House Package Changes to the Senate Bill & A Users Guide on H. C. Reform

[Warph]

In unveiling the CBO score, House Democrats also confirmed the changes they would make (which Obama had supported) to the underlying Senate bill, notably stripping out some sweetheart deals like a special Medicaid funding deal for Nebraska and a provision that would have given special treatment to Medicare Advantage recipients in Florida and a handful of other states. And the House package also makes some substantial changes to other policies in the Senate bill. Relative to the Senate bill, the House package would:


• Delay implementation of a tax on expensive health-insurance plans from 2013 to 2018. This cut 10-year revenue from the tax from $149 billion to just $32 billion. Richard Trumka, president of the AFL-CIO, which opposed the tax out of concerns it would end up hitting many union members' health plans, said in a conference call with reporters Thursday that he was satisfied with the change. While stressing that the Senate bill with the House package is "not a perfect bill," Trumka said it will "end a reign of insurance company terror" and is "an opportunity to change history we can't afford to miss."
(See the top 10 players in health care reform.)

• Close the Medicare Part D prescription drug gap known as the "donut hole," which leaves beneficiaries without prescription drug coverage once their costs exceed $2,830 (in 2010), and doesn't kick back in until they spend $4,550 out of pocket. This provision, which would cost the federal government about $20 billion over 10 years, gradually closes the gap beginning in 2011, so Medicare Part D recipients will eventually pay no more than 25% co-insurance for name-brand drugs. In 2010, Medicare Part D enrollees who reach the gap will receive $250 rebate checks.

• Delay excise taxes on various health industries, such as the pharmaceutical sector and health-insurance sector. These taxes will most certainly be passed directly onto consumers, so the later they are implemented, the later consumers will see drug prices and health-insurance premiums rise as a direct result.
(Read "Who's Winning the Message War on Health Care?")

• Make deeper cuts to the Medicare Advantage program, a federally funded program in which private insurers provide Medicare benefits to seniors. The government currently pays MA plans about 14% more than it pays for traditional Medicare.

• Temporarily increase payments to primary care providers who care for Medicaid payments. Democratic reform would add some 15 million people to the Medicaid rolls, and critics have said this will strain doctors already buckling under Medicaid reimbursement rates, which are substantially lower than what private insurance pays. In 2013 and 2014, this provision would pay primary care providers the same reimbursement rates as Medicare, which falls in between Medicaid payment rates and private insurance. The House package would also increase federal funding to states for Medicaid.

• Increase penalties for larger employers who do not offer health insurance and have at least one employee who qualifies for federal subsidies. Companies with more than 50 employees would have to pay an annual $2,000 penalty for each worker at the firm, even if only one qualified for subsidies. (Penalties assessed for the first 30 workers would be waived, however.)

• Makes subsidies to low- and middle-income Americans buying insurance through exchanges more generous, but calls for those subsidies to grow at a slower rate over time.

• Increases taxes on payroll and unearned income (such as capital gains, dividends, interest) for individuals earning more than $200,000 per year and married couples earning more than $250,000.


Many community hospitals operate on thin margins, in part because of below-cost Medicaid reimbursements and the expense of treating the uninsured. Emergency rooms are overflowing, and many hospitals are struggling to deal with outdated record-keeping systems.

What They Like: Federal investments in information technology could help hospitals modernize medical record-keeping. Getting coverage for the uninsured would mean hospitals could cut down on charity care. Tighter regulation on physician ownership of hospitals would benefit nonprofit community hospitals.

What They Don't Like:
A public health-insurance plan, which Congress is considering, could base reimbursement rates on Medicare, which pays less than private insurers. Hospitals could see gradual reductions in the hardship payments they receive to provide charity care, but which they use to cover other shortfalls.


Time Magazine
Full List - A User's Guide:
Understanding Health-Care Reform
http://www.time.com/time/specials/packages/article/0,28804,1913707_1913694_1913683,00.html

If You Are Insured Through Employer:
http://www.time.com/time/specials/packages/article/0,28804,1913707_1913694_1913684,00.html

If You Are Insured Independently:
http://www.time.com/time/specials/packages/article/0,28804,1913707_1913694_1913685,00.html

If You Are Insured Through a Public Program:
http://www.time.com/time/specials/packages/article/0,28804,1913707_1913694_1913686,00.html

If You Are The Owner of a Small Business:
http://www.time.com/time/specials/packages/article/0,28804,1913707_1913694_1913687,00.html

If You Are Uninsured:
http://www.time.com/time/specials/packages/article/0,28804,1913707_1913694_1913688,00.html


The BIG PLAYERS:

The Insurance Companies:
http://www.time.com/time/specials/packages/article/0,28804,1913707_1913695_1913698,00.html

The Hospitals:
http://www.time.com/time/specials/packages/article/0,28804,1913707_1913695_1913699,00.html

The Doctors:
http://www.time.com/time/specials/packages/article/0,28804,1913707_1913695_1913700,00.html


Insurance Vocabulary:

Health Care Glossary:
http://www.time.com/time/specials/packages/article/0,28804,1913707_1913696_1913703,00.html

[srkruzich]

We just got royally bent over the barrel and screwed!   You can kiss galacia heart and kansas heart hospital goodbye

[sixdogsmom]

So where are they going, Steve?

[Varmit]

Steve, I think we can kiss alot of things goodbye.  Our gov't burned the Constitution last nite, it is indeed a sad day for this country.  Watch out and start planning for the dark times ahead because it can only get worse from here.  Start watching for taxes if not out right bans on cigarettes, salt, sugar...unemployment going even higher, healthcare standards going way down, illegal immigration going through the roof...as a free country we are done. 

[pamagain]

as a free country we are done. 

No

[Diane Amberg]

Steve ,weren't you the one sometime back who said if businesses can't make it let them fail? This will all sort its self out eventually. Besides, don't you have VA coverage?  Some of these changes won't be fully made for years.

[sixdogsmom]

Why would he have VA coverage?

[srkruzich]

Steve ,weren't you the one sometime back who said if businesses can't make it let them fail? This will all sort its self out eventually. Besides, don't you have VA coverage?  Some of these changes won't be fully made for years.

I said let them fail when its their fault because they didn't manage their funding right.  My point when i said that is the Government did not belong in bailing them out.  THe government does not have the right to tell the doctors they can't own part of the hospital.  This is what is commonly referred to as healthcare rationing or the start thereof.  Eliminate Doctor owned hopspitals, and you reduce the level of healthcare.  There is no incentive for them to spend money to do new research.  These Doctors at Galacia and Kansas Heart center go to schools and train under new breaking technology at their own expense and then take that back to their hospitals and do marvelous things with it. 

I don't know whats going to happen to them. I'm going to see my doc and were going to discuss what he plans on doing in the future.  I suspect theres going to be many that close up shop and cut their losses.

[Diane Amberg]

I think you will find that big companies like Astra Zeneca will stop doing their own research anyway.They are going to buy their research from the same overseas companies that already make many of the drugs we use here, even though we aren't supposed to buy them from "over there." Ask any good pharmacist the right questions and you'll be amazed, like country of origin and real expiration dates. As far as Docs owning hospitals, it was considered a conflict of interest and here at least, the feds had nothing to do with it, Blue Cross did.  They wouldn't pay because the doc might insist you go to the facility they had a monetary interest in. Some of that started right here. A surgeon friend started the first ever, free standing,not connected to a hospital, 24 hour Emergency Center here in Newark back in the early 70's. He had lab and x-ray right on the site and slowly brought in others to work with him. The local hospitals screamed like babies because his census was huge. No waiting the hospital ER for hours for a few stitches. Simple kid fractures were x-rayed and set right there. Serious things were stabilized and sent on to the hospital 15 miles away for admission. It took many years for the medical politics to settle down, but it finally did.

[srkruzich]

I think you will find that big companies like Astra Zeneca will stop doing their own research anyway.They are going to buy their research from the same overseas companies that already make many of the drugs we use here, even though we aren't supposed to buy them from "over there." Ask any good pharmacist the right questions and you'll be amazed, like country of origin and real expiration dates. As far as Docs owning hospitals, it was considered a conflict of interest and here at least, the feds had nothing to do with it, Blue Cross did.  They wouldn't pay because the doc might insist you go to the facility they had a monetary interest in. Some of that started right here. A surgeon friend started the first ever, free standing,not connected to a hospital, 24 hour Emergency Center here in Newark back in the early 70's. He had lab and x-ray right on the site and slowly brought in others to work with him. The local hospitals screamed like babies because his census was huge. No waiting the hospital ER for hours for a few stitches. Simple kid fractures were x-rayed and set right there. Serious things were stabilized and sent on to the hospital 15 miles away for admission. It took many years for the medical politics to settle down, but it finally did.

Well with the heart hospitals they only specialize in heart related and respiratory proceedures and i know KHH has some of the best in the nation working there.  The beauty of the hospital is that they don't have to have all the other departments the big hospitals have in order to cover every possible condition.  That cuts costs and improves care tremendously. 
Instead of having to book surgery rooms for heart patients to get around elective surgery patients or other cases, they have a no wait time for surgeries before they become a emergency.   Essentially they took CCR out of the hosptial and made it the hospital for heart patients.