Vol. 10 December 1, 2009 Health Care Reform Bills

“If you like laws and sausages, you should never watch either one being made.”
– Otto von Bismarck

The Senate now begins a two month debate on the Health Care Reform bill, and the outcome will go to a Senate-House conference committee for MORE discussion. During this log-rolling turmoil, which I have no ability to follow nor any influence upon, here are a few facts to keep in mind as guide posts during the legislative meandering (also presented as a table at end of this volume).(1)

Single payor provisions contained in either the Senate or House HCR bill: 0

Per cent coverage of legal residents under 65 yo. in Senate and House bills: S 94%, H 96%
Per cent covered now: 83%

Benefits covered by Senate and House bills respectively: Basic + 4 levels/ Basic

  • There is no consensus on the definition of “Basic benefits”.

Year that insurance coverage denial for “preexisting conditions” is first prohibited:S2014/H2013

Coverage for elective abortions in either bill: 0

  • The Senate bill will allow plans to offer a premium for an elective rider to cover abortion.
  • Estimated actuarial premium for an insurance rider to cover elective abortions: $1/mo(2)
    “How can you tell a gregarious actuarial accountant from all the others?
    …He’s the one looking at other people’s shoes.”

Changes in current rules and regulations that prohibit ILLEGAL immigrants from accessing federally funded health insurance: 0

Chances that final HCR bill will establish a new mechanism for the federal government to help provide affordable access to health insurance for the presently uninsured: 100%

  • Senate bill will establish a “Federal Insurance Exchange” that will “compete” with private health insurance plans in offering subsidized plans. House bill will authorize the Dept. of Health and Human Services to “negotiate rates with providers” via a “public plan”. “The devil in these details” remain obscure at this time.

Employers will be required to offer health insurance: S-No, H- only if company payroll is>$500,000 per year

Costs over 10 yrs.predicted for each bill: Senate $849 Billion, House $1,200 Billion

Costs over 10 yrs. of wars in Iraq and Afghanistan to date: $937 Billion (3)

Allowable annual income for family of four to be eligible for tax credit for health insurance costs in 2013:  less than $82,800

What health insurance companies will call the 47 million uninsured gaining coverage under any of these bills: NEW CUSTOMERS!

How much more in 2006 did health insurance cost in the U.S. than was calculated for a comparably wealthy country:  $91 Billion (of a total cost of $145 Billion) (4)

Number of people in 2005 who had health insurance through Medicaid : 60 million
Per cent of total Medicaid costs paid for by federal contribution to states : 57%
Per cent of poor adults covered by Medicaid in that same period:  28% (5)

Estimated cost to all of U.S. healthcare for overweight and obesity alone: $79 billion
Per cent of that cost borne by Medicare or Medicaid: 50


1. adapted from Assoc. Press, Boston Globe, Nov, 20,2009, A12
2. thehealthcareblog.com, Nov.12,2009, A Lewis
3. http://www.costofwar.com
4.  McKinsey Global Institute, Harpers Magazine, Dec 2009, p.8
5. NEJM361:21, Nov.19.09,2009-15, SRosenbaum


.                              Senate Bill                                       House Bill                               Now

Single payor mechanism NONE NONE None
% coverage under 65yo legal residents 94% 96% 83%
Benefits Basic + 4 levels Basic multiple levels
prohibits preexisting condition denials starts 2014 starts 2013 denials common
cover abortions elective premiums no coverage available no federal/state coverage
illegal immigrants no coverage non-federal coverage states vary
government plan “Federal Exchange” federal plan to compete with private plans via insurance Exchange a new public plan negotiates providers rates via Exchange state Medicaid plans can vary by 100%
employers offer coverage not required required if >$500,00 payroll states vary
COST $849 B over 10 yrs $1.2 T over 10 yrs most expensive in the Western world
Government subsidy tax credit for family of 4 making <$82,800 same; starts 2013 Health Savings Acct.
adapted from Boston Globe, Assoc. Press, A12, Nov. 20,2009

One Response to Vol. 10 December 1, 2009 Health Care Reform Bills

  1. Nina says:

    Would like to have seen stats on comparison of health costs among “developed” countries, along with comparitive stats On:
    1.birth/maternal death rate
    2. average longevity (comparative w. devel. countries
    I believe av. age is now 78 in U.S. and IT IS WAY

    heard on VPR recently that may be plan to offer coverage “LIKE THE MEMBERS OF SENATE AND HOUSE HAVE”!!!!!

    Hope your facts re: immigrant coverage get out there….
    Hope abortion issue does not sink this…$1 premium per mo
    not bad….!
    Did you deliberately leave out issues of preventive screening
    or perhaps saving for blog to come?

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