(which RAISES a lot of QUESTIONS.)
November 19, 2009 NY TIMES URL BELOW
Senate Democrats unveiled sweeping legislation Wednesday to overhaul
the
nation's health care system. Earlier this month the House passed its
own
version. The proposals are broadly similar but differ on some major
issues,
such as on a new government insurance plan, abortion and immigration.
Many
provisions of the Senate bill, including the mandate for individuals
to
obtain insurance and the creation of insurance markets, would take
effect in
2014, a year later than similar provisions of the House bill. A look
at how
the proposals compare on some key issues:
Individual mandate a.. Employer contribution a.. Insurance exchange
Public plan Subsidies for individuals a.. Subsidies for employers
Expand Medicaid . Defining benefits a.. Insurance regulations a..
Dependent coverage . Long-term care a.. Abortion a.. Illegal immigrants
Children of the poor . Total cost and coverage . Paying for the proposals
Require that most Americans have a minimum level of health insurance
or else
pay a penalty.
House version
Penalty: Tax equal to 2.5 percent of adjusted gross income over
certain
thresholds ($9,350 for individuals, $18,700 for couples).
CANADIAN VERSION. Costs half of what we spend in USA. They dumped the INSURANCE COMPANIES and HMOS acting as MIDDLE MAN:
see: http://en.wikipedia.org/wiki/Comparison_of_the_health_care_systems_in_Canada_and_the_United_States
Exemptions: American Indians, people with religious
objections and people
who can show financial hardship.
Penalty: Starts at $95 a year per
person in 2014 and rises to $350 in 2015
and $750 in 2016, with a maximum of $2,250 for a family. No penalty
if the
cost of cheapest available plan exceeds 8 percent of household income.
Require most employers to contribute to the cost of coverage for some
or all
of their employees. If you have no job at all, what?
Require employers with annual payrolls of $500,000 or more to offer
coverage
to employees or pay a new federal tax.
Penalty: Up to 8 percent of wages in payroll taxes. Employers
with payrolls
of $500,000 to $750,000 would pay 2 percent to 6 percent of wages,
and those
with payrolls above $750,000 would pay the full 8 percent.
Employers would have to contribute at least 72.5 percent of the premium
cost
for individuals and 65 percent for families for the lowest-cost plan
that
meets the minimum benefit requirements set by the government.
Senate version
Does not explicitly require employers to offer coverage. But
a company with
50 or more full-time workers would pay a penalty if it does not offer
health
benefits and if any of the workers obtain subsidized coverage through
the
new health insurance exchanges.
Penalty: $750 for each full-time worker in the company.
Create health insurance marketplaces, where individuals and employers
can
shop for insurance and compare prices and benefits.
House version
Would create a national insurance exchange. States could operate their
own
exchanges, with federal approval.
Open to people who do not have qualifying coverage through an employer
or a
public program.
Open to employers with 25 or fewer employees in the first year, 50 or
fewer
in the second year and 100 or fewer in the third year. The exchange
could be
expanded to larger employers over time, "with the goal of allowing
all
employers access."
Until the exchange is established, a temporary program would provide
coverage to "those who have been uninsured for several months or denied
a
policy because of pre-existing conditions."
Senate version
States would form their own exchanges. Several states could join together
to
form a regional exchange.
Open to people who do not have qualifying coverage through an employer
or a
public program.
Open to employers with 50 or fewer employees, but states could allow
employers with up to 100 workers to participate. Starting in 2017,
states
could also allow larger businesses to participate.
Penalty: Typically $750 for each employee at the firm.
Create a new government insurance plan to compete with private insurers.
House version
Public plan would negotiate payment rates with doctors and hospitals
(rather
than using Medicare rates set by the government).
The government would allocate $2 billion in start-up money, but beneficiary
premiums would have to cover the full cost of the plan. The government
would
also provide loans to start nonprofit insurance cooperatives.
Senate version
Public plan would negotiate rates with doctors and hospitals. A state
could
refuse to participate in the public plan by adopting a law to opt out.
Provide tax credits to low- and middle-income people to help them buy
insurance through the exchange.
House version
Available to people with incomes up to 400 percent of the federal poverty
level ($88,200 for a family of four).
Senate version
Available to people with incomes up to 400 percent of the federal poverty
level.
Provide tax credits to small businesses that want to offer coverage.
Subsidize employer plans that cover early retirees ages 55 to 64.
House version
Employers with 25 or fewer workers and average wages of $40,000 or
less
would qualify for tax credits. The amount, up to 50 percent of premium
costs, phases out as firm size and average wages increase. The credit
would
not be allowed for employees earning more than $80,000 a year.
>From 2013 to 2015, the federal government would cover 80 percent of
the cost
of a retiree's medical claims of more than $15,000, with a cap at $90,000
-
at which point the employer's plan would pay the rest.
Senate version
Employers with 25 or fewer workers and average wages of $40,000 or
less
would qualify for tax credits. The amount, up to 50 percent of premium
costs, phases out as firm size and average wages increase.
The federal government would cover 80 percent of the cost of a retiree's
medical claims of more than $15,000 through 2013, with a cap at $90,000
- at
which point the employer's plan would pay the rest.
Expand Medicaid to cover millions of additional people, including parents
and childless adults who are not eligible under current rules.
House version
Cover everyone with incomes less than 150 percent of the poverty level
($33,075 for a family of four).
Estimated number of new recipients: 15 million.
The federal government would pay all the costs for those who are newly
eligible for the first two years and 91 percent of the costs after
that.
Senate version
Cover everyone with incomes less than 133 percent of the poverty level
($29,327 for a family of four).
Estimated number of new recipients: 14 million.
The federal government would pay all the costs for those who are newly
eligible for the first three years. After 2016, the share of federal
spending would vary somewhat from year to year, but would average about
90
percent. Currently, the federal government pays about 57 percent, on
average, of the costs of Medicaid benefits.
Require insurance plans to offer a minimum package of health insurance
benefits, to be defined by the federal government.
House version
The basic plan would cover 70 percent of the cost of the benefits.
Consumers
would pay the remainder, in deductibles, co-payments and other charges.
The exchange would offer three other benefit plans, covering up to 95
percent of costs.
Senate version
The basic plan would cover 60 percent of the cost of the benefits.
The exchanges would offer three other benefit plans, covering 70 percent
to
90 percent of costs. The Congressional Budget Office says policies
bought in
the individual insurance market now average 55 percent to 60 percent.
Prohibit insurers from denying coverage or charging higher premiums
because
of a person's medical history or health condition.
House version
Premiums for older people cannot be more than double the premium for
young
adults.
The legislation would strip health insurance companies of their antitrust
exemption. It would outlaw price fixing, bid rigging and "market
allocations" by companies that sell health insurance or medical
malpractice
insurance.
Senate version
Premiums for older people cannot be more than three times the premium
for
young adults.
The legislation would not strip health insurance companies of their
longstanding exemption from federal antitrust laws.
Require health plans, including employer-sponsored plans, to cover children
of policyholders up to a certain age.
House version
Allow children to stay on their parents' insurance plans through age
26.
Currently, states set the age at which adults can no longer be covered
by
their parents' insurance.
Senate version
Allow children to stay on their parents' insurance plans through age
25.
Create a voluntary federal program to provide long-term care insurance
and
cash benefits to people with severe disabilities.
House version
The premiums would cover the full cost of the benefits, which would
average
at least $50 a day.
Workers would have to contribute for at least five years before they
could
collect benefits.
Senate version
The premiums would cover the full cost of the benefits, which would
average
$75 a day, according to the Congressional Budget Office.
Prohibit use of federal money for abortions, except as allowed by current
law - in cases of rape or incest or if the life of a pregnant woman
was in
danger.
House version
Health plans could choose whether to cover abortion.
Low- and middle-income people who receive federal subsidies to buy insurance
could not choose a health plan that covers elective abortions.
The public plan would not provide abortion coverage.
Senate version
Health plans could choose whether to cover abortion. In each state,
there
would have to be at least one plan that covers abortions and one that
does
not.
Low- and middle-income people who receive federal subsidies to buy insurance
could enroll in health plans that cover abortion. But insurers would
be
required to segregate their federal subsidies into separate accounts
and use
only the premium money and co-payments contributed by consumers to
cover the
procedure.
The public plan could provide abortion coverage but would have to segregate
federal dollars, just like the private plans.
Limit access to the exchange and federal subsidies for illegal immigrants.
House version
Could buy insurance from the exchanges, but could not get federal subsidies
to help pay the costs.
Senate version
Could not buy insurance from the exchanges, even if they were able
to pay
the full cost themselves, without federal subsidies.
Changes to the Children's Health Insurance Program, which benefits children
of the working poor.
House version
The program would no longer exist. Children with family incomes up
to 150
percent of the poverty level ($33,075 for a family of four) would receive
coverage through Medicaid. Families with higher incomes that are still
eligible for subsidies could buy coverage through the exchange.
Senate version
Children now enrolled in the Children's Health Insurance Program would
continue to receive coverage through the program. Beginning in 2014,
states
would receive higher federal reimbursement for the program's beneficiaries,
increasing from an average of 70 percent to 93 percent.
10-year estimates of the cost of the legislation from the Congressional
Budget Office.
House version
About $1.052 trillion. Expected to reduce deficits by $139 billion.
36 million people would gain coverage, leaving 18 million uninsured.
Senate version
$849 billion. Expected to reduce projected federal budget deficits
by $130
billion.
31 million people would gain coverage, leaving 23 million uninsured.
Impose new fees and taxes. Curb Medicare payments to hospitals and many
other health care providers.
House version
A 5.4 percent surtax on high-income people - couples with adjusted
gross
incomes of more than $1 million a year and individuals over $500,000.
Expected to raise $460 billion from 2011 to 2019.
A 2.5 percent excise tax on the medical devices sold for use in the
United
States. Expected to raise $20 billion from 2013 to 2019.
Squeeze $404 bilion out of the projected growth in Medicare and other
federal programs over 10 years, including $117 billion from cuts in
Medicare
Advantage plans. The government pays about 14 percent more for the
private
plans than it would pay for the same people in traditional Medicare.
Senate version
A 40 percent excise tax on so-called Cadillac health plans -
employer-sponsored group health plans with premiums over $8,500 for
individual coverage and $23,000 for family. Expected to raise $149
billion
from 2013 to 2019.
Annual fees, allocated by market share, on health care companies: $6.7
billion on insurance companies, $2 billion on manufacturers of medical
devices and $2.3 billion on drug makers. Expected to raise more than
$100
billion from 2010 to 2019.
Squeeze $436 billion out of the projected growth in Medicare and other
federal programs over 10 years, including $118 billion in cuts to federal
subsidies for privately offered Medicare Advantage plans.
Increase in the Medicare payroll tax rate - from 1.45 percent to 1.95
percent for workers with incomes of more than $250,000 a year. Expected
to
raise about $54 billion from 2010 to 2019.
A 5 percent tax on elective cosmetic medical procedures. The tax would
be
paid by patients, but collected by doctors and clinics and forwarded
to the
government.
If you're not confused by now, wait til the whole mess goes active on us. BEST way out, get an HMO with an alternative clinic. That way they postpone aging, you never need surgery and there's no pharm costs, it's all radishes, carrots and soy groats.
http://www.nytimes.com/interactive/2009/11/19/us/politics/1119-plan-comparison.html?hp
NATUROPATHS: FIND A CLINIC create your office there:
http://www.dca.ca.gov/publications/healthcare_providers.shtml
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