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Table of Contents

• History of the Bill
  • Renaming/Hijacking of the Bill
  • Additional Reconciliation Bill
  • How the Bill(s) passed
• Previous Instances of Convoluted Means to Pass a Bill
• Health Care Key Points of the Bill
  • Cost
  • Deficit
  • Coverage
  • Health Insurance Exchanges
  • Subsidies
  • Paying for the Plan
  • Medicare
  • Medicaid
  • Insurance Reforms
  • Abortion
  • Individual Mandate
    • Policy must include
  • Employer Mandate
  • Immigration
• Lawsuits
• Doctor Survey

Links:
Key Points
http://www.cbsnews.com/8301-503544_162-20000846-503544.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+BuzzGames_Gamecore+%28TheShowbuzz%3A+Games+GameCore%29
http://www.nytimes.com/interactive/2010/03/19/us/politics/20100319-health-care-reconciliation.html#tab=12
LBJ Tapes
http://www.ssa.gov/history/LBJ/lbj.html
Doctor Survey
http://www.cnsnews.com/news/article/62812
Lawsuit
http://www.msnbc.msn.com/id/36001783/ns/politics-health_care_reform/

SHOW NOTES

History of the Bill(s)

H.R.3590 – Patient Protection and Affordable Care Act

• Introduced: 9-17-09 as “Service Members Home Ownership Tax Act of 2009″
• House passed: 10-8-09 as “Service Members Home Ownership Tax of 2009″
• Senate Passed: 12-24-09 as “Patient Protection and Affordable Care Act”
  • Under the U.S. Constitution, federal revenue (tax) bills are required to be initiated in the House of Representatives.
  • Senate basically hijacked this bill created by the House in order to include taxes along with their version of a Health Care Bill
• House Passed: 3-21-10 as “Patient Protection and Affordable Care Act”
  • 219 votes to 212
  • Every Republican opposed the bill, and 34 Democrats joined them in voting against it.
• President Signed: 3-23-10

Before the House would pass H.R. 3590, they created and passed, H.R.4872 – Health Care and Education Affordability Reconciliation Act of 2010.

• HR 4872 included enough changes/amendments to HR 3590 to get enough votes by the House
• Passing HR 4872 would avoid a filibuster by Senate Republicans if, instead, the House were to make changes to HR 3590 and the bill had to go back to the Senate
• HR 4872  is a budget reconciliation bill, so there could not be a filibuster by the Senate Republicans

• Introduced: 3-13-10
• House Passed: 3-21-10
• Senate Passed: 3-25-10
• President Signed: 3-30-10

Previous Instances of Convoluted Means to Pass a Bill

LBJ Tape Recordings Regarding Medicare

• Conversation 3122 In this conversation with Bill Moyers, Special Assistant to the President, LBJ goes over edits in a typed speech, including one intended to divert possible criticism from the AMA. LBJ discusses strategies for his next meeting with the Attorney General.
• Conversation 3686-3687 with Larry O’Brien and Rep. Wilbur Mills (D-AK) provides the president an update on a number of bills, including excise taxes, social security, debt ceiling, assistance for widows, and Medicare. The President then has an extended discussion about his poll numbers. He is particularly concerned about his weak poll numbers for “more help for older people.” Mills and Johnson then have a discussion regarding political strategy on Social Security.
• Conversation 3690 with Earle Clements who updates the President on the status of support for pending legislation, including Medicare. The talk about the prospects of the King-Anderson proposal in the Senate, which was the early form the Medicare legislation took, and about the strategy of trying to add Medicare to a Senate bill.
• Conversation 3804 Larry O’Brien provides a very pessimistic assessment of the prospects for the Medicare legislation. O’Brien reports on a discouraging conversation between Wilbur Cohen and Anthony Celebrezze and Wilbur Mills. Mills says that he sees little hope of passing a Medicare proposal through his Committee. He suggests the Administration may want to consider abandoning Medicare for now and settling for a general Social Security bill; or at best, try attaching Medicare as a rider to a general Social Security bill in the Senate. The Ways & Means Committee was scheduled to vote on the proposal the next day and Mills indicated that if it came to a vote, the Administration’s proposal would be defeated.
• Conversation 4839 In this conversation, the President tells Walter Reuther, President, United Auto Workers, that this is the greatest Congress ever. LBJ states that 32 or 33 of his bills have passed, with an outside chance for Medicare. The President states that he would rather lose the SSA bill than lose the future of Medicare.
• Conversations 5414 Senator Al Gore, Sr. (D-TN) tells LBJ about his call from Tommy Kuchel (Senator, R, Ca.) on the Javits (Senator, R. NY) amendment to the Medicare bill. Gore questions LBJ about his support for the amendment. Gore states that that he will call Clint about Kuchel’s call and work out a compromise with Mike Feldman and Wilbur Cohen.
• Conversations 5416 In this conversation, Mike Mansfield tells LBJ that at best there are 51 votes for Medicare and asks LBJ to call Carl Hayden (Senator, D., Ariz.) in an attempt to get his support. LBJ and Mansfield also discuss a developing FBI investigation.
• Conversations 5419 LBJ reads news articles, describing supporting for him in the upcoming Presidential election to Senator Hayden. He tells Hayden that the vote is close on Medicare and asks Hayden to wait and vote, if his vote is needed to pass the bill. He tells Hayden that Medicare is needed in order to get the older people’s support in the upcoming election.
• Conversation 5445 In this conversation, Carl Albert (House Majority Leader) and John McCormack (Speaker of the House) discuss their strategy with LBJ for how to appeal to Wilbur Mills to support the Medicare bill. Mills has asked for their vote against the bill, as Mills believes he has enough votes to defeat it either way in Conference.
• Conversations 5682 In this conversation, Rep. Hale Boggs, House Majority Whip (D-LA) tells LBJ that Wilbur Mills is acting to get out of Medicare, by bypassing the Rules Committee.

Key Points of the Bill

• Cost:
  • $940 billion over ten years, according to the congressional budget office
• Deficit:
  • Would reduce the deficit by $143 billion over the first ten years. That is an updated CBO estimate. Their first preliminary estimate said it would reduce the deficit by $130 billion over ten years. Would reduce the deficit by $1.2 trillion dollars in the second ten years.
• Coverage:
  • Major coverage expansion begins in 2014. Would expand coverage to 32 million Americans who are currently uninsured. 95 percent of eligible Americans would have coverage, compared with 83 percent today.
• Health Insurance Exchanges:
  • The uninsured and self-employed would be able to purchase insurance through state-based exchanges with subsidies available to individuals and families with income between the 133 percent and 400 percent of poverty level.
  • Separate exchanges would be created for small businesses to purchase coverage — effective 2014.
  • Funding available to states to establish exchanges within one year of enactment and until January 1, 2015.
• Subsidies:
  • Individuals and families who make between 100 percent – 400 percent of the Federal Poverty Level (FPL) and want to purchase their own health insurance on an exchange are eligible for subsidies. They cannot be eligible for Medicare, Medicaid and cannot be covered by an employer. Eligible buyers receive premium credits and there is a cap for how much they have to contribute to their premiums on a sliding scale.
  • Federal Poverty Level for family of four is $22,050
• Paying for the Plan:
  • Medicare Payroll tax on investment income — Starting in 2012, the Medicare Payroll Tax will be expanded to include unearned income. That will be a 3.8 percent tax on investment income for families making more than $250,000 per year ($200,000 for individuals), aiming to raise $210 billion over 10 years
  • Hopes to raise $364 billion over 10 years from the same taxpayers by raising the top two tax rates to 36%-39.6% from 33%-35%
  • Plus another $105 billion by raising the tax on dividends and capital gains to 20% from 15%
  • And another $500 billion by capping and phasing out exemptions and deductions
    • Add it up and the government is counting on squeezing an extra $1.2 trillion over 10 years from a tiny sliver of taxpayers who already pay more than half of all individual taxes.
    • Punitive tax rates on high-income individuals do not increase revenue. Successful people are not docile sheep just waiting to be shorn.
      • Faced with numerous tax penalties on added income in general, many two-earner couples would become one-earner couples, early retirement would become far more popular, executives would substitute perks for taxable paychecks, physicians would play more golf, etc.
  • Excise Tax — Beginning in 2018, insurance companies will pay a 40 percent excise tax on so-called “Cadillac” high-end insurance plans worth over $27,500 for families ($10,200 for individuals). Dental and vision plans are exempt and will not be counted in the total cost of a family’s plan.
  • Tanning Tax — 10 percent excise tax on indoor tanning services.
• Medicare:
  • Closes the Medicare prescription drug “donut hole” by 2020. Seniors who hit the donut hole by 2010 will receive a $250 rebate.
  • Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs. The bill also includes $500 billion in Medicare cuts over the next decade.
• Medicaid:
  • Expands Medicaid to include 133 percent of federal poverty level which is $29,327 for a family of four.
  • Requires states to expand Medicaid to include childless adults starting in 2014.
  • Federal Government pays 100 percent of costs for covering newly eligible individuals through 2016.
  • Illegal immigrants are not eligible for Medicaid.
• Insurance Reforms:
  • Six months after enactment, insurance companies could no longer denying children coverage based on a preexisting condition.
    • and from canceling policies because someone gets sick.
  • Starting in 2014, insurance companies cannot deny coverage to anyone with preexisting conditions.
  • Insurance companies must allow children to stay on their parent’s insurance plans until age 26th.
  • Insurers would be forbidden from placing lifetime dollar limits on policies
  • Insurers would be prohibited from denying coverage to people with medical problems or charging them more. Insurers could not charge women more.
• Abortion:
  • The bill segregates private insurance premium funds from taxpayer funds. Individuals would have to pay for abortion coverage by making two separate payments, private funds would have to be kept in a separate account from federal and taxpayer funds.
  • No health care plan would be required to offer abortion coverage. States could pass legislation choosing to opt out of offering abortion coverage through the exchange.
• Individual Mandate:
  • In 2014, everyone must purchase health insurance or face a $695 annual fine. There are some exceptions for low-income people.
  • Policy must include
    • ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; chronic disease management; and pediatric services, including oral and vision care
• Employer Mandate:
  • Technically, there is no employer mandate. Employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance. Fines applied to entire number of employees minus some allowances.
• Immigration:
  • Illegal immigrants will not be allowed to buy health insurance in the exchanges — even if they pay completely with their own money.

Lawsuits

• Attorneys general from at least 14 states have filed lawsuits to challenge the legislation.
  • 13 state attorneys general — 12 Republicans and one Democrat — signed onto one lawsuit against the U.S. departments of Health and Human Services, Treasury and Labor.
    • The top state lawyers in Florida, South Carolina, Nebraska, Texas, Michigan, Utah, Pennsylvania, Alabama, South Dakota, Louisiana, Idaho, Washington and Colorado joined in the complaint filed immediately after the president’s signing ceremony.
  • A separate lawsuit was also filed by Virginia’s Republican attorney general Tuesday.
• Issues
  • The constitutionality of the so-called “individual mandate,” which requires most Americans to have an insurance plan or else pay a federal penalty.
    • “The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty, that all citizens and legal residents have qualifying health care coverage,” the lawsuit reads.
  • The Constitution gives Congress the authority “to regulate INTERSTATE commerce.” In other words, once someone engages in commerce, the government has the power to regulate that activity.
    • But opponents say that the “commerce clause” does not give the government power to require an individual to buy something — especially insurance for the health of one’s own body.
    • “Just being alive is not interstate commerce,” said Virginia Attorney General Ken Cuccinelli in a statement before the lawsuit was officially filed.

Doctor Survey
Conducted by the Medicus Firm, a leading physician search and consulting firm
Published in the latest issue of the New England Journal of Medicine

• 1,200 doctors surveyed
• 29.2% said they would quit the profession or retire early if health reform legislation became law

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