Health care -- game plan

Dateline: Tue 23 Mar 2010

Andrew Holladay --- ghiotion -- sent this out yesterday.The source is, which is a must-read for everyone under 36:

WITHIN THE FIRST YEAR OF ENACTMENT (of the historic health-care bill)

  • Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.
  • Insurers will be barred from excluding children for coverage because of pre-existing conditions.
  • Young adults will be able to stay on their parents' health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.
  • Uninsured adults with a 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.
  • A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires 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.
  • A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1. WHAT HAPPENS IN 2011
  • Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.
  • Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.
  • A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care.
  • Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare.
  • Employers are required to disclose the value of health benefits on employees' W-2 tax forms.
  • An annual fee is imposed on pharmaceutical companies according to market share. The fee does not apply to companies with sales of $5 million or less.


  • Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form "accountable care organizations" to improve quality and efficiency of care.
  • An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.
  • The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions. WHAT HAPPENS IN 2013
  • A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.
  • The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016.
  • The Medicare payroll tax is raised to 2.35 percent from 1.45 percent 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.
  • A 2.9 percent excise tax in imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.


  • State health insurance exchanges for small businesses and individuals open.
  • Most people will be required to obtain health insurance coverage or pay a fine if they don't. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.
  • Health plans no longer can exclude people from coverage due to pre-existing conditions.
  • Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren't counted for the fine.
  • Health insurance companies begin paying a fee based on their market share.


  • Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services.


  • An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions.

(Reporting by Donna Smith; Editing by David Alexander and Eric Beech)



Tell The Truth [Member] said:

Ruthie dear, I was beginning to think you needed a healthcare bill all your own. Hope all is well--you were missed.

Your prodigy done good in clicking on this handy tool. Thanks.

And so it goes: anyone who's surprised at this health care bill need only look to the 2008 Democratic primary and fall elections: for once a President did exactly what he told us he was going to do: move as close to universal coverage as possible, and pay for it as follows: tax the upper 2-3% of income earners, and generate internal (efficiency) savings.

For my money the bill does too little to solve another huge issue: hospital overbuilding. But that may change. There's a little known agency at the state and federal level that issues public bonds to finance some hospital projects. The purpose is to pass along public bond tax-exempt status, thus lowering borrowing cost.

It seems to me if those agencies became less lapdog and more evaluative, we'd keep more sharp eyes on these ridiculous projects.

Need evidence of the overbuilding? Spend an hour on 465. Within a rock's throw of the interstate are about 2500 hospital rooms built in the last decade at tremendous costs. Each facility duplicated existing capacity that was not fully-utlilzed at their parent hospital. With their associated expensive bells and whistles to attract suburban customers. Operating at 30-40% efficiency.

If a government watchdog agency oversaw that processs the way they oversee, say, public utility construction, we'd have a fighting chance at cutting costs.

The moment Methodist opened its Carmel Westin, er hospital, every single dollar of its cost went into their rate base. Which they pass along in inflated costs to us, and our insurers and the government via Medicare/Medicaid.

Without one moment of consideration of allocation of resources where they're needed. It's insane, and it's duplicated in every major American city. Hundreds of Billions.

2010-03-23 08:42:38

linda [unverified] said:

Trying to have an open mind under the blond hair....I don't quite understand how this is all going to be paid for. And I'm not happy about having our employer sponsored health care benefits (which have a high, monthly premium we already pay) taxed.

2010-03-23 15:47:37

hendy [Member] said:

Premiums cover some of the cost. Employer contributions pay some of the cost. Tax revenues pay some of the cost. Risk pools created by the embodiment of the insured offset some of the costs.

As the plan isn't simple, the costs-answer isn't simple, either.

It's a landmark step. Some people are howling; various opposition states attorney generals are suing, claiming 10th Amendment faults with the legislation. They waste their state's money in doing so. It's one of those quixotish sorts of stands. Their great grandchildren will think of them badly. I know I do, already.

I hope Washington finds some peace after this. The nutjobs are already spewing enormous amounts of lip flatulation.... it's plainly awful to be in politics right now. Bravo for the brave.

2010-03-23 20:51:00

StarStruck [unverified] said:

Reposting from a Facebook friend:
"Let me get this straight--we've got a health care plan passed by a Congress that hasn't read it but exempts themselves from it, signed by a president that hasn't read it and smokes, with funding administered by a treasury chief who didn't pay his taxes, all to be overseen by a surgeon general who is obese, and financed.. by a country that's broke. What could possibly go wrong?"

2010-03-23 21:23:16

Tell The Truth [Member] said:

Funny, StarStruck, but hardly accurate. Try getting your news from something other than CBN and Hannity.

I read the bill. All of it. Took a whole weekend...well, whenever I had time. I skimmed it fast, and much of it is references to other statutes.

But this much is clear: America was ready for a fix. Is this the golden fix? Probably not. It's a damned good start.

I like hendy's take. Try though they might, the opponents of this legislation have gone past righteous indignation and gone squarely into the camp of ridiculous.

Here's the bottom line: the GOP doesn't want to give this president a victory on anything. Period.

I don't require that my Congress fix things in a bipartisan manner. It would be nice, but I respect folks who hold fast to their beliefs, whatever they are. I do require brains, contemplation, and some resolve to carry-out campaign promises. Both sides had their share of demagogues in this debate, but the opponents rushed to the edge of their ideological platform, and somehow redefined the platform's "middle" of our country, as if they were standing in the middle of it. They did not, they are not and they will not.

Keep this in mind: the 52% Gallup respondents who dislike the health plan, include a healthy number of folks who wanted a stronger plan. I've listened to my family, neighbors, colleagues, friends: nobody is as outraged as John Boehner or Mitch McConnell.

For which I'm glad, because if they were, many of them would be having a stroke.

I know that's a lot to ask in this climate. We'll see how it all turns out.

2010-03-24 10:25:10

hendy [Member] said:

There are any number of conservative talk show rubrics floating around right now, and you've addressed most of the talking points, except the congressional exemption of itself from the bill.

The disinformation machine is working at a fevered pitch.

The storm is here; wind damage in a few places from blowhards throwing bricks through various local congressional office windows. It's a good day, it's a sad day. The devils want their due.

2010-03-24 21:11:38

Tell The Truth [Member] said:

It'll pass, hendy. It'll pass. I'm approaching 60 and a cancer survivor. I can't get health insurance--at any cost, anywhere. Unless my spouse has it, in which case I can tag along.

It ain't right. Now I can get it. And I will pay for it. I am able and willing to do so. Those who cannot, should have health insurance and/or care without worrying about the bills.

THAT'S right.

It's a simple concept, and in fact, it even follows the true conservative mantra: take personal responsibility.

Let's face it: they hate it because America's first black president pushed to pass something he promised to do.

And yesterday, he confirmed a new round of START talks with the Ruskies. With solid thanks to his friend Dick Lugar. So, the young kid from Chicago CAN walk and chew gum, huh?

We're so damned focused on large problems and demands that we focus on only one thing at a time. Damnitall, I learned to multi-task on the farm at age 7. Wht can't DC do the same?

A new day, indeed. Warm fuzzies.

2010-03-25 08:14:29

whosear [Member] said:

Nice fixes to a system doomed to continue escalating in costs. It makes the Pentagon look like skinflints.

Perhaps a more radical solution is necessary. I invite one to consider this proposal:

2010-03-26 02:17:26

Marycatherine Barton [unverified] said:

I know one opthamologist who is wearing a black arm band to work, as is his staff, and distributing them to his patients. That is how depressing he finds this so-called healthcare bill for his practice. Will we end up with less doctors and more tax collectors, thanks to Obamacare?

For a view from a Black progressive, read "Obama Democrats vs. Tea Party Republicans: a Fake Fight About Fake Health Care Reform" by Bruce Dixon, at, with cartoon.

2010-03-27 19:04:25

Melyssa [unverified] said:

You left out $10 billion in funding to add new IRS Agents to police our compliance.

I don't want the government tracking me cradle to grave.

2010-03-29 12:28:32

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