As of 10:30pm CDT, the House of representatives passed the H.R.4872 a bill that appropriates the previously passed version of the bill (H.R.3962) with the already passed senate bill H.R. 3590 (the full text of all three bills is linked at the bottom of this post). Due to clever exploitation of congressional rule loopholes, after a simple-majorty vote in the Senate, the bill will head straight to the President bypassing the full Senate floor discussion, where Democrats no longer hold the filibuster-breaking majority.
What follows below is an analysis of what this bill does for the U.S. citizens and legal residents (undocumented immigrants are left with the current emergency-only level of "care").
However, as a disclaimer, I ought to own up to my position on this bill. Despite being a moderate, strongly socially liberal, yet strongly fiscally conservative, this bill has my unanimous support, as do the Democrats who have passed it. The reason is utterly simple. As a policy-focused social researcher,I task all the policy-makers to participate in the legislative process. We pay them from our taxes to critically evaluate societal issues and act on them to the best of their abilities, in line with their ideologies. Democrats, back in the summer of 2009, introduced a decent draft of a legislation, and gave it to GOP for critique and improvement. Despite being rarely done, this kind of critiquing is how the best policy is made; if both parties are willing, that is. Republicans scoffed at this chance to rise from politicians to statesmen and stateswomen and chose the low road of smear tactics, lies and avoiding the legislative process. In what turned out to be a reincarnation of the 60's with is racial, bigoted rouse of ignorant loot of provincial, demagogic, and corrupt "politicians," the debate over healthcare in the U.S. was effectively stalled. Every single Republican just lost my respect and my support; they wasted a year in taxpayer-paid salaries avoiding their job description. Just as people who cannot be bothered to vote lose their right to complain about the election's results, Republicans lost their right to speak on this issue.
President Obama in the Roosevelt Room watching as HR4872 gained 216 votes.
(photo credit: White House Flickr)
With that out of the way, let's see what HR4872 actually brings to the U.S. residents. First, this is much less a healthcare overhaul, than a long-overdue regulation of the health-insurance industry. Vast majority of the provisions in this bill are aimed at regulating the behavior of the insurance companies. Second, the bill expands and reforms Medicare. This entitlement system originally designed for, and still overwhelmingly used by, the elderly and the disabled (not the poor, or children), will be expanded a lot and then contracted some, and its working will be reformed. Third, the bill will eventually regulate the way we and our employers buy health-insurance. Finally, the bill introduces taxes to fund the bill.
First, the bill moves swiftly to ban certain behaviors by the heath insurance companies such as dropping their insured for getting sick, not covering children who are already sick, and imposing annual limits on benefits. The bill will also extend the coverage of dependents through age 26 (instead of the current practice of 19 or college graduation). Over time the bill will also ban not-insuring adults who are already sick and imposing lifetime limits on care, will regulate policy and premium changes, and will force insurers to cover preventitive care. Finally, by 2014 and 2018 health insurance companies will compete in a much more competitive market, the large ones will pay additional taxes, those that hold a virtual monopoly on markets will be pushed to free up market. In return, they will get more insurers on their rolls (more on that later)
Second, the bill reforms Medicare. Temporarily, those currently-uninsurable will be placed under the wings of Medicare, until the legislation is in effect banning discrimination against them by the for-profit insurers. Concurrently the care under Medicare will be reformed. Following the efficiency models from the best for-profit insurance companies, Medicare will begin monitoring the flow of their insured through the medical system, and introduce financial stimuli for care providers to conduct prevention, to coordinate care, and to provide high quality care. In return, the care providers will receive more money for their services for Medicare clients than they do now. These payments will still not equal payments they receive from private insurance companies - that provision is missing in the current bill. Finally, the bill will close the prescription drug donut hole currently in the medicare legislation.
Third, beginning in 2014 every resident in the U.S. will need to purchase health insurance. Those earning less than four-times the (meager) poverty line will receive government subsidy, but will be still free to buy insurance of their choosing. We will buy health insurance through 'health insurance exchanges" which will compare the coverage and cost of different plans from different providers. Those earning more the $200,000 a year (families earning more than $250,000 a year) will pay additional taxes to cover the insurance expenses. Employers with more than 50 employees will be required to buy insurance for their employees (or pay fines), and pay fees for generous insurance policies for their executives. Employers will also have to disclose the value of the employee health insurance on the employees' W2 tax forms, so the employees can see the value they are receiving from their empployers (ending the era of employers pretending to buy healthcare for their employees - I am looking at you WalMart!). The bill does not adeuqtely spell out how it will handle the working poor that do not quite qualify for Medicare and Medicaid, but cannot afford private insurance. My perception is that they will be rolled under the public insurance, which will, of course, drive up taxes. Finally, the bill is funded through new taxes on the wealthy, on employers providing extraordinarily-rich insurance plans (for their executives) or not providing insurance for their employees, and on wholesale medical purchases.
This bill is far from "government takeover of healthcare," or from "socialized medicine." U.S. already has socialized healthcare for prisoners, employees of the federal government, soldiers, the elderly, those with work-impeding disabilities, and poor children. Especially the last program CHIP has been surprisingly successful in covering chindren of poor- and lower-middle-class parents for very little money. However, until now there were no provisions dealing with the insurance of the hard working adults, and middle to upper-middle class children; we simply assumed, they will be covered somehow.
In essence this bill will reduce the extent of communaly-funded health insurance; currently everyone without insurance uses the emergency rooms to receive basic care without paying. These expenses are then passed to the rest of us through higher bills covered by our insurance. Curiously the only ones left in this communally-funded misery are undocumented immigrants, because they will not qualify for the government programs, and being undocumented, their employers will continue to lack any incentive to treat them as decent human beings (but I digress).
This bill mainly adds regulation of the health-insurance companies covering those unlucky schmucks not already covered by the generous government plans. It also aides the purchase of insurance by the working poor, and helps those that are around the threshold to not be left behind and uninsured. Most importantly, it will force employers to finally purchase coverage for their hard working employees, eliminating the fictitious care provided to millions of employees in the service and retail industry. Ted Kennedy's vision has not quite been reached, but we are a one giant step closer - we have access to healthcare for most, we help most actualyl afford it, we strenghten the rule forsing employers to buy coverage, and we finally care how the insirance companies treat their "clients" (controversial, I know!)
Links:
text of H.R. 4872: Thomas.gov
text of H.R. 3962: Thomas.gov
text of H.R. 3590: Thomas.gov
contributing analyses: Reuters analysis by type of effect and by timeline.
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