On Sunday night, a major piece of health care legislation was passed.
My question is, after a year of “debate,” “news coverage,” and conservative and liberal “opining,” what do you really know about it? Do you know what the bill says? Or how it relates to how our government works?
There has been a lot of heated rhetoric about this bill, for sure. For instance, I know that many people vociferously oppose it because it’s socialism, but I also know that one of the explicit purposes of government, as defined by our Constitution, being to “provide for the general welfare.” I never heard how government involvement in something as fundamental as health care—if we’ve proven we can’t do it ourselves—is philosophically any different than it’s involvement in defense, education, or infrastructure… and I never heard what parts of this bill were socialist beyond the price tag associated with it. I also never understood the debate around the number of uninsured people in America: I get it that there is real disagreement about the “real number,” which looks like it could be 10 million and not the 30 or 40 million sometimes quoted,, but on a pragmatic level, if insurance premiums subsidize ~30 million ER visits per year, then how does the debate change if the real number is 10 million uninsured? I haven’t heard that argument used to explain any alternatives to the current bill, only as a reason to oppose it… again, vociferously.
And by the way, neither the socialism/not-socialism debate, nor the number of people insured debate, help me understand the issue of health care reform.
At all.
So now that it’s passed, what do you know about Bill H.R.4872?
How will it change your life?
No rhetoric about fewer ER visits or higher/lower taxes or other future consequences that may or may not materialize—we know this bill will be neither as good nor as bad as anyone hopes. Just “What will it actually do? And when?”
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I'm Jason. I make people shine. My mission is to help 1 million people tell their stories better. 
{ 5 comments… read them below or add one }
You know what’s socialist? The fact that the insurance companies are essentially a monopoly and do not compete. If they were forced to compete for customers, think how quickly those CEO salaries, admin positions, and junkets would drop.
That’s what I would have liked to have seen in the bill. And one reason why the insurance companies actually like the bill.
For me personally, nothing really changes today. My insurance will still be chosen by my employer (and even though I have a say in what gets chosen by our company, the choices offered to our group are pretty limited), my care will be directed by my HMO and sometimes my doctor, and I am still free to make choices about how I take care of my body (or not) on a daily basis.
Rachel Maddow presented an excellent list with specifics on what and when things were going to go into effect as a result of the bill passing on her show last night, but I can’t find it online yet.
And just to show you that I’m only part socialist (lol), here’s a link to a pretty good roundup from NPR: http://www.npr.org/templates/story/story.php?storyId=125015099
Arguing about whether this is or isn’t socialism is a waste of time. Any government program is inherently against principles of free market and many regulations actually encourage non-free market activities (though companies owning a government endorsed monopoly is really not socialism, simply not at all free market). Arguing the merits and downfalls of legislation doesn’t fit into a soundbite though. Socialism does.
I can see value in understanding the breadth of the uninsured. That impacts the potential cost and also extent of the rationing of care that is currently taking place (I know, rationing is happening right now. Absolutely nuts).
I’ve been reading various run downs of the bill but reading the actual bill is a cluster…well, you know. One summary from the Kaiser Foundation was surprisingly thorough though I can’t find a link for it now.
Since Monday, I’ve had 100 employees ask me various questions about what it means to them but mostly centering around whether or not they will need to pay excise tax on their benefits. I’m working with our Communications group to get a mini section of our intranet set-up to discuss the implications, timelines, and renew our commitment to continue to offer insurance. I’ve been asked to update our 10 year strategy to incorporate any reform implications and creating some talking points. It’s been a little busy.
Despite most of the rhetoric and near straight party-line votes, much of the actual content of the bill is fairly centrist. No pre-existing conditions, no rescission, dependents up to age 26 can stay on the plan, FSA limited to $2500 and no more over the counter drugs allowed, and tons of changes to Medicare.
Some of the more contentious parts are the “pay or play” for employers where if you don’t offer insurance, you have to pay $2000/yr and the individual mandate which requires coverage or else a fine of $695 up to 3x capped at 2.5% of household income. There’s also an increase to Medicare tax rates for those making >$200,000 individual by .09%.
Then my least favorite aspect of the entire bill is the 40% excise tax on the value of benefits over $10k individual and $27k family which will be indexed to general inflation which goes into effect in 2018 (based on the Senate passing the reconciliation bill or else 2014 otherwise). These amounts are so low for any employer based health plan – particularly if you have older employees. (there is some age adjustment built into the calculation but it will have minimal effect) So there’s going to be some drastic changes in plans to ensure that people don’t have to pay this. Any amounts contributed to HSAs or FSAs count toward the total as well in addition to the medical premiums.
There’s also some additional taxes that insurers are supposed to pay, but I think that with 100% certainty, they’ll pass them straight on to the employers and individual consumers.
What I am intrigued to see is some analysis on whether this will impact Medicare and it’s projected insolvency in 2017/2018. If that issue isn’t remedied, then further steps will need to be taken to reform health care. In 2012, the government will be running 51% of health care in the US (these were the number prior to reform), and if there are budgetary shortfalls, then the private sector ends up picking up the cost differential.
Keeping my fingers crossed that someone did the math right!
@Lynette—Agreed. We only look like a corporate society today… but that’s changing fast as we move toward a free agent economy.
@Lance—That word’s on the tip of your tongue, isn’t it! Clusterfudge? Clusterbar? Clusterduck? Wait, it’ll come to me…
@Shana—Thank you.