Posted on 03/18/2010 7:06:08 AM PDT by ohioWfan
February 19, 2010
Analysis of the Patient Protection & Affordability Act
HR 3590
• Transfer significant regulatory authority from states to the federal government
• Significant changes in the national health insurance markets
• Dramatically alters the financing and content of employer-provided and individual health insurance
• Significantly changes Medicare / Medicaid
• Changes how hospitals, doctors, and other medical professionals are paid and how care is delivered
• Mandates purchase of insurance
• CBO* estimates up to 10 million Americans will no longer be covered by their employers for health insurance (given the bill’s incentives for employers to discontinue job-based coverage – independent estimates are higher)
*CBO – Congressional Budget Office
• Contains over 12 new taxes
• Reduces Medicare payments $493 billion over 10 years through payment reductions for Medicare Advantage, hospitals, home health and nursing homes
• Provides federal funding for abortion
• CMS’ Office of the Actuary projects increased healthcare spending – $234 billion between 2010 and 2019.
• Actual cost of 1st 10 years* - $2,500,000,000,000 (assuming both full funding and spending)
• Begins cuts and new taxes immediately, but delays new programs for 4 to 5 years
*Senator Baucus, Backgrounder, No. 2353, 12/18/09 – The Heritage Foundation
Individual Mandate
• Forces or mandates Americans to buy a commodity: health insurance
• Anyone failing to obtain insurance will pay a tax penalty of $750 per family member and $375 per child to a maximum of $2,250 (President’s Plan $695 and $325 and maximum of $2,040)
Employer Mandate
• Requires companies with more than 50 employees to offer health plans to full-time employees or pay a tax of $750 per employee (President’s Proposal $2,000/employee)
• Since the penalty is much cheaper than providing health insurance, many employers are likely to opt out and pay the penalty (President’s Proposal doesn’t change this)
• The federal government would determine benefits provided under health insurance plans (sets up four benefit levels – Bronze 60%, Silver 70%, Gold 80%, Platinum 90% of cost of benefits; also Catastrophic plan for those under 30 years of age; out of pocket limits)
• Will effectively result in nationalized health insurance system or a public plan
• 40% excise tax on “high value” healthcare plans of $8,500 or more for an individual and $23,000 or more for a family ($149.1 billion) (President’s Proposal $10,200 and $27,500 and effective from 2013 to 2018)
• .5% increase in the payroll tax on earnings above $200,000 for individuals and $250,000 joint return ($53.8 billion) (President’s Proposal adds 2.9% assessment)
• Changes in health savings accounts, medical spending accounts, flexible spending accounts, and health reimbursement arrangements ($5 billion)
• $2,500 cap on flexible spending accounts ($14.6 billion)
• Increase from 10 to 20% on the penalty for early non-qualified HSA withdrawals ($1.3 billion)
• Tax on branded drugs ($22.2 billion) (President’s Proposal increase to $33 billion, but delay 1 year)
• Annual tax on health insurers ($60.4 billion) (President’s Proposal delays until 2014)
• Tax on companies that manufacture or import medical devices ($19.3 billion)
• .5% excise tax on cosmetic surgery ($5.8 billion)
• Increase in the floor of the medical expenses deduction from 7.5% of adjusted gross income to 10% ($15.2 billion)
• Elimination of Medicare Part D* deduction ($5.4 billion) (President’s Proposal delays)
• $500,000 cap on the tax deduction for the salaries of employees of health insurance companies ($.6 billion)
• Mandate on companies with more than 50 employees to provide health coverage or pay $750 penalty per employee for those who obtain coverage through the insurance exchange ($36 billion) (President’s Proposal $2,000/employee)
* Prescription drugs
• Expands Medicaid eligibility to 133% of the federal poverty level with premium and cost sharing credits to 400% of the federal poverty level
• Increases the federal government’s control
• Legal immigrants immediately eligible for new federal subsidies for welfare and Medicaid (currently they have to wait five years)
1) Value based purchasing (payment modifier providing reduced payments to physicians and hospitals based on quality care vs. cost – plan is to add nursing homes, home health, and ambulatory surgery centers within 2-3 years)
2) Payment adjustment for conditions acquired in hospitals (ex. blood incompatibility, falls, catheter-associated urinary tract infection, etc.)
3) Hospital readmissions reduction program (reduce payments to account for “excess” readmissions – high dollar and high volume)
4) Revisions in home health care and hospice payments (reduction in annual market basket updates and as mentioned earlier will include hospitals, nursing homes, and other Medicare providers)
5) Adjustment to Medicare DSH payments (DSH – Disproportionate Share Hospital; add-on payment applied to the DRG adjusted base payment rate for hospitals that treat a high percentage of low income patients)
6) Reduction in technical component reimbursement on single session imaging from 25% to 50% (for example CT of head and CT of chest)
1) Reasonable break time for nursing mothers for 1 year after child’s birth and requires room other than bathroom
2) Nevada Wage Index Guarantee (nothing below 1.0)
3) Louisiana Purchase ($300,000,000 for Louisiana)
4) Corn Husker Kickback – permanent exemption from the state share of Medicaid expansion for Nebraska, meaning rest of country pays (President’s Proposal eliminates and adds significant additional Federal financing to all States for expansion of Medicaid)
5) No limitation on assisted suicide
6) No limitation to the withholding of medical treatment or medical care
7) No limitation to the withholding or withdrawing of nutrition or hydration
8) Non-profit hospitals required to complete a community health needs assessment annually
9) Mandatory review of community benefit activities once every 3 years (federal audit)
10) Annual report on level of charity care
11) Dependent coverage for children up to age 26
12) Tax on indoor tanning services (10%)
Invitees:
9 Senators (5 Democrats, 4 Republicans)
12 Congressmen (7 Democrats, 5 Republicans)
Each invited Senator and Congressman can designate an additional 4 members to attend plus 1 staff member
• Medical Tort Reform - savings $500 billion per Decade
• Portability
• Patient/physician choice
• Tax reform of health insurance
• Align incentives and payments for physicians and hospitals
• Open insurance competition across state lines
• Personal Responsibility – Financially and Health Behaviors
........*70% of healthcare costs are a direct result of behavior
........*74% of all costs confined to 4 chronic conditions – cardiovascular disease, cancer, diabetes, and obesity
........*Safeway model or auto insurance model – Savings nationally of $550 billion (Safeway employees
…….. are given freedom of choice but if they choose healthy lifestyles, they are rewarded with significant
……..reductions in premium share and co-pay (Senate Bill reduces ability of companies to reward healthy behavior)
........*Major predictable expenses funded by savings and credit
........*Catastrophic care funded by insurance
........*Improved HSA’s, which allow the individual to withdraw money for any purpose without penalty once
…….. the funds exceed a ceiling established for each age and dollars remaining upon death are reimbursed through inheritance
Assume:
• 22 year old single employee $30,000 annual salary
• Marries at 28
• 2 children supported for 20 years
• Retires at 65
• Dies at 80
• Insurance premiums, Medicare taxes and premiums, and out of pocket costs will grow 3%/year
• Earnings grow 3%/year
Results:
By retirement, annual salary $107,000
*September 2009 Article by David Goldhill in The Atlantic
Over lifetime worker + employer together will have paid $1.77 million for healthcare.
If you had access to those funds over your lifetime, wouldn’t you be able to afford your own care?
The proposals passed by the Senate and House are not acceptable and not affordable. We need to let our legislators know that we need real reform and reduced government interference. As Healthcare Professionals, we need to continue to do all we can to continue to provide cost effective expert care.
Continue to Call and Write Your Legislators – It Does Make A Difference. This is still very important because there are discussions underway to break up heathcare reform into multiple bills. We all need to stay engaged.
I’d like to send it to a few family members of my own, but sometimes you need to keep the peace.......especially when they know exactly how you feel anyway.
You’re most welcome, LL2009!
Thank you dear friend.. Good info.
bookmark
ping
You’re welcome, Dolly. I hope it’s helpful.
(Yes. He is a patient and stubborn - in a good way - man).
Hope it will help in your defense of this great country we all love!
Three separate pings to me and I spotted this one. I am so bad! I am going to move away from the computer so that DrO can read it.
Excellent presentation, by Mr. ohioWfan!
“Over lifetime worker + employer together will have paid $1.77 million for healthcare.
If you had access to those funds over your lifetime, wouldn’t you be able to afford your own care?”
thank you ma’am for the ping & for your hubby’s great work.
will forward around.. the legislators need to read this dont they? but hey, they dont care.. those that are bought off are just prostitutes in govt
I was hoping DrO would take a look at this.
If he has any questions or comments to MrOH, he's a freeper so he can answer for himself.
HOWEVER.....we are leaving for DC this afternoon to march on the Capitol. We have GOT to stop this bill!!
And if they vote for this monstrosity, it will be at their own peril. We just need to make sure they KNOW it.
You’re going!!!! Excellent!!!! Yes, yes, yes!!!!
STOP THE DEMOCRATS! SAVE OUR REPUBLIC! YOU HAVE MY PRAYERS!
Now I have to make some sort of sign. I should be preparing a lesson plan instead, but I have my priorities. ;)
Raise heck in D.C.!! Tell them they work for us!
WE WILL BE HEARD!
Ohiowfan, thanks for the ping, it is an excellent outline of this nightmare......
I am flying out of here in a few hours (friend’s private plane).. will just be there the one day... Maybe we will find each other.. I cant really make plans as I am the guest, not the coordinator of this trip.. My sign is made.. This is surely a disgusting mess in DC
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