Have you Read the Health Care Law?
by Bruce Webb
Well me neither. I read through the Tri-Committee and HELP Bills and the Senate Finance Committee’s Chairman’s Mark and then both the Pelosi and Reid versions as introduced and followed as best I could the last minute revisions introduced by the Team of Ten but as I type I have yet to actually slog through the text as passed on Sunday night. I think I know what is in the bill and what was signed into law a few minutes ago but I don’t actually know. But I will. And you can too. And then maybe follow up with the proposed text of the reconciliation fix.
H.R.3590 – Patient Protection and Affordable Care Act
Given that this is the same bill as was passed by the Senate on Dec 24th some of you may be ahead of me here. But this is the law as it stands this morning Tuesday March 23
Health Care Bill – H.R. 4872 – Reconciliation Act of 2010
Hmm, I didn’t realize until just now that the Reconciliation Bill was in the form of a Substitute, meaning that absent any changes mandated by the Parliamentarian or other amendments approved by the Senate this would be the actual final version of the law to be sometime later this month.
Links to our friends (or at least my friend) at Open Congress.org. I am going to take some time and read through the bill and settle out what I think I know from reading all the previous iterations and what we are really dealing with going forward: 300% of FPL or 400%, 11% max out of pocket or 12% or 8.5%? It has been a blizzard of changing numbers. But soon enough it will be what it will be, time to dig down into the data in the true Angry Bear spirit.
Bon appetit!! And consider this an open topical Health Care thread.
Have fun in your slog.
But I have a question for you: what does it matter what specifics are in the bill? when it can and will be changed by political whim? Just like Social Security, Medicare/Medicaid, Post Office etc. That is the whole point of this exercise – just get something, anything, on the books and we libs will take it from there. Trust us, it will be great. Just like Social Security, Medicare/Medicaid, Post Office, etc
Glad you feel that way. I, too, think that Social Security, Medicare, Medicaid and the Post Office are good things, though I was not away the Post Office was a liberal initiative. Yes, these things can be changed. In the sense that the conservative/liberal divide, to the extent those terms are used in their historic sense, has a lot to do with willingness to change as needed, it is a “liberal” thing to change public policy to keep up with changing circumstances. Given that circumstances seem to change pretty quickly these days, we do need liberals to push for improvement to public policy. Glad you see that, too.
>>>Hmm, I didn’t realize until just now that the Reconciliation Bill was in the form of a Substitute, meaning that absent any changes mandated by the Parliamentarian or other amendments approved by the Senate this would be the actual final version of the law to be sometime later this month.
It’s confusing, but this is the wrong read of what’s happening. Health Reform has been signed into law with HR 3590. Another bill (HR 4872) will make a handful of changes to that law, operating under reconciliation rules.
The “in the form of a substitute” is just a reference to a part of congressional process. HR 4872 as essentially a shell bill. It was filled with generic health and education legislation. It passed through the budget committee in this generic form, as changes could only be made in the House Rules Committee, as per reconciliation rules. The Rules committee substituted the original generic language with the actual text that House and Senate Dems had been working on for the past few weeks to modify the Senate bill more to the House’s liking.
Hope that clarifies…
we do need liberals to push for improvement to public policy
Your “improvements” to entitlement programs only go one way – towards more benefits for your voters, paid for by “someone else,” and more power to a central government. If there is tried-and-true formula for a f*cked up program, it would be that.
JS-Kit is doing odd things. This is Bruce
Well Kevin it really doesn’t clarify much. It would appear that even though the bill language of HR3590 is indeed law, HR4872 is actually re-enacting that same language into law with changes, meaning that you don’t need to bother reading HR3590 first unless you want to compare the differences.
Sammy that is true for any bill dealing with any subject whatsoever. “Well we didn’t really pass a Authorization for the Use of Military Force because we could change the details by a new bill tomorrow”. So fricking what? Under your theory we should just ignore the current state of law altogether on the grounds it is subject to change.
Sammy. FYI Social Security and Medicare are not paid by “someone else” although there is obviously some time shift involved. Your sense of grievance is kind of misplaced.
Hospital stocks are recently running 13% above the S&P 500 and health insurance are also holding their own. So much for cost cutting. And Bruce tells me the other day that healthcare was always about access yet on this post he gives the name of the act as : The Patient Protection and Affordable Care Act. I see cost cutting in this title but nothing about increased access.
As a whole, the Hospital Stocks Index is off by -1.2% today, but it remains ahead of the S&P 500 by 13% over the last month – a period in which every component is up by more than 5%.
Reading the bill is a huge waste of time (especially since I am shuttling between several crisis). Plenty of commentators and journalists and wonks are reading it and preparing summaries.
Good phase-in summary iny today’s USA Today, FWIW.
Cantab. First I was referring to the titles of the bills as introduced. Second ‘affordable’ has to do with cost to the enrollee, it has no direct relation to health care costs as such. You could have double digit medical inflation forever and still have health care be affordable to every individual, under a Single Payer system it would just be a question of what share of GDP we would be willing to commit as a nation. But for the average worker not a question of affordability as such.
You really need to stop playing ‘gotcha’. Because one you are bad at it, and two it annoys me. Make some arguments on the merits and stop trying to show me up and maybe you can stay around.
STR oddly I have better luck reading things like HCR bills and Social Security Reports on my own. Near as I can tell I was the first blogger out there that picked up on the significance of the MLR requirement in Sec 116 of the Tri-Committee Bill. Last July 28th. And its existence in the current bill seemed to catch Ezra K at least partially by surprise yesterday. So forgive me for not relying on the lazy reading of others.
My strategy only works if you read lots of stuff from lots of people and homogenize. I also have access to some materials that may not be open to public, provider associates doing their own analysis.
Trust but verify – always.
One of the supposed great benefits of this health care bill, HR #4872, is that starting in 2014, pre-existing conditions & rescission will be made illegal.
However, there is some articles claiming these customer protections are bogus, insofar as a health care insurer could still do rescission existing customers or deny existing customer for pre-existing conditions because
1 No strong enforcement – firedoglake http://fdlaction.firedoglake.com/2010/03/22/signed-sealed-but-not-delivered-six-big-flaws-need-fixing-to-make-new-law-meaningful-health-care-reform/
My sense is that without strong regulation, a sick broke consumer will not get justice, fighting a health ins co & its army of lawyers.
2 Weak fine on health ins co, will be viewed as “cost of doing business” http://www.dailykos.com/story/2010/3/22/849097/-want-to-improve-the-ban-on-pre-existing-conditions
This article claims Michael Moore claims the ins co fine is $100/day. So for costly treatments, such as cancer, an ins co could just say wait 1 year for the patient to day, & pay the $36.5K fine, as opposed to the $50K or $200K or whatever cost of actual health care treatment.
There was another article (don’t recall source) claiming this fine was a flat $5K.
I’ve not been able to figure this out. I searched online. I called my House Rep, & Public Citizen. In each case the operator transferred me to the relevant “expert”, which went directly to voicemail.
Do any of you know? If so could you indicate whether
1 the illegalizing of pre-existing conditions & rescissions is true or bogus?
2 Point to the specific page nbr(s) of the bill with the relevant evidence, along with a url link to said bill
Thanks in advance!
On March 15th, this: http://budget.house.gov/doc-library/FY2010/03.15.2010_reconciliation2010.PDF appeared and this is where the 11 and 12% and 400% of FPL first appeared in the house . . . Page 137. There was also a $5,000 and $10,000 cap on medical expenses. HR4872 is a refinement of that intitial bill which the Senate and House will be hashing out. I only wish we could put them all under the same coverage.
Mahar and I were discussing the 11-12% and the 9.5% language as I had not seen the latter yet. It is 9.5%, unless the Senate changes it, and it starts at 300% FPL.
I am glad to see it in the Reconciliation Amendment In The Nature of A Substitution HR 4872 http://docs.house.gov/rules/hr4872/111_hr4872_amndsub.pdf. And Yes, the MLRs are still there and I agree you were the first to pick up on it. Note this Amendment to the Amendment in the Nature of a Substitution http://docs.house.gov/rules/hr4872/111_managers_hr4872.pdf . Also note these both address the Manager’s Amendment.
An extact from the bill to see how it reads —
a) PAYMENT CALCULATION.–Subparagraph (D) of
subsection (d)(2) of section 4980H of the Internal Rev-
enue Code of 1986, as added by section 1513 of the Pa-
tient Protection and Affordable Care Act and amended by
section 10106 of such Act, is amended to read as follows:
“(D) APPLICATION OF EMPLOYER SIZE TO
“(i) IN GENERAL.–The number of in-
dividuals employed by an applicable large
employer as full-time employees during any
month shall be reduced by 30 solely for
purposes of calculating–
under subsection (a), or
“(II) the overall limitation under
“(ii) AGGREGATION.–In the case of
persons treated as 1 employer under sub-
paragraph (C)(i), only 1 reduction under
subclause (I) or (II) shall be allowed with
respect to such persons and such reduction
shall be allocated among such persons rat-
ably on the basis of the number of full-
time employees employed by each such per-
…and within minutes of the signing of a law that was argued over for months and then passed in the Senate and in the House, now they are complaining it is “unconstitutional.”
Why the hurry? Because once a noticeable number of Americans get a taste, in less than 6 months, nothing but total failure of the state would get them back into the combination strait jacket/iron maiden of the current system. I am guessing that they hope the current Supremes might put a hold on it while they deliberate through spring, summer, autumn and then on into November — y’know, just to be sure.
Run those are just facts and data points.
Well I guess I am an illiterate because I don’t know what ‘extact’ means. But the legislative language makes sense. In context.
Have you parsed the legal language in your software license yet?
Every one thinks of the madate in terms of the commerce clause, if that proves a problem we change it to there is imposed on every taxpayer a tax of x% of income which will be reduced to zero by a credit for health insurance premiums for a qualifying plan paid. This is no differnet than the energy efficency tax credit, the various educational credits and the like. The sixteenth amendment says an income tax on income from whatever source derived. It is just the combination of where what triggers the credit that is different.
I recommend the following two government links for reading the bills. You can access each section separately if you desire. Moreover, links for the related CBO reports are provided.
You may also want to read the Kaiser bill comparison information and make use of its subsidy calculator.
Title: Patient Protection and Affordable Care Act
Title: Health Care and Education Affordability Reconciliation Act of 2010
Side By Side Comparison of H.R. 3590 and H.R. 4872 as well as H.R. 3962
Kaiser Family Foundation
Health Reform Subsidy Calculator — Premium Assistance for Coverage in Exchanges/Gateways
Kaiser Family Foundation home page
It means extract but with a typo. One would think someone that went to Berkeley for graduate school should have been able to figure this out.
The language makes no sense to me. The writing is a bad explanation since its not self contained and has you jumping from section to section to try to figure out what’s going on.
My stategy will be to wait for a well writting document and then only refer to the actual bill when I need to know for sure how a small piece of it works. I think this is what people who are not faking it will mostly do.
Because once a noticeable number of Americans get a taste, in less than 6 months,
In the next six months this bill is going to do nothing to improve my healthcare. However, since its forcing an unfunded mandate on the insurance industry my premiums are only likely to rise. This is a hidden tax. Moreover, in six months we’ll be starting to hear how Obama is going to break his no new tax pledge for the middle class using a commission as a fig leaf. Up until now he’s been selling the snake oil of cutting healthcare costs while he expands demand and does nothing with supply. So he’s been selling all benefit without cost but most Americans will be getting no benift but with higher costs.
On the lawsuits i’m all for them. It seems the government should not come into your kitchen table and start barking at you what you must spend your personal money on. But the court might pass on this and say “Hey, you elected these clowns so live with them until you throw them out of office”. I like the effort to win in the courts but I can live with the courts telling use the political process.
if that proves a problem we change it to there is imposed on every taxpayer a tax of x% of income which will be reduced to zero by a credit for health insurance premiums for a qualifying plan paid.
Nice wish but the democrats no longer will have a filibuster proof majority in the Senate and are likely to lose members in both houses. I don’t see republicans helping Obama out of his lies by helping him with a tax hike to pay for healthcare which he promised was going to reduce its healthcare costs. I’ll be waiting by the mail box for my healthcare savings check. Tick tock ….
Have you ever, ever considered writing in a way that does not present you stray thoughts about what might happen in the future as if the come from Carnak? There has been plenty of opportunity to assess your intellectual talents, and you clearly have no better grasp on the present than the average guy, so why are you so eager to pretend you can see the future. It reads as if you are writing from under a tin hat.
Let me summarize your post: Carnac. You’re stupid, tin hat.
Typical Kharris — giggity giggity.