Saturday, March 27, 2010

Health care reform, part I: We won! We won! Hey, did we win?

I went looking for an article to use as my link for “President Obama signed health care reform into law this week,” and I came up with this one from ABC News. I think the article is pretty typical of the way in which the mainstream media has treated the whole process. In what is a fairly long piece, there are only five sentences about what the health care reform act actually does. The rest of the article is politics, politics, politics. Sure, it's fine to write about the legislative process and to make guesses about who the winners and losers are among the politicians. I write about that stuff too.

But if you're going make the story 90% or more about style and only 10% about substance, it's no wonder that many Americans are afraid of health care reform. No one will tell them what health care reform actually does! Is it any wonder that Republicans have had such an easy time convincing their flock that the new law includes “death panels?” In what called “The Lie of the Year,” Sarah Palin suggested in August 2009 that health care reform would mean that Americans, “will have to stand in front of Obama's ‘death panel' so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,' whether they are worthy of health care.” Sounds outrageous? Guess what? A lot of people bought the “death panels” story hook, line and sinker.

So before I go any further, before I talk about how health care reform will affect the next election, which Congressman will get a brick thrown through his window, or anything else, here are the most important things the new law does:

Between 2010 and 2013:
* Insurance companies barred from dropping people from coverage when they get sick. Lifetime coverage limits eliminated and annual limits restricted.
* Young adults able to stay on their parents' health plans until age 26.
* Uninsured adults with pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.
* Medicare drug beneficiaries who fall into the "doughnut hole" coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.
* A tax credit becomes available for some small businesses to help provide coverage for workers.
* The Medicare payroll tax is raised to 2.35% from 1.45% for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.
* There will be a bunch of improvements to the way in which Medicare operates. You can read about them here.

In 2014:
*All insurers are fully prohibited from discriminating against or charging higher rates for any individuals based on pre-existing medical conditions.
*All insurers are fully prohibited from establishing annual spending caps.
*Expand Medicaid eligibility; individuals with income up to 133% of the poverty line qualify for coverage.
* Offer tax credits to small businesses who have fewer than 25 employees and provide health care benefits for them.
* Impose a $2000 per employee tax penalty on employers with over 50 employees who do not offer health insurance to their full-time workers.
* Impose an annual $695 fine on individuals who do not obtain health insurance; exemptions to fine in cases of financial hardship or religious beliefs.
* Employed individuals who pay more than 9.5% of their income on health insurance premiums will be permitted to purchase insurance policies from a state-controlled health insurance option.
* Establish health insurance exchanges, and subsidization of insurance premiums for individuals with income up to 400% of the poverty line, as well as single adults.

So, did we win? Did we actually get good health care reform? I honestly feel that we did. The big disappointment of course is that we didn't get the biggest, simplest and best reform of them all: a public option to buy insurance from a government source rather than a private sector source.

Insurance from public sources isn't just cheaper. Forcing private insurers to compete would put pressure on them to reform without the need for Congress to sweat over creating thousands of pages of regulations.

About one out of six adult Americans are without health insurance. The new law will make insurance nearly universal. Yes we can!