Health Care Bill: What's In It For Us?

CBS has a wrap-up of what's in the Health Care Bill and when the various provisions take effect. The Daily Beast has a good recap of both what's in it and what's not in it.

Here's the House Summary of the reconciliation bill. Here's a summary of the Manager's Amendment. And here's a summary of the actual bill. [More...]

I'd like to know more about this provision:

Encourages reimbursing health care providers on the basis of value, not volume. The bill includes a number of proposals to move away from the “a la carte” Medicare fee‐for‐service system toward paying for quality and value while reducing costs for America’s seniors.

Is that the provision they say will reward doctors for successful treatments? Does it mean doctors won't get paid if they recommend a procedure for an elderly patient and it doesn't work? Won't that discourage doctors from recommending procedures for elderly patients that aren't a sure thing? I have no idea, but it's one provision that doesn't get much discussion.

Here's the text of the Senate Bill. Here's a timeline for implementation.

Clearly the bill helps those with pre-existing conditions. And more people will be able to get insurance. Those are really important benefits.

Is there anyone who will be worse off under the bill? I've said all along that I would be okay with paying more for premiums and non-covered care (which undoubtedly will happen between my age and the likelihood insurance companies will scale back the benefits in its high-end plans while not reducing premiums) if lots of other folks reaped the benefits. It's looking like that's the case. So I'm in favor of this health care bill. And I think it will be a boon to Democrats in the 2010 and 2012 elections.

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    Whether the legislation proves to be (5.00 / 4) (#10)
    by Anne on Sun Mar 21, 2010 at 08:58:16 PM EST
    a boon or a bane will depend in large part on whether they can successfully placate the millions of people who have been deluded into thinking that there will be immediate assistance with access to health care.

    It may also depend on the behavior of the insurance companies in the time between now and November, whether the Congress blusters with regard to the insurance industry in much the same way it blustered with regard to the financial sector: lots of stentorious railing about getting tough, and then [crickets] when the banksters went back to (more or less) business as usual.  The first insured person who gets dropped from coverage because the insurance company technically still has the right to do so is going to scream bloody murder - and people will listen.

    Will the high risk pools for adults with pre-existing conditions and who have not been able to get insurance truly be up and running within 90 days from enactment?  You can be sure there will be more noise if they are not.

    And what about those who cannot afford insurance now?  How many will qualify for expanded Medicaid coverage and will the states be able to handle the onslaught of applicants?

    When you sell something on the basis that there is a crisis and we have to do this NOW, NOW, NOW, you'd better be prepared to deliver NOW, NOW, NOW, don't you think?

    So, only time will tell whether the Dems have managed to honestly sell historic reform, or whether they have falsely advertised a product they cannot deliver.

    It gives more people access to (5.00 / 1) (#13)
    by observed on Sun Mar 21, 2010 at 09:04:56 PM EST
    insurance, but will they be able to afford health care? According to Jane Hamsher's fact sheet, a significant percentage of Massachusettsans are foregoing medical care now, even though they are insured, because the co-pays are too high.

    I'd like to see the percentage (none / 0) (#18)
    by Socraticsilence on Sun Mar 21, 2010 at 09:08:00 PM EST
    today compared to the percentage pre-Masscare.

    more relevant to compare with other (none / 0) (#20)
    by observed on Sun Mar 21, 2010 at 09:10:07 PM EST
    states today, no?
    18% have insurance but don't use it, according to her fact sheet (it's all sourced, so you can check the numbers)

    Don't know what this means, but I (none / 0) (#23)
    by Anne on Sun Mar 21, 2010 at 09:11:44 PM EST
    read "Masscare" as "Massacre."

    And not even a glass of wine tonight!  Sheesh...

    Time to watch Iron Chef Cat Cora compete using tonight's secret ingredient: ricotta!


    Premiums will go up (none / 0) (#57)
    by BrassTacks on Mon Mar 22, 2010 at 01:43:23 AM EST
    They have to since insurance companies have to insure everyone, regardless.  We pay so much now, I don't see how we can afford to pay more.  Some friends are dropping health insurance now because they don't want to make any payments until they have to.  If they get sick, they'll pick up insurance then.  Smart?  I don't think so, but we may have to do it, depending on how much our rates go up.  

    Off the top of my head these are the people (5.00 / 2) (#14)
    by Dan the Man on Sun Mar 21, 2010 at 09:05:45 PM EST
    who would dislike the bill.

    1.  People who currently do not have health insurance but will be required under the law to pay for it. They are probably younger voters.  These people will either pay the fine or buy insurance they probably won't need.
    2.  People who pay for cadillac plans - like union members.  They will either pay more or get less.  Furthermore, in the future, more and more plans will be considered as cadillac plans due to the greater than inflation rise in premiums.  So more and more people will be considered having cadillac plans as the years go on.  Employers will probably place stricter limits on what kind of plans they offer employees because of this.
    3.  Medicare Advantage recipients - 200+ billion in cuts.
    4.  Medicare recipients - 500+ billion in cuts.  If you add up all the cuts in Medicare the Democrats proposed, it's nearing the Medicare cuts McCain proposed in the 2008 election and Progressive claimed they were against.
    5.  I believe the law raises the amount you can itemize for medical payments from 7.5% to 10%.
    6.  Although the anti-discrimination rule look nice in practice, states like Colorado have noticed higher premiums for some healthier people because insurance companies can no longer discriminate in favor of healthier people.  In any case, I get the feeling insurance companies are going to raise premiums a lot and say the anti-discrimination rule is what caused them to do it, true or not.
    7.  The law depends on the government subsidizing lower and middle income individuals so that their premiums are lower.  But if the government doesn't do this, those individuals/families will have to pay more or, if they can't afford to, pay the fine.

    Of course, there are probably things I've missed.

    Medicare advantage (5.00 / 2) (#17)
    by Socraticsilence on Sun Mar 21, 2010 at 09:07:10 PM EST
    was such a boondoggle- there's a reason that it only got widely implemented after a party-line vote by the GOP- its basically a long con to destroy Medicare.

    Question (5.00 / 1) (#26)
    by Teresa on Sun Mar 21, 2010 at 09:21:49 PM EST
    The law depends on the government subsidizing lower and middle income individuals so that their premiums are lower.

    Can someone explain to me the subsidy for lower to middle income? Is that the up to 400% of the federal poverty level? If that is it, I don't see where any benefit is coming to the middle class.

    For the poor, I think the bill is great. I'm glad the pre-existing conditions I have won't count against me but I don't understand why I have to wait 4 years while a healthy 25 year old can still be on their parent's family policy.


    In part, because lots of states (5.00 / 1) (#28)
    by masslib on Sun Mar 21, 2010 at 09:26:46 PM EST
    already have the law pertaining to young people.  In some states it is actually harder.  It also doesn't take any sort of program.  It just happens.  Got a young adult, you can add them to your insurance.  In part, because the pre-ex. is a deal with the mandates.  The idea is insurers won't lose money when that law goes into effect because at the same time they will expand their market size.

    higher not harder. (5.00 / 1) (#29)
    by masslib on Sun Mar 21, 2010 at 09:27:09 PM EST
    That makes sense on enlarging (none / 0) (#32)
    by Teresa on Sun Mar 21, 2010 at 09:39:54 PM EST
    the pool of healthy policy holders with the mandate requirement. I'm just confused about the cost of a plan for a middle class family of two, one with pre-existing issues.

    Last year I tried through 3 different agents to find insurance for my husband and me. The cheapest (crappy) insurance I could find was $1200 a month and after learning of my pre-existing conditions, there were none at all that would cover me. So in 2014 I'm just wondering if the prices will still be that high?


    I don't have the link at hand (5.00 / 2) (#46)
    by gyrfalcon on Sun Mar 21, 2010 at 11:05:07 PM EST
    but if you go to the Kaiser Foundation Web site, they have a very nifty calculator where you input your info and it spits back what your policy will cost and how much subsidy you get.  Use the calculator for the Senate version of the bill.

    Shoot, the only options are single (5.00 / 1) (#53)
    by Teresa on Sun Mar 21, 2010 at 11:31:19 PM EST
    or family of 4. I need family of 2. Just for me at my old income before I had to leave my job, it's about $150 more a month than what I had with a group plan (that I paid 100% of because I was part-time) so it's hard to tell. It's quite a bit less than the individual policy quotes I got last year before they knew of my pre-existing conditions though.

    I think we'd be better off to get a divorce and just buy for my husband. I guess my assets would zap me from Medicaid though. Sigh.

    I'm still happy thinking of a man I worked with who couldn't leave a job he hated because his son was born with a terrible problem with his liver. He has to go to Pittsburgh several times a year. At least I know he can leave this job without his son losing his insurance and that's wonderful.


    Thank you so much. (none / 0) (#48)
    by Teresa on Sun Mar 21, 2010 at 11:11:54 PM EST
    I'm headed there now. Of course my state (TN) is thinking about opting out so who knows what it will mean for me.

    Here's the KFF link (5.00 / 1) (#54)
    by shoephone on Sun Mar 21, 2010 at 11:37:08 PM EST
    to calculate, based on whichever plan makes up the final bill.

    Phasing in (5.00 / 1) (#30)
    by Salo on Sun Mar 21, 2010 at 09:37:34 PM EST
    Seems reasonable. I'm too old to benefit from this rule. But it's good for the kids. It's good. Now it's time to agitate for single payer.

    I'm with you there Salo but doubt (5.00 / 1) (#33)
    by Teresa on Sun Mar 21, 2010 at 09:41:42 PM EST
    we'll ever see it in this country for many more years.

    There's been some mention of subsidizing middle (5.00 / 1) (#34)
    by Dan the Man on Sun Mar 21, 2010 at 09:42:34 PM EST
    class. For example, here.

    "Billions of dollars would be set aside for subsidies to help families at incomes of up to $88,000 a year afford the cost."

    Frankly, I don't believe those subsidies will ever come in numbers large enough to make a difference for the middle class.  But in any case, this is the trick that the proponents say reduce premium costs.  In any case, those subsidies depend on a future Congress paying for them, and once Republicans have large enough numbers, they'll probably try to kill them.


    Thanks Dan (5.00 / 1) (#35)
    by Teresa on Sun Mar 21, 2010 at 09:51:53 PM EST
    I wish there were more specific numbers available. There may be and I just haven't seen them because I kind of checked out of the discussion after the public option was dropped. Thanks for your help.

    Seeing the bill just pass makes me happy and sad at the same time. I'm glad for the poor and children with pre-existing conditions but sad that we waited too late to push hard for a better bill. (By we, I mean the leadership of the party.)


    You know, I really doubt the (5.00 / 2) (#47)
    by gyrfalcon on Sun Mar 21, 2010 at 11:06:56 PM EST
    Repubs are quite stupid enough yet as to eliminate subsidies for middle class voters.

    Independent Medicare Board can cut Medicare (none / 0) (#44)
    by Dan the Man on Sun Mar 21, 2010 at 10:35:54 PM EST
    without Congress here.  This means Medicare cuts will be easier to make.  I expect there will be a lot of cuts in Mecicare soon.

    Also, the bill goes after generic drugs.  This will probably raise the price of prescription drugs.


    I can tell you one thing (5.00 / 2) (#15)
    by Socraticsilence on Sun Mar 21, 2010 at 09:05:49 PM EST
    the ban on screening for pre-existing conditions for children that goes into effect quickly, should be a boon- Just cut ads with sick cancer kid saying "Thanks [insert pol here] now I can get health insurance"

    You're pretty comical (5.00 / 4) (#25)
    by Militarytracy on Sun Mar 21, 2010 at 09:20:27 PM EST
    If you actually have a sick child...the real game is insurance denials.  Your make believe commercial will be followed by the Republican one of the sick kid laying in bed dying who has parents paying through the nose just so they can be denied payment of certain items and procedures....but whatever.  See I have a sick kid, and I know what the real game is and they didn't do anything to address that at all.  The only thing they have done is mandated that more families live in that specific hell.

    We'll see. (none / 0) (#27)
    by Salo on Sun Mar 21, 2010 at 09:25:27 PM EST
    I think Pelosi is for real. We'll see what they do now.

    Business as usual (none / 0) (#37)
    by Spamlet on Sun Mar 21, 2010 at 09:55:21 PM EST
    Crying "Won't somebody please, please think of the children!" when it's time to pull the wool over our eyes.

    wait you actually (none / 0) (#38)
    by Socraticsilence on Sun Mar 21, 2010 at 09:58:39 PM EST
    think Republicans would respond by arguing against the insurance companies, that's hilarious.

    I think they will to get voted in (none / 0) (#42)
    by Militarytracy on Sun Mar 21, 2010 at 10:20:20 PM EST
    They are no better than Democrats when it comes time to screw your constituency.

    You (none / 0) (#58)
    by Ga6thDem on Mon Mar 22, 2010 at 05:16:46 AM EST
    really don't know much about the GOP and how they operate do you? they are right now campaigning against the Medicare cuts Obama wants.

    I think I just found the source of (5.00 / 1) (#49)
    by Socraticsilence on Sun Mar 21, 2010 at 11:12:06 PM EST
    Boehners opprobrium- the bill included a 10% tanning tax on indoor tanning salon's- John might get bankrupted by this!

    It hurts (none / 0) (#1)
    by Ga6thDem on Sun Mar 21, 2010 at 08:38:15 PM EST
    a lot of people in the middle who make too much for the subsidies. I imagine at first there are going to be lots of people just paying the fees. This bill is bascially just bailing out the insurance companies and an attempt to prop up the currently failing system. I think that it will probably be revisted before 2014.

    The really bad part of this bill is the fact that there are mandates and no public option. This leaves room for the GOP to eliminate the subsidies when they take over and people are just going to be left with a mandate to buy insurance and it might even be junk insurance at that. I read where the copays could go down to 60% on policies.

    All the people spouting off about (none / 0) (#2)
    by oculus on Sun Mar 21, 2010 at 08:41:46 PM EST
    how the federal government is too large, too invasive, etc., will then push Congress to repeal the mandates.  right?

    Who knows? (none / 0) (#4)
    by Ga6thDem on Sun Mar 21, 2010 at 08:48:06 PM EST
    But this wouldnt have been a bad bill if the mandates had come out but now the framework is left for people in this country to get screwed even more down the line with this bill.

    If mandates were removed (5.00 / 1) (#6)
    by Socraticsilence on Sun Mar 21, 2010 at 08:51:30 PM EST
    this bill would be insane- it would basically ensure the collapse of our current healthcare system, leaving nothing to replace it.

    Why (none / 0) (#7)
    by Ga6thDem on Sun Mar 21, 2010 at 08:52:43 PM EST
    do you say that? Or do you agree that this bill is bascially another bail out?

    Because without mandates (none / 0) (#12)
    by Socraticsilence on Sun Mar 21, 2010 at 09:03:57 PM EST
    and with a ban on screening for pre-existing conditions coming in 2014- it would be stupid to ever buy insurance, seriously, why not just wait until after you get sick or hurt and pay for it for a couple of months then.

    Interesting (none / 0) (#16)
    by Ga6thDem on Sun Mar 21, 2010 at 09:07:07 PM EST
    you say that because that was exactly Obama's original plan. But this plan is bad because you are forced to buy a defective product are you not? You arent given any choices.

    It depends on how the exchanges work (none / 0) (#19)
    by Socraticsilence on Sun Mar 21, 2010 at 09:09:39 PM EST
    if they work like they do for federal employee's it should be a great improvement over the status quo, if they don't then you could be right.

    with 50 different pools, one for (5.00 / 1) (#21)
    by observed on Sun Mar 21, 2010 at 09:11:08 PM EST
    each state, maybe they won't work so well?

    Look (none / 0) (#22)
    by Ga6thDem on Sun Mar 21, 2010 at 09:11:28 PM EST
    the exchanges are a joke. They are just a big insurance agency where you can have one stop shopping. They will offer convenience but nothing else.

    The Federal Employee (none / 0) (#39)
    by Socraticsilence on Sun Mar 21, 2010 at 10:00:46 PM EST
    exchange works to control costs and improve quality of care though- its something that multiple studies have confirmed, however the key thing here is the exchanges working in the same way as the Federal Exchange system.

    That's (none / 0) (#59)
    by Ga6thDem on Mon Mar 22, 2010 at 05:26:40 AM EST
    because they are employees and part of their premiums are going to be paid by the federal government. it's not the same as the exchanges which are basically insurance agencies.

    And I bet we all can't wait for the (none / 0) (#24)
    by Anne on Sun Mar 21, 2010 at 09:14:17 PM EST
    full-color, slick promotional materials that will be landing in our mailboxes...wonder how much that will add to insurance company overhead?

    ouch.. 60% is worse (none / 0) (#3)
    by observed on Sun Mar 21, 2010 at 08:48:06 PM EST
    that what I read previously.
    No more post ball-game MRI's for me, that's for sure!

    There are many good things but I worry that some (none / 0) (#5)
    by kempis on Sun Mar 21, 2010 at 08:50:49 PM EST
    people may be worse off, especially those who cannot afford another monthly bill--and could care less about tax credits while struggling to make ends meet each month.

    Specifically, I worry that some who elect to risk the fine will be worse off because they will be even more reluctant now to go to the doctor when something is wrong. If I were in their shoes, I'd be afraid to go to the doctor, afraid I'd be discovered as a "scofflaw" without insurance and hit with a fine.


    IMO (5.00 / 1) (#8)
    by Ga6thDem on Sun Mar 21, 2010 at 08:55:13 PM EST
    it's about 80% good and 20% crap and that's why I think it is a mistake. There are way too many people that make above 2.5 times the poverty rate who are going to forced to spend a lot of money on a defective product. Did you knwo that in Ma even the people that have insurance (18%) still can't afford to go to the doctor?

    that shoudl (5.00 / 1) (#9)
    by Ga6thDem on Sun Mar 21, 2010 at 08:55:37 PM EST
    be 20% good and 80% crap.

    In Massachusetts (none / 0) (#11)
    by itscookin on Sun Mar 21, 2010 at 09:03:49 PM EST
    you have to file a form from your insurance company stating what level of insurance you have with your state taxes every year. No form = fine.

    I just read that there will be 4 million (none / 0) (#31)
    by Joan in VA on Sun Mar 21, 2010 at 09:38:02 PM EST
    fewer people covered by employers than currently. Is that because they will be dumped into Medicaid or what? Will employers go cheap and pay the measly $2k fine rather than provide insurance?

    Anything is possible, but it will most (5.00 / 1) (#40)
    by Inspector Gadget on Sun Mar 21, 2010 at 10:04:16 PM EST
    likely depend upon what the rules in each state are for employers. Many small employers provide insurance to employees even if they aren't obligated by their state. If premiums grow too much, too fast, they may decide to drop plans. But, why would any employer pay a $2,000 fine rather than contribute $2,000 toward a policy for their employees? Especially if they are already paying.

    I'm still working (none / 0) (#41)
    by Spamlet on Sun Mar 21, 2010 at 10:12:40 PM EST
    but I'm self-employed, so I pay for my health insurance myself.

    I have a Kaiser plan with no deductibles, and it costs me $7,176 a year, before any copays or prescriptions.

    I am in excellent health, but my premium is more than 20 percent higher than it was a couple of years ago (difference between being 59 and 61 years old).

    I wonder what an employer, if I had one, would be paying for my health insurance, or for the health insurance of someone less healthy than me. I wonder if my plan would be as comprehensive. And I wonder if the employer might see the fine as a better deal than paying the employer's share of my coverage.


    Excellent Health? (1.00 / 1) (#52)
    by squeaky on Sun Mar 21, 2010 at 11:30:00 PM EST
    No high blood pressure? That is a surprise.

    Again, depends on your state (none / 0) (#43)
    by Inspector Gadget on Sun Mar 21, 2010 at 10:21:49 PM EST
    my employer (3 of us total in the company) covers our premiums 100%. Each of us have the same premium amount of $240/month for PPO insurance through Blue Cross. I raised the premiums for everyone by turning 60 last year, but mine are not higher than the 35 year old. Better still, I have never had a claim processed and the 35 year old is at the doctor all the time for a back injury that required surgery, PT, tests up the kazoo....but, I'm the one who raised the premiums :)

    Individual plans are so awful. My brother is on one as a self-employed person. But, he could go to a broker and get much better coverage than he has for the same $400 a month he pays for major medical. His wife, though, is on an individual HMO plan and she pays nearly $800/month for hers.


    Wow, do you care to give me an idea (none / 0) (#51)
    by Teresa on Sun Mar 21, 2010 at 11:15:44 PM EST
    of what state you are in? Or if not, I know you aren't in TN. There is no group plan for self-employed people here except the CoverTN that the representative spoke about on the House floor tonight. It's beyond bad and the premiums are more than yours. It limits your visits and your total per year can't exceed $25,000 no matter what is wrong with you.

    WA (5.00 / 1) (#55)
    by Inspector Gadget on Sun Mar 21, 2010 at 11:55:54 PM EST
    we do have some really good avenues for decent insurance at rates that seem much lower than other parts of the country.

    You must. That's far better than (none / 0) (#56)
    by Teresa on Mon Mar 22, 2010 at 12:15:10 AM EST
    anything we could get here. That must be a benefit of living with real Democrats as opposed to the few fake ones I live with here.

    Probably (none / 0) (#36)
    by Ga6thDem on Sun Mar 21, 2010 at 09:54:11 PM EST
    paying the fine is less expensive that providing insurance and if your employees are under the income amount they might qualify for medicaid. Here in GA there is an asset maximum so I doubt it will help many people here.

    What's in it for Us? (none / 0) (#45)
    by SOS on Sun Mar 21, 2010 at 11:02:10 PM EST
    No single-payer, no public option, back-door dealing with pharms, IRS-enforced insurance MANDATES and STILL no vehicle to control costs.

    Even when Obama wins he loses.

    No public option (5.00 / 1) (#50)
    by Socraticsilence on Sun Mar 21, 2010 at 11:13:22 PM EST
    is a problem, but no single payer is a mirage- no workable single payer idea was ever proposed- HR 676 was basically a pipe dream with no actual working language.

    A good graphic (none / 0) (#60)
    by jbindc on Mon Mar 22, 2010 at 06:43:12 AM EST
    From the NYT

    Did you know?

    Starting in 2014, most Americans will be required to buy health insurance or pay a penalty.

        *The penalty will be phased in, starting at 1 percent of income in 2014, and rising to the maximum of $2,085 for a family in 2016.

        *American Indians don't have to buy insurance. Those with religious objections or a financial hardship can also avoid the requirement. And if you would pay more than 8 percent of your income for the cheapest available plan, you will not be penalized for failing to buy coverage.

        *Those who are exempt, or under 30, can buy a policy that only pays for catastrophic medical costs. It must allow for three primary care visits a year as well.

    Also - starting on 2013, there will be a smaller limit on flexible spending accounts (FSA's) offered through an employer.

    Starting in 2013, flexible spending accounts, which allow users to escape taxes on many medical expenses now, will be limited. There will be a $2,500 maximum on accounts that typically carry $4,000 or $5,000 limits now, and you will no longer be able to use the accounts for over-the-counter medicines.