A Look At The Health Care Bill

By The Associated Press The Associated Press –
Congressional Democrats have released a final version of President Barack Obama's health care overhaul bill in advance of a House vote planned for Sunday. Some features of the legislation, which makes changes to the bill the Senate passed on Christmas Eve:
COST: $940 billion over 10 years, according to the Congressional Budget Office.
HOW MANY COVERED: 32 million uninsured. Major coverage expansion begins in 2014. When fully phased in, 95 percent of eligible Americans would have coverage, compared with 83 percent today.
INSURANCE MANDATE: Almost everyone is required to be insured or else pay a fine. There is an exemption for low-income people. Mandate takes effect in 2014.
INSURANCE MARKET REFORMS: Starting this year, insurers would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions, and from canceling policies because someone gets sick. Parents would be able to keep older kids on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear. Major consumer safeguards would also take effect in 2014. Insurers would be prohibited from denying coverage to people with medical problems or charging them more. Insurers could not charge women more.
MEDICAID: Expands the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014. The federal government would pay 100 percent of costs for covering newly eligible individuals through 2016. A special deal that would have given Nebraska 100 percent federal financing for newly eligible Medicaid recipients in perpetuity is eliminated. A different, one-time deal negotiated by Democratic Sen. Mary Landrieu for her state, Louisiana, worth as much as $300 million, remains.
TAXES: Dramatically scales back a Senate-passed tax on high-cost insurance plans that was opposed by House Democrats and labor unions. The tax would be delayed until 2018, and the thresholds at which it is imposed would be $10,200 for individuals and $27,500 for families. To make up for the lost revenue, the bill applies an increased Medicare payroll tax to investment income as well as wages for individuals making more than $200,000, or married couples above $250,000. The tax on investment income would be 3.8 percent.
PRESCRIPTION DRUGS: Gradually closes the "doughnut hole" coverage gap in the Medicare prescription drug benefit that seniors fall into once they have spent $2,830. Seniors who hit the gap this year will receive a $250 rebate. Beginning in 2011, seniors in the gap receive a discount on brand name drugs, initially 50 percent off. When the gap is completely eliminated in 2020, seniors will still be responsible for 25 percent of the cost of their medications until Medicare's catastrophic coverage kicks in.
EMPLOYER RESPONSIBILITY: As in the Senate bill, businesses are not required to offer coverage. Instead, employers are hit with a fee if the government subsidizes their workers' coverage. The $2,000-per-employee fee would be assessed on the company's entire work force, minus an allowance. Companies with 50 or fewer workers are exempt from the requirement. Part-time workers are included in the calculations, counting two part-timers as one full-time worker.
SUBSIDIES: The proposal provides more generous tax credits for purchasing insurance than the original Senate bill did. The aid is available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Small businesses, the self-employed and the uninsured could pick a plan offered through new state-based purchasing pools called exchanges, opening for business in 2014. The exchanges would offer the same kind of purchasing power that employees of big companies benefit from. People working for medium-to-large firms would not see major changes. But if they lose their jobs or strike out on their own, they may be eligible for subsidized coverage through the exchange.
GOVERNMENT-RUN PLAN: No government-run insurance plan. People purchasing coverage through the new insurance exchanges would have the option of signing up for national plans overseen by the federal office that manages the health plans available to members of Congress. Those plans would be private, but one would have to be nonprofit.
ABORTION: The proposal keeps the abortion provision in the Senate bill. Abortion opponents disagree on whether restrictions on taxpayer funding go far enough. The bill tries to maintain a strict separation between taxpayer dollars and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for abortion. In plans that do cover abortion, policyholders would have to pay for it separately, and that money would have to be kept in a separate account from taxpayer money. States could ban abortion coverage in plans offered through the exchange. Exceptions would be made for cases of rape, incest and danger to the life of the mother.

GOP HEALTH CARE SUMMIT IDEAS: Following a bipartisan health care summit last month, Obama announced he was open to incorporating several Republican ideas into his legislation. But two of the principle ones — hiring investigators to pose as patients and search for fraud at hospitals and increasing spending for medical malpractice reform initiatives — did not make it into the legislation released Thursday. The legislation incorporates only one, an increase in payments to primary care physicians under Medicaid, an idea mentioned by Sen. Charles Grassley, R-Iowa.

Obama Targets Insurers, Sells Reform Plan

WASHINGTON (Reuters) - President Barack Obama launched a sharp attack on health insurers on Monday and called on his fellow Democrats to rise above politics and pass a healthcare overhaul in the next few weeks.

Hitting the road to rally support in the final push for healthcare reform, Obama used a campaign-style speech to urge Democrats to approve a bill and quickly end the political wrangling that has consumed Washington since July.
"There have been plenty of folks in Washington who have said that the politics is just too hard. They've argued now is not the time for reform," Obama said at Arcadia University in Glenside, Pennsylvania.
"My question to them is: When is the right time? If not now, when?" he asked, shrugging off warnings of a political backlash in November for Democrats who back the overhaul.
"I don't know how passing healthcare will play politically, but I do know that it's the right thing to do," he said.
Obama also offered his toughest criticism yet of a health insurance industry that he said placed profits ahead of patients. "Every year, they raise premiums higher and higher," Obama said "They will keep doing this for as long as they can get away with it."
Turning up the heat, Health Secretary Kathleen Sebelius sent a letter to top companies such as Aetna Inc and Wellpoint Inc asking them to justify rate increases by making public information about costs, enrollment changes and other details.
"It's time for these insurance company CEOs to do their part to make the system more transparent for the American people," Sebelius said. "If insurance companies are going to raise rates, the least they can do is tell us why."
The Obama administration has targeted health insurers in its final push for an overhaul designed to rein in costs, regulate insurers and expand coverage to tens of millions of Americans.
Obama said failure to pass a healthcare overhaul this year would leave intact a broken $2.5 trillion healthcare system that is ravaged by greedy health insurers.

INSURERS MAKE 'A CALCULATION'
"These insurance companies have made a calculation," Obama said "They're OK with people being priced out of health insurance because they'll still make more by raising premiums on the customers they keep.
The House of Representatives is expected to vote by the end of March on the Senate's version of the healthcare bill, with Democratic House Speaker Nancy Pelosi searching for the 216 votes to pass it. The House approved its version with only three votes to spare in November.
Republican leaders say they will make healthcare reform a top issue in November's elections and urged Republican candidates to focus on the Democratic-crafted bills, which polls show are unpopular with the public.
"A vote for this bill opens an entirely new line of attack on House Democrats," Johnny Destefano, a House Republican campaign committee official, said in a memo to Republican House candidates.
"Now is the time to apply pressure and force your opponents into taking a stand on whether they will walk Speaker Pelosi's plank by supporting her last-ditch healthcare push," he said.
Republican Senate leader Mitch McConnell said the new push on healthcare would be a replay of the frantic maneuvering that marked Senate passage just before Christmas.
"Americans don't like this bill any more today than they did three months ago," he said.
But in Pennsylvania, Obama sought the public's help in rallying Congress to pass the overhaul. "It's time to make a decision," Obama said. "The time for talk is over."
The overhaul looked dead in January when Republicans deprived Democrats of their crucial 60th Senate vote by winning a Massachusetts special election, stopping negotiations to merge bills already passed by the House and Senate.
But changes to the Senate bill sought by Obama and House Democrats will be considered separately using a procedure that allows a majority vote in the 100-member Senate rather than the 60 votes needed to clear Republican procedural hurdles.
Obama proposed revisions to the Senate bill last week to ease the concerns of House Democrats, including watering down a tax on expensive insurance plans and boosting federal subsidies to make coverage more affordable.
"I think there's a lot more determination in the Congress now to get it passed," Democratic Senator Arlen Specter of Pennsylvania told reporters after Obama's speech.
"I really think there's sort of reaction on the Democratic side of getting a little angry over the duration and intensity of obstruction and a lot more determination to see it through."
In her letter to insurers, Sebelius asked executives to post on their websites the justification for any individual or small group rate increases they implemented or proposed in 2010, and continue to do so in the future.
The heads of Cigna Corp, UnitedHealth Group Inc and privately held Health Care Service Corp also received the letter.
Health insurer shares were down for the day. The Morgan Stanley Healthcare Payor index was down about 0.4 percent and the S&P Managed Health Care index was off 1 percent.
The CEO of Manpower, a global employment services company that provides temporary workers, said the uncertainty of the healthcare debate in Washington was keeping U.S. employers from hiring.
"The concern is that we have a political system that is too broken to fix systemic issues," CEO Jeff Joerres told Reuters.

Our Own Health Care Clash of the Titans - Just My Perspective

The underlying premise, as I see it, from the President's perspective was simply that we agree on many things, so why don't we modify the finer points on the things upon which we agree and negotiate by adding and subtracting on the points on which we do not agree. The Republican response was that we do not wish to participate; if you can pass the bill, pass it; if you can't, we will let the people decide in November. At one point the President actually conceded on that point. I believe that the President's motives were sincere in the sense that he would take an agreement that achieved less than he wanted, if he could have gained traction in the "process." Ramming the bill through Congress using reconciliation will give added ammunition to the Republicans in November. The size of the bill, the length of the debate and the endless bickering has drained the American psyche at a time when the majority have more pressing concerns such as the economy, unemployment and the next wave of property foreclosures.   In the final analysis the argument has been reduced to this one point: can government administer this massive legislation in an efficient manner.  I don't think so.... they've never done so before.  The unfortunate reality is that both sides are right and a bridge across the philosophical divide constructed by men of good will serve as the best path forward.

Obama, GOP fail to reach accord on health bill

Associated Press -
WASHINGTON – Giving no ground, President Barack Obama and Republican leaders fought forcefully for their competing visions of historic health care reform Thursday in an exhausting, often-testy live-on-TV debate. Far from any accord, Obama signaled the Democrats were prepared to push ahead for an all-or-nothing congressional vote.
The marathon, 7 1/2-hour session did reveal narrow areas of agreement on the topic that has vexed Congress for months and defied U.S. leaders for decades. But larger ideological differences overwhelmed any common ideas, all but cementing the widely held view that a meaningful bipartisan health care bill is not possible as time grows short in this election year.
Obama rejected Republican preferences for starting over, discussing the issue much longer or dealing with it in a limited, step-by-step fashion.
"We cannot have another yearlong debate about this," Obama declared. "I'm not sure we can bridge the gap."
Party officials said March is probably the last chance to act.
It has been more than a year since he proposed his overhaul, which would be important to virtually all Americans in remaking the way they receive and pay for health care. The version he embraces, basically tracking legislation passed by the Senate, would expand health coverage to some 30 million people who lack it and stop insurance companies from dropping people for questionable reasons or denying coverage to people who have certain illnesses.
Obama and the Democrats portray the current situation as a major crisis, with tens of millions of people left with no health insurance at all and health care costs threatening to bankrupt the nation. The Republicans see problems as well, but seek more modest steps to deal with them and say Obama's plan would run up the federal deficit — despite his claims to the contrary.
Obama strongly suggested that Democrats will try to pass a sweeping overhaul without GOP support, by using controversial Senate budget rules that would disallow filibusters. And then, he said, this fall's elections would write the verdict on who was right.
Democratic leaders tried to portray Republicans as hypocrites for denouncing parliamentary tactics they, too, have used. Democratic leaders hope to embolden colleagues who worry about re-election races in the face of polls showing substantial dislike for the party's approach.
The Democrats-only strategy could face particularly strong resistance in the House, where 39 party members voted against an Obama-backed health care bill last year.
Democratic officials confirmed Thursday that the White House has developed a slimmed-down health care plan as a possible "Plan B" fallback.
But that contingency also faces problems, including possible defections from House liberals who insist the overhaul must be expansive. Democratic officials conceded it's possible that no health care legislation will pass this year, which would leave their candidates with little to show while Republicans claimed a big win.
At Thursday's summit, Rep. Eric Cantor, the No. 2 House Republican, agreed with Obama that "we have a very difficult gap to bridge here." But he differed strenuously about resolving it. "We just can't afford this," he said of the $1 trillion, 10-year proposal. "That's the ultimate problem."
Cable news networks carried long portions of the summit, which featured 38 lawmakers sitting around a square table heaped with documents and notepads. They spoke of arcane issues such as insurance "rescissions" between sharp partisan exchanges. Moderator Obama, looking annoyed at times, interrupted Republicans fairly often, and a few of them interrupted him back.
At one point, Senate Republican leader Mitch McConnell of Kentucky accused him of shortchanging the GOP on opportunities to speak.
With the conversation veering between mind-numbing detail and flaring tempers, the two sides held onto long-entrenched positions.
Sen. Lamar Alexander, R-Tenn., derided Obama's plan. "This is a car that can't be recalled and fixed," he said, "and we ought to start over."
Alexander challenged Obama's claim that insurance premiums would fall under the Democratic legislation. "You're wrong," he said. Responded Obama: "I'm pretty certain I'm not wrong."
Democratic officials said House and Senate leaders will confer with colleagues in coming days or weeks to see if they have enough votes to push a far-reaching bill through both chambers with no GOP help.
Republicans repeatedly pressed Obama to renounce the possibility of using "budget reconciliation" rules to push the Democratic plans through the Senate without allowing GOP filibusters. Obama brushed them off, saying they seemed more interested in process than substance.
Americans want a decision on health care, the president said, and most of them think "a majority vote makes sense." Democrats control 59 of the Senate's 100 seats, one vote short of the number needed to halt bill-killing filibusters.
Top Democrats described the summit as the beginning of the end of their long push to overhaul health care, a bid rocked by raucous, conservative-dominated forums last summer that threw Democrats on the defensive. Eyeing the November elections, rank-and-file Democratic lawmakers are desperate to resolve the debate and focus on jobs and economic revival.
"If nothing comes of this, we're going to press forward," Democratic Senate Whip Richard Durbin told reporters during a break in the summit. "We just can't quit."
One of the sharpest exchanges occurred between Obama and Sen. John McCain, the Arizona Republican he defeated for the presidency. As McCain criticized numerous provisions in the Democrats' plan, Obama said, "we're not campaigning anymore. The election is over."
McCain laughed and said, "I'm reminded of that everyday."
At another point, McCain refused to yield to Obama, saying, "Can I just finish please?"
Obama ribbed Cantor, the House GOP whip, for bringing to the table the 2,400-page Senate bill, which the Virginia congressman described as too costly, bureaucratic and intrusive. Obama called it a political prop, and said health care is a complex issue that can't be reduced to snippets.
Republicans repeatedly noted that polls suggest Democrats are on the wrong track. A USA Today/Gallup survey released Thursday found Americans, by 49 percent to 42, lean against Democrats forging ahead without any GOP support. Slightly more than half oppose the idea of Senate Democrats using budget rules to bar filibusters to stop the bill.
Congressional aides said top Democrats will take a few days to gauge the summit's impact on the public and, perhaps more importantly, on moderate House members who are likely to determine whether any health care bill will pass.
If the effort fails, Democrats may try a scaled-back plan to insure about 15 million more Americans, rather than 30 million. Among other things, the plan would require insurance companies to let people up to age 26 stay on their parents' health plans.
The summit participants noted a handful of areas where the two parties seem largely to agree. They include barring insurers from dropping customers who become sick, ending annual and lifetime monetary limits on health insurance benefits and letting young adults stay on their parents' health policies to their mid-20s or so.
But Republicans stuck to their main talking points. "The American people want us to scrap this bill," said House GOP Leader John Boehner of Ohio, reaching over and touching the massive Senate legislation.
As darkness neared, McConnell also urged Obama to "start over with a blank piece of paper."

White House sends out invites for health summit

Associated Press Writer – 6 mins ago
WASHINGTON – In a make or break move, President Barack Obama on Friday challenged three dozen Republicans and Democrats to participate in a one-of-a-kind televised summit this month to thrash out a deal on health care.

House Republicans immediately greeted the invite to the Feb. 25 event with derision, casting doubt on whether it would yield any bipartisan agreement to extend coverage to millions of Americans and rein in medical costs. "We need answers before we know if the White House is more interested in partisan theater than in facilitating a productive dialogue about solutions," said Kevin Smith, a spokesman for House Republican leader John Boehner of Ohio.
But Senate Minority Leader Mitch McConnell, R-Ky., was more receptive, saying he would work with the White House "to maximize the effectiveness of the meeting."
The summit is considered a last, best attempt to revive Obama's yearlong quest, now stalled after Democrats lost their filibuster-proof Senate majority. Yet since Obama proposed the summit last weekend, Republicans and Democrats have voiced skepticism, with some in the GOP wondering if would be nothing but a spectacle that could benefit the president at their expense.
By presiding over a meeting with three dozen lawmakers trying to get a word in edgewise, Obama may be able to dominate the conversation and the visual images. That's what many Democrats say he did at a Jan. 29 session when he faced a roomful of GOP House members in Baltimore, controlling the microphone for much of the event.
The Baltimore event proved riveting for many Americans because it ranged over many topics and included numerous moments of partisan sparring. A half-day televised session on the complexities of health care may prove much less inviting to the average viewer.
In its invitation, the White House argued that remaking health care was imperative, and Obama challenged Democrats and Republicans to come up with comprehensive bills before the Blair House event — legislation that would be posted online.
Citing bills passed in the House and Senate, the White House said "this is the closest our nation has been to resolving this issue in the nearly 100 years that it has been debated. The Blair House meeting is the next step."
White House Chief of Staff Rahm Emanuel and Health and Human Services Secretary Kathleen Sebelius cited the recent 39 percent rate hikes by Anthem Blue Cross in California as urgent proof the overhaul effort must be completed.
"As the president noted this week, if we don't act on comprehensive health insurance reform, this enormous rate hike will be 'just a preview of coming attractions,'" they wrote.
The letter was sent to McConnell, Boehner, Senate Majority Leader Harry Reid, D-Nev., and House Speaker Nancy Pelosi, D-Calif.
The White House named 21 lawmakers the president wants to attend the Feb. 25 event: the top leaders in the House and Senate and of the committees with jurisdiction over the health legislation. Obama also invited the top four leaders to invite four more lawmakers each, bringing the total to 37 — 20 Democrats and 17 Republicans.
Even prior to the invitation, Rep. Tom Price, R-Ga., a physician and head of the Republican Study Committee, demissed the summit in an op-ed as "simply an attempt by the president to use the White House as a political tool to intimidate his way into a government takeover of health care. The American people and Republicans in Congress will not be taken by this Chicago-style politics."
At the summit, Obama will offer opening remarks, followed by comments from a Republican leader and a Democratic leader, according to the format detailed in Friday's letter. Obama will then moderate a discussion on four topics: insurance reforms, cost containment, expanding coverage and the impact of health legislation on the deficit.
Officials from the White House Office of Management and Budget and the nonpartisan Congressional Budget Office and the Joint Committee on Taxation also have been invited.
The letter stands as a challenge not just to Republicans but also to Democrats, who have yet to finalize a deal on sweeping overhaul legislation. They were on the verge of doing so last month before the special election victory of Republican Scott Brown in Massachusetts deprived Democrats of the filibuster-proof supermajority they need to move forward in the Senate.
That threw the whole undertaking into disarray and congressional leaders have been struggling to pick up the pieces. Some hope the summit will break the logjam one way or the other.

In the letter, Obama pressed Democrats to resolve their difference in the disparate House and Senate bills and come up with final legislation before the session. He also asked the Republicans to produce a comprehensive bill.
Democratic leaders are working toward a package that could pass the Senate under controversial and complex rules that require only a simple majority vote, not the 60-vote supermajority they no longer control — a strong-arm partisan approach that infuriates Republicans and makes moderate Democrats uneasy.
Democrats and Republicans are far apart in their approaches. Democrats' legislation would cover more than 30 million uninsured, while a House Republican plan would cover only 3 million. Members of both parties say they see a few areas for common ground, including reforming the medical malpractice system, and finding ways to allow consumers to shop for insurance plans across state lines.