I keep seeing "it would expand coverage to all but 6% of Americans" can someone tell me who those 6% of Americans would be and why they wouldn't be eligible?
@veronykah: Probably above the threshold for Medicaid but would rather take the penalty than buy insurance. If you let people opt out of programs (even if they incur a fee), you'll have these folks.
@Maritsa: Interesting bit of news. Haven't read the article yet, but I wonder if that means major surgery like face lifts, or does it also include minor procedures like IPL laser treatments to get red of those pesky sun spots?
@Maritsa: I'd say that's smart, given that one of the most common objections I hear regarding health insurance is that "money is wasted on cosmetic surgery!" (Never mind that I've never seen a plan that covers elective cosmetic surgery.)
@la.donna.pietra: I'm LOLing at the idea of my insurance company, which just fought me on a benefit whose coverage is (1) clearly in my plan and (2) mandated by state law, paying for a boob job or face lift.
@la.donna.pietra: My roommate used to work in Hollywood. She said that a lot of actor's health plans covered elective plastic surgery as a necessity for their careers. Women would marry actors specifically for the insurance so they could get some plastic surgery done. Weird.
@angryyoungwoman: I have serious difficulty believing that. I've worked for a number of companies managing their insurance plans and reviewing possible new plans, and I've never seen a plan that covered elective plastic surgery. While the Screen Actors Guild does have health insurance, it's notoriously bare-bones. Your roommate sounds a mite naive.
@la.donna.pietra: Well, it's been a long time since she was an actress (or auditioning for shows and dating actors, more accurately), so I could see that a lot of things have probably changed. She's also crazy, so there is that . . .
"There is a conscience clause that makes it perfectly acceptable for insurance companies to deny that coverage or health care providers to refuse carrying out the procedure. But the bill also requires each exchange to offer one plan that provides abortion coverage and one that doesn't"
Can someone help an English expat get her head around this - what is an 'exchange'? And if your healthcare comes with your job, you still get to choose a plan with abortion, right? Or does your employer choose? Also, side issue, this 97% thing - who are the 3% who won't get the option for free healthcare?
@Diziet_Sma: They will have the option but are likely to opt out. They will not be penalized for doing so.
Here you go:
c) Exceptions-
`(1) DEPENDENTS- Subsection (a) shall not apply to any individual for any taxable year if a deduction is allowable under section 151 with respect to such individual to another taxpayer for any taxable year beginning in the same calendar year as such taxable year.
`(2) NONRESIDENT ALIENS- Subsection (a) shall not apply to any individual who is a nonresident alien.
`(3) INDIVIDUALS RESIDING OUTSIDE UNITED STATES- Any qualified individual (as defined in section 911(d)) (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during the period described in subparagraph (A) or (B) of section 911(d)(1), whichever is applicable.
`(4) INDIVIDUALS RESIDING IN POSSESSIONS OF THE UNITED STATES- Any individual who is a bona fide resident of any possession of the United States (as determined under section 937(a)) for any taxable year (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during such taxable year.
`(5) RELIGIOUS CONSCIENCE EXEMPTION-
`(A) IN GENERAL- Subsection (a) shall not apply to any individual (and any qualifying child residing with such individual) for any period if such individual has in effect an exemption which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section.
1. An exchange is a system where different insurance companies can sell their plans to people who don't have employer coverage and some proposals will also let small businesses purchase through the exchange. It will have rules limiting what types of plans can be offered and how premiums can be determined.
2. If your health care comes with your job, you often have no choice at all. Many employers offer just one plan and you take it or leave it. Other employers offer a choice of 2-4 plans that cost different amounts. But your employer is choosing the plans offered and often, they don't understand what they are doing and just taking what the insurance broker tells them is in their price range.
3. Health reform is not providing 97% of Americans with free health care. Only people with extremely low incomes will get free health care. Everybody else will have to pay or have their employer pay. Most employers only pay a portion of the health premium. It can easily cost people $400 or $500 or even more a month to insure their families through their employer plan. The reform proposals will offer government subsidies to people with low incomes, but many will get subsidies that only pay for part of the cost.
4. The reason some people won't get coverage is that they still have to pay for it and they won't or can't pay for it, that some states won't have exchanges so affordable coverage won't be available, or they are undocumented immigrants who don't have employer coverage.
@winner: Thank you. But when you say, "They will have the option but are likely to opt out. They will not be penalized for doing so," do you mean employers can choose a plan for you that doesn't include abortion, so that if you needed one, you would have to pay for it? Sorry, am a little confused.
@Lymed: Thanks for taking the time to explain it so well in plain English! If I could heart you again, I would.
Now I understand it more, I don't get why we're celebrating this. It seems like in many cases, a woman's access to abortion will still be in someone else's hands - her employer's.
@Diziet_Sma: Oh, no. I'm saying that specific people will have the option to opt out without penalization. The religious objection, for example; undocumented workers are NOT included in that 3%.
@Diziet_Sma: Oh, also, 2/3rds of private insurers cover elective abortion. That wouldn't change. Apparently, you can ask your employer for additional insurance options but I'm not sure how often this happens.
Insurance you have through the military has never covered elective abortion. Through Medicaid, only a few states offer coverage beyond life endangerment, incest or rape.
This is a great tool, click on the links to the left to see the key difference in the bills: [www.nytimes.com]
But you're right - we're "celebrating" this because Reid is a Mormon and our expectations were low...
So does anyone else think the progress on this is due in large part to the internet and forums just like this that manage to EXPLAIN what these douchebags are doing? Which makes it possible for us to hold their feet to the fire - the first thing I did this morning was respond to an email from one of my reps on this issue.
@sybann: I definitely think the internet is making people more politically aware, informed and active. We've already seen how powerful that can be - I doubt Obama would be president now if it hadn't been for all the online organizing. So, Yay!
@sybann: While I'm sure that was a part of it, remember the President has been out of the country engaging in mostly mostly behind-closed-doors talks and otherwise staying out of the news, so for political news organizations, the health care debate has been literally the only show in town.
While their coverage may be more inflammatory than explanatory, I think the fact that Congress has been debating this bill in the public eye, rather than as a footnote to news coverage of the executive office, probably had a significant effect on bringing both parties closer to their base in the discussions.
@Cardbross: I refuse to give any credit to traditional media anymore - I think in their pursuit of ratings/profits over truth in reporting they've betrayed their audience/real customers - us - and I'm unwilling to forgive them for it. And I'm IN the media.
@sybann: I'm with you there. I'm no fan of traditional media (does TV count as traditional? what does that make newspapers?). I just think, in this instance, and regardless of what their actual stories where, they were dragged into mentioning the healthcare debate by a lack of other stories, and that probably had a beneficial effect by virtue of creating incidental accountability.
Harry Reid didn't stab insurers with an excise tax. He stabbed Americans and small businesses. The excise tax on so-called Cadillac plans won't just be absorbed by insurance companies. It means union workers who gave up wage increases for health benefits will have those benefits cut by legislation that is supposed to increase coverage. It means small businesses that employ high cost employees, perhaps because they employ people with HIV or who are undergoing a transplant, will have insurance rate increases. You can take two equal benefit plans offered by the same insurance company and one plan will be taxed and the other won't. How does that make sense?
He is also ripping the exchange to shreds by creating an exchange in every state rather than one national exchange. So people who live in Maine, Rhode Island and Delaware won't have the opportunity to participate in an exchange with as large a pool as people who live in California and New York.
@Lymed: As far as I know, employers will not be required to offer coverage and it is large companies who will be taxes but only when the government is subsidizing coverage for their employees.
And two equal benefit plans offered by the same company will not be taxed similarly; the more expensive - PPO for example as opposed to HMO - will be taxed.
This is my understanding of Reid's bill - I'm still reading...
@Lymed: I've done a bit more research and it appears, at least in an older Senate bill, that states can join into regional gateways/exchanges. So the exchanges can still have a larger pool if the state chooses. I wouldn't be surprised to see New England states come together, for example.
@winner: The excise tax is a tax on insurance companies who offer high cost health insurance plans. If an employer purchases an insurance plan for its employees that costs more than $8,000 per year for single coverage or more than $21,000 per year for family coverage, the insurance company has to pay a tax. The expectation by economists is that those plans will stop being offered and people will get more pay instead. But that means people will get benefit cuts.
It is not just that a PPO is more expensive than an HMO. A PPO in Maine or Southern Texas will probably be more expensive than the exact same PPO in California. Because health care costs more in Maine and Southern Texas. The exact same PPO will cost more to an employer who happens to employ multiple people with HIV or people getting transplants than it does to an employer who employs primarily health individuals averaging about 30 years in age. Insurance charges more if the people use the insurance more.
@Lymed: I'm with ya - Firefighters often have really expensive medical benefits but it's not just for shits and giggles, it's because of the dangers of the job. Also, we've negotiated for better healthcare instead of bigger raises. So yeah. We are also concerned about this at my work. I understand the reasoning, but there are some flaws.
@Lymed: In my experience, there is increasingly little (if any) difference in benefits or services for high-end PPO plans and lower-end HMO plans. The premium / deductible / copay is the only difference in plans at my firm.
But I see what you're saying and I found this and read a bit more:
[T]he Finance Committee... approved a 40% excise tax on insurance companies that offer "Cadillac" health plans that cost more than $8,000 for individuals.
Labor unions and other critics say the Cadillac tax would hit too many middle-income consumers whose health premiums are high because they live in high-cost areas, not because the plans offer luxury benefits.
Reid, who is facing a tough reelection campaign with the strong backing of organized labor, is exploring ways to scale back the Cadillac tax. He is considering the Medicare payroll tax hike to make up for the revenue that would be lost if the Cadillac tax applied to fewer plans.
@Lymed: Of course all this is relative to the importance of containing health care costs, which has been ditched as a goal in favor of coverage because coverage is sexy and heroic and cost control is for nerds. The House bill doesn't contain costs, really. Everything I've read considers what tiny cost containment measures it included to be pretty piddly, and the CBO said it wouldn't bend the cost curve in the long run.
As far as I can tell, wonks feel like costs can be contained by one or both of these things: consumer spending and delivery reform. Consumer spending advocates are under the impression that many employer-covered folks spend too much on health care (not the ones in the trouble zone) because they have a tax-free health care piggy bank. Non-group types have to pay taxes on insurance, so each dollar of income they would allocate to health care is worth less. This Cadillac tax thing was an attempt to capture these alleged people with posh plans so they won't order them anymore and thereby stop inflating prices.
But now, this was just a poor man's attempt at yanking away the employer tax exemption, which creates this imbalance in purchasing power and keeps people chained to their jobs. It would have a consumption effect by catching all the "Cadillac" types, leave the non-group people no worse off, and would level the consumer playing field, freeing people from their jobs' group plans to pursue the public plan (pleasepleaseplease). What I gathered was if employees, union or sick or otherwise, get hosed by this tax, you lob some subsidies at them. And as with the mandate, all its possible flaws aside, this revocation would drum up some tax income for the program. But oh, Barack Obama must never impose any sort of tax on anyone making less than $250k or the universe will explode.
I know you and I disagreed (amicably, happy to say) about this earlier because you are in favor of total-market tax exemption (non-group people included, that is), thereby liberalizing the consumer market and saving the high cost types from getting hosed. As I recall, you said the entire bill would be paid for, tax-wise, with wealthy income tax hikes. But then, nothing is done about consumer spending, so in theory no cost-curve bending and no increased efficiency. We'll be playing millionaire tax-hike catch-up with the cost curve until we run out of rich people.
So okay, fine, maybe I'll entertain the idea that consumer spending has little to do with rising costs, but that means the legislature has to pass another bill following this one focusing on cost reduction. Maybe some of the stuff this Leonhardt guy proposes will be on the menu.
I know that this sounds naive, but I am continually stunned that reproductive rights are even a debate these days. It just seems so...retrograde. This battle was fought a long time ago, and decided by both the Supreme Court and ensuing legislature. Let it go, anti-choice nutbags. Let it fucking go.
@Tchotchke: I agree, it's completely ridiculous. I'm living in the UK right now, and I was just struck by the weirdness of the idea that my home country is stuck in these bitter arguments about abortion, healthcare, and gay marriage-- not a single one of which is even an issue here! I can go get a free abortion on the NHS (you have to wait for an appointment, if you want it within a week you have to go private), then marry a woman if I wanted to and no one would even bat an eye. Land of the free indeed.
@Tchotchke: The worst part is, in the '70s, most religious leaders embraced Roe v. Wade as a compassionate decision for desperate women. It wasn't until the rise of the Religious Right that it became a wedge issue.
@noisy doll: How ironic. I mean, I don't care to speculate what Jesus thought about abortion, but I know (for the Bible tells me so) that if a poor woman who could barely feed herself found out she was pregnant, Jesus would be there to give her a hug as she walked out of Planned Parenthood.
@whynotshesaid: Hahaha. It's just one of those issues that I understand why it's contentious from a political standpoint, but when I step away from that and look at it just as it is, I don't get it.
Sometimes, I feel like this country is on the brink of another 1968. Everything in the past few years just seems like it's unravelling and the culture wars have gotten to a point of dangerous aggression.
@Tchotchke: Social issues are the only way conservatives can get any traction for their immensely unpopular economic theories (everyone's a libertarian until it's THEIR mortgage tax credit being sacrificed for the good of the nation, or THEIR favorite government service or THEIR defense contractor's lavish base that happens to employ 20% of the Congressman's population). Even the stereotypical racist white southerner really doesn't give two craps about increasing the capital gains tax if it's explained to him/her accurately (something that will never affect you and only affects people like Bill Gates who pays less taxes on his money a year than you do making 20,000 a year). That is not going to get him to vote in an election between two wealthy people who have no idea how to fix his problems.
Basically, conservatives have made the historical accident of the shanking of the working class and the liberalization of the lives of non-hegemonic white males a cause and effect relationship, when there's probably not even a correlation. That's why most conservative rhetoric sounds idiotic. Gay marriage and NAFTA have nothing to do with each other, but working class whites can't do anything about globalization. They CAN, however, shank a gay person because their dreams were wrecked long ago by god knows what arcane piece of legislation passed by Reagan while he was wavin' the flag (or sadly, by Bill Clinton triangulating).
As long as people with money need abortion to upset despairing white people, abortion will be an issue. People with money (health insurance companies) needed to upset old white people. Hence, death panels and now abortion.
@jeninmotion: See also: Susan Faludi, The Terror Dream (white men are pissed off about not getting what is "theirs" and therefore pining for a mythical time long ago when they ruled the world).
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[www.nytimes.com]
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#tips
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#tips
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Can someone help an English expat get her head around this - what is an 'exchange'? And if your healthcare comes with your job, you still get to choose a plan with abortion, right? Or does your employer choose? Also, side issue, this 97% thing - who are the 3% who won't get the option for free healthcare?
11/19/09
Here you go:
c) Exceptions-
`(1) DEPENDENTS- Subsection (a) shall not apply to any individual for any taxable year if a deduction is allowable under section 151 with respect to such individual to another taxpayer for any taxable year beginning in the same calendar year as such taxable year.
`(2) NONRESIDENT ALIENS- Subsection (a) shall not apply to any individual who is a nonresident alien.
`(3) INDIVIDUALS RESIDING OUTSIDE UNITED STATES- Any qualified individual (as defined in section 911(d)) (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during the period described in subparagraph (A) or (B) of section 911(d)(1), whichever is applicable.
`(4) INDIVIDUALS RESIDING IN POSSESSIONS OF THE UNITED STATES- Any individual who is a bona fide resident of any possession of the United States (as determined under section 937(a)) for any taxable year (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during such taxable year.
`(5) RELIGIOUS CONSCIENCE EXEMPTION-
`(A) IN GENERAL- Subsection (a) shall not apply to any individual (and any qualifying child residing with such individual) for any period if such individual has in effect an exemption which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section.
11/19/09
1. An exchange is a system where different insurance companies can sell their plans to people who don't have employer coverage and some proposals will also let small businesses purchase through the exchange. It will have rules limiting what types of plans can be offered and how premiums can be determined.
2. If your health care comes with your job, you often have no choice at all. Many employers offer just one plan and you take it or leave it. Other employers offer a choice of 2-4 plans that cost different amounts. But your employer is choosing the plans offered and often, they don't understand what they are doing and just taking what the insurance broker tells them is in their price range.
3. Health reform is not providing 97% of Americans with free health care. Only people with extremely low incomes will get free health care. Everybody else will have to pay or have their employer pay. Most employers only pay a portion of the health premium. It can easily cost people $400 or $500 or even more a month to insure their families through their employer plan. The reform proposals will offer government subsidies to people with low incomes, but many will get subsidies that only pay for part of the cost.
4. The reason some people won't get coverage is that they still have to pay for it and they won't or can't pay for it, that some states won't have exchanges so affordable coverage won't be available, or they are undocumented immigrants who don't have employer coverage.
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11/19/09
Now I understand it more, I don't get why we're celebrating this. It seems like in many cases, a woman's access to abortion will still be in someone else's hands - her employer's.
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Insurance you have through the military has never covered elective abortion. Through Medicaid, only a few states offer coverage beyond life endangerment, incest or rape.
This is a great tool, click on the links to the left to see the key difference in the bills: [www.nytimes.com]
But you're right - we're "celebrating" this because Reid is a Mormon and our expectations were low...
11/19/09
Bravo Latoya and Jez.
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While their coverage may be more inflammatory than explanatory, I think the fact that Congress has been debating this bill in the public eye, rather than as a footnote to news coverage of the executive office, probably had a significant effect on bringing both parties closer to their base in the discussions.
11/19/09
11/19/09
#tips
11/19/09
Please or please, just this once, let reasonable compromise and sensible thought prevail in my country's government.
Amen,
-BB
11/19/09
He is also ripping the exchange to shreds by creating an exchange in every state rather than one national exchange. So people who live in Maine, Rhode Island and Delaware won't have the opportunity to participate in an exchange with as large a pool as people who live in California and New York.
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And two equal benefit plans offered by the same company will not be taxed similarly; the more expensive - PPO for example as opposed to HMO - will be taxed.
This is my understanding of Reid's bill - I'm still reading...
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11/19/09
It is not just that a PPO is more expensive than an HMO. A PPO in Maine or Southern Texas will probably be more expensive than the exact same PPO in California. Because health care costs more in Maine and Southern Texas. The exact same PPO will cost more to an employer who happens to employ multiple people with HIV or people getting transplants than it does to an employer who employs primarily health individuals averaging about 30 years in age. Insurance charges more if the people use the insurance more.
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But I see what you're saying and I found this and read a bit more:
[T]he Finance Committee... approved a 40% excise tax on insurance companies that offer "Cadillac" health plans that cost more than $8,000 for individuals.
Labor unions and other critics say the Cadillac tax would hit too many middle-income consumers whose health premiums are high because they live in high-cost areas, not because the plans offer luxury benefits.
Reid, who is facing a tough reelection campaign with the strong backing of organized labor, is exploring ways to scale back the Cadillac tax. He is considering the Medicare payroll tax hike to make up for the revenue that would be lost if the Cadillac tax applied to fewer plans.
[www.latimes.com]
I still think Reid's bill is superior to the House bill as a whole. And it's reassuring to know that he's working toward an even better bill.
11/19/09
11/19/09
As far as I can tell, wonks feel like costs can be contained by one or both of these things: consumer spending and delivery reform. Consumer spending advocates are under the impression that many employer-covered folks spend too much on health care (not the ones in the trouble zone) because they have a tax-free health care piggy bank. Non-group types have to pay taxes on insurance, so each dollar of income they would allocate to health care is worth less. This Cadillac tax thing was an attempt to capture these alleged people with posh plans so they won't order them anymore and thereby stop inflating prices.
But now, this was just a poor man's attempt at yanking away the employer tax exemption, which creates this imbalance in purchasing power and keeps people chained to their jobs. It would have a consumption effect by catching all the "Cadillac" types, leave the non-group people no worse off, and would level the consumer playing field, freeing people from their jobs' group plans to pursue the public plan (pleasepleaseplease). What I gathered was if employees, union or sick or otherwise, get hosed by this tax, you lob some subsidies at them. And as with the mandate, all its possible flaws aside, this revocation would drum up some tax income for the program. But oh, Barack Obama must never impose any sort of tax on anyone making less than $250k or the universe will explode.
I know you and I disagreed (amicably, happy to say) about this earlier because you are in favor of total-market tax exemption (non-group people included, that is), thereby liberalizing the consumer market and saving the high cost types from getting hosed. As I recall, you said the entire bill would be paid for, tax-wise, with wealthy income tax hikes. But then, nothing is done about consumer spending, so in theory no cost-curve bending and no increased efficiency. We'll be playing millionaire tax-hike catch-up with the cost curve until we run out of rich people.
So okay, fine, maybe I'll entertain the idea that consumer spending has little to do with rising costs, but that means the legislature has to pass another bill following this one focusing on cost reduction. Maybe some of the stuff this Leonhardt guy proposes will be on the menu.
[www.nytimes.com]
11/19/09
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I think I need to sit down for a minute.
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Sometimes, I feel like this country is on the brink of another 1968. Everything in the past few years just seems like it's unravelling and the culture wars have gotten to a point of dangerous aggression.
11/19/09
Basically, conservatives have made the historical accident of the shanking of the working class and the liberalization of the lives of non-hegemonic white males a cause and effect relationship, when there's probably not even a correlation. That's why most conservative rhetoric sounds idiotic. Gay marriage and NAFTA have nothing to do with each other, but working class whites can't do anything about globalization. They CAN, however, shank a gay person because their dreams were wrecked long ago by god knows what arcane piece of legislation passed by Reagan while he was wavin' the flag (or sadly, by Bill Clinton triangulating).
As long as people with money need abortion to upset despairing white people, abortion will be an issue. People with money (health insurance companies) needed to upset old white people. Hence, death panels and now abortion.
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[reid.senate.gov]
11/19/09
@ElleL: I was going to send this:
#tips
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#tips
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Is it snowing white kittens?
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