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SHOW NOTES:
Links
www.progress.org
www.downsizedc.org
www.usatoday.com
www.geneveith.com
www.cato.org
www.opencongress.org
Link to AP Article Comparing Healthcare Bills: http://www.mail.com/Article.aspx/health/0/APNews/Health/20091226/U_US-Health-Care-Comparing-the-Bills?pageid=1
Senate Bill
HR 3590 – Patient Protection and Affordable Care Act
introduced 9/17/09; 989 words (short title: “Service Members Home Ownership Tax Act of 2009″)
- To amend the Internal Revenue Code of 1986 to modify the first-time homebuyers credit in the case of members of the Armed Forces and certain other Federal employees, and for other purposes
House passed 10/8/09
- passed as “Service Members Home Ownership Tax of 2009″
Senate passed 12/24/09; 353,330 words after amendments in Senate
- passed as “Patient Protection and Affordable Care Act”
- Amendment in the nature of a substitute intended to be proposed by Mr. REID (for himself, Mr. BAUCUS, Mr. DODD, and Mr. HARKIN)
- They basically deleted the text of the bill that passed the House and inserted their version of the health insurance bill
WHO’S COVERED: About 94 percent of legal residents under age 65 — compared with 83 percent now. Government subsidies to help buy coverage start in 2014. Of the remaining 24 million people under age 65 left uninsured, about one-third would be illegal immigrants.
COST: Coverage provisions cost $871 billion over 10 years.
HOW IT’S PAID FOR: Fees on insurance companies, drugmakers, medical device manufacturers. Medicare payroll tax increased to 2.35 percent on income over $200,000 a year for individuals, $250,000 for couples. A 10 percent sales tax on tanning salons, to be paid by the person soaking up the rays. Cuts to Medicare and Medicaid. Forty percent excise tax on insurance companies, keyed to premiums paid on health care plans costing more than $8,500 annually for individuals and $23,000 for families. Fees for employers whose workers receive government subsidies to help them pay premiums. Fines on people who fail to purchase coverage.
REQUIREMENTS FOR INDIVIDUALS: Almost everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. Those who are obligated to buy coverage and refuse to do so would pay a fine starting at $95 in 2014 and rising to $750.
REQUIREMENTS FOR EMPLOYERS: Not required to offer coverage, but companies with more than 50 employees would pay a fee of $750 per employee if the government ends up subsidizing employees’ coverage.
SUBSIDIES: Tax credits for individuals and families likely making up to 400 percent of the federal poverty level, which computes to $88,200 for a family of four. Tax credits for small employers.
BENEFITS PACKAGE: All plans sold to individuals and small businesses would have to cover basic benefits. The government would set four levels of coverage. The least generous would pay an estimated 60 percent of health care costs per year; the most generous would cover an estimated 90 percent.
INSURANCE INDUSTRY RESTRICTIONS: Starting in 2014: no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age and family size. Starting upon enactment of legislation: children up to age 26 can stay on parents insurance; no lifetime limits on coverage.
GOVERNMENT-RUN PLAN: In place of a government-run insurance option, the estimated 26 million Americans purchasing coverage through new insurance exchanges would have the option of signing up for national plans overseen by the same office that manages health coverage for federal employees and members of Congress. Those plans would be privately owned, but one of them would have to be operated on a nonprofit basis, as many Blue Cross Blue Shield plans are now.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Self-employed people, uninsured individuals and small businesses could pick a plan offered through new state-based purchasing pools. Would generally encourage employees to keep work-provided coverage.
DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson’s and other deadly diseases. Drug companies contribute $80 billion over 10 years with the majority of the money used to limit the prescription coverage gap in Medicare.
CHANGES TO MEDICAID: Income eligibility levels likely to be standardized to 133 percent of poverty — $29,327 a year for a family of four — for parents, children and pregnant women. Federal government would pick up the full cost of the expansion during the first three years. States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid.
LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.
ANTITRUST: Maintains the health insurance industry’s decades-old antitrust exemption.
ILLEGAL IMMIGRANTS: Would be barred from receiving government subsidies or using their own money to buy coverage offered by private companies in the exchanges.
ABORTION: The bill tries to maintain a strict separation between taxpayer funds and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for the procedure. In plans that do cover abortion, beneficiaries would have to pay for it separately, and those funds would have to be kept in a separate account from taxpayer money. Moreover, individual states would be able to prohibit abortion coverage in plans offered through the exchange, after passing specific legislation to that effect. Exceptions would be made for cases of rape, incest and danger to the life of the mother.
House Bill
H.R.3200 – America’s Affordable Health Choices Act of 2009
This is the original health care bill that was marked up by three House Committees in the summer of ’09. The final version that was passed by the House is H.R. 3926.
HR 3200 introduced 7/14/09; 176,276 words
- “America’s Affordable Health Choices Act of 2009″
HR 3962 introduced 10/29/09; 348,220 words
- · “Affordable Health Care for America Act”
HR 3962 passed House 11/7/09; 351,993 words
WHO’S COVERED: About 96 percent of legal residents under age 65 — compared with 83 percent now. Government subsidies to help buy coverage start in 2013. About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants.
COST: The Congressional Budget Office says the bill’s cost of expanding insurance coverage over 10 years is $1.055 trillion. The net cost is $894 billion, factoring in penalties on individuals and employers who don’t comply with new requirements. That’s under President Barack Obama’s $900 billion goal. However, those figures leave out a variety of new costs in the bill, including increased prescription drug coverage for seniors under Medicare, so the measure may be around $1.2 trillion.
HOW IT’S PAID FOR: $460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making more than $1 million. The original House bill taxed individuals making $280,000 a year and couples making more than $350,000, but the threshold was increased in response to lawmakers’ concerns that the taxes would hit too many people and small businesses.
There are also more than $400 billion in cuts to Medicare and Medicaid; a new $20 billion fee on medical device makers; $13 billion from limiting contributions to flexible spending accounts; sizable penalties paid by individuals and employers who don’t obtain coverage; and a mix of other corporate taxes and fees.
REQUIREMENTS FOR INDIVIDUALS: Individuals must have insurance, enforced through a tax penalty of 2.5 percent of income. People can apply for hardship waivers if coverage is unaffordable.
REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 annually are exempt — a change from the original $250,000 level to accommodate concerns of moderate Democrats — and the penalty is phased in for companies with payrolls between $500,000 and $750,000.
Small businesses — those with 10 or fewer workers — get tax credits to help them provide coverage.
SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level, or $88,000 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Beginning in 2013, through a new Health Insurance Exchange open to individuals and, initially, small employers. It could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules.
BENEFITS PACKAGE: A committee would recommend a so-called essential benefits package including preventive services. Out-of-pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange.
INSURANCE INDUSTRY RESTRICTIONS: Starting in 2013, no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age.
GOVERNMENT-RUN PLAN: A new public plan available through the insurance exchanges would be set up and run by the health and human services secretary. Democrats originally designed the plan to pay Medicare rates plus 5 percent to doctors. But the final version — preferred by moderate lawmakers — would let the HHS secretary negotiate rates with providers.
CHANGES TO MEDICAID: The federal-state insurance program for the poor would be expanded to cover all individuals under age 65 with incomes up to 150 percent of the federal poverty level, which is $33,075 per year for a family of four. The federal government would pick up the full cost of the expansion in 2013 and 2014; thereafter the federal government would pay 91 percent and states would pay 9 percent.
DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson’s and other deadly diseases. Phases out the gap in Medicare prescription drug coverage by 2019. Requires the HHS secretary to negotiate drug prices on behalf of Medicare beneficiaries.
LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.
ANTITRUST: Would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price-fixing and bid rigging. The bill also would give the Federal Trade Commission authority to look into the health insurance industry at its own initiative.
ILLEGAL IMMIGRANTS: Would be barred from receiving government subsidies but permitted to use their own money to buy coverage offered by private companies in the exchange.
ABORTION: Private companies in the exchange could not offer plans covering abortion if those plans received federal subsidy money. Most plans in the exchange would be affected, because most consumers in the exchange would be using federal subsidy money to buy coverage. The new government plan could not offer abortion coverage. Insurance companies would be permitted to offer supplemental abortion coverage in separate plans that people could buy with their own money. Use of federal money for abortion coverage would be limited to cases of rape, incest or danger to the woman’s life.
Buried Provisions
- Companies with 50 or more employees would have to set aside “reasonable” break times for nursing mothers and create a private space for breastfeeding.
· Restaurants with more than 20 locations would be required to post nutritional information.
· vending machines must include nutrition labels consumers can see before they plug in their change
· Sen. Jeff Merkley, D-Ore.: “The best odds of passing anything relative to health care is to put it in a bill that’s going to be debated and voted on.”
· amendments to Indian laws and health care
Comments
- cooperbry: This legislation is ridiculous. How on earth can anyone get through the volumes of text? Bills should be as short and clear and uncomplicated as possible. Why not just shorted it to one page:
Everyone must have health insurance. This is not an attempt to reform health care in the US, it’s just forcing everyone to get health insurance. If you don’t, you’ll be taxed. Any company with a payroll of 500k or more will be taxed. Any way we can expand this in the future, we will and we will tax you more. If not, we’ll run up the national debt and you’ll be taxed.
Government bureaucrats have the reverse midas touch. Everything they touch turns to s@#$. Get out of our lives. Let us make our own choices and restore the liberties we once had. End the Federal Reserve – take back our money supply and tie it to the market. That will force fiscal responsibility on you clowns. If you keep going at the rate you’re going, people will be exiting the US. - thePHOENIX: I think Mr. Reid should be banned from using an eraser freely without engaging others in a civil manner about any bill. No one made Mr. Reid “Editor Czar”, and Mr. Baucus needs an extra writing course or two, on how to be concise, specific, and how to maintain the focus of what he’s writing about.
- thejeffersondemocrat: A more fitting title would be the Unconstitutional Mandate with More Taxes and More Expensive Coverage Act. This bill’s mandates and taxes will do little more than suppress coverage and overwhelm the system. The extra taxes and mandates for providers will drive the costs up, and ultimately set the stage for a single payer style power grab. The mandate, if it survives expected court challenges will give the federal government unprecedented power to dictate the financial and medical decisions of the population. The Constitution does not enumerate the power to mandate the purchase of insurance or any other product to the federal government.
In fact, a certain revolution that occurred in 1776 was in part against government mandates to purchase a product (tea) from England…
Buying Votes
backroom deals were made to buy, or, secure the 60 votes needed to end debate and hold a final vote
- “Louisiana Purchase,” $100 million in extra Medicaid money for the Bayou State, requested by Sen. Mary Landrieu (D-La.).
- “Cornhusker Kickback,” another $100 million in extra Medicaid money, this time for Sen. Ben Nelson (D-Neb.).
- Sen. Christopher Dodd (D-Conn.) had written into the legislation $100 million meant for a medical center in his state. This one was quickly dubbed the “U Con.” . . .
- Gator Aid: Sen. Bill Nelson (D-Fla.) inserted a grandfather clause that would allow Floridians to preserve their pricey Medicare Advantage program.
- Handout Montana: Sen. Max Baucus (D-Mont.) secured Medicare coverage for anybody exposed to asbestos — as long as they worked in a mine in Libby, Mont.
- Iowa Pork and Omaha Prime Cuts: Sen. Tom Harkin (D-Iowa) won more Medicare money for low-volume hospitals of the sort commonly found in Iowa, while Nebraska’s Nelson won a “carve out” provision that would reduce fees for Mutual of Omaha and other Nebraska insurers.
- Sens. Byron Dorgan and Kent Conrad, both North Dakota Democrats, would enjoy a provision bringing higher Medicare payments to hospitals and doctors in “frontier counties” of states such as — let’s see here — North Dakota!
- Hawaii, with two Democratic senators, would get richer payments to hospitals that treat many uninsured people. Michigan, home of two other Democrats, would earn higher Medicare payments and some reduced fees for Blue Cross/Blue Shield. Vermont’s Sen. Bernie Sanders (I) held out for larger Medicaid payments for his state (neighboring Massachusetts would get some, too).
Constitutionality
Robert A. Levy and Michael F. Cannon
- This health-care overhaul gives Congress a power that the framers of the Constitution never envisioned: the power to force Americans to purchase unwanted goods or services.
- The legislation’s centerpiece is really the “individual mandate” – an unprecedented legal requirement that Americans purchase health insurance under penalty of law.
- But is it constitutional? The Constitution grants Congress the power to regulate interstate commerce. Does that power extend to behaviors, such as not purchasing health insurance, that are neither interstate nor commerce? · The Supreme Court has held that the power to regulate interstate commerce extends to trade within a single state if it has a substantial effect on interstate markets. Even noncommercial activities within a state can be restricted if they threaten to undercut federal regulation of interstate markets.
- That’s the framework into which Senate Majority Leader Harry Reid (D., Nev.) shoehorned his health bill. What he came up with is a paper-thin pretense for asserting extra-constitutional powers.
- Reid tucked away a citation of a 1944 Supreme Court ruling that deemed insurance to be interstate commerce. Reid conveniently omitted any reference to the McCarran-Ferguson Act passed the very next year, which gave states absolute authority to regulate health insurance.
- That law’s effect has been to bar individuals from purchasing health insurance across state lines. Accordingly, there is no interstate market to be affected, much less undercut.
- Reid would enforce this unconstitutional mandate with an unconstitutional tax. The Senate bill attaches a penalty for not complying with the mandate to the Internal Revenue Code. But the penalty is not based on income, so it’s not an income tax. And it’s not based on the value of the policy not purchased, so it’s not an excise tax. Instead, the tax is a fixed amount based on family size. That means it’s levied per person and therefore a “direct tax” under the Constitution, which requires that such taxes be apportioned among the states according to their population, as determined by the census.
- Congress’ attempt to punish a non-act that harms no one is an intolerable affront to the Constitution, liberty, and personal autonomy.
Fred E. Folvary
- The Constitution states that Congress only has the powers specifically allocated to it by the Constitution.
- The Tenth Amendment makes it clear that all other powers are left to the states.
- The Ninth Amendment recognizes that there are moral and common-law rights that exist prior to and apart from the U.S. Constitution, and that such rights shall not be denied by Congress, thus making natural moral rights also Constitutional rights.
o By natural moral law, each human being is a self-owner, with the single moral obligation to avoid harming others. The absence of insurance does not harm others. A person without insurance in effect becomes self-insured. If he requires medical services, he has a moral obligation to pay for them. - The authorization of power in one section of a constitution does not cancel out constraints of power in other sections. Commerce may be regulated only within the constraints specified by the other sections.
- If the requirement to buy insurance becomes law, it will be brought to the Supreme Court, which will then have to decide whether to shred what remains of the spirit of the Constitution, limited government.
- In effect, the requirement to pay for medical insurance is a tax. But it is a tax on personhood rather than on a privilege or an activity or on property. Such a direct tax is Unconstitutional unless it is apportioned according to state population.
James Leroy Wilson
- The decision to NOT purchase a good or service is NOT commerce, let alone interstate commerce.
- But under the absurd logic of this bill, if I choose to take a nap rather than go to a movie, I’m engaging in “commerce” and Congress can compel me to either go to the movie or pay a tax penalty.
Michael Connelly – Retired attorney, Constitutional Law Instructor
- this legislation really has no intention of providing affordable health care choices. Instead it is a convenient cover for the most massive transfer of power to the Executive Branch of government that has ever occurred, or even been contemplated. Major portions of the Constitution of the United States will effectively have been destroyed.
- The first thing to go will be the masterfully crafted balance of power between the Executive, Legislative, and Judicial branches of the U.S. Government. The Congress will be transferring to the Obama Administration authority in a number of different areas over the lives of the American people and the businesses they own.
- The irony is that the Congress doesn’t have any authority to legislate in most of those areas to begin with. I defy anyone to read the text of the U.S. Constitution and find any authority granted to the members of Congress to regulate health care.
- This legislation also provides the Obama administration access to of all of your personal healthcare information, your personal financial information, and the information of your employer, physician, and hospital. All of this is a direct violation of the specific provisions of the 4th Amendment to the Constitution protecting against unreasonable searches and seizures. You can also forget about the right to privacy. That will have been legislated into oblivion regardless of what the 3rd and 4th Amendments may provide.
“The Constitution is not an instrument for the government to restrain the people, it is an instrument for the people to restrain the government — lest it come to dominate our lives and interests.” — Patrick Henry, Founding Father
cool u hit it 0n the dot will submit 2 twitter