the slippery slope.... and yet?

ok, I will get into the meat of this at the end of what im going to copy and paste. if youre patient enough to read all of this, then i'll tell you what i think. note, this comes courtesy of the christian science monitor....

The House of Representatives passed the health care reform bill Sunday night with a 219-to-212 vote. With the Senate already having passed the bill on Christmas Eve, it now stands ready for President Obama to sign into law, perhaps as early as Tuesday.

Many challenges remain, though. Attorneys general in 11 states have said they will challenge the constitutionality of the health care bill. Moreover, Democrats still want to make changes to the final bill after the fact.

The House has already passed this package of fixes – which would rein in some of the special deals made with senators last year. Now the Senate must pass the same package of fixes before Mr. Obama can sign them into law. To do that, the Senate will have to turn to the contentious and time-consuming process of reconciliation.

But the outlines of the bill are now clear. Here is the Monitor's comprehensive look at what is in the health care bill and how it might affect you.

So we’re going to try to describe what’s in the healthcare reform bill in plain English.

That’s not easy. For one thing, the bill is full of sentences that begin “For the purposes of subparagraph 6(b)....” For another, healthcare reform would be the most sweeping change in US domestic policy in a generation. It’s big, and it’s complicated.

Healthcare 101: What the bill means to you

But here’s a key thing to remember: There is a simple concept at the center of this rambling, Rube Goldbergian machine. Democratic healthcare reform would expand insurance coverage in America by requiring people to obtain it.

That’s right. The healthcare reform bill would mandate that most US citizens and legal residents purchase “minimal essential coverage” for themselves and their dependents. They can get this either through their employer, or, if their employer doesn’t offer health insurance, they can buy it through new marketplaces that will sell policies to individuals.

Those marketplaces would be called “exchanges.” We’ll talk more about them in a later story. (We’ll also cover subsidies for health insurance, when it all would take effect, how it would be paid for, and what it means for businesses.)
Are there penalties if you don't buy insurance?

If you ignore this mandate and don’t get health insurance, you’ll have to pay a tax penalty to the federal government, beginning in 2014. This fine starts fairly small, but by the time it is fully phased in, in 2016, it is substantial.

An insurance-less person would have to pony up whichever is greater: $695 for each uninsured family member, up to a maximum of $2,085; or 2.5 percent of household income.

There are exceptions. Certain people with religious objections would not have to get health insurance. Nor would American Indians, illegal immigrants, or people in prison.
Why the requirement?

Why is Congress doing this? It’s a pretty obvious way to expand coverage, for one thing. Also, it will help bring in a flood of new customers for health insurance firms, including healthy young people who might not need much healthcare.

For insurance firms, those new customers could balance out the losses they might incur if they can no longer deny coverage to people with preexisting conditions. (Yes, that’s another change the bill makes.)

And remember, many people will not be buying this coverage purely on their own. Uncle Sam will be helping them. The bookend to the individual mandate is federal subsidies for insurance purchases, which reach deep into the middle class. We’ll talk about those next.

Yes, the legislation now in Congress would require most people in the US to buy health insurance. That’s the main way it would expand coverage by upward of 32 million people.

We told you about that in the first installment of our attempt to describe bill provisions in plain English. (Our next installments cover the timetable for rolling out reforms, how they would be paid for, and what they mean for businesses.)

Healthcare 101: What the bill means to you

But there’s a carrot that goes along with this stick: subsidies. Uncle Sam would help many lower- and middle-income Americans purchase their health coverage.
What's the formula for aid?

Let’s start with people who are unemployed, self-employed, or work for businesses that don’t offer insurance. Beginning in 2014 (that’s right, this is four years away), these people would be able to shop for coverage in new “health exchanges,” a sort of online bazaar in which insurers would hawk different kinds of plans. We’ll talk more about how these malls might work in our next story.

Congressional budget experts figure that about 25 million people will shop for coverage in these exchanges. That’s a pretty big market. Of these, about 19 million are likely to be eligible for financial aid.

The cutoff level would be an income of four times the federal poverty level. For one person, that’s about $44,000 a year. For a family of four, the comparable figure is about $88,000.

Subsidies would be figured on a sliding scale, with those who make less getting a bigger boost and those nearer the top getting a smaller one.

The formula is pretty complicated. Basically, though, people who make three or four times the poverty level would get enough federal money so that they would not have to pay more than about 10 percent of their income for a decent health insurance package.

People who make less would have to pay a smaller slice of their income for coverage. For instance, individuals who make about $14,000, and four-person families with incomes of about $29,000, would not have to pay more than 3 to 4 percent of their incomes for insurance.

And those who make even less – under 133 percent of the federal poverty level – would be able to enroll in a newly expanded Medicaid program.

The federal subsidy would go straight to the insurer. It would look like a discount on the policy to the customer.
Anyone else who qualifies?

But what if you work for an employer who does offer health insurance? You’re not shopping for policies on the individual market. At least, not yet. Can you still get a subsidy?

Excellent questions. Glad you asked.

Yes, if you make less money than the poverty cutoff level, you would still be eligible for aid. The federal government will in essence guarantee that you do not have to pay more than 9.8 percent of your income for your share of health insurance costs.

There’s something of a catch there, however. The main way the feds would ensure this is to steer you, too, into this new exchange. Your employer would give you a voucher equal to the amount of money it contributes to your policy. Then you’d dive in there and shop for plans with all the self-employed people.

(Unsurprisingly, the Congressional Budget Office numbers indicate it does not expect that many people will do this. Only about 1 million.)

The Department of Health and Human Services would be the umpire making calls as to who would and would not get subsidies. The bill, if enacted, would set up a process for appealing HHS decisions.

We’re thinking the bill, if enacted, also would make HHS one very busy place.

We talked about these topics in the first and second installments of our "in plain English" series on healthcare reform.

The legislation also would set up new places to shop for health insurance. They would be called “exchanges,” and they’re the subject of this piece.

Not everyone could use exchanges, and they won’t be open for some time. But they’re an attempt to inject some retail competition into a marketplace that today is not exactly teeming with bargains.

Theoretically, they’d allow individuals and small businesses to band together and get better prices and more variety in health insurance options – the kinds of breaks that big corporations can negotiate for their employees today.

How would they work? Would they be actual stores, in a mall, next to Hot Topic? Would they be Internet sites, or toll-free phone lines? What?

They would at least have to have call centers. So you could try to get them on the phone. But for the most part, their design is up to the states.
How many exchanges would there be?

The House’s original version of healthcare reform would have created a national exchange, but that particular bill is gone with the wind. Instead, the reform that’s now on the edge of passage (or defeat, who knows?) would have states set up health option exchanges administered by either a government agency or a nonprofit organization.

The federal government would provide states with start-up money for exchange establishment. The exchanges are supposed to be open for business by 2014. If a state declines to open one, Uncle Sam can step in and open an exchange himself.

Who will the customers be? Not you, if you work for a medium or large company, and if your employer offers health insurance benefits. That sort of arrangement is grandfathered in, according to the legislation, and can continue pretty much as before.

In their initial years, the exchanges will be open only to those who work for firms with 100 or fewer employees, and to individuals looking to buy insurance for themselves. Because they’re self-employed, for instance. Or unemployed. Or retired but not yet eligible for Medicare.

As all who have tried to buy health insurance on their own know, currently most policies available are much more expensive than comparable products offered to big firms. Partly, this is because big firms can offer lots of customers, both healthy and less so, so that insurers know they can spread their risk.

The exchanges are meant to be cooperatives that allow these individuals to band together and, for health insurance purposes, become like their own big firm.
What oversight duties do exchanges have?

The exchanges themselves would inspect offered policies to make sure they meet government standards. They’re supposed to make sure the plans are “in the interest” of buyers, according to the healthcare reform bill.

They are prohibited from setting premiums. They can, however, ask insurers to justify rate hikes – and if they’re unsatisfied with the answer can use price as a reason to ditch that particular plan from their product lineup.

Then the exchange would offer approved policies to interested buyers, in the same way that a food coop offers oranges (“Ten for $5! Florida sunshine!”), free-range chicken, and bag-your-own rolled oats.

They're supposed to have four levels of plans to offer, of declining expense. The levels would be labeled "platinum," "gold," "silver," and "bronze." (We guess somebody spent a lot of time watching the Winter Olympics.)

Yes, you would be able to buy health insurance for yourself outside the exchanges. They would not be monopolies. But an insurer would have to charge the same rates outside the exchange as it does inside, for comparable plans, among other new regulations.

But some of the most important provisions of the mammoth health bill aren’t set to take effect until 2014, or even later. As we said in the first installment of this plain-English series on what’s in the health bill, healthcare reform is a big, rambling, Rube Goldbergian machine.

It would take time to set that up, and write the regulations that will govern its operations.

You’ll note that by 2014 the US will have had two Congressional elections. Three, if you count the one that will occur in late 2014 itself. And in 2012 there’s the little matter of President Obama’s run for reelection.

That’s just to point out that the implementation of healthcare reform could come in a very different political environment than the one in which passage occurs. If the bill passes, that is.
Things that happen first

The healthcare reform bill makes a point of putting first the things that are supposed to happen first. They’re in subtitle A, right up top: “Immediate Improvements in Health Care Coverage for All Americans.” Things in the bill that take effect right away include:

* Insurance companies will be prohibited from placing lifetime caps – limits on the amount of money that can eventually be paid out – on their policies. They’ll face new restrictions on setting annual caps, as well.
* Insurance companies also will be prohibited from pulling your coverage, except in case of fraud or intentional misrepresentation.
* Children won’t be excluded from coverage due to pre-existing health conditions. Plus, children will be able to stay on their parents’ policy until age 26.
* Small businesses that offer health coverage to employees will be eligible for tax credits of up to 50 percent of premium costs.
* Seniors who fall into the coverage gap, or “doughnut hole”, in the middle of the Medicare Part D prescription drug coverage plan will get $250 to help them pay their bills.
* People with pre-existing health conditions will be able to enroll in a new, but temporary, national high-risk insurance plan.

Things that happen later

The central element of the superstructure of President Obama’s healthcare reform effort is its individual mandate, as we described in part one of this series. Most people who live in the United States will be required to obtain health insurance.

But this does not kick in until 2014, when fines begin for those who don’t have coverage.

Similarly, the subsidies intended to make policy purchase affordable – the subject of part two of this series – don’t start until then. And the exchanges where individuals and small business can buy health insurance (you guessed it – part three) are not supposed to be up and running for four years, either.

Finally, one of the most popular provisions in the health bill, its ban on the denial of insurance coverage due to pre-existing health conditions, won’t take effect until 2014 either. That’s because insurers will need the flood of new customers brought in by the individual mandate to cushion the costs of accepting people who already have health problems.

As we’ve noted throughout this series on what’s in the health care bill, the legislation, if the vote succeeds, would represent the most sweeping change in national domestic policy in a generation.

Among other things, it would provide or subsidize health coverage for 32 million currently uninsured people. That’s more than one-tenth of the entire population of the US.

Healthcare 101: What the bill means to you

Change like that doesn’t come cheap. More specifically, change like that would cost about $940 billion over its first 10 years, according to the Congressional Budget Office.

Add these two things together, throw in $40 billion worth of tax credits for small business, and you’re pretty close to the bill’s top line for expansion of health coverage.

So where’s the cash to pay for this coming from? Remember, CBO says this bill will actually cut the deficit over 10 years. That means it has to raise a little more money than it will spend.

The answer is that the money will be provided by new taxes, fees on industries involved in health care, and cuts in projected spending growth for existing government health efforts, primarily Medicare.

Here are specifics on some of the biggest money raisers:
Higher Medicare taxes on rich people

If you are an individual making more than $200,000 a year, or a married couple making more than $250,000 a year, get ready to pay more for your Medicare if health care reform passes.

First of all, your Medicare Part A (that’s hospital insurance) tax rate would be increased by 0.9 percent, to 2.35 percent. Second, the bill creates an entirely new tax of 3.8 percent on unearned income (dividends, interest, stuff like that) for people in those same income brackets.

The good news is that this would not take effect until Jan. 1, 2013. And it is a big money raiser, truth be told. The Joint Committee on Taxation estimates this would bring in $210 billion between 2013 and 2019.
New tax on expensive health insurance

They used to call this the “Cadillac tax,” but it’s been pared back enough so it might better be called the “Chevy with leather and A/C” tax.

The health care bill would impose an excise tax on insurers of employer-sponsored health plans that cost more than $10,200 annually for individual coverage, or $27,500 annually for family coverage. The tax in question would be 40 percent of the cost of the plan that exceeds those dollar thresholds.

This tax would not kick in until 2018. The JCT figures it would bring in around $32 billion in its first two years.
Fees on health care industries

The Obama administration figures it is only fair to slap some fees on health care industries, since they’d be getting lots of new customers if health care reform passes. So after negotiations with some big sectors, the White House struck a number of deals.

* Drug manufacturers would pay the US a total of $16 billion between 2011 and 2019.
* Health insurers would pay $47 billion over the same period.
* Medical device manufacturers would pay a 2.9 percent excise tax on the sale of any of their wares, beginning Jan. 1, 2013.

The tanning tax

OK, it’s not a big money raiser, but we could not resist mentioning that health care reform would establish a tax of 10 percent on indoor tanning services. (Outdoor tanning services remain untaxed, of course.) This would raise $2.7 billion between 2010 and 2019.
Medicare cuts

Government payments to Medicare Advantage – plans run by private insurers that are an alternative to traditional Medicare – would be reduced by $132 billion over 10 years under the health care reform bill. (Those plans now get around 14 percent more per person than traditional Medicare does.)

Medicare payments for home health care would also be reduced by $40 billion over 10 years. And cuts in certain payments to hospitals would raise another $22 billion by 2019.

Quite a bit. It could affect business decisions on health coverage for employees at tens of thousands of firms.

Let’s start with a caveat: that dry cleaner, and probably the restaurant, might be too small to be affected by some of the most important business-related elements in the bill. Employers with 50 or fewer workers would be exempt from coverage provisions.

But for top executives at firms with 50 workers or more, the most important question may be this: would the health care reform bill require us to offer health insurance to our employees?

The answer to that is “no,” strictly speaking. But if you don’t, you might have to pay fairly large fees to Uncle Sam.
How does the bill work for businesses?

Here’s how that works: If you are a firm with more than 50 employees, and do not offer health insurance as a benefit, and at least one of your full-time employees gets a subsidy from the federal government to purchase health insurance on his or her own, you would have to pay Washington a fee of $2,000 for every one of your full-time workers. (Company accountants take note: you could subtract the first 30 of your employees from that assessment.)

Got that?

Also, even if you do offer coverage, you might have to take some extra action to help any of your low- or middle-income workers who want to buy insurance on their own.

Take an employee who makes less than 400 percent of the federal poverty level, which today is about $10,800 for an individual, or $22,000 for a family of four.

Perhaps that employee is finding firm-offered insurance expensive. If their share of health premiums is more than 8 percent of their income (but less than 9.8 percent), they would have the option of going out and buying insurance on their own through the new-fangled “exchange” marketplaces the health care reform bill would establish.

And you, as an employer, would have to help them. You’d have to provide them a “free choice voucher” equal to what the firm would have kicked in to provide coverage in the company plan.
When do the changes take effect?

All of the above changes would take effect beginning on Jan. 1, 2014.

One final item: if you’re a firm with more than 200 employees, and you do offer health insurance, you would have to automatically enroll your workers in the plan.

They could opt out of the coverage. But they are the ones that would have to make that decision.

For those struggling to pay bills, who’ve avoided buying insurance because it costs too much, reform might mean they'll have coverage, at least in a few years. For those at the top end of the income scale, it will mean higher taxes, fairly soon.

For the vast majority of middle-income families, details of employment, dependents, and place of residence might change how the healthcare bill will alter their lives.

Here are a few specific family-oriented changes in the legislation:

Kids with health problems. Healthcare reform legislation prohibits insurers from excluding from coverage children with pre-existing health conditions. This provision takes effect immediately upon the bill becoming law.

The bill would also prohibit insurers from excluding adults with pre-existing conditions, but not until 2014.

Older children and parental insurance. Dependent children up to age 26 will be able to stay on their parents' family policy, after President Obama signs the bill. (There’s no special regulation as to what this will cost, however.) Currently, states regulate the age at which children are kicked off their parents' insurance policies. Generally, it's around 18 years old.

Children's health insurance program. Kids' eligibility for the popular CHIP (Children's Health Insurance Program), which helps lower-income families, must be maintained, under the bill. States, even if hard-pressed by budget shortfalls, will not be able to cut children from the program until 2019.

Wellness program. Under bill language, "qualified health plans" will have to provide – with no cost-sharing – immunizations and other preventive health services for infants, children, and adolescents. This provision takes effect six months after the bill becomes law.

Would the healthcare reform legislation that President Obama plans to sign into law on Tuesday affect seniors in any direct way?

The short answer is “yes.”

The longer answer is that some seniors may lose Medicare benefits they now enjoy. Many others will gain from an enhancement of Medicare’s prescription-drug program.

Here are some specifics on these changes:
Medicare cuts

Under the healthcare reform bill, government payments to Medicare Advantage – plans that are run by private insurers such as Humana and are an alternative to traditional Medicare – will be cut by $132 billion over 10 years. (Those plans currently get somewhat more per person from the government than traditional Medicare does.)

Medicare Advantage plans often offer extra benefits that seniors in traditional Medicare don’t get. It is possible that these extras will be dropped as Medicare Advantage plans feel a budget squeeze.

In most areas of the United States, this reduction will be phased in over three years, beginning in 2011, although in some places it will take longer.

The bill does not contain cuts to traditional Medicare benefits. However, Medicare payments for home healthcare would be reduced by $40 billion between now and 2019. And certain payments to hospitals would be cut by $22 billion over that same period.
Medicare enhancements

The bill would bolster the existing Medicare prescription-drug benefit by addressing part of its “doughnut hole” problem.

Right now, after a senior has spent $2,700 on drugs in a year, coverage stops until that same person has spent $6,154 on drugs, when it starts up again.

Hence the “doughnut hole” nickname.

Beginning in 2010, people who fall into this hole will get $250 from the government to help. Thereafter, according to the bill, the US will gradually increase the percentage of drug costs it pays within this gap. By 2020, the US will pay 75 percent of senior drug costs between $2,700 and $6,154.

Medicare will also begin to pick up the tab for annual wellness visits.
Medicare payment advisory board

Healthcare reform legislation also establishes what it terms an Independent Payment Advisory Board, made up of 15 members, that would submit legislative proposals to reduce per capita Medicare spending if that spending grows too fast.

“Too fast” is defined as exceeding the growth rate of Consumer Price Index measures for a five-year period that ends in 2013.

If that happens, beginning in 2014, this board will submit proposals to Congress and the president for consideration.

Some critics have charged that this board will be the leading edge of Medicare reductions. Legislative wording in the healthcare reform bill prohibits the board from submitting any idea that would ration care, raise taxes, or change benefits.

Now you have what I consider to be one of the best outlines of the facts that I have found. You have been educated beyond what 90% of your countrymen know of this topic, congrats.


So what do you think?

this is the best outline of the new law that I have been able to find, and having read or scanned most of the actual text, it seems somewhat accurate.

I can hear you already. you're yelling the word socialism at the top of your lungs. and i dont blame you. it is socialism. no argument.

But. there's always one. But.

You are already in a socialist environment when it comes to healthcare. The uninsured already get healthcare in this country. We still pay to have thier babies born, thier cuts stitched; basically and emergent or necessary care provided. The difference is that we dont force them to be responsible for it. And there is not any kind of control over the cost.

Fundamentally, I do not agree with the govt taking control of private enterprise.

In this case, I understand why it may be needed. I can see the spiraling costs of healthcare, and of insurance for it.

And frankly, if it takes the fed getting involved to put things back in line, I'm for it.

Except.

I am just like you. I dont want the govt getting too involved in the day to day of my life. I dont want to be controlled. I care a great deal about my freedoms. And I believe in the constitution.

I realize that this one step does not mean that we are all going to be living in cold war russia soon. but it is scary.

The journey of a thousand miles begins with one step. Its a slippery slope.

I think you know what I mean.

Style

Have you ever seen somebody at a wedding who could REALLY dance? I'm talking about that person, or couple, who steals the show. Clears the floor. You know what I am talking about. Sometimes they are an older couple who has been married for forty years, sometimes they are 20. But when they start dancing, wow.

Or what about the way people dress? I am sure you can think of somebody that you know who always seems to look good, always seems to out dress those around them. they have the right shoes, great pants and shirt, their hair is just so, etc.

Of course cars are an image for me. How much different of an image does a car present about the person behind the wheel? There are so many cliche's about cars that it seems endless to make the list. Think of 3 cars, then think about the type of person who drives them. I'll do it for you. What sort of person drives a Porsche? A Cadillac? What about a jacked-up pickup truck?

Style. Attitude.

Some people have inherently more style than others. I know a lot of people who definitely have a style that belongs solely to them. I also know a lot of folks who just sort of blend in. I know some of those show stoppers. I know some of the ones who sit in the back of the crowd and watch.

I have been fortunate in my life to have had some times that I felt i did something with a unique style.

The odd part is that showing a little style always seems to take a lot of guts for me. It is usually easy to blend in. To stand out seems to require that a person extend themselves, put themselves out there just a little more or further than what they are comfortable with.

Stylish clothes are not my norm. So when I do choose to dress well, I usually feel as though it is a little over the top. In order to show that you can really sing, or dance, you have to be willing to be on stage a little. And because the idea of style usually goes hand in hand with the idea of being unique, IE, not the same as everybody else; the risk of course, is that people wont like your style.

We are social creatures, we don't want to put on a show that people don't like. We want to fit in. Doing something with style is the opposite of fitting in.

My standard response to this is as follows. Everybody will have an opinion. There will be those that don't like your style. There will be those that really like your style. But when you really lay it out there and do something that doesn't blend in, everybody will have an opinion. You will have already transcended the mediocre.

Doing something with style removes you from the masses. It shows your character. I think that the reason most people don't stretch the limits is because of this separation. There is a risk of negative feedback, which by and large, the social human animal does not want to be subject to. As much as most people want to be unique, and known for something; we also don't want to be KNOWN for anything in particular. Especially if it isn't popular. Oddly, to me, doing something popular is just about as close to the opposite of doing something with style as I can think of.

I brought up the couple at the wedding who can really dance. They have style in the eyes of the onlookers. A certain celebrity status if you will. and generally, everybody likes to watch them. But yet, most people don't ever learn to dance because doing so would separate them from the masses and put them in the public eye. Picture a middle school dance during which all of us sat on the sidelines most of the time. It is probably hardest to show any style during adolescence.

Another example, which shouldn't surprise anybody coming from me, has to do with cars. Foose painted his truck a while ago, and I did this weekend with mine, in a style which we know will likely not be enjoyed by roughly half of those who see it. Why would we do something to our vehicle that we know most of the people are not going to appreciate? For the sake of style.

Part of style is not being afraid of the opinion of others. When you consider something like a unique vehicle, it makes sense to me. Lets face it. Everybody can appreciate a perfect shiny red paint job. Nobody really cares, but nobody really dislikes it either. But if you do something controversial, everybody has an opinion. Granted, you may garner as many dislikes as you do likes. But the essence of style is the ability to generate interest.

And maybe that is the essence of tonight's thought. Maybe having style has less to do with doing what is popular than it is to do with generating interest. Maybe it is that little extra touch that makes you unique.

I guess my biggest fear in life is being forgettable. I want to know that I have made some sort of a dent somehow. That I have been of influence. That I have been noticed. And that I have done something good.

In the last post, I referenced the song "Feed Jake"

Tonight I reference another country song. "and on the day they lay me down, I want everyone to gather round, say he was a husband, father, neighbor and an friend. he was a good man" That's style.