It took lawmakers a year to shape President Barack Obama’s health care bill. If it finally passes Congress, it’ll take the better part of a decade to write the user manual for consumers and doctors, employers and insurance companies.Some health insurance consumer protections would go into place immediately, significant but limited in scope. The big expansion in coverage comes in four years. About 25 million people would sign up, with most getting tax credits to help pay premiums. Ripple effects continue well after Obama has to leave office in 2017, if he’s re-elected.But even if the 2,700-plus-page bill passes, it’s only the end of the beginning. The Obama blueprint will be carried out under less-than-ideal circumstances. Rising medical costs and an aging population will keep squeezing the federal budget. Lawmakers will have to revisit hard choices they sidestepped.The House is expected to vote on the final legislation this week, with the Senate to follow later. Here’s a primer on some of the major effects for consumers and other key players:
Uninsured people with medical problems will have a workable alternative. The bill pumps $5 billion into high-risk insurance pools run by the states to provide coverage to those in frail health. Taxpayer-backed insurance won’t be free, but premiums should be much lower than what’s charged by private insurers willing to take those in poor health.For people with private health insurance — about two-thirds of Americans — there would be some new safeguards. For example, insurers would be barred from placing lifetime dollar limits on coverage and from canceling policies except in cases of fraud. Children could stay on their parents’ coverage until age 26.
Starting in 2014, self-employed people and those whose employers don’t offer coverage would be able to pick a plan through a health insurance exchange, like a supermarket. It’s modeled on the federal employee health program available to members of Congress, with a range of private plans. Small businesses could also join.About 25 million people would buy coverage through state exchanges, and nearly 6 in 10 would be eligible for help with their premiums. The new tax credits would be computed according to income and other household characteristics. The money would go straight to the insurer. To consumers it would look like a discount — generous for lower-income families, less so for those solidly in the middle class.For example, a family of four making $44,000 would pay $2,763 in premiums _about 6 percent of its income_ for a policy worth $9,435.But a similar family making $66,000 would have to pay $6,257 in premiums, close to 10 percent of its income. That may be less than a mortgage, but it’s more than a car payment.Once the exchanges open, most Americans would be required to carry health insurance or pay a fine. Medicaid would be expanded to cover childless adults living near poverty, bringing the total who’d gain coverage to more than 30 million.People with employer-provided insurance would not see major changes. But if they lost their job, they’d be able to get coverage through the exchange.
Seniors have been understandably worried about the health care plan, much of it financed with Medicare cuts the government’s own experts say could be unsustainable.
In the crosshairs are subsidies to private Medicare Advantage insurance plans, which now enroll about one-quarter of seniors. The government overpays the plans when compared to the cost of care under traditional Medicare. That largesse translates to lower costs for seniors in the plans, and the overhaul could trigger an exodus from Medicare Advantage as insurers are forced to raise rates to stay in business.
But seniors stand to gain as well. Obama would gradually close the coverage gap in the middle of the Medicare prescription drug benefit. The so-called doughnut hole would start to shrink immediately, but it wouldn’t be fully closed until 2020. In the meantime, seniors in the gap would get a 50 percent discount on brand name drugs. The plan also improves preventive benefits for seniors in traditional Medicare.
Primary care doctors and general surgeons practicing in underserved areas such as inner cities and rural communities would get a 10 percent bonus from Medicare. But the more significant changes for doctors would unfold slowly. The goal is to start rewarding doctors for keeping patients healthy, not just treating them when they get sick. The plan would use Medicare as a testing ground for new ways of coordinating care for patients with multiple chronic illnesses such as high blood pressure, diabetes and heart problems, a common combination. Primary care doctors would become care managers for such patients, keeping close tabs on medications and basic health indicators. Doctors and hospitals would be encouraged to band together in “accountable care organizations” modeled on the Mayo Clinic.
Obama’s plan wouldn’t require employers to provide insurance to their workers, but it would hit them with a stiff fine if even one of their workers gets a federally subsidized coverage. Companies with 50 or fewer workers would be exempt, and those with 25 workers or fewer could get federal assistance.
But the fines could turn into a big headache for many employers, particularly since they may not be able to tell if their workers are getting benefits from the government. For example, a company with 100 employees that fails to provide coverage could face a fine of $140,000 under the plan Obama unveiled Feb. 22. Getting the bill from the IRS would become a dreaded moment for business owners.
Health insurance companies would face unprecedented federal regulation and particularly close scrutiny of their bottom line. A fixed percentage of income from premiums would have to go to medical care, otherwise insurers would be forced to provide rebates to consumers. That share is 85 percent for large group plans, and 80 percent for plans in the small group and individual markets. One of the central reforms of the bill won’t start until 2014, when the exchanges open. From then on, insurers will not be able to turn away people with medical problems or charge them more.
The world marks International Women’s Day today, an annual celebration that highlights their economic, political and social achievements.The day was marked for the first time in the early 1900s. More than 1 million women and men attended rallies in Austria, Denmark, Germany and Switzerland in 1911, according to the United Nations. They demanded that women be given the right to vote and to hold public office, and an end to job discrimination.While a celebration of progress, International Women’s Day is also a time to acknowledge the struggles women still grapple with around the globe. In India, angry protests disrupted the Parliament several times Monday in a bid to thwart a landmark bill that would reserve one-third of the seats in federal and state legislatures for women. While the president is a woman — Pratibha Devisingh Patil is India’s first female president — women make up just 11 percent of the members of the lower house of the Indian Parliament. On Saturday, Indian Prime Minister Manmohan Singh vowed to work for greater female representation in the country’s democratic process, citing Women’s Day as a time to “reaffirm our government’s commitment to all-round social, economic and political empowerment of our women.”
Half of India’s female population cannot read or write, authorities say.In Iran, female activists were honored Sunday by Zahra Rahnavard, wife of Iranian opposition leader Mir Hossein Moussavi, in celebration of International Women’s Day. About 30 of Iran’s most prominent women’s rights activists and their supporters held a private gathering in Tehran. Rahnavard declared that the women’s opposition movement was still alive. She said the movement would not forget the sacrifices by women who were jailed, beaten or died in the post-election protests last year. Women, treated as second-class citizens under Iranian law, were noticeably front and center at the massive demonstrations after the disputed election in June.
National GOP leaders are doing damage control today after a Politico scoop lifted the curtain on the party’s plan to tap voters’ “fear” in the coming campaign season. The PR problem started when an absent-minded attendee at the Republican National Committee (RNC) confab on February 18 in Boca Grande, Florida, left a 72-page document from its 2010 strategizing session in a hotel room. Today, Politico reporter Ben Smith’s expose is making headlines.The memo tracks the fundraising presentation that RNC Finance Director Rob Bickhart delivered to the RNC’s $2,500-a-head annual retreat. The best path to victory in 2010, the document advises, is for Republican candidates to depict themselves as the best hope for resisting the “trending toward socialism” taking shape in a Democrat-dominated Washington.
Authorities put the death toll from Saturday’s magnitude-8.8 quake at about 300, but believed the number would grow. They said 1.5 million Chileans were affected and 500,000 homes severely damaged by the mammoth temblor.A tsunami caused by the quake that swept across the Pacific killed several people on a Chilean island and devastated over coastal communities near the epicenter, but caused little damage in other countries, after precautionary evacuations of hundreds of thousands of people. The tsunami warning was lifted a day after the earthquake.Police said more than 100 people died in Concepcion, the largest city near the epicenter with more than 200,000 people. The university was among the buildings that caught fire around the city as gas and power lines snapped. Many streets were littered with rubble from edifices and inmates escaped from a nearby prison.Police used water cannon and tear gas to scatter people who forced open the doors of the Lider supermarket in Concepcion, hauling away everything from diapers to dehydrated milk to a kitchen stove.Across the Bio Bio River in San Pedro, others cleared out a shopping mall. A video store was set ablaze, two automatic teller machines were broken open, a bank was robbed and a supermarket emptied, its floor littered with mashed plums, scattered dog food and smashed liquor bottles.The largest building damaged in Concepcion was a newly opened 15-story apartment that toppled backward, trapping an estimated 60 people inside apartments where the floors suddenly became vertical and the contents of every room slammed down onto rear walls.
The quake tore apart houses, bridges and highways, and Chileans near the epicenter were thrown from their beds by the force of the mega-quake, which was felt as far away as Sao Paulo in Brazil — 1,800 miles (2,900 kilometers) to the east.
The full extent of damage remained unclear. Ninety aftershocks of magnitude 5 or greater shuddered across the disaster prone Andean nation within 24 hours of the initial quake. One was nearly as powerful as Haiti’s devastating Jan. 12 earthquake.
In the village of Reumen, a tractor trailer slammed into a dangling pedestrian overpass and 40 tons of concrete and steel crunched the truck, covering Chile’s main highway with smashed grapes, tomatoes and cucumbers — one of several overpasses toppled along the highway.