Democrats' health care bill has mandates and penalties

By DAVE HELLING, The Kansas City Star
Nov. 08, 2009

The House Democrats’ bill is called the Affordable Health Care for America Act, HR 3962. The information below was gathered from the bill’s text, an analysis by the Congressional Budget Office, an analysis by the non-partisan Kaiser Family Foundation, and reporting by The Associated Press. Links to those sources can be found at kansascity.com.

What’s the goal of the bill?

“To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes,” according to the text.

Would I have to have health insurance?

Yes, or pay a penalty of 2.5 percent of your income. Hardship and religious waivers would be available, and some very low-wage earners would be exempt. The requirement would begin in 2013.

People who don’t get insurance and don’t pay the penalty face fines and possibly jail time.

Would my employer have to provide it?

Yes, or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 would be exempt. Companies would have to pay 72.5 percent of the cost of the premium for a single worker and 65 percent of premium costs for a family policy, and small companies could get tax credits to help pay their costs.

Could I keep my current insurance?

Probably, at least for a while. Your employer could always change your carrier, and it’s possible employers might decide it’s cheaper to pay the 8 percent penalty and drop coverage for workers, forcing you to buy coverage elsewhere.

It’s also possible your coverage won’t meet standards for a basic policy, and would have to be changed when the bill is fully implemented.

What if I don’t have a job and can’t afford insurance premiums?

Beginning in 2013 you could get subsidies, based on your income, to buy your own insurance. Subsidies would end at 400 percent of the federal poverty level, or $88,000 for a family of four.

What if I use Medicaid, the insurance program for the poor?

Medicaid eligibility would be expanded to include everyone earning less than 150 percent of the federal poverty level, or $33,075 for a family of four. States would have to pick up some of the additional costs beginning in 2015.

How would I find health insurance?

For those not insured at work, a national health exchange would be established beginning in 2013 where you could compare and buy coverage, using subsidies if you qualify. States could set up their own exchanges, which could be expanded beyond individuals and small businesses to include large businesses, too.

Could I get a government-run public policy in the exchange?

Yes, if you’re not covered at work. You would pay a premium, just like a private policy, and the government would negotiate with doctors and hospitals to establish payments for services.

Could my children get coverage under my policy?

Yes, until age 27.

Will insurers have to accept me, even with pre-existing medical conditions?

Yes, and premiums could not be increased based on illness or gender. The bill also establishes a temporary “high risk” pool, beginning next year, so individuals with uncovered pre-existing conditions now could get insurance and not have to wait for the exchange to start.

How much is this going to cost?

The CBO said it would cost $1.052 trillion over the first 10 years to expand insurance coverage. Because people who don’t buy insurance and businesses that don’t provide it would pay penalties, the budget office said the net cost would be $891 billion over 10 years.

The CBO said higher taxes and fees and other spending cuts would mean the bill could reduce the projected deficit by $109 billion over 10 years.

But the figures don’t include spending for expanding the prescription drug benefit under Medicare and don’t include raising doctors’ rates under Medicare. And CBO calculated the 10-year cost as the various provisions are phased in; once fully implemented, the costs will be higher.

Who pays for it?

Individuals earning more than $500,000 and couples earning more than $1 million will pay a 5.4 percent income tax surcharge, raising $460 billion over 10 years.

There are other taxes and fee increases, including a $20 billion fee for makers of medical devices and a limit on how much you can put into existing flexible spending accounts.

What about Medicare?

The bill cuts roughly $425 billion from projected spending on Medicare and Medicaid over 10 years. The Medicare cuts would largely come from Medicare Advantage, an HMO-like program involving private insurers.

Will the plan reduce the cost of health care?

Unclear. There are mechanisms designed to lower costs, like requiring the government to negotiate drug prices under Medicare, better use of technology, and efforts against “waste, fraud, and abuse.” It isn’t known how well they’ll work.

Does it cover everyone?

No. The CBO estimates 18 million people under age 65 will be uninsured in 2019, including about 6 million illegal immigrants.

The CBO said about 96 percent of Americans under the age of 65 would have insurance, though, compared with about 83 percent coverage today.

@ Go to KansasCity.com for:

•The full text of the House bill

•The CBO analysis of the bill

•The Republican alternative

•The Kaiser Family Foundation analysis.

To reach Dave Helling, call 816-234-4656 or send e-mail to [email protected]. © 2009 Kansas City Star and wire service sources. All Rights Reserved. http://www.kansascity.com












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