Understanding Obama's 2009 Health Care Reform Plan - What's in it for You and How Much Will it Cost Tax Payers
[Updated August 2009] Confused about the Obama health care plan and where it is at? Well, you can join millions of other's in this boat. Despite all the media coverage many Americans are still not sure what Obama's health care reform is about and this makes them wary of supporting it. Today the main version (there are many in Congress) was passed by a Senate committee and will be sent to Congress for further review and approval.
Senate Democratic leaders will now have to merge the bill with a more liberal measure approved in July by the Senate health committee. Three House committees also approved health care bills in July and House leaders are now working to distill from the three bills one package that will go to the floor. To easily understand and see how the measures compare on some key issues see this NY times health section.
I will continue to update this news item as it moves through Congress and more information is made available, and I encourage you to subscribe (free) via Email or RSS to get the latest news.
[Updated August 2009] After looking like stalling, President Obama's health care reform agenda has taken a major step forward with the House Democrats agreeing to a potential version of a health reform bill. Reports say that under the deal, Democratic leaders promised to defer a vote by the full House until September, so lawmakers could test public sentiment on the measure, which could fundamentally restructure one-sixth of the nation’s economy.
Under the House agreement, the federal government would still establish a public insurance plan to compete with private insurers, but the public plan would not use Medicare fee schedules to pay doctors and hospitals, as envisioned in the original House bill. Instead, the public plan would negotiate rates with health care providers, as private insurers often do.
Most employers and small business' would still be required to provide health insurance to workers or pay a new federal tax, but more small businesses could qualify for the exemption, which would be available to businesses with annual payrolls of $500,000 or less, compared with a threshold of $250,000 in the original House bill. The maximum tax rate, 8 percent of wages, would apply to employers with payrolls exceeding $750,000, rather than the original threshold of $400,000.
People with low or moderate incomes could still get federal subsidies to help them buy insurance, but they might have to spend slightly more of their own income — a maximum of 12 percent, rather than 11 percent.
The Congressional Budget Office said the bill would ultimately provide coverage to most people who are uninsured. Mr. Ross said the fiscally conservative democrats (Blue Dogs) had won concessions that should bring the 10-year cost below $1 trillion, a goal shared by the Senate Finance Committee.
A number of committees are working on their versions of the health care bill and the House and Senate have yet to reach consensus on a unified bill. If both chambers pass their own versions, another battle looms when the House and Senate try to reconcile their plans for another round of votes. Which means there is still a long way to go before any health care bill is passed and years before consumers feel any changes.
[Updated July 2009] One of President Obama’s biggest campaign promises was to reform health care, and it looks like the first steps towards delivering on that promise are underway with the introduction of a far reaching and very expensive health care reform bill. Many an administration has fallen into the deep abyss of health care reform, but none have had the political capital and forces that support the Obama administration. Whether or not you think the early plans (proposed by House democrat members) are fair or not, it looks like the US health care system is in for a major overhaul and more likely than not, you will be directly impacted. President Obama has set an August deadline for both chambers to pass the final versions of the reform bill, and to get it to his desk by the end of the year. With that time frame in mind there will be many twists, change and debates on this key national issue.
The current proposal and how it will be funded
The proposed house legislation would fund a landmark and far reaching health-care expansion primarily by raising taxes on medical providers, corporations and the wealthiest Americans, including a 5.4 percent surtax on couples earning more than $1 million - becoming known as the “millionaire” health care tax. Couples making $350,000 and individuals earning $280,000, would pay a 1% tax, which would ramp up to 1.5% for those above $500,000 of income until they hit the millionaire tax bracket. Democrats estimate the income tax increase would apply only to the top 1.2% of households, those who earn about one-quarter of all income and will raise $540 billion over 10 years - about half the cost of the health care overhaul - and calls for the taxes to increase if the measure doesn’t hit a target for cost savings. Capital gains (currently taxed at a 15%) as well as earned income would be subject to the surtax.
The legislation would also raise taxes on corporations. Among other things, it would make it easier for the IRS to prosecute tax shelters, and deny certain cross-border deductions that some companies are able to claim through tax treaties. The plan would also slow Medicare and Medicaid payments to medical providers.
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The bill would prohibit insurance companies from establishing any lifetime or annual ceiling on benefits and limit companies from charging higher rates due to health status, gender or other reasons. Premiums would only be allowed to vary based on age, geography and family size. Medicare would be overhauled to reward the efficiency of health-care services, not the volume, as is the case now. The government would provide subsidies to make coverage more affordable for households with incomes up to four times the federal poverty level, or $88,000 for a family of four and $43,000 for an individual. Medicaid — the federal-state health program for the poor — would be expanded to individuals and families up to 133% of the poverty line.
Health care providers would also be held to account for quality care, not just ordering up tests and procedures. Insurance companies would be prohibited from denying coverage to the sick and the industry would face stiff competition from a new government plan designed along the lines of Medicare.
“This proposal controls the skyrocketing cost of health care by rooting out waste and fraud and promoting quality and accountability,” the president said in a statement about the House plan today. “Its savings of more than $500 billion over 10 years will strengthen Medicare and contribute to our goal of reforming health care in a fiscally responsible way.”
The House bill would change the way individuals and many employees get health insurance. It would set up a new national purchasing pool, called an exchange. The exchange would offer a menu of plans, with different levels of coverage. A government plan would be among the options, and the exchange would eventually be open to most employers. Insurers say that combination would drive many of them out of business since the public plan would be able to offer lower premiums to virtually all Americans. But backers of a public plan - including Obama - say it would instead provide healthy competition for the insurance industry.
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The federal government would ultimately be responsible for ensuring that every person, regardless of income or the state of their health, has access to an affordable insurance plan (target is to have 97% of Americans covered by 2019.). Individuals and employers would have new obligations to get coverage, or face hefty penalties. Employers who don't provide coverage would be hit with a penalty equal to 8% of workers' wages with an exemption for small businesses. People (employees) would also be penalized as much as 2.5 percent of their income for failure to buy health insurance.
The plan would cost between $1 to $1.5 trillion over the next 10 years and reduce the number of uninsured by roughly 37 million Americans (currently 46 million uninsured), according to a preliminary analysis by the Congressional Budget Office and other reputable sources.
As with any legislation of this magnitude and impact, they are many stumbling blocks and there will a number of public and private discussions that take place before the bill is finalized. Business groups and the insurance industry immediately assailed the legislation. In a letter to lawmakers, major business organizations branded the 1,000-page bill a job-killer. Its coverage mandate would automatically raise the cost of hiring a new worker, they said. Efforts to reach a bipartisan compromise in the Senate have failed so far as well, with most republicans opposed to the plan (without really having a viable alternative themselves). And in the House, the Democrats’ plan is considered too costly by dozens of their own members - which means that the final version of the health care reform bill is far from finalized.
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July 15, 2009 12:05 AM
Congress is trying to solve two diametrically opposite problems simultaneously: save money and insure more people. Never going to work and more tax payer money will be wasted
July 15, 2009 10:54 AM
This is amazing to me. And what’s more it really comes down to taxation without representation because you will be hard pressed to find any of our representatives who have actually read any of this bill let alone the cap and trade bill.
Add to that the news I saw last night that a company like Goldman Sachs earned over 2 billion in profit last year and didn’t pay any tax and I’m left scratching my head.
My plan is to get out of debt asap and get some money into wealth securing assets and commodities because I have a feeling that the worse isn’t over.
You know. The thought suddenly occurs to me that this makes wanting to reach the American dream of wealth and security less appealing. Why try if the government is going to take half of what you earn? Shot for mediocrity. Depend upon big brother. Maybe that’s the desired effect.
July 15, 2009 11:02 AM
So let me get this straight - the more succesful you are (financially) the more you will be taxed. Since when did America enter the twighlight zone? We are going from the USA to the USSR.
As a relatively well to do small business owner, I employ over 20 people. With these extra taxes on my personal and business income, I will probably end up letting go of up to 5 people. At least, they will have health insurance and with all the other government subsidies, pepople will be encouraged to stay on welfare rather than work and pay it all back in taxes.
July 15, 2009 11:26 AM
IF OBAMA WAS IN THE BEST INTEREST OF HIS CITIZEN.HE WOULD BE STRAIGHT FORWARD ABOUT A PLAN!! YES,IT WOULD BE NICE IF OUR TAX MONEY,COULD PAY FOR OUR HEALTH INSURANCE...WE NEED A PREVENTIVE COVERAGE IN INSURANCE POLICY,THAT MOST DON'T COVER!!! IF WE CAN PREVENT A ILLNESS,THERE WOULD BE LESS HEALTH COST...ALSO,THERE ARE HERBALS;THAT ARE SAFER THAN MAN MADE MEDS.SEVERAL MEDS DO CAUSE MORE HEALTH PROBLEMS,THAN THEY HELP.I WOULD LOVE TO A COVERAGE IN PLAN THAT DO COVER HERBALS AND PREVENTIVE CARE!!
July 15, 2009 2:20 PM
Thanks for this post. I have not paid attention the this bill as closely as I should have. I heard the Senate passed something today. I need to take a look at the text.
July 16, 2009 10:17 AM
Thanks for all the comments. This is clearly a key topic for all American and it is good to have a lot of debate. I just hope it is not rushed through without the required thought process. America needs health care reform, but it needs to be done right and not just to win re-election and espically not at the cost of American values and ideals.
July 21, 2009 2:01 PM
The problem with this bill is that it doesn't address the fundamental reasons that health care is so expensive.
Insurance and legal costs dramatically inflate medical costs, while contributing zero to providing quality health care.
On top of that, perscriptions and other medical services are way out of whack, while they spend billions in advertising and "promotional" schemes.
The Obama plan doesn't address any of these medical cost problems, but instead cuts everybody in for a full share of taxpayer money.
Sticking it to the rich isn't going to solve this problem. Someone needs to cut out some very powerful special interests and Obama doesn't have the will or the political capital to pull that off.
July 25, 2009 7:54 AM
When ever you see the words "$1.5 trillion" and "solution" in the same sentence, you know the sentence is only half true. Let's see the government fix social security and medicare first. If that can do that, how can we trust the government with an even bigger social program. While I did not vote for President Obama, I did expect him to come to the table with a more creative solution than this. Anybody can throw $1.5 trillion at a problem and call it a solution. But all we'll be doing is forcing our grandchildren to pay for our health care.
July 29, 2009 9:43 AM
PLEASE READ., THEN GET ON THE COMPUTER OR PHONE AND ENCOURAGE -DEMAND THAT YOU SENATORS AND REPS. KILL THIS BILL - WE ARE ALL SCREWED IF THEY PASS THIS.
Page 22: Mandates audits of all employers that self-insure!
Page 29: Admission: your health care will be rationed!
Page 30: A government committee will decide what treatments and
benefits you get (and, unlike an insurer, there will be no appeals process)
Page 42: The "Health Choices Commissioner" will decide health
benefits for you. You will have no choice. None.
Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.
Page 58: Every person will be issued a National ID Healthcard.
Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.
Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN)
Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.
Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans)
Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens
Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan.
Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter.
Page 124: No company can sue the government for price-fixing. No "judicial review" is permitted against the government monopoly. Put simply, private insurers will be crushed.
July 29, 2009 9:44 AM
And more...
Page 127: The AMA sold doctors out: the government will set wages.
Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives.
Page 126: Employers MUST pay healthcare bills for part-time employees AND their families.
Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll
Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll
Page 167: Any individual who doesnt' have acceptable healthcare (according to the government) will be taxed 2.5% of income.
Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them).
Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records.
Page 203: "The tax imposed under this section shall not be treated as tax."Yes, it really says that.
Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected."
Page 241: Doctors: no matter what speciality you have, you'll all be paid the same (thanks, AMA!)
Page 253: Government sets value of doctors' time, their professional judgment, etc.
Page 265: Government mandates and controls productivity for private healthcare industries.
Page 268: Government regulates rental and purchase of power-driven wheelchairs.
Page 272: Cancer patients: welcome to the wonderful world of rationing!
Page 280: Hospitals will be penalized for what the government deems preventable re-admissions.
Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government.
Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies!
Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.
Page 321: Hospital expansion hinges on "community" input: in other words, yet another payoff for ACORN.
Page 335: Government mandates establishment of outcome-based measures: i.e., rationing.
Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc.
Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals.
Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone).
Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia?
Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of time.
Page 425: Goverment provides approved list of end-of-life resources, guiding you in death.
Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends.
Page 429: Advance Care Planning Consult will be used to dictate treatment as patient's health deteriorates. This can include an ORDER for end-of-life plans. An ORDER from the
July 29, 2009 4:30 PM
Mandatory end of life counceling? I have been racking my brain as to why the pharm gave thier ok to Obama care immediately there must be a pill they are planning to give us to end are life.How are they going to get us to the Doctor for his counceling, is thier going be a squad that comes for us or what?
July 30, 2009 11:00 AM
Clearly a lot of debate on this topic is taking place and there is a number of questionable points in the 1200 page proposal. Need to check some of the point from Robert - as they do look worrying.
DR - Our grandkids are going to have to deal with so much debt that 1 trillion will be a drop in the bucket. If we can really fix health care then I think 1 trillion is a fair price.