Health Care Reform Bill According to The GroundHog


Reviewing the Senate and House bills (as outlined by AARP), here’s my suggestion on a viable health care bill.

Insurance Companies:

  • Insurance companies can no longer deny coverage for preexisting conditions; a temporary high-risk pool would be created to provide insurance to those with preexisting conditions before the program takes full effect in 2014
  • Insurance companies cannot cancel coverage because of illness.
  • Insurance will set a cap on premium costs of not more than 1.25 times for older adults ages 54 thru 64 (not yet covered under Medicare but are at a high risk of losing their job, therefore losing insurance coverage) than what they charge adults between ages 18 thru 53.
  • Insurance companies must provide coverage to all eligible people regardless of any preexisting conditions.

Employer-based insurance and Business Owners:

  • Employers with less than 50 employees and with an overall payroll of more than $500,000, must cover 65% of an employee’s family premiums or pay a fine.
  • Employers with 50 or more full-time employees must offer insurance or pay a fee of $750 per employee for employees who receive federal subsidies.
  • Employers will pay a tax on “Cadillac” coverage plans (cost more than $8,500 annually or $23,000 per family).
  • Employees will not lose coverage if they get sick, or lose their jobs, or change jobs.
  • Employees who drop their employer coverage must purchase coverage within with in a specified period or are subject to a penalty depending on ability to pay the average premium cost for their geographic area and, depending on income.

Individuals who currently pay for their own insurance:

  • Cannot lose/be dropped from coverage even if you get sick.
  • Would have the option of purchasing insurance through a health insurance exchange, where choices include private insurance plans and one from a government-run plan.
  • Would have the option of keeping their current insurance plan/provider.

Everyone is required to have health insurance or is subject to penalties:

  • Everyone is now required by law to either purchase or apply for (if unable to purchase) insurance either through a private insurer or through a health insurance exchange, where choices include competing private companies and a government option.
  • Individuals who do not purchase coverage and are able to do so (based on the average premium cost for their geographic area) would pay a penalty between $1500 and $3800, depending on income.
  • Individuals who are not able to purchase coverage at the average premium cost for their geographic area and do not apply for some kind of coverage would pay a fine of $95 to $750, depending on income.
  • Families of four earning less than $88,200 per year would receive a subsidy to help pay premiums.
  • Families of four earning $29,326 per year (and indigent families) would be eligible for Medicaid.

Medicare Recipients:

  • Close the doughnut whole gap for costs of brand-name prescription drugs by cutting costs in half, starting in 2010; the gap closes completely by 2023.
  • Eliminate $170 billion in overpayments to Medicare Advantage programs, which make the cost of those plans 14% higher than traditional Medicare.
  • Extend the life of the Medicare Trust Fund by at least five years.
  • Provide $7.5 billion in funding to skilled nursing homes and rehabilitation centers that have been fully audited for health standards before approval is given for receipt of such funds.  Funds will be allocated for:
    • Automating health records
    • Periodic updating of nursing and rehabilitation machinery and equipment
    • Continuing education for nursing home and rehabilitation center administrative and medical staff.
  • Provide Medicare coverage for doctors giving end-of-life counseling

Medicaid Recipients: Expand Medicaid

  • Families of four with income under $31,000 would now be eligible.
  • Families of four earning $88,000 would pay no more than 12% of their income for health insurance; government subsidies would pay the rest.

Financing the plan – Total cost: $870 billion over the first 10 years

  • Funding from various taxes:
    • Individuals who get elective cosmetic surgery would pay a 5% excise tax.
    • Individuals earning over $200,000 per year would pay an increased Medicare payroll tax from 1.45% to 1.95%.
    • Individuals earning over $500,000 per year would pay 5.4% surtax.
    • Families earning over $1 million per year would pay 5.4% surtax.
    • Health care insurers, clinical laboratories and manufacturers of health care devices would pay approximately $300 billion in new taxes and fees
    • $420 billion in cuts from the future Medicare and Medicaid spending (savings realized from reduction of fraud, misuse, and optimization of services), which wouldn’t affect guaranteed Medicare benefits.
      • An independent Medicare Advisory Committee will be set up and authorized to impose Medicare cuts directly.
      • $118 billion from Medicare Advantage, which wouldn’t affect guaranteed Medicare benefits.

Can I get 60 Amens, right now!

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Words matter.

One comment

  1. Backpacker Insurance

    Nice Article..,I know your site from Search Engine,thanks to your Insurance info,I love your site,my site also same nichie with your site…thanks

Comments are closed.

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