Monday, March 22, 2010

The Health Care Reform Bill passed the House... and I'm...

...happy about it.  If nothing else, this is important for what it represents.  For the first time in 40+ years, a President has been able to care enough about the people of this country to push through at least some form of health care reform.  And while the bill is still severely lacking, make no mistake, it does provide immediate relief for some and does have some important reforms that take effect in a very short time, that will help people... lots of people.

My hope is that the country will look back at this at the amount of time and effort the Republican party spent trying to oppose this bill... trying to oppose legislation whose only goal was to help American citizens... in a politically fed, partisan flop-sweat attempt at just opposing any legislation the Obama administration put forth, just because it is Obama putting it forth.  It has been a despicable display of the ugliest order and I think in the end the Republicans will be irreparably damaged for it.  In fact, they stand to become even more publicly humiliated once they begin using pathetic stall tactics in the reconciliation phase of this bill for all to see.  It will be infantile and silly, and will be wide open for the entire country to see.  More on that later...

But first, now that the bill is passed, the important questions are: what does this bill do and what does it not do for the American people?  I've refrained from posting about this bill until now because I wanted to wait till I could see in what form it was passed. I'll try to break it down in failry simple terms.  This bill is huge, and it is complicated.  But the items that are important to you the people can be broken down fairly simply, so I'll attempt to do that as much as possible.

First, what does the bill include?  Well, its components are broken down and will be phased in over time.  In six months, here are the following items the bill will enact:

  • Insurers will no longer be able to refuse coverage to children because of pre-existing conditions (this provision kicks in for the rest of us in 2014... which sucks, but is still better than nothing).
  • Insurers will no longer be able to dump a person's coverage because they get sick.
  • Insurers will no longer be able to cap how much coverage a person can receive in their lifetime.
  • Parents will be able to carry their kids on their insurance plan until they are 26.
So... this is a good start.  So what are the other things that kick in down the road?  Below is that list along with the year they become effective:

  • Insurers will no longer be allowed to deny anyone of any age coverage because of pre-existing conditions. (2014)
  • Each State will create a "insurance exchange" for both individual buyers and small businesses, which will consist of several insurers, based on minimum requirements for benefits, and have strict limitations on how much their premiums can vary... so that insurance plans for the elderly and ill can not cost considerably more than for young and healthy individuals.  People can then buy from insurers in the exchange based on the best cost and plan for them. (2014) --- I have my doubts about how well this will work, but I'm willing to see how it goes.  Again, it's still an improvement over the status quo (or as I call it, the Republican Plan of Doing Absolutely Nothing)
  • Subsidies for buying insurance will be offered on a sliding scale, so that families making less would pay less for the same coverage as families making more. (2014)
  • There will be an excise tax on the most "plush" of health care plans.  (2018).  This was once referred to as the "Cadillac Tax", but as this would have effected many policies currently used by Union workers, this has been amended to include only the very most opulent plans, and is now referred to by Nancy Pelosi as the "platinum Rolls-Royce Tax".  Whatever.  It still stinks to me. I don't care for this provision but I do understand the necessity as a means to pay for the Reform Bill.
  • High Income households (individuals making more than $200,000 and families making more than $250,000) will see an increase in their contributions to the Hospital Insurance payroll tax from 1.45% to 2.5%. (2014)
  • Those same households will see an increase of 3.8% on taxes of income from interest, dividends, annuities, royalties and rent. (2014)
  • You will be penalized for not having insurance.  (2014) This has been an issue of much debate and heated argument, but looking at the reasons for having such a penalty (similar to auto insurance, costs come down when everyone is insured, because the chance of having to eat the cost for services for the uninsured goes down) versus the actual fines that will be instituted ($95 a year or 1% of your income, whichever is greater), it's ridiculous to argue that this is the wrong thing to do.  If you choose to not carry healthcare even though you can easily afford it, fine... but you will help to make sure when you do get sick and we have to eat the cost, you've helped contribute to that.  And if you simply can't afford it, well then the $95 fine is hardly a hardship (and those for which it is an undue burden, you will have the ability to have this fee waived).  So quit whining about this provision... it's the right thing to do in a system that isn't single-payer.
  • Employers who don't offer their employees insurance will face fines of up to $2000 per year, per employee.  Small businesses with less than 50 employees are exempt, but small businesses will be able to use tax credits to help pay for insurance through the State insurance exchange. (2014)
  • Provisions have been put in to attempt to lower the costs for Medicare, and close the "hole" in the prescription drug policy for Medicare. (2014)
  • Primary Care physicians and surgeons will receive a 10% bonus from Medicare as a push to improve preventative care (2011).
  • Additional education funding falls into this bill, including funds specifically for colleges and universities that serve large numbers of minorities. (2010)
  • Oh... and facilities that use Tanning beds that use UV lamps will be taxed 10% starting July 1 of 2010 

There are some other odds and ends in there, but those are the important pieces.  Now, let's talk about what's not in this bill that is of interest to my fellow left-leaning, people loving liberals:

  • No public option.  BOOO.  Big, huge, loud, resounding BOOOOOOOO.  There was no reason this bill could not have included a public option through reconciliation.  And it would have passed.  But the Dems got cold feet about passing the House, and chickened out.  This is the biggest failing of this bill.  People deserve to have the option to have a cheap, medicade-like option available to them the same way the people putting the goddam bill together in the first place have.  The same way our armed forces veterans have.  I am proud of our veterans, but are the truly more deserving of basic, affordable health care than the average citizen?  The lght at the end of the tunnel here is that I do not think this part of it is over... as the summer rages on and the Senate begins to hear the clamoring that the country wants and needs a public option, this may come back to the fore-front. Or maybe not.  We'll have to wait and see... but for now, big, huge thumbs down to the Dems for not getting this done at the one, single time in history they could have.
  • Several of the "back-door" deals that had been put in to win support from certain Senators (most notably the deal with Ben Nelson of Nebraska in which all new Nebraska Medicaid enrollees would be paid for by the Federal government, forever) are thankfully gone.  There are still a few "back-door" deals in place for certain circumstances (all of which do serve a "public service" at this point), but the most egregious of these have been removed.
Those are the two biggest "left out" issues.  Some of you may take issue with some other things that aren't there... but I think these are the two that matter to most people.

So... is this a slam dunk now?  Well, no... not really. It will in all likelihood get passed, but there are some items the House added to the Senate Bill (some of the things listed above fall within that area) which must be passed through reconciliation.  Essentially this means that the Senate need only agree to the addenda or changes attached to the Bill by a majority 51 vote.  And while this will happen, the Rethuglicans have already stated that they will take whatever measures necessary to delay this reconciliation process indefinitely.  To do so, they will use the tactic of proposing amendment after amendment to the bill, which they can do an unlimited amount of times, and must be voted down each time.  And they will come up with some pretty boorish and stupid things, just to delay the process... for example, put forth an amendment that all insurance cards must be printed on pink velvet.  It is likely to get pretty boorish, and I really hope the Rethuglicans try this route, because it will expose them for what they really are to the American people who will, I predict, have little patience for this behavior.

Also, there is the looming issue of the abortion language in this bill.  For some reason, middle-aged to elderly white men still think it's somehow their right to limit resources to allow a woman to decide what's best to do to her own body.  It's disgraceful and I'm hoping the will exists to shut these assholes up, but we'll have to see.  It could be a real problem if enough of these god-bothering, misogynistic assholes have their way. 

So, at the end of the day, I feel a sense of tempered excitement over the passing of this bill. As I said above, it's an important message that after decades of deciding the american people were not worthy enough for the government to step in and take steps to stop the insurance companies from publicly raping and ultimately killing hard working Americans, a president has been able to step up and say "This is the most important thing on my agenda. Period." And actually get something done.  Is it all we should have or all we deserve?  No.  Is it all we're going to get going forward?  I don't think so.  The faucet of Health Care Reform has been turned on... even if only a trickle. And once on, I think it will be much easier to open it up further than it will be to shut it back off.  Go ahead, Republicans.  Try it... I dare you.

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