers to cover full-time students up to age 26 on their parents' plans.  I don't know of any.

    My other question would be this:  if the bill would require all insurers to allow all kids under 26 (full-time student or not) to be covered under the parents' plans, would this mean that those kids under 26 who are unemployed or working at jobs that don't offer insurance will also be barred from electing to get covered instead under the public option (as all other Americans who work for employers with over 10-20 employees who offer health insurance will be)?


    WA State doesn't (5.00 / 2) (#23)
    by Inspector Gadget on Thu Nov 19, 2009 at 07:45:58 AM EST
    I worked for Blue Cross and children could only stay on the plan until they turned 25. That was considered great since I was used to 21, and don't know when the age was extended.

    Agreed -- but do check it out (none / 0) (#27)
    by Cream City on Thu Nov 19, 2009 at 08:40:12 AM EST
    as the friends found that the coverage was as good as their (apparently lousy?) employer plan.  A lot depends upon how hard your student government and/or administration worked to find good plans, negotiate for better coverage, etc., per campus.

    And well I know that not everyone under 26 is a student -- in part as some are pushed out of school by this deadline, including one of my own with a chronic health condition, so we could not afford, with our pay cuts and so many children laid off and needing help, too, to pay for that child's extreme cost of health insurance or for the care and meds without it . . . if we even could find coverage, with the pre-existing condition.

    That is what has to stop -- pushing students out of school, as I see so often with others as well, because of the health insurance mess here.  I am not assured from what I see, though, that the pre-existing condition problem will be fixed.  No one can be denied, but I don't see a lid on the cost, which effectively continues to deny a lot of people.


    Hmmmmm..... (none / 0) (#34)
    by Inspector Gadget on Thu Nov 19, 2009 at 02:17:35 PM EST
    My employer allowed children on the plan to age 25 whether they were a student or not.

    Some plans (none / 0) (#35)
    by CST on Thu Nov 19, 2009 at 02:40:48 PM EST
    are better than others...

    state's opt out is bogus (none / 0) (#8)
    by diogenes on Wed Nov 18, 2009 at 10:47:43 PM EST
    One big objection to public plan is cost (Lieberman's view of a new entitlement program).  Of course states wouldn't opt out of getting free federal help to dump off the sickest patients on the public plan.
    The point of a state OPT-IN is to let states use their OWN money to pursue a public option if they really want it, not to allow states to mooch "free"federal dollars.

    I guess if Joe Lieberman says so, it must be true (5.00 / 2) (#10)
    by andgarden on Wed Nov 18, 2009 at 11:14:42 PM EST
    Sigh .. $250k income ... (none / 0) (#29)
    by nyrias on Thu Nov 19, 2009 at 09:08:53 AM EST
    per family is NOT a lot in places like the Bay Area or NYC.

    This is not taxing the rich but taxing the middle class.

    Shouldn't all providers of service be looked at (none / 0) (#32)
    by vicndabx on Thu Nov 19, 2009 at 11:33:08 AM EST
    to determine what's cost effective?


    CMS's 2006-2007 Financial Report

    See Note 7, Entitlement Benefits Due and Payable, page 47 (57)
    How much tax payers shell out, in Millions:
    $19,410 Part A (Hospital & Skilled Nursing Facility Charges)
    $22,194 Part B & D (Doctor's, Labs, Drugs, DME, etc.)

    Yet the Senate bill looks mainly at Hospitals for Quality Outcomes:

    Subtitle A--Transforming the Health Care Delivery System
    Sec. 3001. Hospital Value-Based purchasing program.
    Sec. 3002. Improvements to the physician quality reporting system.
    Sec. 3003. Improvements to the physician feedback program.
    Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation hospitals, and hospice programs.
    Sec. 3005. Quality reporting for PPS-exempt cancer hospitals.
    Sec. 3006. Plans for a Value-Based purchasing program for skilled nursing facilities and home health agencies.
    Sec. 3007. Value-based payment modifier under the physician fee schedule.
    Sec. 3008. Payment adjustment for conditions acquired in hospitals.



    Sec. 3101. Increase in the physician payment update.
    Sec. 3102. Extension of the work geographic index floor and revisions to the practice expense geographic adjustment under the Medicare physician fee schedule.

    Sec. 3103. Extension of exceptions process for Medicare therapy caps.
    Sec. 3104. Extension of payment for technical component of certain physician pathology services.
    Sec. 3105. Extension of ambulance add-ons.
    Sec. 3106. Extension of certain payment rules for long-term care hospital services and of moratorium on the establishment of certain hospitals and facilities.
    Sec. 3107. Extension of physician fee schedule mental health add-on.
    Sec. 3108. Permitting physician assistants to order post-Hospital extended care
    Sec. 3109. Exemption of certain pharmacies from accreditation requirements.

    Cost savings are achieved by looking at what works best across all provider groups.  Combine this with the fact that the gov't will neogitiate rates w/providers under a PO if passed, seems like we miss a grand opportunity to reduce the impact to our pockets.

    Add to that the fact that this bill puts a lot of costs back on insurers (e.g. guaranteed issue, improved efficiency, reporting and other unfunded mandates,) and asks for rebates (which will likely amount to a few bucks,) where are the savings coming from?

    Oh boo hoo (none / 0) (#36)
    by DancingOpossum on Fri Nov 20, 2009 at 04:14:41 PM EST
    $250k income per family is NOT a lot in places like the Bay Area or NYC.

    Yes it is. It's a lot of money anywhere.If you make that you're in the top 2 percent of earners in the country--granted, you're sharing that slot with the millionaires and billionaires but the point remains -- you're a lot better off than the vast majority of Americans.

    Spare me the bitter tears of Petra Von Moneygrubber. 250K may not be "as much" as it is in, say, Kallispell, Montana, but it's still a very substantial income. People making that income in other very expensive areas (like, say, Washington D.C.) live very nicely indeed.