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A bill becomes a law

4453307340_0cc74c35a6.jpg

Almost, anyway. According to Rep. Henry Waxman, Barack Obama will sign the Senate bill within the next two days. At that point, the decades-long struggle to pass a universal health-care system into law will finish, and the decades-long work of building and improving our system will begin.

The politics of health-care reform have gotten enough attention in recent weeks, and I don't mean to give them much more. Minority leader John Boehner's closing scold was an angry, divisive capstone; his shouts of "hell no" on the floor of Congress were far more inappropriate, and far more embarrassing, than any yelp that ever escaped Howard Dean's mouth. The presiding officer's admonishment "to remember the dignity of the House" was a sad commentary on how much of it had already been lost. But he represented his members fairly: Earlier in the evening, Rep. Devin Nunes exhorted his colleagues to say "no to socialism, no to totalitarianism, and no to this bill."

It was a reminder of how far our politics have strayed, and how much more extreme our rhetoric has become, than the underlying legislation warrants. The deafening volume of the debate long ago drowned out its subject. Sadly, the Senate bill remains a careful contradiction that most people still don't understand. It is a comprehensive reform with an incremental soul, but neither side has done enough to explain it that way.

The legislation builds a near-universal health-care system, but it only uses the materials that our system has laying around. It leaves private insurers as the first line of coverage provision, but imposes a new set of rules so that we can live with -- and maybe even benefit from -- their competition. It spends $940 billion in the first 10 years and more than $2 trillion in the second decade, but its mixture of revenues, spending reductions, and cost-controlling reforms are projected to save even more than that. It is the most sweeping piece of legislation Congress has passed in recent memory, but it is much less ambitious than the solutions that past presidents have proposed. It is routinely lambasted for being too big and comprehensive, but compared to the problems it faces, it is too small and too incrementalist.

But it's a start. And its passage offers one more chance to better understand it. So today, the blog will be dedicated not to the politics of health-care reform, but to the policy the United States Congress just passed. I'll try to explain what will go into effect in the first year, how the cost controls work, how the coverage works, and how the bill fits into the broader system. I'll also ask some experts to explain the legislation as clearly and succinctly as they can, so you're getting more than just my voice and take.

What I ask of you is to send me your questions on the bill, or leave them in the comment section. I won't be able to answer all of them. But I'll do my best to answer the most common among them. All posts will be filed under the category "Explaining health-care reform," so people can find them later. Let's begin.

Photo credit: Official White House Photo by Pete Souza.

By Ezra Klein  |  March 22, 2010; 1:22 AM ET
Categories:  Explaining health-care reform , Health Reform  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati   Google Buzz   Previous: Hollow reconciliation threats
Next: How big is the bill, really?

Comments

Thanks to you Ezra, for staying with the story--explaining in ways most of us can understand, and calling out those that undermine and lie instead of illuminate and inform.

Others may have the same knowledge, but you impart it with a calm grace that allows us to appreciate the process, even while being frustrated by it.

Continue to maintain your strong sense of personal integrity, and know how much you are appreciated for the incredible dedication you have shown.

Posted by: PointsBeyond | March 22, 2010 2:18 AM | Report abuse

I've enjoyed reading your blog. It's really helped me understand the process and helped me explain it to other people. Thanks for walking us through this mess.

I guess I'll get started.

We heard so much about the special deals for Florida, Nebraska, and Louisiana. Can you sort of go over what those deals are in the bill that passed both houses and how they will be changed in the reconciliation bill? My understanding is the Louisiana deal is basically a correction to the formula that the federal govt. uses to calculate state income for medicaid payments. After Katrina, the state income was calculated to be increased 40% due to the influx of insurance and FEMA money. As a result, the fed. govt's share of medicaid payments would go down. The Louisiana deal would restore medicaid payments to pre-Katrina levels. This seems like a reasonable deal since its ridiculous to think that Katrina made the state's income 40% higher.

Thanks.

Posted by: DDAWD | March 22, 2010 2:24 AM | Report abuse

Ezra, dude, it's time for a vacation.

Posted by: oppster | March 22, 2010 2:26 AM | Report abuse

I read frequently, but rarely post. You, along with Jonathan Cohn and Chait deserve an award for the incredibly hard work you've done over the past year in both reporting on, and fighting for health care reform.

I look forward to continue reading, and maybe hope you can respond to critics like Douglas Holtz Eakin (in yesterday's Times) who continue to argue that the bill will fail to reduce the deficit.

PS-that White House photo keeps reminding me of the safe re-entry in Apollo 13

Posted by: jmoisica | March 22, 2010 2:33 AM | Report abuse

As a previous commenter said, credit to you Ezra for your serious, sustained, and extremely informative coverage of this issue. I think you clearly shaped and influenced the debate and legislation, for the good.

You asked for questions. Here are two:

1) In your Newsweek column, you listed five ways the bill will help reduce the deficit. One is the IMAC (Independent Medicare Advisory Board). From your description and what I have read, it sure sounds like the IMAC has real teeth and the potential to be one of the most significant elements of the new system. But if I understand the fine print correctly, hospital costs are excluded from the IMAC's purview for several years. How can it control costs if the largest single source of costs in the health care system - hospitals - are ignored?

2) Also, I have read that none of IMAC's 15 members can have any affiliation with or background in health care. How are we going to get good decisions from the IMAC if its members must by law be ignorant of the subject matter?

3) Do you ever sleep?

Posted by: kevin_mcgilly | March 22, 2010 2:37 AM | Report abuse

Hey Ezra, great job throughout this whole healthcare process explaining the bills on this site and on msnbc. Although I disagreed with the idea of just accepting the bill without a public option, I think a mandate without a strong public option is unacceptable. But on to my question

Considering that I highly doubt the congress will ever revisit the public option in a serious way, and they definetely won't pass one; what prevents the health insurance industry from raising premiums whenever they want (just as they do now?). I know the idea of having everyone in the same pool is supposed to contain costs BUT the private sector proves time and time again that greed overtakes most considerations and no doubt insurance companies will find a way to jack-up rates regardless of the pool-size, so what prevents them from unnecessary rate-hikes? Is there something in the bill that treats them as a utility so they have to ask the government for permission to increase rates?

Long question I know, thanks for reading.

Posted by: obnox113 | March 22, 2010 2:38 AM | Report abuse

First of all, Ezra, thank you for your incredibly valuable commentary over these past months. Your analysis is always informative and unfailingly insightful. We all benefit from your work.

I am a 23 year old recent Masters graduate who is currently unemployed (not unlike many young people at the moment). I was forced to leave my parents' health plan after graduating in December, and while I purchased individual coverage, I was hoping you could clarify the specifics of the bill's provision regarding children up to the age of 26. This is one of the reforms that has received a great deal of attention as something that will take effect immediately, but does "immediately" mean instantly or within six months? Also, New York state - where my parents live - has a similar provision for children up to 26, but it only applies when the child continues to live in-state (I live in Virginia). I assume that the new bill eliminates all such state distinctions, correct? Finally, are there are financial implications for individuals who left their parents' coverage after turning 18 but now seek to return to it under the new bill? Any new fees, requirements for more expensive categories, etc?

Ezra, thanks again for all of your tremendous work throughout this debate. You were, dare I say, a voice of reason.

Posted by: schneidy32 | March 22, 2010 2:42 AM | Report abuse

THANK GOD. I guess Congress can still act.

I'm self-employed, and happily and profitably so. I didn't choose to be this way, but I love it and already earn more than I used to and see a path to being able to hire others.

But what happens when my COBRA runs out in September? I know the "good stuff" doesn't happen until 2014, but I know some interim plans to prevent people with preexisting conditions from completely falling through the cracks--but is it worth anything???

Posted by: daninor | March 22, 2010 2:48 AM | Report abuse

Can you clarify who exactly the "affluent" are who will be taxed under this plan (according to this NYT piece: http://www.nytimes.com/2010/03/22/your-money/health-insurance/22consumer.html?hp) I thought it only taxed those with Cadillac insurance plans. (Or are we calling it Mercedes?)

Also, the piece says children up to age 26 will be covered, but I thought it was up to the 27th birthday. This is important for us, since our 21 yr old daughter wants to go to grad school. Is the TImes article wrong?

Posted by: KathyF | March 22, 2010 2:49 AM | Report abuse

Thanks for the heroic coverage so far.

I was wondering, if pre-existing conditions illegal for children but the universal mandate is not yet in place what will prevent at least a partial death spiral until 2014?

Posted by: theamazingark | March 22, 2010 3:01 AM | Report abuse

My mom is covered by Medicare Advantage through Kaiser, a non-profit HMO (and from what I hear, one of the best at providing quality care while keeping costs down).

My understanding is that funding for Medicare Advantage is going to gradually decrease until it's on parity with regular Medicare, but there's some sort of incentive system to reward the best insurers.

How does the incentive system work? Are my mom's premiums inevitably going to go up, or are the incentives big enough that they could counteract that if Kaiser qualifies?

Posted by: davidmarin | March 22, 2010 3:10 AM | Report abuse

House Republicans are making a big deal out this, so I was wondering if you could explain why at the top of page 83 in the reconciliation amendment, regarding multiemployer plans (typically unions and retirees) it says a single person should be counted as a family for the purposes of calculating the excise tax. If this is a giveaway to unions, like the Republicans allege, why restrict it to just single people? What's going on here?

Posted by: bmull | March 22, 2010 3:13 AM | Report abuse

Thank you Ezra for all your hard work on this. If you could please post what's in this bill for single adults, I would really appreciate it.
Thanks.

Posted by: mscal | March 22, 2010 3:17 AM | Report abuse

Nice to see FDR and TR on hand for the celebration.

Posted by: tomjf | March 22, 2010 3:29 AM | Report abuse

You should be commended for your hard work on this issue. Your knowledge, pragmatism, and voice of reason resonated beyond your loyal reader base. I have no doubt many in Congress were reading alongside. Huge kudos to you.

As for my question: What would happen to a single person who, under the income guidelines, would be "eligible" for Medicaid but has some savings (not a lot, but more than is allowed under the current guidelines in most states). My mother has a part time job (works at a small candy store that has about ten employees -- so they won't be offering insurance) and her income fits the Medicaid parameters, but she has savings and is therefore denied (she resides in NY). Will savings still be a dis-qualifier? If so, would she get bumped into the exchanges and be eligible for subsidies based on some type of income/savings formula? I have not been able to get an answer. We were contemplating taking her savings out of her name, but rather not and hoping with this new law we wouldn't have to engage in this bizarre dance many are forced to do (i.e., make the modestly poor very poor to get insurance).

Any advice you could provide would be much appreciated. Thanks!

Posted by: luke7474 | March 22, 2010 3:45 AM | Report abuse

Thanks Ezra, for your consistently great writing on this important issue.

This bill is a good first step, but real reform will only come when competition is introduced into the system through a strong public option. The best way to accomplish this, which in all fairness is a pretty big expansion of government, is to show the public that the government they already HAVE is working for them. I feel like there's a lack of information on the subject, so I was hoping you could do some writing on the state of Medicare, and how this bill will affect it.

Also, once the reforms in this bill take effect, how will our health care system compare to other industrialized nations? Is it possible to have a really good system without any public plan?

Posted by: Hunter631 | March 22, 2010 3:51 AM | Report abuse

Ezra,

Amazing job in contributing to this historic advance for our country. You should be very proud.

As for questions, I would like to see a more detailed summary (in clear laypeoples terms) of the CBO report, with a nice breakdown of what the costs, savings, and revenues will be over the next 10 and 20 years, with the estimates of the specific dollar amounts for each.

How exactly does the (highly respected, highly expert, non-partisan) CBO say the bill gives us $600 billion to $1.2 trillion in deficit reduction in years 11-20? Please breakdown the specific exact amounts of savings and revenue increases that the CBO estimates will cause this.

Posted by: RichardHSerlin | March 22, 2010 4:05 AM | Report abuse

Ezra, thanks for the great coverage. Here are my most urgent questions:

1) In today's debate, several representatives claimed that women will no longer have to pay higher insurance premiums than men. Is this change part of the Senate bill or the House reconciliation bill? When would it go into effect?

2) Is there anything in the bill that will put increased pressure on insurers like Anthem to back away from their intended 40-50% increases this year or will exchange oversight over such increases only begin years from now? (In other words, is there going to be so much time before regulation kicks in that insurers will be able to jack up their premiums like the credit card companies jacked up their interest rates?)

3) When will subsidies begin for families to help them afford the cost of buying their own insurance?

Thank you!

Posted by: katerina1 | March 22, 2010 4:09 AM | Report abuse

Like evryone else, thanks a lot Ezra.

I'll keep it short:

Am I going to be able to get my tooth fixed?

Regards
Bot

Posted by: Robot_17 | March 22, 2010 4:11 AM | Report abuse

Ezra,
All praises and platitudes stated above are incorporated herein by reference.

On the Sunday talkies before the vote, the Repubs were all about the "double counting" within the CBO estimate. Alas, the Dems did not outright say it's silly. Is there a kernel of truth to their claim? I'm skeptical about such talking points, but the old saying about broken clocks.

Also, is the anti-trust exemption repealed in the Senate bill? Because I know it can't be done via reconciliation.

Posted by: nomadwolf | March 22, 2010 4:25 AM | Report abuse

Very well written wrap up piece. I so appreciate your unique 'take' on HCR, both the micro and macro view.

I'll say it again: I hope you write a book about this bill, America's first comprehensive HCR policy. Someone needs to preserve it for the historical record (and those policy wonks of the future) and no one could do as fine a job as you.

Posted by: onewing1 | March 22, 2010 4:27 AM | Report abuse

Ezra-- you call it a Universal Healthcare bill. Does it actually DO that? I was under the impression it didn't create a universal guarantee, and, even in practice, would still leave millions uninsured?

Posted by: adamiani | March 22, 2010 4:48 AM | Report abuse

Never has such legislation of such magnatude passed without a single Republican vote. Even Medicare in 1965 had about half of the other party on board. And that's what makes this legislation illegitimate along with Democrats' deaf ear to what the people wanted

It is inevitable that this awful legislation be replaced as will most of the Democrat house members in the next two elections.

Democrats and liberals, in particular will be shocked....SHOCKED, I SAY....at the blowback to come.

Posted by: WrongfulDeath | March 22, 2010 5:08 AM | Report abuse

Ezra, as someone in your home state of CA, I'd like to know what sorts of subsidies will be available for Medicaid expansion. Will a state like CA be able to afford to add many more people to the Medicaid rolls with the new legislation?

Your work has been very helpful to me in understanding healthcare; thank you for it.

Posted by: the_lorax | March 22, 2010 5:14 AM | Report abuse

Thanks Ezra. So I'm 30 years old, I have a pre-existing condition, lost my job, I have COBRA but it will run out in a few months. Before my last job, Blue Cross and Health Net and other companies denied me any coverage because of my condition. It's not even anything life threatening, just a skin pigmentation issue (vitiligo) that none of my friends even know about.

Anyway, will I have to wait until 2013/2014 to be able to buy health insurance? And what income level would I have to be at to qualify for Medicaid as a single young man with no kids?

Posted by: existenz | March 22, 2010 5:17 AM | Report abuse

Hey Ezra:

How exactly are the insurance subsidies going to work? Will it just be deducted from your insurance bill like the FICA tax? Do you get a tax-credit? A check in the mail? What's the process?

Thanks for the great analysis.

Posted by: MattMilholland | March 22, 2010 5:19 AM | Report abuse

While we celebrate, we need to remember that many Democrats feel like they have gone out on a limb for us here. They need to know that we have their back, and that voting progressive is the politically safe thing to do. We must work hard to make sure that every single congressperson who voted Yes gets to keep their seat in November, and that the No votes get kicked out.

Posted by: opinionpieces | March 22, 2010 5:25 AM | Report abuse

My brother in law complained that he cannot find anyplace that explains what the bill actually does in human language.

I saw one months ago, where it was like a PowerPoint presentation... the feature, and then the pro's and cons (benefits and costs). If you can make an updated version, that would be fantastic. Thanks.

And good job to you and Rachel; you two are up there with the President and Speaker of the House in my book (well in the same neighborhood anyway).

Posted by: mestory | March 22, 2010 5:34 AM | Report abuse

Thanks, Mr. Klein, for your efforts this past year to help us understand it all.

Posted by: Neal3 | March 22, 2010 5:48 AM | Report abuse

Are people who live abroad and get coverage through another nation's health care systems considered to have a break in coverage? Will this bill help with those people getting health care coverage when they return to the US?

Posted by: jsslusky | March 22, 2010 6:04 AM | Report abuse

Dear Ezra,

I am traveling to Michigan soon to attend my niece's wedding. Her parents, (my sister and especially my brother-in-law) are staunch conservatives. They are also small business owners employing probably 4-5 people. They are in their late 50's and early 60's. My sister does the bookkeeping and makes the decisions about health care coverage for their employees; something that has long been a difficult chore. From what I understand, this legislation is likely to make their situation much more tenable, but I need help in mitigating some of the noxious propaganda they've been chewing on lately.

How will health care reform help their business be more successful?

Thanks and best wishes,

Posted by: Valpey | March 22, 2010 6:13 AM | Report abuse

It is easy enough to laud the improvements in the bill. The problem arises when one must address the cost of the bill. Anyone can may vast improvements to anything as long as the costs are ignored. See the article www.nytimes.com/2010/03/21/opinion/21holtz-eakin.html by Douglas Holtz-Eakin, who was the director of the Congressional Budget Office from 2003 to 2005. Mr Holz-Eakin predicts the savings will turn into a cost of $562 Billion and will grow from there.

Posted by: kansas-thoughts | March 22, 2010 6:31 AM | Report abuse

Ezra, please explain whether the Senate HCR bill becomes law---officially---when the President signs it, or only after the Senate passes the reconciliation fixes and signs those. I'm still confused about the extent to which (if any) the House used "deem and pass." In other words, if the reconciliation fixes fail in the Senate for some reason, do we still have HCR?

Posted by: leejoshr | March 22, 2010 6:53 AM | Report abuse

Hi, I have heard that contrary to the claims of banning rescission, the Senate bill just passed leaves in place the ability for health insurance companies to drop a policy for "fraud". So what exactly has been banned? Wouldn't health insurance companies still be able to drop coverage for made up trivial reasons like failure to disclose minor ailments from the past, just like they do today?

Thanks.

Posted by: mufti2 | March 22, 2010 7:04 AM | Report abuse

My soon-to-be inlaws are convinced that HCR will negatively impact their Medicare coverage. I've got a fair understanding, I think, of most of the big pieces here, but I don't really have a specific response for them anymore. Little help?

Posted by: MosBen | March 22, 2010 7:19 AM | Report abuse

I have heard conflicting information on how easy it will be to take some of the pilots that reform the delivery and incentive system and turn them into the standard for Medicare, Medicaid or private insurance. Will it take new and separate acts if Congress? If so, that will make these reforms a harder, more drawn out slog.

Posted by: jdhalv | March 22, 2010 7:21 AM | Report abuse

I have heard conflicting information on how easy it will be to take some of the pilots that reform the delivery and incentive system and turn them into the standard for Medicare, Medicaid or private insurance. Will it take new and separate acts if Congress? If so, that will make these reforms a harder, more drawn out slog.

As a related question, Kevin near the top of the thread mentions that hospitals may be at least temporarily excluded from the payment reforms. What's the deal?

Posted by: jdhalv | March 22, 2010 7:24 AM | Report abuse

This bill is going to bankrupt states. The Federal government has "generously" decided to expand the ranks of those covered by medicare--forcing the states, with budgets already stretched to the limit, to pay out more than ever for Congress' generosity. The Federal government will provide some help to states--but the bill specifically requires states to pay a higher and higher percentage of the costs as time goes by. The alleged deficit reductions in the bill will be fully eaten up by the doc fix--which Democrats have sneakily left for a separate bill in order to make the bill's budget numbers look good. And in a time with record high unemployment, Congress has passed a bill that places additional costs (insurance or fines) on the backs of businesses!!! How many businesses do you think will expand from 50 workers to 51? That 51st person suddenly costs them over $100,000! But Congress doesn't care. All they care about is increasing their power and control over our lives. Did they do anything to lower costs of medical care? NO! Did they do anything to increase the quality of health care? NO! They just made their own laundry list of health insurance requirements that companies will substitute for the benefits you used to get--and they'll charge a higher premium. And what's with the Marriage penalty? Two people living together can early $400,000 and avoid the extra tax, but if married, after $250,000 of joint income, they are over taxed. I am so sick of the sheep-like media coverage of this huge Federal power grab--they think they know better than all of us how to manage our lives and how to run businesses.

Posted by: sam38 | March 22, 2010 7:32 AM | Report abuse

You asked for questions. I live in Virginia. Our General Assembly has passed a law to forbid an individual mandate, even though that will now be the law of the land as of 2014. I assume this means nobody will be following the other aspects of the law here, which I was really counting on.

Obviously the Virginia law is now unconstitutional, but Supreme Court cases can take many years to resolve. When will people here get healthcare reform? Do we have to wait for the case to be resolved? Or would the mandate go into effect and then the court case would be to rescind it? Does this one issue about mandates mean that other federal requirements like kids under 26 on parents' insurance, etc., would also not apply in Virginia until the Supreme Court case is resolved?

Posted by: fairfaxvoter | March 22, 2010 7:38 AM | Report abuse

Ezekiel Emanuel emerged last night from the blackout that had been around him during the last months. How powerful an advisor will be be on healthcare, and will his "complete lives" system, which quantifies the value of an individual according to his prospects of being a "contributing citizen" be applied to all Americans? What about those whose lives are deemed less "contributory" by Ezekiel Emanuel? Will they get less access to care?

Posted by: truck1 | March 22, 2010 7:40 AM | Report abuse

Mosben

Whether or not Ezra updates us all on the small business issues, I would recommend you google for, and print out relevant articles to show your relatives.

For example, this mediamatters link countering some nytimes right-wing disinfo shows how reform is designed to protect and help small business in certain ways....

http://mediamatters.org/research/200907180006

Here's another relevant link....

http://www.smallbusinessmajority.org/

Again, do some diligent research, find credible and substantive articles, and then print them out and have your relatives read them instead of you trying to debate them.

No matter how much you study the issue, your relatives will have become more familiar with the propaganda talking points and GOP fear-mongering than you would of the facts of the matter.

The best you can do is have good data/facts/articles in your hand and give them over as the debate threatens, and then let them decide for themselves whether they will read the articles and accept what they contain.

As Ghandi once said, you can't change anyone (so don't try).

Posted by: Lomillialor | March 22, 2010 7:41 AM | Report abuse

House Republicans are making a big deal out this, so I was wondering if you could explain why at the top of page 83 in the reconciliation amendment, regarding multiemployer plans (typically unions and retirees) it says a single person should be counted as a family for the purposes of calculating the excise tax. If this is a giveaway to unions, like the Republicans allege, why restrict it to just single people? What's going on here?

Posted by: bmull | March 22, 2010 3:13 AM | Report abuse

bmull,

its absolutely a giveaway. Let's say the single rate for healthcare for the year for that "union" for arguments sake is $8000 and the family rate is $21000. This line says that the fine will be based upon the $8000 figure but use the family cost figure for determining the excise tax. This will allow union cadillac plans to continue to go on untaxed while those non-union folks in the same situation will be taxed.

Posted by: visionbrkr | March 22, 2010 7:44 AM | Report abuse

Question: I read somewhere that a part of the bill that kicks in immediately is "temporary coverage for early retirees".
Could you explain what this is about?

Posted by: schmandt | March 22, 2010 7:46 AM | Report abuse

MosBen,

It depends honestly on what type of medicare plan your in-laws have. If they have standard medicare (Part A and B -hospitalization and doctors services) and then a supplement (part C) and Rx coverage (part D) then they're less affected. They're helped by a $250 credit towards their donut hole.

If they have Medicare Advantage (a replacement for parts A, B and C) then they'll start to lose subsidies from that and they'll likely see their premium go up. That's why CMS' study showed that many people in those plans (in the millions I believe) will (because of increased costs) eventually move to other Medicare plans (ie supplements).

Posted by: visionbrkr | March 22, 2010 7:47 AM | Report abuse

Ezra, on the passage of HCR, is there a better tweet than this one from Kieran Healy:

"Hello America! Germany says, Welcome to 1883! The UK says, Welcome to 1911! France says, Welcome to 1930!"

http://twitter.com/kjhealy/status/10852366160

Posted by: bdballard | March 22, 2010 8:04 AM | Report abuse

Oops.

My last post should have been directed at valpey, not mosben.

Posted by: Lomillialor | March 22, 2010 8:07 AM | Report abuse

As a related question, Kevin near the top of the thread mentions that hospitals may be at least temporarily excluded from the payment reforms. What's the deal?

Posted by: jdhalv | March 22, 2010 7:24 AM | Report abuse


Hospitals are exempt from the Medicare commission for the first 10 years. Doesn't get mentioned much. Here's the link from the NYT article back in October.

I'm assuming this is still in the legislation.

http://www.nytimes.com/2009/10/11/health/policy/11cost.html?pagewanted=2&_r=1

Posted by: visionbrkr | March 22, 2010 8:07 AM | Report abuse

bdballard

I don't know what those twitter dates correspond to, but they don't correspond to any historical health care events in those countries that are relevant today.

Those countries all adopted their current health system AFTER WWII. Since then, their health stats have improved, whereas ours are in decline according to latest figures. Link with one example follows....

http://www.alterpolitics.com/politics/amnesty-international-condemns-u-s-for-soaring-maternal-death-rates/

Posted by: Lomillialor | March 22, 2010 8:13 AM | Report abuse

I'll keep it short:

How soon before I am legally forced to buy a GM automobile?

Posted by: JakeD2 | March 22, 2010 8:15 AM | Report abuse

BTW: all true pro-lifers should donate to Rep. Radanovich's campaign:

https://www.completecampaigns.com/FR/contribute.asp?CampaignID=radanovich

Posted by: JakeD2 | March 22, 2010 8:21 AM | Report abuse

First of all, thank you for your excellent coverage and for continuing to explain this bill--much appreciated! My question is as follows:

1. I am a county employee and my family health insurance is provided by the municipality at no cost to me. I believe it is considered a 'CADILLAC' plan. What does the health care reform mean for me tax wise?
When does it take effect? Thank you!

Posted by: bbq797 | March 22, 2010 8:21 AM | Report abuse

How will the saving from the drug companies be obtained? Have they agreed to lower prices on some drugs or is the money saved when patents expire on drugs like Lipitor?

Posted by: Neal3 | March 22, 2010 8:22 AM | Report abuse

Kudos to exra and all his hard work on covering this issue. And kudos to the Democrats for actually accomplishing something. ;)

Now, the question is: has Obama burned up all his political capital? Or is this going to give his administration new momentum to try and tackle the next big policy goal, whatever that may be?

Posted by: Kevin_Willis | March 22, 2010 8:22 AM | Report abuse

Many thanks, Ezra. I still can't quite believe we crossed the finish line ahead of Nixonland. You played an invaluable r role here; and while I haven't always supported your tactics (why concede the PO last fall, long before the votes?), I'm grateful for your hard work and strong voice for reform.

Posted by: scarlota | March 22, 2010 8:35 AM | Report abuse

kevin

Good question.

And I say to it that the Dems have taken a big risk with this reform. (see my lengthy comment as to this on Ezra's previous post).

Anyway, in my view, this risk is tantamount to a Texas Hold'em "all-in" moment.

If the Dems don't now continuing showing fortitude and fight to contain medical costs and control insurance premiums in a reasonable way, the GOP will succeed at sabotaging reform and inflating the deficit to pin blame on the Dems and reform.

Because I think Obama is a smart cookie (actually, I think most of the Dems are pretty smart, whereas most of the Repubs are viscerally ideological), I predict they have no choice but to play that all-in hand to the max. They know this was not a bluff. They have to lead now and fight for other accomplishments.

This all-in moment indelibly binds the Dems to change and binds the GOP to the status quo. Poitics will only get more fierce now as the Dems seek further change to consolidate yesterday's success, and the GOP will seek to sabotage reform and much things up so they can say "See, we told you so."

Either way, Americans will get what they deserve now, and how can anyone want anything other than that.

Posted by: Lomillialor | March 22, 2010 8:36 AM | Report abuse

Ezra,

Let's say I'm an insurance company, and I hate this bill. Does it contain provisions that will prevent me from arbitrarily increasing premiums and then screaming, with some sort of weird logic, that the bill forced me to increase premiums? (I seem to remember something in an earlier version of the bill that empowered states to investigate this type of abuse.)

A hearty thanks to you for helping me and my fellow concerned citizens understand this process. And thanks for committing yourself to the even harder -- and more thankless -- work ahead.

Shane Pekny, Omaha

Posted by: spekny | March 22, 2010 8:50 AM | Report abuse

Do Americans "deserve" free GM cars too?!

Posted by: JakeD2 | March 22, 2010 8:53 AM | Report abuse

Ezra, a couple quick questions:

Will this bill cover members of firedoglake? Will they be able to opt out?

More seriously, what about congress members? Will they now be on the exchanges?

Posted by: jeirvine | March 22, 2010 8:54 AM | Report abuse

Ezra,

my question deals with reconciliation. Am I correct in assuming that the excise tax fix (which pushes back the time frame of the excise tax) increases the deficit from the original bill and thus can be easily struck from the reconciliation bill?

If so then it does it have to go back to the house or can whatever is left of the reconciliation bill (after Republicans attack it) be signed into law by the President.

Posted by: visionbrkr | March 22, 2010 8:58 AM | Report abuse

I do not understand how this bill will affect my family and me. Please help me undertand. I am a self-employeed single mother. I cannot afford health care for myself and my children. I made $38,000 last year and I expext to make less than $35,000 this year. What does this health care reform mean for me? Will I be able to get coverage for my children and myself in this first year?

Posted by: jab1974 | March 22, 2010 8:59 AM | Report abuse

spekny:

They won't have to "arbitrarily" increase premiums. 32 million previously uninsurable people will hike the costs for all of us. Employers who think it will be cheaper to just pay the penalty per employee will have to drop insurance coverage as a benefit. Unfunded mandates will bankrupt a few more States. This is only the beginning.

Posted by: JakeD2 | March 22, 2010 9:00 AM | Report abuse

Lomilliaor, the dates refer to enactments of mandatory health insurance provisions, each covering different segments and portions of the respective national populations. These are arguably the foundations on which were built the post war schemes you refer to.

Posted by: bdballard | March 22, 2010 9:02 AM | Report abuse

spekney

Ezra had a post earlier about the health exchanges, and how if insurers raised rates too high, they would be excluded from being able to be a member of the exchange, and thus be blocked from selling insurance.

However, I don't know if they can abuse the system before all that kicks in, or whether I understood it all correctly. Anyway, you can browse Ezra's recent posts (last month or so) for that info.

Posted by: Lomillialor | March 22, 2010 9:03 AM | Report abuse

Good Morning Ezra,

Not much news media coverage was given to aspects of the law, the establishment of comparative effectiveness institute and approval of generic bio-similar drug with extension of exclusive right to 15 years.

Do you have any insights on these?

Posted by: Martin-H | March 22, 2010 9:04 AM | Report abuse

visionbrkr:

If there's ANY change in the Senate to the House version of reconciliation, it has to go back to the House (or Conference Committee). I understand that more than 50 Senators have signed a letter promising to pass reconciliation as is.

Posted by: JakeD2 | March 22, 2010 9:04 AM | Report abuse

Lomillialor:

Do Americans "deserve" free GM cars, yes or no?

Posted by: JakeD2 | March 22, 2010 9:08 AM | Report abuse

My question is about the individual mandate, and how it will work/be enforced. For example, last year, I was unemployed for about 3 months, during most of which time I had no health insurance. Once I got a new job, I was covered under my new employer's plan. How would the individual mandate have interacted with this situation, and who would be in charge of enforcing this? Thanks for all the work--I've enjoyed the blog immensely.

Posted by: meelar | March 22, 2010 9:12 AM | Report abuse

bdballard

I don't think so. Post-war reforms were comprehensive and bear no resemblance to pre-war systems dating to the 1800s and 1911, and so on. Common sense and objective facts tells you that twitter was pure BS. Also, go look at the other crazy conspiracy theories that twitterer spouts, and you know you are citing a lunatic and therefore pinning your own integrity on a wingnut.

Great Britain, France, Japan, etc, all have significantly reformed their systems after WWII to deal with the misery left over from the war.

Also, eastern european countries, newly freed from Soviet oppression, all chose non-capitalist health systems because they had observed declining health stats and rising costs in the USA.

As i said, other western countries are showing gains in health stats as compared to the USA.

I think Nicholas Kristof had a column recently citing evidence that almost all of America's increase in life expectancy rates was due, not to modern medical technology or knowlege, but to immediate post-WWII health care reforms that gave more access to more people. Access is the key to better national health. This has also been shown in other countries (western or not) that work to provide access.

America has a great system if you are rich, but for everyone else, it is increasingly becoming marginal.

Posted by: Lomillialor | March 22, 2010 9:14 AM | Report abuse

"Do Americans "deserve" free GM cars, yes or no?"

What kind of inane question is that?

You get to ask the question, no matter how silly, but not impose an answer.

Posted by: Lomillialor | March 22, 2010 9:16 AM | Report abuse

previously an individual was limited to a lifetime cap on how much the insurance companies had to spend on an individual, which I think was approximately$1.8 million. However, I thought this health care legislation would eliminate those individual lifetime caps.

Posted by: progressivelibertarian | March 22, 2010 9:17 AM | Report abuse

Hi Ezra, I'll put in a few questions about what the dissenting Republicans were saying about the bill last night in the House:

1) Republicans repeatedly said that parts of the bill's spending were unfunded. What's their argument here? Is it that they disagree with the CBO? Is it Paul Ryan's line about the doc fix? Is it just a lie?

2) Republicans argued again and again that the bill would allow for taxpayer-funded abortions. Is this simply false, or is there something more to this accusation?

3) Could you explain in more detail how the student loan overhaul will work?

Posted by: bigmandave | March 22, 2010 9:18 AM | Report abuse

Q: A much-touted benefit of the bill is that if you lose your job, you'll now no longer lose your insurance. How will this work? Will a government subsidy just start immediately so you can keep the same employer plan you had before? What if it's a near-cadillac plan that you could never afford on your own? Are all plans available for gov't subsidy or just ones on on the exchange?

Posted by: jdobb | March 22, 2010 9:21 AM | Report abuse

Ezra,

First, along with other posters an obligatory congrats to you for doing a great job covering this process for the past several years now.

You've stated in the past that this bill isn't perfect, that it isn't the best bill, but it was the best politically possible bill (I position I generally agree with - I am not a huge fan of parts of the bill as I've made apparent in other comments, but I'll agree the bill is better than what the do-nothing Republicans would have done).

What would you consider the bill's biggest flaw, the thing that we'll absoultely have to go back and change sometime in the future?

Posted by: justin84 | March 22, 2010 9:21 AM | Report abuse

$1.8 million cap?

It is currently often far less.

Depends on which plan you buy (if private) or accept (if your employer provides insurance).

And yes, I do believe the new bill removes caps at some point in the future.

Posted by: Lomillialor | March 22, 2010 9:22 AM | Report abuse

"What would you consider the bill's biggest flaw...?"

IMO, it is that no law, no matter how well it is designed, can stand up to intentional sabotage, as this one will suffer from if the GOP gets a chance.

Posted by: Lomillialor | March 22, 2010 9:24 AM | Report abuse

Lomillalor,

The caps go away in 2011, its one of the first "benefits" of reform.

I've also never heard of an insurer that has a cap of $1.8 million.

usually caps are 1 million, 2 million, 5 million or unlimited (from my experience).

Also note many states and plans have caps on individual benefits (ie physical therapy, speech therapy, chiropractic care etc). I don't believe the legislation addresses this issue and hope it doesn't because those caps are in place to address abuses to the system from over-utilization where its not warranted (ie if someone's going for physical therapy forever its making the physical therapist rich but not necessarily helping the patient.)

Posted by: visionbrkr | March 22, 2010 9:28 AM | Report abuse

Lomillialor, it's just a twitter, calm down. Don't worry, everyone already knows that you know lots of stuff.

Kieran Healy is not a wingnut or anything remotely nuttish. http://www.kieranhealy.org/

Posted by: bdballard | March 22, 2010 9:30 AM | Report abuse

FISCALLY INSANE


Michigan is the only state (of 50, not 57) that has NO CAPS on medical liability in auto insurance. Some individual cases are $6+ million -- and still climbing. Thanks to a STEAL-O-CRAT history.

Our auto insurance rates are 15% HIGHER than nearby states.

Great job, STEAL-O-CRATS. You have no control, whatsoever. IGNORE Medicare/Medicaid fraud -- raise JOB-KILLING taxes. Brilliant.


NOV. 2 -- GET RID OF STEAL-O-CRAT INCOMPETENCE

Posted by: russpoter | March 22, 2010 9:33 AM | Report abuse

Ezra, I'm curious about the likely legal challenges to the new law. As one of the Republicans said last night while exhorting colleagues to defeat the bill, something like 30+ states have legislation pending to somehow block implementation of the mandate. First of all, how could these laws work? Will these states make it illegal for a person to purchase health insurance that isn't employment based? That approach itself obviously wouldn't stand up in court. But what other mechanism is there to block the individual mandate? Impose state fines on people who pays the federal fine for failure to oblige the mandate? Wouldn't that be some juicy irony!

Secondly, I know you've posted previously that more-or-less "most" constitutional scholars believe the federal reforms, including the individual mandate, can withstand judicial challenge but the risk of Supreme Court rebuke seems real to me. I also know that legislation always has that clause, "if any part of this is ruled invalid all other parts remain in effect." Still, if the courts do knock down the individual mandate to purchase insuance from a private-insurer only pool, would the presence of a public option exhonerate the mandate? Under such a scenario, do you think the Dems would rally enough to add a public option to the pool and so overcome the constitutional challenge or would they let the reform package die from such a mortal blow?

Posted by: JonathanTE | March 22, 2010 9:36 AM | Report abuse

I'd like to see a breakdown of the Republicans' biggest complaints about the bill. For all the grandstanding and claims of "socialism" and "unconstitutional" I haven't seen anyone take the time to explain exactly what about the bill they don't like. Specifics please, not just quips.

Posted by: eadc | March 22, 2010 9:41 AM | Report abuse

"The caps go away in 2011, its one of the first "benefits" of reform."

Untrue.

In 30 days I will apparently qualify for a high-risk insurance pool as a result of this new bill.

There are numerous stories all about the news about other imminent changes, such as bans on children pre-existing conditions, and so on.

Posted by: Lomillialor | March 22, 2010 9:41 AM | Report abuse

bdballard

If you don't want people to react to nonsense, then don't post it.

Posted by: Lomillialor | March 22, 2010 9:43 AM | Report abuse

how do we adapt to creating legislation, in an era where the two governing parties are essentially at "uncivil war" with one another?

the president has tried to reach out and find common ground, but when there appears to be no common philosophical ground, good will, or compromise, what is going to happen over time, and to the whole process of lawmaking, under these circumstances?

Posted by: jkaren | March 22, 2010 9:44 AM | Report abuse

Top 10 immediate changes all Americans will benefit from.

http://www.huffingtonpost.com/rep-john-b-larson/he-top-ten-immediate-bene_b_501748.html

Posted by: Lomillialor | March 22, 2010 9:45 AM | Report abuse

Questions:

CBS posted a "what's in this bill" summary, which was kinda nice (http://www.cbsnews.com/8301-503544_162-20000846-503544.html), but it was unclear whether this was the Senate bill with or without reconciliation.

My biggest request is to detail exactly when various provisions kick in.

For a family who is self-insured, today: when will any of this help? (If exchanges don't kick in till 2014 or 2015, does a self-insured family get any help this year?)

Are all the exchanges state-based only? What if you live in a red-state that will resist this?

If exchanges don't kick in till 2014, what's to prevent insurance companies from jacking up their rates starting today?

Will anybody see any benefit in time to effect the Nov 2010 elections?

Thanks

PS: Ezra, your tireless coverage during this entire debate has been truly outstanding. Thanks for cutting through the crap to present us a more fact-based reality. Again: truly outstanding. You show what journalism *should* be -- helping to actually cover the issues, rather than focusing solely on the horse race.

Posted by: ADCWonk | March 22, 2010 9:47 AM | Report abuse

Listening to people complain about health care reform is like listening to Nicole Simpson complain about someone criticizing O.J.

Very surreal.

Posted by: Lomillialor | March 22, 2010 9:48 AM | Report abuse

Can you comment on what extent (or not) ancillary health benefits like dental and vision coverage are included? Both in the individual mandates as well as the rules about maximum coverage (most dental plans cover a much lower % of services than medical plans do). There was some concern that insurers who cover these lines but not medical (such as MetLife, Guardian and Delta Dental) would be excluded from the exchanges - is that still true?

Posted by: ahaase1 | March 22, 2010 9:49 AM | Report abuse

Lomillialor,

When I ask about Ezra's view of the bill biggest flaw, I don't mean the biggest flaw of legislation in general (that in your response is that the legislation itself could be repealed one day), but what Ezra could change in the bill if he were to be proclaimed dictator for about 60 seconds and had enough time to change one of the bill's provisions.

For example, one of my concerns is with implicit marginal taxes of subsidy withdrawal. If a family of four makes $30,000 with a single earner, and a second earner could bring in another $30,000 currently that person would probably take the job. However, if the additional taxes, child care costs, and now the loss of ~$6-$7k in health care subsidies are all added up, the household might decide financially it isn't really worse off with only one spouse working.

I don't think that's one of Ezra's primary concerns, hence my question of what he would change with the bill if he could change one major provision of it.

Posted by: justin84 | March 22, 2010 9:49 AM | Report abuse

Lomillialor:

It's not an "inane" question at all. I am simply asking where (if at all) you would draw the line. See how easy it is to answer?

Posted by: JakeD2 | March 22, 2010 9:49 AM | Report abuse

Hi Ezra,

How does the individual mandate penalty system work? Do the insurers get part of the mandate penalty as rebates to buffer from those who free ride and would cause adverse selection? I know the individual market is relatively small, but someone could easily get more out of having access to insurance anytime than the 2% of income they'll pay in penalties, i.e., the insurance companies will take the hit on these people.

Thanks,

Ruben

Posted by: rglvr | March 22, 2010 9:50 AM | Report abuse

Ezra,

My wife asked me how this is going to save money when its costing 90 billion a year. I couldnt explain that in a couple sentences. Can you walk through how this bill will save the country money?

Chad

Posted by: chad6 | March 22, 2010 9:50 AM | Report abuse

Oh yeah, the other question I've had tickling the back of my mind for months: the reforms include the mandate and all so on paper should establish universal coverage. Yet the estimates are that the result will be about 30 million currently uninsured will gain coverage, which leaves roughly 20 million others still without coverage. Who are those that are predicted to remain uninsured? Why are they predicted to remain uninsured? Is the prediction that roughly 20 million people are going to pay the failure-to-comply fine rather than sign up for coverage? Is this because the fine is less expensive than the coverage for these folks, and/or because some X million people are predicted to refuse to buy insurance as a political statement, and/or something else? Thanks!

Posted by: JonathanTE | March 22, 2010 9:50 AM | Report abuse

I keep reading that the law will result in about 95% of all Americans being insured. Some of the remaining uninsured (about 1/3, according to the New York Times) are illegal immigrants.

My question is -- who else will continue to be uninsured under the new law?

Posted by: Craig643 | March 22, 2010 9:52 AM | Report abuse

I understand that Senator Rockefeller and a few other legislators wanted subsidies that would make mandated coverage affordable for those within 300%-500% of poverty. I supported them in this, and I wonder: have they prevailed? If hardship inadvertently arises from subsidies that are too low, can Congress move quickly to raise them? Thanks.

Posted by: Bertilak | March 22, 2010 9:52 AM | Report abuse

I have a question regarding the ability of children to stay on their parents' insurance until age 26.

My sister is currently in medical school, and when my mom called the insurance company to verify that my sister could stay on her insurance until age 26, the insurance said that the new law would only apply to public (i.e. those of government employees) insurance plans. As my parents are employed in the private sector, this new law would not apply. Is there any truth in that, or is that a case of an insurance company trying to evade compliance with the new law?

Any information you can provide regarding this and the application of the other new requirements would be greatly appreciated. Thanks for all of your help!

Posted by: herowlness | March 22, 2010 9:53 AM | Report abuse

@eadc: "I'd like to see a breakdown of the Republicans' biggest complaints about the bill. "

A) It might make Obama look good.

B) It might make the Democrats look competent.

C) Doesn't outlaw abortion.

E) Via the slippery slope argument, it inevitably leads to single-payer.

F) The government isn't good at doing big things.

G) The expect it's going to end up being a never-ending entitlement that costs a whole heckuva lot more than we're being told.

H) Being against it plays well with the base, whose votes they will need if they expect to keep their seats.

Posted by: Kevin_Willis | March 22, 2010 9:54 AM | Report abuse

I want to know how providers of Durable Medical Equipment and Oxygen whose main client is Medicare are going to be affected?

Thank you

Posted by: angelencarn | March 22, 2010 9:57 AM | Report abuse

Queries:

What are the prospects for the law supporting HSAs and other similar plans that give the consumer incentives to save our money by choosing better value providers?

Does the bill force us to cover any particularly expensive services for widespread conditions? Here I am thinking of things like the gastric bypass rider that would cost me a huge amount per employee, questionable and hugely expensive mental health care, to include inpatient?

I understand that Medicaid payments are going to be raised to the Medicare level? Is this going to cause a huge expansion in the use of Medicaid (at a time when many more people are going to be added to the coverage) and the cost of Medicaid that was underpriced in the recent CBO score?

Medicare payments to providers are going to be cut around 20%. Will this cause many providers to stop accepting Medicare? Since this plan also eliminates Medicare Advantage, does that mean that if seniors on Medicare want to see one of the doctors that can't survive on the new Medicare payment schedule, there will be a new market for Medicare supplemental insurance that covers more expensive providers, sitting on top of part B?

And my BIG question for Ezra- what conditions could happen that would cause you to question the effectiveness of this law? (In other words, does your position in support of this bill contain any falsifiable claims of success, or is it more an emotional statement of wanting to show how much we care about the people without insurance? )

Posted by: staticvars | March 22, 2010 9:57 AM | Report abuse

Ezra, can you explain what exactly happens with Medicare Advantage plans? Do they lose their extra incentive, and if so, do they go away? My Representative has been telling his constituents forever that he thinks 'they shouldn't be taking away your wheelchairs, and your oxygen tanks," etc, and scaring the bejesus out of them. What is he talking about? I know standard Medicare will cover their durable medical equipment.

Posted by: mary26 | March 22, 2010 9:57 AM | Report abuse

@JakeD2: Regarding your question on if we all deserve free GM vehicles from the government, all I have to say is that if it's a free Hummer H2 and it's for me, then yes . . . yes, we do.

I'd fully support voting for the Free H2 Hummers for Me Act of 2010. And since their discontinuing the Hummer, they better get this piece of legislation done quick.

Posted by: Kevin_Willis | March 22, 2010 9:58 AM | Report abuse

Fun with amendments.

For starters, I'd like to see the Republicans force the Democrats to put the money where their mouth is propose an amendment in reconciliation requiring passage of the $500 billion in cuts to Medicare before implementation of health care legislation. :) Also a requirement that all members of Congress purchase their coverage on the exchange. I'll dream up a few more in the next few days.

Posted by: bgmma50 | March 22, 2010 10:01 AM | Report abuse

The bill passed includes numerous provisions aimed at preventing certain well-recognized abuses by insurers.

How does a person who feels that he has been abused by his insurer resolve the matter? That is, what is the procedure by which the protective provisions can be enforced?

As a parallel example, the consumer protective provisions in ERISA require the injured party to seek permission to sue from both the Secretary of Treasury and Secretary of Labor, thereafter requiring the injured party to sue in Federal Court without the potential for reimbursement of legal fees and with the maximum claim being the money actually paid into the retirement plan. The Enron debacle offers an example of the actual effectiveness of ERISA provisions. Extending the question, what procedures in the health care bill make its provisions more effective in practice than those of ERISA?

Posted by: rmgregory | March 22, 2010 10:01 AM | Report abuse

"My question is -- who else will continue to be uninsured under the new law?

Posted by: Craig643"

Everybody who has half a brain. Why buy insurance for $10,000 per year when you can pay a penalty of $750 and be guaranteed coverage when you get sick?

Posted by: bgmma50 | March 22, 2010 10:04 AM | Report abuse

Questions:
1. How will the legislation hold down premiums for those who buy insurance themselves?
2. What will be cost controls on the fee for adding children up to 26?
3. What will prevent insurance companies from raising premiums greatly until 2014?

Posted by: bob16 | March 22, 2010 10:05 AM | Report abuse

Is there anything in this bill that will help people get better coverage from their insurers. Pre-existing conditions and dropped coverage aside, you hear that people like their insurance until they really need to use it for something unforeseen, from medicine to procedures. Is there anything that will require that insurance companies cover more treatments/preventions/care/etc, that is not generally covered now? Thanks Ezra! (Loved your coverage on MSNBC last night, and your tweets!)

Posted by: holly_f | March 22, 2010 10:05 AM | Report abuse

Lomillalor,

In all my experience when laws are passed they generally have to take time to ramp them up to be put in place. If i'm wrong with the 2011 figure I'll gladly admit it but again its not even signed into law yet so i don't know how anyone can reasonably tell you that you can get into a high risk pool in 30 days. Is the pool even set up yet? Its not necessarily something where someone flips a switch and "boom" you have healthcare no matter how much we think that is or should be the case.

Posted by: visionbrkr | March 22, 2010 10:07 AM | Report abuse

Ezra, here is a question I don't think anyone has asked:

What happens to Massachusetts HCR? Does it immediately get consumed by federal HCR now? What can we expect the changes to be in MASS on a short-term, medium-term and long-term basis?

Posted by: MyrtleParker | March 22, 2010 10:08 AM | Report abuse

Ezra,

When will people that can not afford to purchase insurance who are to young for medicare be eligible for Medicaid?

Posted by: tara_brownlee | March 22, 2010 10:09 AM | Report abuse

I'm self insured with a lousy policy because of what they call "pre-existing conditions". So only Anthem will insure me and there's no preventive care covered and the policy costs a fortune. So, before the exchanges start, will Anthem be forced to cover preventive care? Are there any restrictions on how much they can raise my rates?

Posted by: marde1 | March 22, 2010 10:12 AM | Report abuse

My questions are simple:

1. When does the law go into effect?

2. How do I go about getting insurance.

LOL Sorry my question isn't intensely cerebral but I'm sure that's what 90% of Americans want to know. Bottom line, how do we get our affordable healthcare coverage?

Posted by: tiga_lilee | March 22, 2010 10:13 AM | Report abuse

I second Craig643's question.

Posted by: Minivet | March 22, 2010 10:25 AM | Report abuse

Vision

regarding your comment below, your original comment (earlier) about the "first" change being done in 2011 was simply wrong.

Let's look at it in the terms you just conveyed below. In other words, your original claim was that the switch would be first flipped in 2011. Again, that is wrong. The switch was flipped last night (actually, after Obama signs it in two days), and now there are people working TODAY to implement the features coming online NOW. Yes, it might take some amount of time to get certain features up and running, but that STOPWATCH starts NOW and not in 2011, as you claimed.

See my earlier link to other features that come online immediately. Some of those features do take effect immediately. For example, as of two from from now, when Obama signs the law, insurance companies will not be able to ban children due to pre-existing conditions. That will happen in 2010 (two days from now), not in 2011, as you implied. In two days, if a child is banned due to pre-existing conditions, the parents will lave legal recourse to correct the situation.

Vision: "In all my experience when laws are passed they generally have to take time to ramp them up to be put in place. If i'm wrong with the 2011 figure I'll gladly admit it but again its not even signed into law yet so i don't know how anyone can reasonably tell you that you can get into a high risk pool in 30 days. Is the pool even set up yet? Its not necessarily something where someone flips a switch and "boom" you have healthcare no matter how much we think that is or should be the case."

Posted by: Lomillialor | March 22, 2010 10:28 AM | Report abuse

Jake

Do you understand that if you wreck an insured car your insurance company may be obligated to repair or compensate you appropriately, and that it has nothing to do with being free (and more to do with the premiums you pay for that protection)?

If you can show me an insurance company that hands out free cars to any and all who need transportation, then I'd agree your question is not inane.

Posted by: Lomillialor | March 22, 2010 10:32 AM | Report abuse

"Why buy insurance for $10,000 per year when you can pay a penalty of $750 and be guaranteed coverage when you get sick?"

Where, pray tell, will you get guaranteed coverage if you refuse to get or buy health insurance?

Posted by: Lomillialor | March 22, 2010 10:34 AM | Report abuse

Minivet and Craig,

I expect the healthy who'd rather pay a small tax than spend a lot of money on healthcare.


Lomillalor,

Again you're getting that from the Huffington Post. A liberal website. I'm not saying its wrong but I'm just saying that in my experience these things take time and when they don't do them right they get screwed up (see ARRA and the COBRA provisions).

Look I'm all for ending pre-ex on kids right now, last year, ten years ago. I'm all for these high risk pools and its not an attack on any one person to simply ask a question "where is the mechanism to set this up?" Who fills out an application to get on this? How do you prove you were denied due to pre-ex thus making you eligible for this? These and many other questions need to be answered.


I'm sure I'll see you on here in 30 days and I hope you have coverage at that point. I'm just not so sure that that is feasible.

Posted by: visionbrkr | March 22, 2010 10:36 AM | Report abuse

1. When does the law go into effect?

Answer: Two days from now, after Obama signs the law.

2. How do I go about getting insurance.

Answer: either get a job that provides benefits, or go to a private health insurance company and apply for a policy. If you are refused a policy or can't afford one, contact your state health insurance commissioner to find out about getting into a high risk pool or getting subsidies.

Posted by: Lomillialor | March 22, 2010 10:38 AM | Report abuse

Ezra, great work following this!

I'm a very, very small business owner living in Seattle. Currently, I have an HSA-friendly plan from the state's high-risk pool (WSHIP). I have an HSA, with a deductible of $3K. I can deduct the costs of my premiums ($5,940) up to the amount of my business income. Right now, my business earns less than $25K, though I have investment income.

How will the bill affect me in the short-term? Longer term?

Thanks.

Posted by: dxkraus | March 22, 2010 10:39 AM | Report abuse

Visionbrkr, thanks for the info. I'd still like Ezra to explain how the bill affects people on Medicare, and the interplay between Medicare and Medicare Advantage, since I'm a bit fuzzy on it. If I remember correctly, Medicare Advantage is basically private insurance provided through Medicare subsidies? Does the coverage go beyond that provided by regular Medicare?

Posted by: MosBen | March 22, 2010 10:39 AM | Report abuse

Ezra, First, thanks for your always insightful and informative comments that have helped me understand HCR much better. I have two questions.

First, re cost and cost savings: I assume that all the CBO cost estimates measure the cost to the federal government, and savings to the federal government, for health care under the new bill. Are there any studies/estimates of the overall cost savings to the economy as a whole(perhaps as a percentage of GDP) for health care as a result of this bill? It seems to me that that is the real test of cost containment, since right now the US is such an outlier in terms of % GDP spent on health care.

Second, it's my impression (based solely on my experiences as a health care consumer) that the health care system overall underspends on capital items that would increase efficiency and ultimately cut costs, compared to other segments of our economy. Is there any research to back this up? And does the HCR bill do anything about this?

Posted by: juliecon | March 22, 2010 10:41 AM | Report abuse

Lomillalor,


Look at ARRA subsidy as an example. That took 90 days to implement and it was botched very badly (and I know from personal experience). It had to, after it was approved go to the state departments of insurance to get the regulations approved there then the insurance companies had to determine what size companies would have to apply the amounts to their 941 tax returns and what size companies would insurers be required to front the money for and get the money back on their returns. In my state of NJ this was changed back and forth and you literally looked on the website every other day and it was changing.

We're all about to find out that government does not work as smoothly as we all hope.

Posted by: visionbrkr | March 22, 2010 10:42 AM | Report abuse

Ezra,

Good morning comrade! As I rise today and bask in the glory of our new Socialist utopia.......... oh wait....... No, the world seems very much the same......

One question my wife asked me that I couldn't answer: How or will we all actually have access to the "same coverage that members of congress have"? This gets tossed about so much I have lost perspective. My guess is that it will be a function of minimum standards on the new exchanges. Then I imagine you need to make as much as congress does...... Anyway help a comrade out.

Posted by: crieser | March 22, 2010 10:42 AM | Report abuse

vision

You are being obstinate and defensive because you are simply wrong.

I showed you one example of a link that explains the changes that are imminent in just a few days.

You made a foolhardy claim that the "first" change comes in 2011.

You can easily use google and your own brain to confirm that many changes are imminent upon signing of the bill.

Even Foxnews reports on some of the immediate changes:

http://www.foxnews.com/politics/2010/01/09/obama-highlights-immediate-benefits-health-care/

And if you don't like Huffington or Fox, just use google and you'll find it reported at every major news site.

Posted by: Lomillialor | March 22, 2010 10:45 AM | Report abuse

"Where, pray tell, will you get guaranteed coverage if you refuse to get or buy health insurance?

Posted by: Lomillialor "

What, pray tell, do you think eliminating the penalty for preexisting conditions is all about? The insurance companies have to cover all comers, remember?

The Massachusetts experiencs has been that about 40% of its new enrollees stay covered for less than 5 months at a time, get thousands of dollars worth of treatment while covered, and then drop coverage.

Posted by: bgmma50 | March 22, 2010 10:46 AM | Report abuse

vision : "That took 90 days to implement and it was botched very badly (and I know from personal experience)."

You didn't claim SOME of the benefits would occur in 2011.

You specifically claimed the "first" benefit was in 2011.

You're wrong.

For example, the ban on children's pre-existing conditions happens in two days after Obama signs the law. In other words, such children will be able to obtain insurance in TWO DAYS.

Posted by: Lomillialor | March 22, 2010 10:49 AM | Report abuse

Ezra, where do I send my check for $750 that will then guarantee me cadillac coverage if I get sick?

My daughter is going to grad school in the fall and she wants to quit her job and play all summer. When will the rest of you suckers ante up the money to pay for her medical insurance?

Posted by: bgmma50 | March 22, 2010 10:50 AM | Report abuse

What is going to happen to flex spending accounts? And when?

Thanks!

Posted by: prstark | March 22, 2010 10:51 AM | Report abuse

I thought I understood the bill moderately well for an interested amateur, but I kept getting questions wrong yesterday at msnbc.com's online quiz. I'm not really sure where to begin, but I hope you will find time to comment on the bill's impact (in the first and second decades) on:

1.) Prescription drugs, including drug trials, prices, and standards of care. I know pharma got on board - so did they give us anything?

2.) Hospitals - will care begin to move away from giant, do-everything hospitals? Will hospital pricing become more transparent? I know that hospitals are supposed to benefit under the bill - how?

3.) Duplicate/unnecessary tests - is there a road here to making sure you get the right test the first time, and then get to transport the results as needed? (I say this as someone who, in recent years, has *repeatedly* been given duplicate or incorrectly chosen medical tests. I heard the President mention this last night as something that would be addressed, but I don't understand how it's going to happen.)


Thanks again Ezra!

Posted by: JaneG | March 22, 2010 10:51 AM | Report abuse

POTUS, Congress: Now do the REAL Health Care Reform:

Stop Bush-Era Homeland-Led Atrocities that Destroy American Lives, Livelihoods...

HOMELAND-RUN 'FUSION CENTERS' SILENTLY ASSAULT, TORTURE, IMPAIR, SUBJUGATE U.S. CITIZENS WITH CELL TOWER MICROWAVE WEAPON SYSTEM, FINANCIAL SABOTAGE, 'COMMUNITY WATCH' VIGILANTE DOMESTIC TERRORISM: VETERAN JOURNALIST

* Thousands of Americans slandered as "dissidents" or undesirables, targeted by Bush legacy program for debilitating, cell tower- based precision-targeted microwave//laser assault, held hostage in their homes to fed-supported vigilante "community policing" stalking units equipped with warrantless GPS devices, who vandalize and terrorize as local police look the other way.

* Electromagnetic radio frequency microwave/laser weapon system -- a nationwide installation employing cell towers and satellites -- silently, invisibly induce weakness, exhaustion, mood changes, pain, head and body aches, physical and neurological impairment, strokes, aneurysms, sickness, cancer -- and many victims do not realize what is making them sick.

===== POLITICAL LEADERS MAY BE AMONG TARGETS =====

* Regional Homeland Security- administered "fusion centers" reportedly serve as command centers for covert electromagnetic radiation attacks, pervasive surveillance, financial sabotage of those identified as "dissidents," "trouble-makers" or slandered as threats to society.

* Use of microwave weaponry to torture and impair political opponents recently confirmed by deposed Honduras President Manuel Zelaya.

* Pleas for justice, to local police and FBI, go unanswered -- as do demands for a Department of Justice Civil Rights Division investigation and congressional hearings.

"These are crimes against humanity and the Constitution, being perpetrated under the cover of national security and 'safe streets' by multiple federal and local agencies and commands -- an American genocide hiding in plain sight, enabled by the naivete of those who think 'it can't happen here.'" -- Victor Livingston, former reporter for WTXF-TV Philadelphia, Phila. Bulletin, N.Y. Daily News, St. Petersburg Times; producer/host, MSG Network Sports Business Report; columnist, NowPublic.com/scrivener.

www.poynter.org/subject.asp?id=2 (click, "More Reporting and Writing") OR

http://nowpublic.com/world/u-s-silently-tortures-americans-cell-tower-microwaves

BUCKS COUNTY, PA- BASED MAGLOCLEN FUSION CENTER -- "Centom of a Mid-Atlantic States Fed- and Police-Protected American Gestapo."

Why won't FBI Open a D.O.J. / Civil Rights Division investigation?

http://nowpublic.com/world/gestapo-usa-govt-funded-vigilante-network-terrorizes-america

OR NowPublic.com/scrivener (see "stories" list).

Posted by: scrivener50 | March 22, 2010 10:52 AM | Report abuse

"What, pray tell, do you think eliminating the penalty for preexisting conditions is all about? The insurance companies have to cover all comers, remember?"

Insurance companies do NOT have to provide benefits to someone who refuses to pay for insurance and who instead prefers to pay a penalty.

You claimed such people were guaranteed to get medical coverage/care if they refused insurance and instead paid the penalty.

So I am asking, where will an uninsured person who instead pays the penalty get medical care if they need it? The only way I know they can get guaranteed coverage in that scenario is if they are rich enough to pay their won bills.

Posted by: Lomillialor | March 22, 2010 10:53 AM | Report abuse

MosBen,

no problem.

Let me take a step back and note I don't specialize in Medicare but have helped some clients in this area.

Medicare has 4 potential parts that not everyone has.

Part A is hospitalization and is guaranteed to you if you're over 65 (or medicare disabled) assuming you've worked enough base weeks in your lifetime (ie paid somewhat into the system)

Part B is doctors services. This needs to be paid for in premiums that since 2007 are variable based upon your income. I think it starts with very little per month up to $300+ per month.

Part C would be a Medicare Supplement plan. This does just as it says, it supplements Medicare where it has gaps (ie Part A has a $1000+ deductible that normally raises every year. It fills in the gaps of Part A and B.

Part D is the drug plan that covers up to a deductible usually and then has an initial coverage limit and then a donut hole (around $2900-$4750 which will be closed or partially closed with this reform) and then covered patients pay a small percentage of their prescriptions thereafter and those figures are based on annual calculations.


Medicare Advantage takes the place of A,B and C. It basically says that if you go through insurer "X" and use their network you've covered however the policy states.

Its these medicare advantage plans that are losing their subsidies slowly so these people will see their premiums go up. Some a little, some more. If i remember correctly CMS estimates that some 4 million people nationwide will opt out of Medicare Advantage due to those cost increases and they'll lose benefits like gym memberships, vision coverage etc.

hope that helped!

Posted by: visionbrkr | March 22, 2010 10:53 AM | Report abuse

Michele Bachman (not my district) proclaimed that this bill will result in a 30% increase in abortions. I'm not one to buy into her ravings, but I would like some clarification regarding the impact on abortion.

As I understand it, to adhere to the ban on federal funding for abortions, the reform bill prevents plans covering abortion from being sold on the newly-created insurance market. As a result, if a woman wants abortion coverage, she will have to purchase supplemental coverage off the market.

This seems to suggest a potential long-term decline in abortions, since I don't anticipate an overwhelming number of people buying supplemental coverage. Thus, the decline would not be due to a drop in demand (which would result from contraception and education), but rather due to an inability to afford the procedure.

Obviously, health plans through one's employer would still be likely to cover abortion, so this wouldn't impact those currently covered.

Posted by: JohninMpls | March 22, 2010 10:54 AM | Report abuse

"Ezra, where do I send my check for $750 that will then guarantee me cadillac coverage if I get sick?"

Send it to me. And trust me, you will then have access to all the health care you and your daughter can handle.

Posted by: Lomillialor | March 22, 2010 10:55 AM | Report abuse

"So I am asking, where will an uninsured person who instead pays the penalty get medical care if they need it?"

Same way the 40% of Massachusetts residents who have figured out how to work the system do. They get coverage after they get sick, get medical care, then drop coverage.

Posted by: bgmma50 | March 22, 2010 10:56 AM | Report abuse

Ezra, you are my hero. Thank you so much for all that you do to help us understand this important stuff. And thank you even more for doing it with such a wonderful sense of humor.
My question: What exactly are the "Medicare cuts" going to include?
Again, thank you- you're the best, and you deserve a huge raise!

Posted by: loveridehorses | March 22, 2010 10:58 AM | Report abuse

bgmma

OK, thanks for that clarification.

One purpose of the penalty is to ensure that "gamers" (people such as you describe) are in a way paying for costs associated by other gamers.

I suspect in time (if it's not already in the bill) that such gamers will find they won't have full coverage after they get sick or will have significantly higher premiums.

Posted by: Lomillialor | March 22, 2010 11:02 AM | Report abuse

Kudos to Ezra, the one journalist who thought his job was to provide actual reporting on the substance of the bill. When we eventually reassess the last several months we will have to note that most journalists failed the American public by never actually understanding the substance of the proposed legislation, but instead elected to become mired in process and high visibility conflict. As a result, they were easily manipulated, letting misinformation fill the airwaves in the name of "free speech".

Every citizen who will benefit from this bill should send Ezra a thank you note.

Posted by: pbkritek | March 22, 2010 11:06 AM | Report abuse

"One purpose of the penalty is to ensure that "gamers" (people such as you describe) are in a way paying for costs associated by other gamers."

I'll bet you anything that the penalty goes to the government and not to the insurers to offset the increased cost of guaranteed issue and community rating.

I suspect in time (if it's not already in the bill) that such gamers will find they won't have full coverage after they get sick or will have significantly higher premiums.

Why in time? Why not now?

Posted by: bgmma50 | March 22, 2010 11:06 AM | Report abuse

visionbrkr, that helped a ton! I have a sneaking suspicion that the future inlaws are in Medicare Advantage.

I checked Ezra's archives and it looks like the last time he posted on Advantage was back in September, so I don't know how accurate this info remains. He said that Advantage plans cost 114% more than regular Medicare and that only 14% or so of that additional cost is actually benefitting the Advantage customers.

You mentioned that they'll lose stuff like gym memberships, which makes it sound to me like they're losing stuff which might be nice, but isn't the end of the world. Given what seems like a huge amount of waste in the system currently, that doesn't sound like such a bad deal.

Posted by: MosBen | March 22, 2010 11:11 AM | Report abuse

"I suspect in time (if it's not already in the bill) that such gamers will find they won't have full coverage after they get sick or will have significantly higher premiums."

By Jove, Lommilliator, you've just given me the third amendment on my list of amendments I'd like to see the Senate Republicans propose in reconciliation. Anti-gamer language. Perfect.

Posted by: bgmma50 | March 22, 2010 11:15 AM | Report abuse

Lomillalor,

You're right, i'm absolutely 100% wrong.

Make sure you remind me when you get onto the high risk pool in 2 days.

Posted by: visionbrkr | March 22, 2010 11:17 AM | Report abuse

In my discussions with opponents of this bill, two points were made as evidence that this is a government takeover of medical care:
1) A boatload of new IRS employees will be hired to evaluate whether each citizen is obeying the individual mandate.
2) A new unelected commission will be setup to arbitrarily evaluate insurance offerings.
Can you offer a cogent explanation on these two issues ?

Posted by: braghothaman | March 22, 2010 11:18 AM | Report abuse

Ezra--
I also add my thanks for your explanations. My question deals with Medicare and the impact this will have on the costs for the average-to-low earning Seniors (those who stay under the $16,000 limit of earning before it affects their Social Security). The Republican have done an excellent job terrifying these Seniors into believing that they will continue to see the cost of their Medicare rising. In plain, simple language what can these Seniors expects to see in their Medicare costs and how will their health coverage be strengthened? Many thanks--kmaes

Posted by: kmaes | March 22, 2010 11:18 AM | Report abuse

26 or 27? The President keeps saying that young adults can stay on their parents' plans until they are 26, but the "fix" says through their 27th year, I believe. Can you clarify? It's not a huge deal, but we should all be accurate - can they stay until they turn 26 or until they turn 27?

Posted by: LindaB1 | March 22, 2010 11:26 AM | Report abuse

Lomillalor,

oh i'm sorry my bad. The high risk pool was 30 days, right? The end to children's pre-ex was two days. You do realize that to many that will mean being added to a healthplan and that doesn't happen necessarily in two days. Again I hope you're right, i really do, i just know how these systems work.

Posted by: visionbrkr | March 22, 2010 11:27 AM | Report abuse

Ezra-
You are a gift to us fellow Millenials. Outstanding effort. Keep it up.

Question on reform: now that insurers can't exclude people, what effect does reform have on insurers charging different rates based on lifestyle? Can they charge different rates for smokers, overweight, vs. active or people fitting some "healthy measure". Incentives for people who commit to exercise/health initiatives?

I've really enjoyed "getting to know you" over this health care issue, and looking forward to following you over the years and issues to come.

Posted by: dandoiter | March 22, 2010 11:30 AM | Report abuse

Lomillalor,

unfortunately neither of us are technically correct (which is why we need to wait for it to actually be done).

ending pre-ex for kids is 6 months after enactment

high risk pools are 3 months after enactment

end to lifetime caps-- 6 months after enactment.

http://docs.house.gov/energycommerce/IMMEDIATE_PROVISIONS.pdf


this is assuming this is accurate.

Posted by: visionbrkr | March 22, 2010 11:40 AM | Report abuse

Lomillialor:

I do understand how insurance companies repair or compensate for wrecked automobiles, and none of them give away free cars. I was asking you about the GOVERNMENT giving away free cars.

visionbrkr:

Those provisions do not go into place right when the bill is signed, some are even six months down the road.

http://voices.washingtonpost.com/ezra-klein/2010/03/what_does_the_health-care_refo.html

Posted by: JakeD2 | March 22, 2010 11:42 AM | Report abuse

The rest of us need to vote out the following Dems:

Ackerman
Adler (NJ)
Andrews
Arcuri
Baca
Baird
Baldwin
Bean
Becerra
Berkley
Berman
Bishop (GA)
Bishop (NY)
Blumenauer
Boccieri
Boswell
Boucher
Boyd
Brady (PA)
Braley (IA)
Brown, Corrine
Butterfield
Capps
Capuano
Cardoza
Carnahan
Carney
Carson (IN)
Castor (FL)
Chu
Clarke
Clay
Cleaver
Clyburn
Cohen
Connolly (VA)
Conyers
Cooper
Costa
Courtney
Crowley
Cuellar
Cummings
Dahlkemper
Davis (AL)
Davis (CA)
Davis (IL)
DeFazio
DeGette
Delahunt
DeLauro
Dicks
Dingell
Doggett
Doyle
Driehaus
Edwards (MD)
Edwards (TX)
Ellison
Ellsworth
Engel
Eshoo
Etheridge
Farr
Fattah
Filner
Foster
Frank (MA)
Fudge
Garamendi
Giffords
Gonzalez
Gordon (TN)
Grayson
Green, Al
Green, Gene
Grijalva
Gutierrez
Hall (NY)
Halvorson
Hare
Harman
Hastings (FL)
Heinrich
Herseth Sandlin
Higgins
Hill
Himes
Hinchey
Hinojosa
Hirono
Hodes
Holt
Honda
Hoyer
Inslee
Israel
Jackson (IL)
Jackson Lee (TX)
Johnson (GA)
Johnson, E. B.
Kagen
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick (MI)
Kilroy
Kind
Kirkpatrick (AZ)
Kissell
Klein (FL)
Kosmas
Kratovil
Kucinich
Langevin
Larsen (WA)
Larson (CT)
Lee (CA)
Levin
Lewis (GA)
Loebsack
Lofgren, Zoe
Lowey
Luján
Lynch
Maffei
Maloney
Markey (CO)
Markey (MA)
Matsui
McCarthy (NY)
McCollum
McDermott
McGovern
McMahon
McNerney
Meek (FL)
Meeks (NY)
Michaud
Miller (NC)
Miller, George
Minnick
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (VA)
Murphy (CT)
Murphy (NY)
Murphy, Patrick
Nadler (NY)
Napolitano
Neal (MA)
Nye
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor (AZ)
Payne
Pelosi
Perlmutter
Perriello
Peters
Pingree (ME)
Polis (CO)
Pomeroy
Price (NC)
Quigley
Rahall
Rangel
Reyes
Richardson
Rodriguez
Rothman (NJ)
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Salazar
Sánchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schauer
Schiff
Schrader
Schwartz
Scott (GA)
Scott (VA)
Serrano
Sestak
Shea-Porter
Sherman
Sires
Slaughter
Smith (WA)
Snyder
Space
Speier
Spratt
Stark
Stupak
Sutton
Tanner
Teague
Thompson (CA)
Thompson (MS)
Tierney
Titus
Tonko
Towns
Tsongas
Van Hollen
Velázquez
Visclosky
Walz
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Welch
Wilson (OH)
Woolsey
Wu
Yarmuth

Posted by: JakeD2 | March 22, 2010 11:48 AM | Report abuse

A question:
For those of us on Medicare who carry a "medigap" policy as well, will the new legislation have any impact on whether or not we need to continue our medigap policies? Will we be able to drop it without consequences if we are under a certain income level?

Posted by: redpencil555 | March 22, 2010 12:06 PM | Report abuse

Here's another question. A friend of mine (no, seriously) is self employed and pays a boatload for insurance today. He asked how this will change things for him. I said, once the exchanges are up, pay less for the same, hopefully. Any chance of a more descriptive answer?

Posted by: tomrini | March 22, 2010 12:35 PM | Report abuse

Hi Ezra! Thanks for all your hard work. My question is this: I've heard that the bill will reimburse Certified Nurse Midwives at the same rate as physicians when they perform the same services. Also that there will now be reimbursement for birth center births attended by licensed Certified Professional Midwives (although not all states license CPMs, so this wouldn't apply nationwide.) Can you provide some further info on this? Does it apply just to medicaid, or is it a regulation that all plans on the exchange will have to abide by? It's good news for cost controls, since midwife-led care is way more cost-effective than surgeon-led care.

Posted by: willow8300 | March 22, 2010 12:38 PM | Report abuse

Ezra:

This is more of a "big think" question for you and whatever experts you bring in:

What aspects of the bill over which the Administration has considerable administrative discretion have the most potential to make a major difference if done well or done poorly over the next 2 years and 6 years? What administrative problems should the Administration be most keen to avoid, and what areas have the potential to make a huge difference if done really well?

Posted by: bartik | March 22, 2010 12:39 PM | Report abuse

I'd like to thank you too for such great coverage of this story over many months.

A conservative friend of mine tweeted: Does it disturb anyone else that at 26 the Feds still consider you a "child"?

I answered: FYI in many states, young dependents age 26 or even older could already be on parents' insurance. Source: http://www.ncsl.org/default.aspx?tabid=14497

So, nothing new under the sun. Just making age 26 standard in every state.

Posted by: billkarwin | March 22, 2010 1:18 PM | Report abuse

Please elaborate on how the bill will affect Medicare recipients.

Thanks.

Posted by: Merula | March 22, 2010 1:32 PM | Report abuse

Question:

My husband, who is a technical writer, is unemployed. When he turned 65, he was transitioned from subsidized COBRA to Medicare. However, our 22 yr old college student son and I are still on subsidized COBRA. Both of us have significant pre-existing conditions. Will the Health Care Reform Bill help us when our COBRA coverage ends early next year?? We're very worried because the post-COBRA HIPAA plans in Virginia are not very good, but cost a lot more than non-subsidized COBRA. Help!

Posted by: OrangeBlossom44 | March 22, 2010 1:40 PM | Report abuse

Billkarwin,

yes but in those state groups that offer that to their employees pay a premium for that. Here they don't. But don't assume its free to treat them.


OrangeBlossom44,

I'd expect you'd be eligible for the high risk pools that start in 3 months. At that point (3 months from now) you can review if you're better off on the subsidized COBRA (now until the end of the year at least) or the high risk plans.

Posted by: visionbrkr | March 22, 2010 2:01 PM | Report abuse

Hi Ezra,

Does the bill also include the overhaul of the student loan system, cutting out the middleman (private student loan system) and passing along the savings directly to students? I read that it was in the bill before the vote, but now nobody seems to mention it.

Please make a separate post on the education part of the bill. Thanks for your work.

Posted by: pryrodny | March 22, 2010 6:06 PM | Report abuse

Marxism always fails. The Repeal will be easy as Millions are harassed by the IRS, are threatened with Jail, or choose a religious exemption ( as the Amish have ). Yes, the People wanted HealthCare Reform but through privatization, not a Communist revolution. The media however studioulsy ignored the simplicity of finding answers through limited government, such as allowing competition across state lines . The Obama powerplay is therefore based on the false belief that you can justify Big Government through convincing the people that both God, and personal rights, do not exist. However, the greatness of America is that we have permission to believe in ourselves and the rights God gave us. As the boot of Socialism presses in on the peoples throats they will revisit the misplaced concept of Hope and Change under this Marxist dictator.

Posted by: givenallthings | March 22, 2010 9:03 PM | Report abuse

Ezra,

I've been following this blog for a while now, but have never posted. Excellent work covering health care and domestic policy in general.

Here's my question: could you please discuss the Long Term Care benefit in the bill? Very little has been said about it.

My mother has Alzheimer's, and I just recently needed to get a caretaker for her when I'm at work. Eventually she will probably need to be placed, and none of this is covered by Medicare. This looks like the beginning of a slow motion financial train wreck for my mother. I'm guessing the LTC portion of the HC bill won't kick in soon enough to help her, but hopefully it will help other people avoid getting wiped out.

Posted by: chrisc4 | March 22, 2010 10:47 PM | Report abuse

Question:

How did Kaiser-Permanente, Geisinger, and the other comprehensive health care providers fare under the bill? Is their approach recognized in the legislation?

Are they better off, worse off, or what?

Posted by: JohnRDC | March 23, 2010 9:31 AM | Report abuse

Pete Stark is a Socialist: http://commieblaster.com/progressives/

Posted by: CommieBlaster | March 28, 2010 2:29 PM | Report abuse

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