Health Care Bill Passes

[Bananafish]

http://english.aljazeera.net/news/ameri ... 61653.html

WITHIN THE FIRST YEAR OF ENACTMENT

Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.

Insurers will be barred from excluding children for coverage because of pre-existing conditions.

Young adults will be able to stay on their parents' health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.

Uninsured adults with pre-existing conditions will be able to obtain health coverage through a new programme that will expire once new insurance exchanges begin operating in 2014.

A temporary reinsurance programme is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.

Medicare drug beneficiaries who fall into the "doughnut hole" coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.

A tax credit becomes available for some small businesses to help provide coverage for workers.

A 10 per cent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

WHAT HAPPENS IN 2011

Medicare provides 10 per cent bonus payments to primary care physicians and general surgeons.

Medicare beneficiaries will be able to get a free annual wellness visit and personalised prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.

A new programme under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care.

Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare.

Employers are required to disclose the value of health benefits on employees' W-2 IRS forms.

An annual fee is imposed on pharmaceutical companies based on market share. The fee does not apply to companies with sales of $5 million or less.

WHAT HAPPENS IN 2012

Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form "accountable care organisations" to improve quality and efficiency of care.

An incentive programme is established in Medicare for acute care hospitals to improve quality outcomes.

The Centers for Medicare and Medicaid Services, which oversees the government programmes, begin tracking hospital re-admission rates and puts in place financial incentives to reduce preventable readmissions.

WHAT HAPPENS IN 2013

A national pilot programme is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.

The threshold for claiming medical expenses on itemised tax returns is raised to 10 per cent from 7.5 per cent of income. The threshold remains at 7.5 per cent for the elderly through 2016.

The Medicare payroll tax is raised to 2.35 per cent from 1.45 per cent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income at a rate of 3.8 per cent for that income group.

A 2.9 per cent excise tax is imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.

WHAT HAPPENS IN 2014

State health insurance exchanges for small businesses and individuals open.

Most people will be required to obtain health insurance coverage or pay a fine if they don't. Healthcare tax credits become available to help people with incomes up to 400 per cent of poverty purchase coverage on the exchange.

Health plans no longer can exclude people from coverage due to pre-existing conditions.

Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidised insurance on the exchange. The first 30 employees aren't counted for the fine.

Health insurance companies begin paying a fee based on their market share.

WHAT HAPPENS IN 2015

Medicare creates a physician payment programme aimed at rewarding quality of care rather than volume of services.

WHAT HAPPENS IN 2018

An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions.

[Master Gunner]

What Matt said. In comparison to pretty much every Canadian and most others on this forum, I'm very much on the conservative end of the spectrum, and if you try to take away my health care, I will pull out your teeth with my wrench knife and then gouge out your eyes with a rusty spork (dentistry and optometry are two things not covered by our health care system). I think our system is horribly flawed and needs to undergo some massive overhauls, but so long as I can go to the hospital after breaking several bones in a biking accident or passing out in the middle of a room for no reason, or come down with an almost-unheard of disease that requires months of hospital care and dozens of specialists to treat (all of which have happened to at least one member of my family), and walk out of the hospital right as rain and my wallet only thinner in proportion to how badly I was craving a blueberry muffin from Tim's on my way out, I am a happy man.

[Bananafish]

http://healthreform.kff.org/SubsidyCalculator.aspx

Calculator to determine where you'll fall when the bill passes(how much it'll cost, whether you'll qualify for Medicaid &etc.)

http://fdlaction.firedoglake.com/2010/0 ... care-bill/

Some of the things here are a little exaggerated, and they're right that the bill could've been a lot better. There are some positive things in the bill and some negatives. Compared to the list on Aljazeera, this one outlines some negatives.

[Angnor]

Do you? Are you sure they hate the system, or do they just have a few gripes about it?

Yes. Of the 5 Canadians and 4 Brits I talk with on some sort of a regular basis, only 1 of the Canadians thought the US should move to a NHS. The other 8 said fight it at all costs. The person who liked it has a child with mental health issues.

Fact of the matter is, that while our heath care systems are a common thing for Canadians and Brits to complain about, on the whole, the populations of both countries are resolutely unwilling to go without them, and find the idea of moving to a systyem modeled on the american private insurance system absolutely fucking repugnant.

The system in Canada and in the UK has it's issues - but those issues are minor. And while we like to gripe about the various shortcomings and inefficiences of our systems, we are terrified of what life would be like without them.

We love our health care. A lot. In a nationwide survey, Canada voted Tommy Douglas, the father of our universal healthcare system 'The greatest Canadian of All-Time'.

So don't mistake some complaints with hatred, because if there is one thing, one single service, you'd have to pry from our public's cold dead hands, it's UHC.

edit: honestly, the only canadian I can imagine who might "hate" our system, is someone who's never had to use it.

-m

And hence my request for information from people who live with it. I'm not a healthcare expert (and the current bill passed certainly isn't a NHS), but all the information I've received has been negative. That doesn't make it true **Waits patiently for the requisite 'anecdotal evidence' comment**.

So if it's mostly just mild griping, what are the worst aspects of the system you (any of you) have?

[epocalypse]

out of curiosity, since I don't know myself, can you buy additional private coverage for health in Canada to supplement NHS? I'd heard that you can.

[Master Gunner]

Anything that's covered under public health care (either by the federal or provincial programs) you cannot buy additional coverage for (as it's already covered, though it's still one of the things I'd like to change). Anything else that isn't covered though, such as dentistry, optometry, drugs, private insurance is available for. Kinda. It's complicated and changes by province. Anyways, 65% of Canadians have some form of private insurance, and 30% of total health care costs in Canada are payed privately (private insurance or out-of-pocket), if the Wikipedia statistics I glanced at were correct.

[Matt]

So if it's mostly just mild griping, what are the worst aspects of the system you (any of you) have?

We have a shortage of GPs - a fact which is often attributed to the UHC system and 'brain drain' to the US, where doctors can earn more, but I have read that that attribution is largey false - and is more a result of us simply not training enough doctors, rather than any specific failing of the health care system. So, it can be very difficult to locate a family doctor, and if you do, that doctor is going to be very busy.

On the flip side, we do have numerous walk-in clinics, so for most things, if you don't mind sitting in a waiting rooms for an hour or so, you can usually see a doctor without incident.

waiting times are a common complaint, but one which I would consider to be mostly overblown.

I had some elective surgery done last year, and the wait time was about a month. The procedure ttreated a persistent condition I have, (and that condition is far from life-threatening). I would call that wait time totally reasonable for the condition and the procedure.

Naturally, if you have something very serious or urgent, you don't wait, (or at least not as long).

I dont really have any other major complaints coming to mind.

I also differ with M_G - introducing private insurance for services already covered would weaken public insurance and has the potential to create a preferred class in patients. Problems that I see as more serious than the ones that private competition might solve.

-m

[Angnor]

So if it's mostly just mild griping, what are the worst aspects of the system you (any of you) have?

We have a shortage of GPs - a fact which is often attributed to the UHC system and 'brain drain' to the US, where doctors can earn more, but I have read that that attribution is largey false - and is more a result of us simply not training enough doctors, rather than any specific failing of the health care system. So, it can be very difficult to locate a family doctor, and if you do, that doctor is going to be very busy.

With or without healthcare reform I've heard this quoted as a major problem here as well. Basically here nobody coming out of medical school wants to be a GP because specialists earn more. There's no incentive for it.

[2stepz]

.... I'm a rather poor grad student, and I'm living off a research grant of 25K for this year. That, according to the calculator above, puts me at 233% the poverty level, and puts me into the bracket where ~7.5% of my already meager living money now goes to healthcare. Ummm... I already pay for student health on campus. (And honestly, our student health system is pretty good. A GP, NP, Sports Med Physician, Psych, and "Life Coach" all available at no cost to students. )So... unless this bill will give money to the campus clinic in lieu of the portion of my tuition, I'm getting ripped off.

[Keith K]

The main criticism I have of our Healthcare is that it doesn't extend to basic Dental Care as well.

The biggest issue is the imbeciles who control it and divert spending from it to pander to SIGs and personal agendas. I would very much like to see a Federal reform of the ability of the provinces to pick and choose if and when they're going to fund Healthcare in their province. An non-negotiable sum should be alloted to Healthcare per capita. It is the number 1 priority of our tax dollars, in my opinion, and should be treated as such.

Politician salaries should be at the bottom.

[Bananafish]

.... I'm a rather poor grad student, and I'm living off a research grant of 25K for this year. That, according to the calculator above, puts me at 233% the poverty level, and puts me into the bracket where ~7.5% of my already meager living money now goes to healthcare. Ummm... I already pay for student health on campus. (And honestly, our student health system is pretty good. A GP, NP, Sports Med Physician, Psych, and "Life Coach" all available at no cost to students. )So... unless this bill will give money to the campus clinic in lieu of the portion of my tuition, I'm getting ripped off.

I put this into the Senate bill and it says the government will subsidize $1,600 of the $3,500 annual fee so I guess that's good?

[Elomin Sha]

I have to say that I'm glad of the NHS. My 3 year old brother is going in for a massive heart operation this Thursday (possible 2 in one day depending on the outcome of the first). I have no idea how much that would cost in the US and to say no to treating him would be diabolical.

[Matt]

.... I'm a rather poor grad student, and I'm living off a research grant of 25K for this year. That, according to the calculator above, puts me at 233% the poverty level, and puts me into the bracket where ~7.5% of my already meager living money now goes to healthcare. Ummm... I already pay for student health on campus. (And honestly, our student health system is pretty good. A GP, NP, Sports Med Physician, Psych, and "Life Coach" all available at no cost to students. )So... unless this bill will give money to the campus clinic in lieu of the portion of my tuition, I'm getting ripped off.

Uh, yeah, I'm reading that as your premium is capped at a maximum 7.5% of your income, and that you qualify for a substantial government subsidy if your insurance is provided via specific provisions, so correct me if I'm wrong, but isn't this, majorly beneficial, especially if the insurance program you're buying from now qualifies you for the subsidy?

-m

[Bananafish]

I have to say that I'm glad of the NHS. My 3 year old brother is going in for a massive heart operation this Thursday (possible 2 in one day depending on the outcome of the first). I have no idea how much that would cost in the US and to say no to treating him would be diabolical.

I think the bill has a provision that disallows insurance companies from covering children due to pre-existing conditions, I'm not sure how much it'd cost though

[2stepz]

Yes and no, Matt.... Student Health Services aren't considered "Insurance." At least in the interpretation I'm seeing.

I guess my real question, and not one I expect anyone to be able to answer here, is if the student clinics around the states will now be subsidized through this program and take that fee out of my tuition bill. (In a way, I've been paying into a mini socialized medicine every time I take a class.)

[Matt]

I have to say that I'm glad of the NHS. My 3 year old brother is going in for a massive heart operation this Thursday (possible 2 in one day depending on the outcome of the first). I have no idea how much that would cost in the US and to say no to treating him would be diabolical.

I think the bill has a provision that disallows insurance companies from covering children due to pre-existing conditions, I'm not sure how much it'd cost though

I have a pre-existing inherited condition that pre-disposes me to higher liklihoods of cancer in the throat and stomach, as well as requiring periodic and life-long surgical treatments.

Without an employer plan, health insurance would be absolutely unaffordable for me under the existing american system.

Even with the reform bill, I'd probably be required to pay the absolute maximum that the reform bill allows.

So, pardon me while I give Canada's UHC a big hug.

-m

[Bananafish]

Why this bill is fucked up:

They really fucked up when they voted against allowing drug reimportation, it would've cut the exorbitant drug costs in the US and made this bill cheaper.

The bill disallows states from setting up their own health system until 2017.

As we saw a minute ago 2stepz is at the 233% poverty line, the bill will grant subsidies to people up to 300% of the poverty line because private insurance is fucking expensive. The subsidies will come from the taxpayers to pay the insurance costs that the government has little control of, the subsidies will be given back to the person who will pay it to the insurance companies. At any time the insurance companies can raise their premiums and since the government is giving money to people to help pay for them they will get even more profits along with the government forcing you to buy insurance (or they will fine you 2% of your annual income)

In reference to the above, the bill doesn't put a cap on premiums, yes there are committees that investigate unfair premium increases but they don't do much right now and I seriously doubt they'll do anything later.

[Matt]

Yes and no, Matt.... Student Health Services aren't considered "Insurance." At least in the interpretation I'm seeing.

I guess my real question, and not one I expect anyone to be able to answer here, is if the student clinics around the states will now be subsidized through this program and take that fee out of my tuition bill. (In a way, I've been paying into a mini socialized medicine every time I take a class.)

without having actually read up on it, my assumption is that student health programs would either be considered a private insurance plan, or an "emplyer-provided" insurance plan. I can't imagine them just ignoring them, since student health care is one of the major sources of health serivces for students.

-m

[Bananafish]

If you have a problem with insurance companies trying to fuck you because you're in college (like postponing a treatment until your insurance runs out, yes they do this) go to the student legal office at your university and they should be able to do something about it.

[MotorWaffle]

I don't know enough about how this bill is supposed to work to really know it's long and short term effects. However, this is something of a relief since a pre-existing heart condition was going to make it almost impossible for me to become insured without it.

[Bananafish]

http://didtheypasshealthcarereform.com/

[Theremin]

I have to say that I'm glad of the NHS. My 3 year old brother is going in for a massive heart operation this Thursday (possible 2 in one day depending on the outcome of the first). I have no idea how much that would cost in the US and to say no to treating him would be diabolical.

Too right.

As a child of a poor family, I'm also very glad of the NHS.

[TheRocket]

I'm happy to admit there are problems with the NHS, like staff pay and hospital conditions and waiting times and quality of care. But at the end of the day, I'm happy to have it rather than the alternative of no healthcare at all or of the US health system. I especially don't think it's morally or ethically right for someone to get life-saving treatment and then be presented with a mammoth bill for it. That just isn't right.

Every country needs universal healthcare, that's just the only model that works, in my opinion.

This. This. This.

I don't know who it was that said "is it mild griping or do they hate it?" This. It's mild griping. I have the same probs as Lying with UHC, but by GOD I'm glad we have it. At the ned of the day I am glad I can go to a clinic and get diagnosed and patched up when I'm sick and have to be at work the next day with an ear infection. At the end of the day, I'm glad my brothers life was saved, and all we had to pay was a 300$ ambulance ride, and not the $30,000+ it would have cost if we were in the states (for treatment, ER and ICU extended stay). At the end of the day, I might have to wait 2 weeks to get into see my family doctor, but at least I got in and out and didn't have to pay, where as now in the USA, I have no doctor, and I have been needing to see one for 6 MONTHS. (yes, I went to a walk in, but they didn't fix the problem, and we got stuck with $140 bill that my travel insurance company has been dicking around. Point being, in canada, I wouldn't have $140 bill just to see the doctor.)

Yes, there are problems with UHC. But I'd take those anyday over the Private Health Care.


Also, I don't pretend to know a lot about politics, or understand a lot about this bill. I know Wraith is up in arms and is hating it, and I cannot see why. I am of the other mind set that it will help and not hinder. However, I'm super scared that Obama is going about it the wrong way and it will fail, leaving the USA in an even rougher spot then he started with. But Jebus I want shit to change down here.

[Arius]

I like how people are screaming out, "No one read it."

They wrote it. It wasn't mailed in by a random constituent and voted on. They just spent a year debating it, changing it, and reworking it according to what it would take to get it passed. It's not like you're going to go through it and see "Psyche! We're killing your grandparents. Lol." written on the last page.

And 1200 pages are impossible to read in three days? Only if you don't actually care about the bill.

[2stepz]

ARius - Didn't say it was impossible to read it... just said that they DIDN'T. Maybe their staffers did, but I guarantee majority of the congressmen/women didn't read the final bill.