The Morning After bill

[seafan]

Here is a review of what went down last night.


Mike Madden over at Salon sums it up:

1) For people with preexisting health conditions: Insurance companies would no longer be allowed to deny coverage to people based on their past medical history; everyone would be entitled to insurance, and insurers couldn't charge vastly higher prices for people with preexisting conditions. Right now, states allow insurers to deny coverage to people with any number of conditions -- from acne to cancer -- and some let insurers deny coverage to victims of domestic violence.

The provision wouldn't take effect until 2014, though within six months of the bill becoming law, insurers would be barred from denying coverage to children with preexisting conditions. People with preexisting conditions who are uninsured now would have access to a temporary national "high-risk pool" insurance plan as a backup until then. That coverage wouldn't be as comprehensive, though.

2) For people who buy their own insurance or for small businesses: Instead of leaving small businesses and individuals to negotiate on their own with insurance companies, the bill would set up exchanges where insurers offer plans. Each state would set up its own exchange, but the idea is to provide a regulated marketplace to select a plan. You could look through the different available plans, compare them on one Web site and enroll directly through the exchange.

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Abortions could not be covered by plans that get subsidies; if women who use the exchanges wanted to make sure their insurer would cover abortions, they'd have to pay separately for an additional policy.

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The exchanges, like the ban on preexisting condition denials, would be set up in 2014. Ninety-two percent of the population that isn't old enough to get Medicare would have insurance -- up from 81 percent now.

3) For people who get insurance through their jobs: Employers with more than 50 workers would be required to offer insurance.

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Little else would change for people who have insurance through work, which is how the vast majority of Americans get their coverage. Premiums could fall by as much as 3 percent over what they would be if the bill doesn't pass (but they'll still be higher than they are now, because healthcare costs keep rising). There would be a new tax on the most generous plans -- those with a value of more than $27,500 for families. That value would be indexed to inflation, so as prices go up in general, the limit for the tax would rise with them. The goal of the tax is to keep employers from offering so-called Cadillac plans, because experts believe they encourage patients and doctors to spend money unnecessarily on care that might not actually improve health.

4) Other reforms .....

Children would be allowed to stay on their parents' insurance until they turn 26. Insurers would have to spend 80 to 85 percent of what people pay in premiums on actual medical services; right now, they're allowed to spend less, pocketing the difference. Insurance companies would no longer be able to drop people from coverage once they get sick, a practice known as "recision." Lifetime limits on the amount of medical care your insurer would pay for would be illegal, and annual limits would be "tightly restricted."

5) For seniors: The Medicare prescription drug "donut hole," which left seniors on the hook for significant drug bills, would be closed completely by 2020. Seniors who spend enough to fall into the gap in coverage now would get $250 rebates. Medicare taxes would be charged on dividends, capital gains and other unearned income for people making more than $250,000 a year, which would help keep the program solvent.

Payments to private insurance companies that run Medicare Advantage plans would be frozen in 2011, which Democrats say would eliminate overpayments. (Republicans argue that's basically a cut from Medicare.)

6) How much does it cost? The price for all that isn't cheap -- $943 billion over 10 years, mostly because of the subsidies to help people buy insurance. The country spends nearly $2.5 trillion each year on healthcare now, though.

The bill is mostly paid for, in part by new fees on pharmaceutical companies, manufacturers of medical devices and other industries that will benefit from the expansion of access to healthcare it would allow. Those companies will all make more money, the theory goes, because they'll have millions of new customers who don't have insurance now. Other fees, including payments from people who don't buy insurance despite the mandate, penalties on companies that don't provide insurance, and a higher payroll tax to cover Medicaid and Medicare for people who make more than $250,000, would help make up the rest of the tab.

7) What about the deficit? The Congressional Budget Office says the bill would lower the deficit by $138 billion over the next 10 years. The decade after that, the bill would cut the deficit by $1.2 trillion. Projections that far out are hard to put much stock in, though.

Most of those savings would come because the government would be spending less on Medicare and Medicaid.

8) How will medicine change? The bill includes incentives to use more electronic medical records,
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...set up pilot programs for medical malpractice tort reform. Community health clinics, which help serve people who often don't have access to other forms of care, would get more funding. Medicare payments would be linked to quality of care, which should shift more providers toward evidence-based standards to see how well treatments work.

Other pilot programs would be set up to study how to improve public health in general, and improve care for people with chronic diseases, rural patients and other groups. The goal is to improve the quality of care while holding the costs down.

9) What doesn't it do? Even if the bill passes, the fundamental structure of the U.S. medical system will remain more or less the same -- you'll pay a private insurance company, they'll reimburse your doctors for care. There's no public health insurance option, which many progressives wanted; there's nothing remotely like a single-payer healthcare system, which progressives had hoped for at the outset.

That's by design. The White House decided early on to try to work with the big industries involved in healthcare and get them to join the effort, rather than trying to fight against them. Believe it or not, that's made it easier to pass the bill (the opposition would be far greater if most industry groups weren't still on board). But it also limited its ambition -- the goal was to tinker with the way the system worked, not scrap it and replace it with something else.

10) How did it get to this point? Congress debated the bill for more than a year. It went through three House committees and two Senate committees, including one --Finance -- where Democrats spent months trying to get a bipartisan proposal put together. A lot of Republican ideas made their way into the legislation, even though no Republicans are likely to vote for it.

The House passed its version of the bill on Nov. 7, and the Senate passed its own on Dec. 23. But after Scott Brown won a Massachusetts Senate special election in January, Republicans had enough votes to filibuster any additional healthcare action. So the only way forward was for the House to pass the Senate bill unchanged -- sending it to President Obama to sign -- and then for both chambers to pass a package of changes using the budget reconciliation process.

Here are a few more.

These are the items that weren't addressed thoroughly with the public, paving the way for the inevitable rise of anger and confusion.


Brace ourselves.





Jon Walker summarizes:

The six main areas that need to be fixed are: cost control, enforcement, individual mandate, abortion, competition, and immigration.



1) Lack of Real Cost Control

This bill does not create real cost control and will not bring down premiums for most Americans. Congress and state legislatures need to adopt real cost control measures like: drug re-importation, Medicare direct drug price negotiation, a public insurance option, Medicare buy-in, or a central provider reimbursement negotiator (all-payer system). These changes would save the government and regular Americans hundreds of billions of dollars over the next decade.

The bill also needs to provide a better pathway for states to opt-out of this bill so they can experiment with better health care models that could truly bring down cost.

2) Dangerously Weak Enforcement

There are some good new regulations, but regulations are only as good as the strength of the agency tasked to enforce them. This bill is dangerously lacking in this area, leaving enforcement mainly up to the same state insurance commissioners that now often lack the will, funding, or power to hold the private insurance companies honest. Only a national exchange and a federal insurance commissioner would have the power to make sure the new regulations are more than over-hyped window dressing.

3) Individual Mandate

The individual mandate, which uses the IRS to force people to buy a product from a poorly regulated, private industry, is an affront to the American people. The policy is not needed, and must be corrected before it has a chance to go into effect. People must be offered the choice of a public alternative, or the individual mandate must be repealed. Alternatives like a back premium payment system could achieve a similar policy goal to an individual mandate without a massive expansion of the IRS or government coercion.

4) Abortion

This bill is a massive rollback of a woman’s right to choose. It would take away the abortion coverage of millions of Americans. The system of exchanges and affordability tax credits could easily be modified to ensure federal funds are not used to pay for abortions, while still not taking away the ability of women and small businesses to buy insurance packages that cover abortion. Having an individual mandate that forces women to buy insurance, but also a law that prevents them from getting insurance that covers a legal medical procedure, is a disgusting abuse of women’s rights.

5) Lack of Health Insurance Competition

The bill will do almost nothing to address the problem of lack of competition in the health insurance market. Repealing the anti-trust exemption and adding a public option would be two big steps toward solving the problem. Creating an all-payer system would make it easier for new insurers to enter new markets. Requiring a standardized insurance package, instead of a confusing set of choices based on actuarial value, would allow Americans to do real apples-to-apples comparison shopping. Finally, adding much stronger risk adjustment mechanisms would force insurance companies to compete on quality instead of on avoiding the sickest Americans.

6) Immigration

Under this almost-law, undocumented immigrants would not be allowed to buy insurance on the new exchanges, even if they are willing to pay the full cost of the insurance with their own money. This policy is not only cruel and immoral, but fiscally irresponsible. The more undocumented immigrants that pay for their own health care, the more taxpayers save by not being forced to pick up the cost of undocumented immigrants’ uncompensated care when they use the emergency rooms.

The White House and Democratic leaders have made many promises about health care reform throughout this long and winding process—from guaranteeing affordable, quality care for everyone to pledging tougher regulation of the medical industrial complex that created this broken system in the first place. If the majority party wants to honestly deliver on these promises—not to mention if they want to remain in the majority—then a concerted and immediate effort is required to prove that this week’s legislation is truly the first step toward reform, and not the last.

When all was said and done, this health care bill really did all come down to abortion.


Who, now, is surprised?





As this stands, women will be mandated to purchase insurance, but if they enroll in an exchange that receives federal subsidies, these women will be then be unable to use it for coverage of this legal medical procedure because it offends Bart Stupak.

Instead, these women will have to find a separate source for insurance (or cash) to cover abortion services. As a result, many of these insurance companies will be sorely tempted to phase out abortion coverage altogether, effectively curtailing these women's access to a legal medical service.




That brings us to Obama's Executive Order to appease Stupak.



On the Executive Order, Jane Hamsher explains:

Right now, the Hyde Amendment has to be renewed each year in the Appropriations bill. Having a Democratic President state it in the form of an Executive Order would be quite a coup for anti-abortion activists.

But Stupak has been after more than just Hyde. The health care bill contains $10 billion for Bernie Sanders’ community clinics, which would begin immediately rather than waiting until 2014. Planned Parenthood had pledged their support for the bill with the knowledge that much of that money would be going to their clinics, but would not be used for abortion services. However Stupak has pursuing the agenda of American’s United for Life, who want a commitment that no money go toward Planned Parenthood clinics regardless of what it is used for.

And it gets worse. Take a look at the new "conscience clause" language in Obama's Executive Order:

5. Addition Conscious Provisions

“(1) Nothing in this Act shall require an otherwise qualified health plan, including an Exchange-participating plan, to cover any items or services to which the issuer, plan sponsor, or purchaser has a moral or religious objection, provided the plan is at least actuarially equivalent to a qualified health plan that covers the essential health benefits.

“(2) If a health plan is permitted not to cover items or services under paragraph (1), then the issuer, plan sponsor, or purchaser shall not be required to include such items or services in such plan as a condition of (A) being eligible for a premium tax credit or cost-sharing reduction, or (B) avoiding any assessable payment or any other tax, assessment or penalty under this Act.

“(3) Nothing in this Act shall prohibit a qualified health plan, including an Exchange-participating plan, from contracting with an individual or institutional health care provider that declines to provide, participate in, or refer for an item or service to which the provider has a moral or religious objection.

“(4) Nothing in this Subsection shall be construed to deny, alter, or modify any right or duty any person may have under state or local law, or under federal laws other than this Act.”

“(5) Nothing in this Subsection shall be construed to authorize a health plan to deny coverage for all medical care, or for life-preserving care, to an individual based on a view that treats extending the life or preserving the health of the individual as of lower value than extending the life or preserving the health of others because of the individual’s disability or other characteristic.”

Diarist Cynthia Kouril cuts to the chase with this new Executive Order language:

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I was struck by the conscience objection language:

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It is unbelievably overbroad. Think about the literal meaning of these words: "Nothing in this Act shall require an otherwise qualified health plan, including an Exchange-participating plan, to cover any items or services to which the issuer, plan sponsor, or purchaser has a moral or religious objection.” .

Not just abortions, birth control, HIV treatment, tubal ligations, vasectomies, what about circumcisions? Some people think mental illness is actually demonic possession, do they get to opt out? Some people think that drug and alcohol addiction are moral failings, not illnesses—can providers opt out of those treatments?

What happens to an emergency patient brought in to a Catholic hospital? Her religion does not forbid therapeutic abortion to save the life of the mother, and it’s too late to transfer her elsewhere (a real issue in remote and rural locations). Does she have to die for something that does not run counter to her own religion or morality?

Further, it creates a way for anti (name the medical procedure of your preference) groups to put pressure on any for-profit business to force that business to develop a, ahem, “moral objection” to the procedure that will cause the picketers to go away.

Under this language expect to see picketers outside major pharmacy chains, threatening to shut down their lucrative business in magazines, bottled ice tea, snacks and cosmetics unless they stop dispensing Plan B. Then it will be unless they stop dispensing the pill, then vaginal rings, spermicides and eventually condoms.

And you know what? If you are a big pharmacy chain, with a CEO who answers to shareholders, what are YOU going to do? Go for conscience or profits? Soooooo, your Board of Directors will develop a moral objection to whatever it is that will make the picketers go away. Independent pharmacies will have even less ability to handles the pressure to their bottom line, leaving those few who put conscience ahead of profit still dispensing the full range of available treatments—and then they will be forced to suffer the fate of Planned Parenthood clinics, bomb threats, assaults on patients, murder of the health care provider.

And once the Catholic Charities Hospital System gets this language and uses it to cow doctors and patients into religious submission, watch and wait for one or both of the following: 1) a proliferation of religious sponsored hospitals that have all sorts of religiously tailored treatment gaps, and 2) attacks and pressure upon non-religious hospitals of the sort Planned Parenthood has suffered for decades.

It also has implications for doctors’ career tracks. Soon, if a doctor worked at a public hospital that performed abortions, will that mean they can never be hired at a private religious hospital or other private hospital that has developed a pecuniary, whoops, “moral“ –I meant to say MORAL objection to a particular treatment or procedure?

Do you think it will never come to that?

Story from my own life: I was student at St. John’s University. .....

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I would say that aside from a bit of roughing up at the end, Mr. Stupak, Democrat of Michigan, scored quite a coup.


What has just happened is a grave rollback of women's reproductive rights in this country.


Because these rights offend Bart Stupak.


And he did it without any Republican help.

[seafan]

1. Day after Health Care bill passage: MarketWatch: Stocks rise as health-care sector paces gains

Stocks rise as health-care sector paces gains


By Kate Gibson, On Monday March 22, 2010, 2:48 pm

NEW YORK (MarketWatch) -- U.S. stocks climbed Monday, with the health-care sector rising the most, on the belief that the passage of the reform bill would translate into more insured customers for hospitals and pharmaceutical firms.

"We investors understand the broad outlines of health-care reform and we know, almost immediately, children with pre-existing conditions will be covered; and we do know that kids who graduate from college and don't yet have a job will be covered, and some adults with pre-existing conditions will be covered. But not much else happens right away," said Hugh Johnson, chairman of Johnson Illington Advisors.

"Health-care reform will now be transferred from the politicians to the professionals to work out the details, and that's good news," said Johnson.

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Pharmaceuticals also bolstered the Dow, with Pfizer Inc. (PFE - News) gaining 1.8% and Merck & Co. (MRK - News) up 1.7%.
The S&P 500 Index rose 3.88 points to 1,163.78, with health care leading the gains among the index's 10 industry groups. Utilities and energy were the only two sectors on the decline.

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Tenet Healthcare Corp. (THC - News) was among those rallying, its shares up 8%, in the wake of passage of a health-care overhaul after a year of debate. Health Management Associates Inc. (HMA - News) was up 8.4% at $8.81 after earlier rising to a 52-week high of $8.90.

President Barack Obama is expected to sign the bill into law on Tuesday.

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"The additional folks that will be added to the insured ranks is helping pharmaceutical companies, since (more people) will now have a way to pay for drugs," said Robert Pavlik, chief market strategist at Banyan Partners.

The market's rise also reflects "the 2014 date it kicks in," Pavlik added.

And that new "way to pay for drugs" is the incoming flow of our mandated tax dollars to these salivating middle men.




Just amazing, the giddiness from AHIP, PhARMA, Big Hospital Association, AMA, etc.


Who could have predicted?

[leftstreet]

2. Thanks for putting all this together

That's a lotta work!

K&R