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What You Need to Know About the House Health Care Bill

The House of Representatives passed their version of the health care reform bill last night. But what does it all mean? The media coverage on the issue has been decidedly mixed. I’ll try to boil down for you the most important points on the House bill.

The first thing I should probably spend some time on is clarification. With all this debate over the validity of so-called “Obamacare”, many people may not realize that there are various versions of health care reforms bills floating around, and that none of them were authored by Obama (hence the irony of the name “Obamacare”).

Here are the details of the House version of the bill: (a good source of information are the NYTimes, and an NPR podcast entitled Health Care Legislation Deconstructed)

How the House Bill Expands Coverage to Uninsured Americans

  • Projected to cover 96% of legal residents under age 65.
  • Provides subsidies for individuals up to 400% of the federal poverty level $88,000 for a family of 4)
  • Expands Medicaid to 150% of federal poverty level ($16,000 for an individual; $33,000 for a family of 4)
  • No denial of coverage or higher premiums due to pre-existing conditions

How the House Bill Effects Businesses

  • Most employers will be required to provide health care for employees or pay a penalty of up to 8% of payroll.
  • Businesses up to $500,000 in payroll a year are exempt.
  • Penalties are phased in for businesses from $500,000 to $750,000
  • Small businesses are provided with tax credits to help them purchase health care

The House Bill’s Public Option

  • No state opt-out
  • Negotiated Rates — the public plan will talk to hospitals, doctors, and health care providers to negotiate a state-level payment rate

Costs of the House Bill

  • Gross Cost $1.1 trillion over ten years.
  • However, the Net Cost is $894 billion because of revenue raisers.
  • Revenue will come from surcharge on high income earners (taxes on individuals that earn above $500,000, or on couples that earn above $1 million  – projected to raise $460 billion)
  • Penalties for businesses who don’t provide health care (up to 8% of payroll)
  • Penalties for individuals who don’t buy health care (2.5% of income — but can apply for hardship waivers if can’t afford)
  • Medicaid/Medicare cuts
  • Corporate taxes/ fees

Health Insurance Exchange

  • The Exchange is essentially a marketplace where people can go to shop for health insurance. Currently, with our employer-based system, you can only really choose from the plan(s) your employer offers. Going out and buying your own insurance is expensive and messy. The Exchange creates a market of insurances options and allows you to choose which plan you want, allowing market forces to take their toll — the better plans will thrive and the uncompetitive ones will die.
  • Would begin in 2013.

Lobbyists’ Role in the Bill

  • Why was there no large-scale campaign launched against this reform by insurance industries, drug companies, and the like? Because this time around, they were brought into the fold. Yet, with lobbyists winning, the biggest loser stands to be — in many instances — the consumer. The pharmaceutical industry has lobbied for amendments, like one that would grant 12-year exclusivity to biologics, instead of 5. Read the article in TIME for more on that, but basically, it means that instead of allowing generics onto the market after a shorter waiting period (say, 5 years), it will now take 12 years for this to happen, when concerning biologics, which is rapidly growing. The downside to this is that generics help control costs by offering similar solutions for much less money. Essentially, this monopolizes the market for 12 years for each new biologic.

There was a Republican alternative to the House Bill, which included:

  • No public option
  • Individual mandate
  • State high risk pools
  • Not having language barring pre-existing conditions
  • Businesses can combine resources and buy health insurance across state lines
  • Reforms to control costs