House Health Bill
The House of Representatives is now prepared to unveil their health reform legislation with markup taking place tomorrow and Thursday. It’s a good bill (more on that later) but it’s worth also giving a tip of the cap in the direction of the House process. The chairs and members of the three relevant committees did a great mitzvah by putting egos aside, forming a unified “tri-committee” bill writing process, largely shutting up about their internal negotiations, and getting down to the job of writing a bill that fits the parameters Americans voted for in November. I appreciate that the Senate has its own idiotic self-imposed supermajority requirement to deal with, but it would be nice to see the same discipline and seriousness of purpose from Senators at the committee stage.
So what’s in the bill?
Well, there’s a fairly strong public plan. It needs to be financially self-supporting and nobody will be forced to accept its reimbursement rates, but it will be open to anyone with access to the Health Insurance Exchange will model its payments on Medicare and they say the default assumption will be that anyone who serves Medicare clients will also take Public Plan clients.
Speaking of which, there’s a Health Insurance Exchange which will be national in scope, though states will be able to opt-out if they can meet some state guidelines. That seems like a reasonable compromise to me. It’s basically designed for employees of very small businesses, but there’s the possibility of larger businesses entering the exchange via mutual agreement between the employer in question and the Commissioner governing the exchange. Clearly how that cashes out will have a lot to do with how the discretionary authority is used.
Minimum benefits are defined in a slightly circular way as equivalent to the prevailing employer-based coverage in the area.
About half the cost is paid for via entitlement savings—$500 billion over ten years will be saved from Medicare and Medicaid. The other half is paid for via a surtax on rich people. The bill prudently calls for the level of the tax to be adjusted depending on whether or not the bill actually costs what it’s projected to cost.
The CBO sees a net cost of $1 trillion to the non-revenue portions of the bill. The intention is to have the revenue portions cover the cost of the non-revenue portions, but we’ll have to wait and see for that part of the analysis to get done.
25 Responses to “House Health Bill”
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July 14th, 2009 at 5:19 pm
Most notably I think, the tax is more progressive than previously reported: 5.4% on income over $1 mil. And if the savings are high, the $350k and $500k brackets are reduced or repealed (depending on the amount of savings) starting in 2013, but the top bracket stays. That’s much better than I was expecting.
July 14th, 2009 at 5:35 pm
Why can’t some of the costs be paid by taxing junk food,sodas,and increased taxes on cigs and alcohol. Why can’t medicare start at the same age for full benefits as in social security. Why can’t all Medicare recipients fill out health care directives which might alleviate some of the costs associated with one’s last year of life
July 14th, 2009 at 5:36 pm
yup. we’re all communists now.
July 14th, 2009 at 5:47 pm
[sung to entire US Senate]
You’re so vain, you probably think this bill is about you.
We’re almost there. Three more months of blah blah blah then pass this sucker through reconciliation.
July 14th, 2009 at 5:55 pm
1. The austensible purpose of sin taxes is to reduce consumption, which means it is not a stable revenue source.
2. Age harmonization should occur when the Part D reform occurs in two years.
3. Everyone should be encouraged to sign DNRs.
July 14th, 2009 at 6:19 pm
So… people living in wealthy areas are entitled, under a publicly funded plan, to superior care than those living in poorer areas?
July 14th, 2009 at 6:40 pm
So… people living in wealthy areas are entitled, under a publicly funded plan, to superior care than those living in poorer areas?
It works great for public schools!
Oh wait…
July 14th, 2009 at 6:41 pm
So… people living in wealthy areas are entitled, under a publicly funded plan, to superior care than those living in poorer areas?
Most of the data shows no correlation between more spending and better care. So… no.
July 14th, 2009 at 6:44 pm
[...] pays for the public option? Matt Yglesias: About half the cost is paid for via entitlement savings—$500 billion over ten years will be saved [...]
July 14th, 2009 at 7:25 pm
OK, who is NOT covered – and why?
July 14th, 2009 at 7:29 pm
Um, this seems like a really good bill. I’m suspicious. Who’s going to destroy it? I predict the blue dogs.
July 14th, 2009 at 8:52 pm
I think that ’someone’ (maybe the DNC?) needs to set up a tutoring program on “How to Turn Your Party’s Agenda Into Law”. The main tutor would be Nancy Pelosi. Maybe bring Henry Waxman in to talk about effective committees, have Rahm come back to discuss the steamroller option. The students, of course, would be the Senate Democratic leadership.
The House of Representatives is not just passing legislation, they seem to be reconfiguring themselves (as in this health bill) specifically to make sure they pass good, progressive bills. The House leadership appears to have taken their cue on how to deal with the Republicans from the President – “Yes, we are happy to receive your input. Contribute something positive to the debate, and we’ll include it. But we have no obligation to include bad ideas into legislation just so we can say it’s bipartisan.” A lot of the credit for this has to go to the Speaker. She has set a tone and has a solid agenda, and is getting things done. The Senate, on the other hand… well, that’s why they need tutoring.
July 14th, 2009 at 9:19 pm
. The austensible purpose of sin taxes is to reduce consumption, which means it is not a stable revenue source.
But wouldn’t this be offset my having a healthier population, thus lower health costs
2. Age harmonization should occur when the Part D reform occurs in two years.
3. Everyone should be encouraged to sign DNRs.
It should be mandatory
July 14th, 2009 at 10:04 pm
Well, it’s half a loaf, but a lot better than nothing, and a lot better than what we have today. To our shame, we will still have nine million Americans–American citizens, mind you; we can discuss the moral dimension of illegal aliens another time–without coverage. But this bill will move us much closer to the standards of decency and fairness seen in every other developed country in the world. It will soften many of the injustices in our present “system” and reduce the fear many people have to live with of losing their jobs or their coverage.
Far from perfect, but, in my initial read, good enough. Enough to fight for.
July 14th, 2009 at 10:06 pm
An amendment I would like to see added is one that ties Republican Members of Congress’ health care coverage to the passage of this one. We’ll see then how much they are really against government-funded health care.
July 14th, 2009 at 10:34 pm
Proud To Be A Nancy Boy:
I think you’re damn right. To be fair, they do have an easier institutional job, but it’s clear that the spirit is willing in the House, but in the Senate, there’s a lot of weak flesh despite a (rather large) handful of progressives trying to push a rock up a mountain.
July 15th, 2009 at 12:01 am
I’m with you. Bring it on. I’ll be sending a few more bucks to HCAN to do my tiny bit to help out.
July 15th, 2009 at 12:38 am
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July 15th, 2009 at 1:12 am
A mitzvah, eh? Let’s hope it doesn’t turn out to be an aveirah.
July 15th, 2009 at 1:40 am
If it is true that the public option is only available to those making less then $40k (sure to be reduced to $30k) and there are no fixes for the individual plan market then this bill sucks and is no better then the finance cmte. it is not ok, acceptable or necessary to screw over this group of people.
July 15th, 2009 at 8:53 am
The bill is obviously very imperfect in a lot of ways, but our fucked-up political system was never going to allow us to get to a sane system in one go. My test for a bill this year is whether it puts us on the road to reach such a system eventually, or onto a siding. My reading is that this bill for all its manifest absurdities does do the former. In particular the employer mandate with its provision to substitute a payroll assessment for coverage is like a mine laid under the current system. It will eventually blow that system up, which is what we want. So I’m on board.
July 15th, 2009 at 10:00 am
Beauregard: I’ve not heard anyone say that. The public plan seems to be available to all; however, what you might be talking about is that affordability credits, which is something completely and utterly different, phase out for people making more than 400% of the poverty line (which for single person households is about $40k).
July 16th, 2009 at 10:18 am
[...] Matthew Yglesias: The House of Representatives is now prepared to unveil their health reform legislation with markup taking place tomorrow and Thursday. It’s a good bill (more on that later) but it’s worth also giving a tip of the cap in the direction of the House process. The chairs and members of the three relevant committees did a great mitzvah by putting egos aside, forming a unified “tri-committee” bill writing process, largely shutting up about their internal negotiations, and getting down to the job of writing a bill that fits the parameters Americans voted for in November. I appreciate that the Senate has its own idiotic self-imposed supermajority requirement to deal with, but it would be nice to see the same discipline and seriousness of purpose from Senators at the committee stage. [...]
July 16th, 2009 at 1:48 pm
[...] is that they don’t suck. If you don’t have time to read or review the full bills, Matt Yglesias and health care mega-expert Ezra Klein have good takes on them. As their commenters note, not [...]
July 17th, 2009 at 11:17 am
I am truly amazed at the dumbing down of America and how many of you gobble up the propaganda like candy. America has turned into a land of “I wanna be taken care of” idiots. Canada has a population of 33 million almost similar to California. Each Canadian pays 59% of its check into the socialized system. Many Canadians have to wait 3 years just to get a doctor. One Canadian city has a lottery and the winner actually gets to see a doctor. There is a 2 to 10 hour wait in the Emergency rooms just to see a NURSE. They have taxes on top of taxes for food and necessities. This Progressive March toward Socialism has ruined California and that is what is in store for the rest of you yokels.. Current Medicaid/Medicare costs are at $2.1 TRILLION RIGHT NOW. Do any of you bright ones know how much money that is? If you spent a Million Dollars every day since the day Jesus was born you still have not come close to a Trillion Dollars ! This Public Option will be a huge Medicaid/Medicare program that will be turned over to each State in 5 years to pick up the costs. It will bankrupt each and every State. The Clowns have taken over….