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Sunday, December 6, 2009

What is and what isn't in the two versions of the healthcare bill

Of course, there is the one that squeaked by in the House and the one that is pending in the Senate.
Here is Justin Reuben's brief analysis of what is in what and what needs to be fixed.

Overall, both pieces of legislation would do four major things:
  • Create a "Health Insurance Exchange." The bills create a one-stop marketplace where people can choose from various insurance plans, including the public option. The details aren't set yet, but initially the Exchange would likely be open to the self-employed, people without insurance at work, and small businesses.The key with the Exchange is that it brings "the bargaining power and scale that's generally accessible only to large employers" to individuals—and with that, lower costs and better options.
  • Provide insurance to over 30 million more people. The House bill would expand coverage to 36 million people by 2019. The Senate bill extends coverage to 31 million.
  • Outlaw discrimination based on pre-existing conditions and gender. Insurance companies will have to stop denying coverage to people with "pre-existing conditions." And they won't be allowed to charge women more than men for the same coverage.

  • Eliminate coverage limits and price-gouging. The bills differ on some details, but in general would place limits on how much people have to pay for health care beyond their premiums. They both cap out-of-pocket costs and ban insurance companies from setting limits on how much health care they'll cover for a person each year.
Of course, the devil is in the details, and much in these bills still needs work.

Here's what still needs to be fixed:

  • Both bills leave millions uninsured. The House bill leaves 18 million without insurance in 2019; the Senate bill, 24 million. Neither comes close to the vision for universal coverage so many of us fought for for years. We'll all need to fight to continue to expand coverage in the bills this year, and in the years to come.
  • The Senate public option is weak, and conservatives are pushing to make it weaker. The public option is a core piece of reform that will create real accountability and competition for private insurance—and that's why it's at the center of such a huge fight. While the House bill creates a national public option, the Senate lets states opt out, denying their residents access to it. Plus, conservatives are working to weaken it even more. We're all going to have to fight hard for the strongest version possible.
  • Many reforms don't start quickly enough. While some pieces of reform go into effect right away, the larger structural changes are not scheduled to go into effect until 2013 (House bill) or 2014 (Senate bill). This includes the Exchange, the public option, and subsidies—the major ways coverage will be expanded.
  • Required insurance could still be too expensive for many. Both bills require virtually all Americans to have insurance. But the caps on how much we're expected to pay are way too high, and the subsidies are way too low. Many progressives are working to fix this, but it's going to be a significant fight.
  • Reproductive rights are severely restricted in the House bill. An egregious anti-choice amendment in the bill virtually prohibits anyone purchasing insurance in the Exchange from buying a plan that covers abortion—even if paid for with their own money. We need to make sure the final bill doesn't include this rollback of reproductive rights.
  • The Senate bill could discriminate against lower income workers. The current Senate legislation retains a version of what's called the "free rider" provision, which essentially penalizes employers for hiring lower income workers. This provision needs to be fixed before the bill is finalized.


Anonymous said...


The CBO says that under the Democrats' Senate bill, the average premium would rise by 10 to 13 percent in the individual market, compared to premiums being lowered by 5 to 8 percent by the House Republican bill -- a swing in costs of between 15 and 21 percent. In the small-business market, the CBO says that the Democrats' Senate bill would raise premiums by up to 1 percent or lower them by up to 2 percent, compared to the House Republican bill, which would lower premiums by 7 to 10 percent -- a swing of 5 to 11 percent. (The CBO says that each bill would have the same effect on the large-employer market, except that the Senate bill would dramatically increase premiums for "Cadillac" plans.) What are these two bills' costs in their real first decades in operation, according to CBO projections? The House GOP bill would cost $64 billion, and the Democrats' Senate bill would cost $2.5 trillion -- a swing of $2.44 trillion and a ratio of 1 to 41

My (Barry's lie) plan will lower costs $2,500 per year for the typical American family." But the Congressional Budget Office has now released an analysis of the proposed Senate bill that the President is championing, and it turns out that his prior estimate was off by $4,600 a year. The CBO says that the average American family would see its premiums rise by $2,100 a year, at least in the individual market -- the part of the market where everyone agrees that "reform" is most needed. Were you expecting more for a price-tag of $2,500,000,000,000.00 over 10 years

EvilJam said...

I'll have what you're smoking.