Network News

X My Profile
View More Activity

What does the health-care bill do in its first year?

health-care_reform's_balance_sheet_2010-2019.png

As most of you know, the bulk of the bill kicks into effect in 2014. But it's become a common GOP talking point to say that there are 10 years of taxes for six years of spending. The graph above compares what the bill spends with what it raises for each year between 2010 and 2019. What you'll see is that there are two years -- 2013 and 2014 -- when the bill is raising a lot more than it spends. The GOP has painted this as some sort of rank deception. Apparently, saving up before you purchase something is no longer fiscally responsible.

But though the bill won't be spending much in its early years, it won't be entirely absent. For a full list of benefits scheduled to activate in the first year, download this document (pdf). For a full timeline of the bill's implementation, grab this one (also pdf).

I'm not going to list every quick-acting provision here, because it would be redundant. The most genuinely useful of them will be the ability to keep kids on their parents' insurance until they're 26 (that begins six months after the bill passes), the $250 rebate for Medicare enrollees who fall into the prescription drug benefit's "doughnut hole" (the bill eventually closes the hole altogether), and an end to rescission of coverage or annual limits. At the beginning of 2011, employers in the individual and small-group markets have to spend 80 percent of each premium dollar on actual medical care, or they have to rebate the difference. Oh, and the tanning-salon tax triggers in July. Sorry, Mr. Boehner.

As the bill prepares for full implementation, there are some other policies worth pointing out. Many have been concerned that there will be a shortage of primary care doctors to deal with the influx of new patients. Starting in 2010, a variety of new loan repayment and scholarship programs kick into effect. But more importantly, in 2011, the government directly expands primary-care training programs and sends a 10 percent increase in payments to primary care doctors in the Medicare program (which makes being a primary care doctor relatively more lucrative).

You can pick through the policies yourself, and it's anyone's guess whether they'll be enough. But the architects of the bill are thinking about how to build a medical workforce that works with this legislation. That's why the American Medical Association, the American Nurses Association and the American Hospital Association all endorsed the legislation.

By Ezra Klein  |  March 22, 2010; 11:02 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: How big is the bill, really?
Next: The five most promising cost controls in the health-care bill

Comments

"Oh, and the tanning-salon tax triggers in July."

And thus the Democrats have sealed their doom. This is both blatant discrimination against the well-tanned, and a strike against our natural born right as American's to enjoy affordable, easy-to-accesss all-over tans. Bronzed Americans, imbued with a healthy glow, will show up at the polls to vote out these pasty, sun-hating cave-dwelling incumbents and thrust a fresh, young crop of new, sunbathed politicians who support the right of every citizen to evenly darken their skin pigmentation.

Truly, this is the end of the Democrat party as we've known it.

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

--"[T]he architects of the bill are thinking about how to build a medical workforce that works with this legislation."--

I had no idea Pelosi had workforce building skills. From wife of vineyard owner to health care central planner for a nation, what a story!

Posted by: msoja | March 22, 2010 11:21 AM | Report abuse

Great graph -- thanks.

One quick question: didn't CBO also say that it would save $1B in the following 10 years? If so, where can we find data and/or a graph for that?

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

msoja: Democrats are naturally smarter than everybody else, and also right about everything. So, of course Nancy Pelosi knows better how to manage your health than you do. I would think that, by now, that would have been obvious.

Posted by: Kevin_Willis | March 22, 2010 11:23 AM | Report abuse

Yes, very nice Ezra, but the real question is how long until Rush Limbaugh fulfills his promise to move to Costa Rica if HCR passes.

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

personally I think that tanning tax was targeted at John Boehner but that's just me :-)

Posted by: visionbrkr | March 22, 2010 11:36 AM | Report abuse

Rush Limbaugh is as likely to move to Costa Rica as is anyone else who pledges to move if something happens that they don't like. As I recall, Alec Baldwin and Barbara Streisand have both pledged to move out of the country is Bush won in 2004, or something else like that, which did end up happening. Yet they didn't move.

Rush ain't going nowhere.

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

"At the beginning of 2011, employers in the individual and small-group markets have to spend 80 percent of each premium dollar on actual medical care, or they have to rebate the difference."

You mean, insurers, right? Not employers?

And does this change go into effect for existing health plans next January, or only for new plans negotiated/purchased?

Posted by: denagreenblum | March 22, 2010 11:41 AM | Report abuse

Vision - Heh, that's funny.

Posted by: nisleib | March 22, 2010 11:43 AM | Report abuse

"Many have been concerned that there will be a shortage of primary care doctors to deal with the influx of new patients. Starting in 2010, a variety of new loan repayment and scholarship programs kick into effect. But more importantly, in 2011, the government directly expands primary-care training programs and sends a 10 percent increase in payments to primary care doctors in the Medicare program (which makes being a primary care doctor relatively more lucrative)."

This is a point that bothers me more than any other. I am in favor of this bill, but I really don't see how we are going to solve for the shortage of primary care doctors. In the status quo, this is a huge problem; now, as we had over 30 million to the ranks of the insured, it can only get worse (See here for status quo problem: http://www.nytimes.com/2009/04/27/health/policy/27care.html).

Yes, there are steps to ameliorate all of this. But, I have no reason to be confident that they will be anywhere near enough.

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

I curious as to what happens to all that Obamacare tax money that'll be flowing in before all the "benefits" of Obamcare kick in? Will Congress put it into Al Gore's "lock box" or will they as expected simply spend it all on the current out of control Obama budget? Just wondering.

Posted by: RobT1 | March 22, 2010 11:51 AM | Report abuse

"The most genuinely useful of them will be . . . an end to rescission of coverage or annual limits." I think you mean an end on *lifetime* limits; the ban on annual limits seems to take effect in 2014.

Posted by: tobiasaf | March 22, 2010 11:51 AM | Report abuse

denagreenblum

Yes its insurers not employers in this market. Don't go waiting by the mailbox for a check. My state of NJ has had an MLR at 80% for 16 years and I think its been paid out about 3-4 times. Premium vs claims run at 85 cents on the dollar recently and insurers are already shoring up their bottom lines to make sure that doesn't happen.

Posted by: visionbrkr | March 22, 2010 11:57 AM | Report abuse

--"Yes, very nice Ezra, but the real question is how long until Rush Limbaugh fulfills his promise to move to Costa Rica if HCR passes."--

I believe Limbaugh said he would travel to Costa Rica for health care, not that he would move there, much like Canadians travel to the U.S. to get around the limitations of their health care system.

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

"much like Canadians travel to the U.S. to get around the limitations of their health care system."

You mean that he was lying, much like you're lying?

Posted by: pseudonymousinnc | March 22, 2010 12:54 PM | Report abuse

--"You mean that he was lying, much like you're lying?"--

Which part are you having trouble with, pseudo? You didn't hear about the Canadian premier who flew to Florida for his heart surgery a few weeks ago?

Posted by: msoja | March 22, 2010 1:17 PM | Report abuse

Hehe. "Kids" at 26? Good lord!

Will the grandkids be covered too? You can have lots of real kids, by the time you hit the ripe adult age of ... 26.

Your concept of teh Real World continues to amaze me.

Posted by: Mary42 | March 22, 2010 1:37 PM | Report abuse

Danny Williams != "Canadians", soggy. Looks like your rugged, rugged individualism gives you problems with plural nouns.

(I could talk about how Americans travel to Mexico, and Thailand, and India, and countless other places -- including Canada! -- to get round the limitations of their healthcare non-system, but soggy would surely assert that the border arbitrage of Tijuana pharmacies are some triumph of the free market.)

Posted by: pseudonymousinnc | March 22, 2010 1:48 PM | Report abuse

My dear Ezra: You are so youthful, so very blind to the insane machinations of this fine Republic, meaning those buggers in congress who would sell their souls to gain the path of fame and glory, i.e. power! Where are the funds coming from to hire and house hundreds of thousands of new government employees-local, state and federal? It's blind faith again that assumes these funds come out of the ether and build towering office buildings wherein they administrate and control the very mandates of this near-3,000 page piece of nonsense. The CBO itself said the bill was yet to be completely written; the Senate is yet to add their little tidbits of wisdom here and there. And, where to house the additional 17,000 IRS agents required to collect these new taxes and fines? To maintain their federal salaries and endless benefits, of course, they'll come hand-in-hand with liens and bills of attainder to attach and collect from those 'evil' enough to NOT buy into this boondoggle. Ever been run down by the IRS - it ain't pretty, I hear.

Oh well, as all rainbows have an ending filled with pots of gold, perhaps the wiser-than-snot in Washington can figure out how to dodge the bullet yet again. I doubt it - come November, the fur flies once more!

Posted by: snoocks2 | March 22, 2010 2:52 PM | Report abuse

"Oh, and the tanning-salon tax triggers in July."

I wonder why there were no new taxes on Botox and tities implants? Could it be that Pelosi doesn't want to tax her own a$$?

Posted by: darkskin1977 | March 22, 2010 9:09 PM | Report abuse

For all of you who are concerned about the taxes on tanning.... stop and think about how much we are going to have to pay for your healthcare in the future!

Posted by: NancyBeyond | March 23, 2010 8:43 AM | Report abuse

I am a healthy person. However, I hope that the government taxes the rest of your unhealthy butts until the cows come home. Do you realize how much you unhealthy hypochondriacs are gonna cost me?

So you will lose a bit of your liberty. Who cares? In this world we lose more and more of it each day. The most important thing is to grow your own self-righteousness.

The only reasons to be against this Health Bill are: racism and greed.

Many of you alarmists will point to so called "failed" socialism projects here at home and in many parts of the world. I've heard many of you point to the fact that the European and Canadian systems are also either failing or woefully inferior to our current system (in quality of care).

To all this I say: you are all stupid and wrong and greedy racists!

Posted by: scott3 | March 26, 2010 2:13 PM | Report abuse

Ezra,

I get a little nervous when I see you used a combined "savings/revenues" on your graph.

My experience has been that "savings" are always suspect when coming from a government or corporate entity. Bundling them together with tax revenues here makes you look inexperienced (or biased).

Posted by: scott3 | March 26, 2010 2:18 PM | Report abuse

The comments to this entry are closed.

 
 
RSS Feed
Subscribe to The Post

© 2010 The Washington Post Company