I can tell you that if 'the medicare rate' if for all patients at all hospitals/physicians offices, there will be many, many closures of those facilities.
Services such as EMS might cease to exist, or at the very least be seriously diminished. On Tue, Jul 14, 2009 at 7:36 PM, Dana<[email protected]> wrote: > > Don't have time to read the material right now, but am interested in > everyone's comments. (Even Sam's ;P) > > http://voices.washingtonpost.com/ezra-klein/2009/07/the_house_releases_its_health-.html?hpid=news-col-blog > > On first glance, it looks > good<http://edlabor.house.gov/blog/2009/07/americas-affordable-health-choices-act.shtml>. > A few thoughts: > > *The Process Is the Message*: Three separate committees -- Energy and > Commerce, Ways and Means, and Education and Labor -- have come together on > *one > bill*. This is an incredible achievement. If you read histories of the 1994 > health-care reform fight, all of them have a substantial section on the > committee crack-up: One passed a version of single-payer, another a variant > of Bill Clinton's reform, another went further to the right. There was no > unity. > > There is unity now. And if it holds -- if the House of Representatives > manages to pass this plan with a substantial majority of enthusiastic > Democrats -- that significantly strengthens the House's hand in its eventual > negotiations with the more fractious Senate. That's a big "if." But so too > would have been the idea that three separate committees could cooperate on a > bill of this size. > > *The Public Plan: > *<http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-PUBLICOPTION-071409.pdf>You > can download a summary sheet here. The public plan -- which is really three, > or maybe four, insurance plans -- pays Medicare rates to hospitals (*and > Medicare rates plus five percent to physicians -- thanks to Marci Wheeler > for the correction*) for the first three years and then begins negotiating > on its own. It is open to anyone with access to the Health Insurance > Exchange. > > *The Benefit > Packages:<http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BENEFITS-071409.pdf> > * This is why I say there could be three, even four, public plans. Within > the Health Insurance Exchange, the basic plan that everyone needs to offer > is, well, the "basic plan." On first glance, it's pretty comprehensive: It > has to be equal in value to the prevailing employer-based insurance in the > area. Cost-sharing cannot exceed $5,000 for individuals or $10,000 for > families in the first year (it can then grow by the rate of inflation each > year after that). It is heavily regulated. And then there is an "enhanced" > plan above it, with less cost-sharing, and then a "premium" plan above that, > with even less cost sharing, and then a "premium-plus" plan above that. Of > these, only the "premium-plus" plan can vary in benefits, as opposed to vary > in cost-sharing. The public plan can offer all levels of plan. > > *The Health Insurance > Exchange<http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-EXCHANGE-071409.pdf> > :* It's run nationally, though states can opt out of the national structure > and go it alone if they choose, and if they follow federal rules. In the > first year, it accepts those without health insurance, those who are buying > health insurance on their own, and small businesses with fewer than 10 > people. In the second year, it accepts small businesses with fewer than 20 > people. After that, "larger employers as permitted by the Commissioner." In > other words, expansion is discretionary, not mandated. The only people able > to access the public plan in the early years will be on the exchange, and > the exchange will be, relative to the population, pretty limited. So the > public plan will be limited, and so too will any anticipated savings. > > *Affordability and > Subsidies:*<http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-AFFORDABILITY-071409.pdf>The > House bill has subsidies up to 400 percent of poverty, which is equal > to > $43,320 for an individual and $88,200 for a family of four. At the bottom > end -- 133 percent if income, as below that, you're eligible for Medicaid -- > the subsidies limit your health premiums to 1.5 percent of income. At the > top end -- 400 percent -- it's no more than 11 percent of income. Speaking > of the out-of-pocket cap, all of the benefit packages -- from the "basic" > plan on upward -- cap total costs for members. So if you're not eligible for > subsidies, you're still going to be protected from catastrophic health-care > costs. > > *CBO Score* <http://bit.ly/18AHhR>: The Congressional Budget Office has > released its estimates for the coverage side of this bill. They project that > within 10 years, it will cost $1 trillion and cover 97 percent of the legal > population. > > *Revenue*<http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-PAYINGFORHEALTHCAREREFORM-071409.pdf>: > If I'm reading this correctly, about half is paid for through $500 billion > or so in savings from Medicare and Medicaid. The rest comes from a surtax on > the richest 1.5 percent. The surtax is 1 percent on income between $350,000 > and $500,000; 1.5 percent on income between $500,000 and $1,000,000; and 5.4 > percent in income above $1,000,000. The surtax can vary if the bill is less > or more expensive than initially anticipated. There are also revenue > expectations from the employer and individual mandates, though they're > relatively modest ($200 billion over 10 years is one estimate I've heard). > > You can download the full bill > here<http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf>. > There are a whole lot of fact sheets and summary documents > here<http://edlabor.house.gov/blog/2009/07/americas-affordable-health-choices-act.shtml>, > though I'm not finding them very helpful. I'd like to see if we could > crowdsource this a bit: Dig through the legislation and tell me, either in > comments or over e-mail, of anything particularly interesting that you'll > find. I'll pull important nuggets and discoveries onto the front page. > > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| Want to reach the ColdFusion community with something they want? 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