The saga of health care reform is beginning to seem like a soap opera. Twists and turns occur on a daily basis. I thought about adding fuel to the fire by speculating about what might happen (as I have done in the past), but thought it might be more helpful to provide some background and facts. I realize that in doing so, I run the risk of offending everyone. That is not my intent. I simply want to dispel some false rumors by providing information. To the extent that any bias of mine has crept in, it reflects my personal opinion and not that of the Disability Management Employer Coalition or my employer.
First, it is important to understand that there is no one health care reform proposal. There was one bill in the House, which went to three committees, each of which changed it, so now there are three versions with some conflicting provisions. In the Senate, there is an entirely separate bill passed by one committee (Health, Education, Labor & Pensions—HELP) and a very different bill being prepared by the Senate Finance Committee. That means there are four different versions passed by different committees with a fifth version in process.
A disclaimer is also in order: each of the bills that has been passed out of a committee is about 1,000 pages long. I have only read certain provisions, not all of them. I have used www.factcheck.org as a source of some information.
One of the most controversial provisions involves the so-called “death panels”, which have been called “a government run plan to decide when to pull the plug on grandma”.
Section 1861(s)2 of the Social Security Act, defines the services covered by Medicare. Section 1233 of the original H.R. 3200 (now modified by three committees), which is titled “Advance Care Planning Consultation” would amend this section to add some end-of-life planning counseling sessions with a health care practitioner to the list of services Medicare would cover. Counseling would be voluntary.
You have probably heard it said “if you like your health care plan, you keep your health care plan”. If passed, health care reform will almost certainly require employers to make changes to their plan design. Furthermore, there is nothing in current law or anything I have seen in the proposals that would prohibit employers from changing plan design or insurers.
A group is running a TV ad saying Congress plans to pay for overhauling health care “by cutting $500 billion from Medicare.” It claims that this “will mean long waits for care” and cuts to services, that “seniors may lose their own doctors” and that “government, not doctors, will decide if older patients are worth the cost.” According to the Congressional Budget Office (CBO), the original version of the House bill would cut a net of $219 billion from the projected growth of Medicare spending over the next 10 years. I have seen nothing in any Congressional proposal that would cut benefit levels or deny treatment, although there are proposals to reduce payments to insurers under Medicare Advantage plans.
Some people have said that health care reform will be deficit-neutral. According to the CBO and Joint Committee on Taxation, the original version of the House bill would add a net $239 billion over 10 years to the deficit, while the HELP Committee bill would cost $597 billion over 10 years.
In July, Investor’s Business Daily published an editorial in which it claimed that H.R. 3200 would make private insurance illegal. Under the House bill, people who want to buy new individual coverage will have to purchase it through a new health insurance exchange. They can still buy private insurance – the exchange would offer a number of private plans, possibly in addition to a new federal health insurance option. People who were already buying individual insurance policies before the bill went into effect will have their plans grandfathered. The part of the bill the magazine cites doesn’t forbid insurers from issuing new plans. It says that new individual plans will not be considered grandfathered, and will have to be purchased through the exchange.
People have said health care reform could save $2,500 per family. However, the CBO says: “[E]xperts generally agree that changes in government policy have the potential to significantly reduce health care spending—for the nation as a whole and for the federal government in particular—without harming people’s health. However, achieving large reductions in projected spending would require fundamental changes in the financing and delivery of health care.”
A press release claims that “5,600,000 Illegal Aliens May Be Covered Under Obamacare”. Section 246 of H.R. 3200 says: “Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.” That’s legalese for “no federal payment for undocumented aliens.”
We need a vigorous debate on health care reform’s details, but we also need to keep our facts straight. I hope this helps.
September 10, 2009 at 9:16 pm |
I agree with one particular point identified in this article. That point is there are five (5) different senate and congressional bills in various stages. They do not all include or exclude the same elements we hear about in the media. We need to see what the “final” bill proposes. Then citizens can choose to like or dislike as they see the particulars affecting themselves and their children.
October 13, 2009 at 3:50 pm |
One of the issues which was not discussed above and which will impact all employers is the proposed 8% payroll tax penalty that employers will be required to pay if they do not provide a minimum of health insurance coverage. Why is this not being discussed more frequently by professional organizations? I occasionally see some discussion in news outlets. Employers currently spend an average of 11.5% of payroll on health insurance with a high of 17% and a low of 8%. Most employers would prefer not to have to deal with the complexities of providing health insurance. Most employers will eventually decide to pay the tax rather than be subject to ever rising healthcare costs. Job recruitment and retention is often cited as a reason for why this will not happen. However, once a few leading companies make this decision there will be a mass exodus from employer-sponsored healthcare. One way to stem this tide would be to continue to focus on the productivity aspects of an HPM strategy rather than purely the cost reduction strategy.