Tuesday, September 15, 2009

Analysis: What do you think the final outcome will be this year regarding the health care debate?

Reform Bill Will Address GOP Fears
But Affordability Questions Remain

By Lori Montgomery and Shailagh MurrayWashington Post Staff Writers Tuesday, September 15, 2009

The chairman of the Senate Finance Committee said Monday that he will propose an overhaul of the nation's health-care system that addresses a host of GOP concerns, including blocking illegal immigrants from gaining access to subsidized insurance, urging limits on medical malpractice lawsuits and banning federal subsidies for abortion.

But even after Max Baucus (D-Mont.) spoke optimistically of gaining bipartisan backing, lawmakers continued to haggle over a question at the heart of the debate: How can the government force people to buy insurance without imposing a huge new financial burden on millions of middle-class Americans?

Even within his own party, Baucus confronted a fresh wave of concern about affordability. Sen. Ron Wyden (D-Ore.) declared himself dissatisfied with the chairman's plan, which, like other congressional reform proposals, would require every American to buy health insurance by 2013.
"Additional steps are going to have to be taken to make coverage more affordable," Wyden said, "and my sense is that will be a concern to members on both sides of the aisle."

Under the Baucus plan, described in a "framework" he released last week, as many as 4 million of the 46 million people who are currently uninsured would be required to buy coverage on their own, without government help, by some estimates. Millions more would qualify for federal tax credits, but could still end up paying as much as 13 percent of their income for insurance premiums -- far more than most Americans now pay for coverage.

People further down the income scale would receive much bigger tax credits, effectively limiting their premiums at 3 percent of their earnings. But experts on affordability say even those families could find it difficult to meet the new mandate without straining their wallets.

"We're talking about the equivalent of a middle-class tax increase," said Michael D. Tanner, a health-care expert at the libertarian Cato Institute. "Yes, they're paying it to an insurance company instead of to the government. But, suddenly, these people are paying more money to somebody."

A plan drafted by House Democratic leaders would offer more generous tax credits, but it would cost more than $1 trillion over the next decade.

Baucus's team of three Democrats and three Republicans from the Finance Committee has labored for months to cut that cost as it crafts a reform plan that could win support from both parties. By squeezing the size and scope of the subsidies, the negotiators have lowered the cost to a more politically palatable $880 billion -- within the range President Obama specified last week in a speech to Congress.

But a smaller bill would mean less help for people -- particularly those who earn too much to qualify for Medicaid but too little to easily slip the equivalent of a second rent payment into their budgets.

According to the latest Census data, about three-quarters of the uninsured earn less than 300 percent of the poverty level, or about $32,500 for an individual and $66,150 for a family of four. Nearly half are childless adults. In surveys, many say that they are not offered coverage by their employers or that they simply cannot afford it.

The centerpiece of the Baucus proposal is a series of "exchanges" where people without access to affordable coverage through their employers could apply for government subsidies and choose among a range of private insurance options. The plan would not, as liberals have demanded, create a government-run insurance option to compete with private firms, but would finance the creation of state or regional cooperatives run by consumers -- a concession aimed at winning over Republican lawmakers.

Baucus and his colleagues wrangled Monday in the hopes of persuading Republican Sens. Charles E. Grassley (Iowa) and Mike Enzi (Wyo.) to support the measure. The two conservatives have stayed at the bargaining table all summer, despite GOP leaders' strong opposition to the reform effort.

Baucus said the strategy is working. "Senators on and off the committee, their comfort level is starting to come up a bit," he told reporters. "I believe, in the end, we'll have some significant bipartisan support." But the chairman said Monday night that he will move forward Wednesday with or without Grassley, Enzi and Sen. Olympia J. Snowe (Maine), the most moderate Republican involved in the negotiations. He said the bipartisan group, known as the Gang of Six, would continue to negotiate until the full committee begins work on the bill next week.

Baucus said he will comply with Republican demands that illegal immigrants would receive "no benefits" through the new insurance exchanges. Meanwhile, negotiators are crafting a provision that would authorize states to start pilot projects to try to lower health-care costs by reducing the number of malpractice lawsuits, an approach similar to the one Obama outlined in his speech. "States would be given resources to help them experiment with what works best," said Sen. Kent Conrad (D-N.D.), another participant in the talks.

Also unresolved Monday was the question of how to pay for an expansion of Medicaid to cover every U.S. citizen whose income falls below 133 percent of the federal poverty level, about $14,500 for an individual or $29,500 for a family of four. Governors in both parties strongly oppose an expansion that is not fully financed by the federal government. The Senate negotiators are scheduled to brief governors by conference call Tuesday afternoon, and Baucus predicted they would be "pleasantly surprised."

"The Medicaid costs," he said, "are not going to cost states near as much as feared."

Under the Baucus plan, subsidies would be offered to people who earn up to 400 percent of the poverty level ($43,000 for an individual or $88,000 for a family of four) in the form of tax credits that would be paid directly to the insurance company of the person's choice. The credit would be calibrated on a sliding scale to ensure that people at the bottom of the income range paid no more than 3 percent of their earnings for premiums while those at the top would be liable for as much as 13 percent.

That would amount to more than $700 a month for a family of four making $66,000 a year -- significantly more than most people at the same income level now pay, according to research conducted by Linda Blumberg, a senior fellow in the Health Policy Center at the Urban Institute. Families earning less than 300 percent of the poverty level also would be eligible for assistance with deductibles and other out-of-pocket expenses, but families who earn more would be on their own.

"That group does spend in the neighborhood of 12 percent of their income. But it's not just the premium. It includes out-of-pocket spending," Blumberg said, adding that the Baucus plan "is going to be somewhat of a wakeup call."

Families that do not purchase insurance would face penalties on their annual tax returns of up to $1,500 a year if they make less than 300 percent of the poverty level, or $3,800 a year if they make more.

But Senate Finance Committee negotiators are quick to point out that a hardship waiver would be available.

"We're doing our very best to make the insurance requirement as affordable as we possibly can," Baucus said, without driving up the overall cost of the bill.


PMiner said...
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Astoiber said...

This is going to be a strenuous process. Obama promises to pass the bill before the end of the year. I think because of the opposition by fiscal conservatives, the public option will not be passed. Both major parties agree that there needs to be health care reform. The controversy is whether or not to have a public option. I believe that the majority of educated, responsible people will vote against this bill since it is a blatant display of fascism.

rlepak said...

By the end of the year I think we will have accomplished nothing in Washington regarding health care. First, because the democrats and the republicans won’t be able to reach a bipartisan agreement. The democrats won’t agree to a bill without a public option, while the republicans won’t agree to a bill with a public option. Second, if a bill were to be passed with a public option that would cause an uproar with the already protesting “teabaggers”, a group that congress may not be able to ignore for much longer. Finally, as we had discussed in class, our government is not set up in a way for things to be done quickly. Obama has been president for less than a year, so this would be a quick reform if it were passed by the end of the year.

MKlinka said...

I'm going to have to disagree, I think that while this bill will go through, it's going to be even more gutted. We can see that Baukus is trying to negotiate with the republicans, and we know that the democrats want this bill passed in some manner. Now, since the last transcript of the bill available is from July, we have to wait to see all of the little changes and concessions that have been made. That being said, the democrats wouldn't willingly castrate their bill so they could not pass it. The bill will pass, maybe not for a while, but it will pass, albeit in a weakened state. Also, I would really like to know how anyone could think that the bill promotes Fascism, I can see socialism, but fascism is something different entirely unrelated to this bill.

Diana said...

I think, in theory, the idea is good. But, I don't think Obama will be able to accomplish this by the end of the year. In my oppinion, I don't think the democrats and republicans will be able to come together and make a decision about the whole matter.

K-Laz said...

I dont see this proposal getting passed before the end of the year. It's way too expensive and actually raises prices for middle & upper class people. I also don't see how people who can't afford health insurance in the 1st place will bennifit from being pentalized on their tax returns.

K-Iglinski said...

I believe that this isn't going to work. Obama says that he will pass the bill by the end of the year, but in my opinion the two parties won't agree on the bill by then. Yes, they both agree that Health Care needs reform, but it's what all needs to be reformed that is the problem. People know about this problem and are educating themselves to what they need to do. It may be passed one day, but for the now the bill needs to be remade and they need to sit down and start from scratch. The people fgor now will vote against it because it will cost to many of the average americans to much money that they don't have.

aprichard said...

On this issue, I will have to agree with mklinka. The bill will most likely pass, but after much squabbling and after it loses many aspects that the republicans have rejected on the bill. However,it seems that Baucus is playing straight into the hands of the 6 and his republican aggressors. With majority of the house on his side, it seems that he should be pushing what his democratic party wants instead of dividing it over issues such as public option. The democrats have fundamental intrests that they are willing to preserve. To quote mklinka "wouldn't willingly castrate their bill so they could not pass it". As we have discussed, congress takes time to approve legislature and even more time when it is opposed as severly as it is in this situation. In due time this bill will pass because health care is a necessary insurance that all should have regardless of economic class. Health care has been monopolized for too long, and it is about time that the government created an option that will cause health care companies to lower their prices and help those who can't afford it.

JakeK said...

The fact of the matter is that the Republicans should not even be a road bump in Obana's plan. With the majority the Democrats have in congress, the only people they can blame for the stagnation of their health care bill is themselves. Obama is using the bully pulpit to pin blame on the GOP for the blunders of health care reform, but last time I checked, there was what? maybe 6 or 7 Republicans left in congress? The Democrats don't even like this bill, and what's more is the American people have spoken, and they don't like it either (can you say town hall meetings?). What it boils down to is 1. We can't pay for it. Even Magic Man Barack can't foot this bill. 2. No one can agree on it. Sure it will pass, but it will be watered down and no one will be happy. 3. This is not good news for our generation. We will be the ones left to finance this blunder and face an era of outrageous health care. The American people made their bed and now they have to lay in it- let's just hope they don't wake up in a vegetative state because a panel of doctors will decide whether or not to pull the plug, not your family.

Brandon D said...

I dont see this being passed by the end of the year. Its too expesive and it will take time to pass unless they come to agreement without taking out key aspects of the proposal

Tereza said...

I have to agree with what JakeK has said. I can't understand why there is an issue with the GOP- they shouldn't have any control with Congress when they have such a little minority. Although this bill is costly, and it is unpredictable whether or not it will be effective, it will probably pass. But as it passes it will be a completely different, unrecognizable, butchered bill. I can also agree with Kyle Laz, if you can't afford healthcare now, how will you be able to afford tax penalties. I'm sure those without healthcare will be ecstatic to learn that they are not only being forced by their government to get the necessity but fined if they don't! Another weakness in the bill is the appeasement of the GOP's desire to not have some sort of government run healthcare. Also, I would like to throw in that Astoiber's fascist remark is 100% absurd. Let's just attach the word fascism to everything, that'll get a ridiculous, ineffective opinion across. I have to agree with MKlinka."Fascists advocate the creation of a single-party state.[7] Fascist governments forbid and suppress openness and opposition to the government and the fascist movement" Pretty sure, that's not what's going on here, not only has this bill nothing to do with fascism it is the direct opposite of what fascism is described to be. The direction Congress is taking for this bill is bipartisan!

jreichart said...

I believe that some form of this bill will be passed by the end of the year. Whether you agree with the policies outlined or not, Obama is quite persistent with his will to have some form of the bill passed. Although there will never be a bipartisan agreement about this issue, democrats will make a point to get some form passed. We can see evidence of this as democrats are willing to make modulations to the plan for republicans' sake, as stated in this article. I think that for Obama and democrats, no matter what form of the bill is passed, it will be a "victory" for them, as they will have reached Obama's goal to have it passed by the end of the year, no matter how far diverged from the original plan it may be.

KLatour said...

This bill is too insanely huge to get done by this year. I agree with Diana that it will be a big challenge to get democrats and republicans to come to a final agreement that is fair. Also, the large amount of people who fall in the "very low income but not low enough for MedicAid" will suffer greatly because of the penalty they will face on their taxes. Overall, I think the bill is way too expensive and considering how big of an issue it is, there is no way it will pass in three and a half months.

nicky said...

First of all, I think it's going to be hard to gain bipartisan backing. I don't believe the two parties will be able to resolve the issue this year. All in all I think the health care reform process will be more expensive than many people think, especially for the middle class citizens. And punishing the people who can't afford health care to begin with is not helping anyone.

ayork said...

I think that the
Democrats are all pushing this bill a lot more than they outwardly put on. Because of the failure to get a similar plan passed in the early nineties, liberals will want to save more enbarassment and make this bill a law. Democrats opposing this bill may just be attempting to gain more conservative support so the law actually passes. I (surprisingly) agree with MKlinka in believing that this bill will get passed before the year ends. The White House administration will make sure of that. I fear, as many others do, that this bill will no longer be the bill it started out as--which could be catastrophic for the end result. Right now, Congress is trying to please too many people. There is a gargantuan debate taking place where each side is giving and taking to benifit themselves. Some might call it anarchy; others, democracy.

nsomers said...

With the way the bill stands today, I do not believe that it will be passed by the end of the year. Possibly a less comprehensive version will pass, but will most likely not have that great of an impact. Maybe they will pass a version that regulates insurance companies on pre-existing conditions and medical malpractice. Insurance companies should not be allowed to reject people according to pre-existing conditions and limits should be placed on ridiculous lawsuits that patients place on doctors. Putting a plan like this in place will give the government another year to work on a bipartisan health care plan, and allow Obama to keep his promise on delivering a health care plan by this year.

Mr. Bretzmann said...

For informative purposes:
1. Republican and Democrat are proper nouns and should be capitalized.
2. There are no government panels to make any life and death decisions (see jakek) in any bill I've seen reported on. Like Hogwart's, this is fiction.
3. Most of the plans have subsidies for people who cannot afford to buy healthcare insurance (whether it helps or makes it worse is up to you). Look up what a subsidy is.


The Towel said...
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AAgostini said...

It seems in this situation that both sides are aiming to accomplish too much, too quickly on a very substantial American issue. I have to agree that this bill as it was originally intended--a revolutionary impact on the health care industry--will not be passed by the end of this year. As previously discussed, the U.S. government resists dramatic, instantaneous change to prevent change for the worse. Passing a bill that suddenly provides millions with health insurance, pleases the general public, and pleases bipartisan interests (as well as hastily molding the issue to other great American debated issues such as illegal immigration and abortion) in a matter of months is quite the feat. By aiming to accomplish this vast array of goals
in such a manner, it seems the bill is deviating from its original intention which was to solve the involvement of finances in individual health. Considering the issue at hand--human wellness--perhaps it is best that the bill is not rushed.

The Towel said...

Let's just get one thing straight: OF COURSE some sort of health care reform will pass...Obama's second term depends on it. And with all of the liberals in Congress? Duh. I doubt Obama is going to let the centerpiece of his campaign fall through just because some ignorant Republicans think that there will be "death panels" *cough* Sarah Palin *cough*. Because just about every other conservative agrees that there must be some sort of health care reform (just not the public option). Then again, Sarah Palin probably doesn't even know what the word "reform" means in the first place. There's always a dictionary if she can't understand the internet. Or I could just tell her that it's another name for a desk; she'd blindly believe me just like she blindly believes Fox News or whoever told her that there'd be "death Panels". But she isn't the only one at fault for believing ludacris things they hear about health care refom, it's a myriad of Americans.

Yes, the bill will be very expensive no matter what. But what do you expect? I mean after all, it IS health care reform. This isn't going to be cheap by any means, obviously.

Kyle and Tereza, people who can't afford health insurance WILL NOT get a huge tax hike. They'd then be able to afford it with big government subsidies. You're simply misinterpreting. What the bill really means, and as the article stated, is that the government is mandating that everyone must have health insurance and if you STILL refuse now that you can afford, then you will be taxed.

Tereza, you said;
"I have to agree with what JakeK has said. I can't understand why there is an issue with the GOP- they shouldn't have any control with Congress when they have such a little minority." I'm not sure that you've read any of your textbook...at all. If politics really worked like that, we'd always be ruled by the tyranny of whoever the current majority is. It's also common sense that if you're the majority, you'd want to include the minority in hopes that when party power shifts, they'll include you too. You're also totally leaving out the fact that people in Congress have a desire to be elected. Have you seen the townhall meetings for healthcare on the news/youtube? What if people that reside in libreral represented areas don't want health care reform? Maybe the residents are so vehemently against it that the said representative fears for their re-election time? Then it wouldn't hurt to have some Republican votes for the bill, now would it?

What should really be included in the upcoming health care reform is allowing the sale of health insurance across state lines (creates better competition) and tort reform (deals with lawsuits for malpractice against doctors). This also happens to be what top GOP leaders want and would get the bill bipartisan as wanted. That's literally all the liberals need to do to get this bill to be somewhat bipartisan. Though other Republicans are so opposed to a public option that they view it as completely unacceptable.

Something amusing: Remember how Obama, during his campaign, promised that he won't raise taxes for families that are fiscally under the top 95% of all earners in America? Yet he's finding all these new ways to tax us without actually calling it a "tax". Like, this public option is merely another "insurance premium". Or with cap and trade (secret enormous carbon tax, go look up "cap and trade" if you don't know what it is), it's merely a "trade" with money for credits or "guide". Or the 8% payroll tax on small buisinesses in this healthcare bill, which is pretty horrible in a bad economy.

Mr. Bretzmann said...

Mr. or Ms. Towel,
Please don't attack a person's intelligence or insinuate that they are dumb. Argue your opinion: yes
Call people names: no

Tereza said...

The Towel, I understand the town meetings and the purpose to get reelected, HOWEVER, when the majority was Republican, did they take in account of the Democrats of the minority as much as the Democrats do for them? Absolutely not. The Republicans got what they wanted when they were the majority in Congress, they didn't purposely include any sort of liberal notions. Even though the Americans are unsatisfied with this plan, and the Republicans are feeding off the negatives to cause controversy and get reelected, they should not have this big of influence, the bill should not work around precisely what they, the conservatives want. Just to give you some awareness, I ACTUALLY HAVE READ my textbook.

JakeK said...

Mr. Bretzmann, after researching the topic, I was incorrect in that statement in the sense that there is no panel of doctors determine the life/death outcome of a patient; however, I would check out Dick Morris's remarks in this piece. http://www.youtube.com/watch?v=hQ-cVPgODoc&feature=related

jmarczewski said...

I don't see this plan coming to fruition any time soon, though it is seemingly becoming stronger and stronger. I see where the Democrats are coming from, as the plan plays directly to their ideals of playing Robinhood--taking from the rich to give to the poor. However, I oppose the plan, as it seems too vague and insecure for me to buy into it. I only expect the debate to become more and more aggressive as the process becomes further drawn out, and in the end I think there will be some form of healthcare reform; I just don't expect it to be as drastic as many reports are announcing that it will be.

dlang said...

I don't believe anything will get done with the whole healthcare debate because look at it already this has been going on for a while and nothing really has happened even now. So, I agree with stoiber with him saying that it is going to be hard to finalize something, but they should kick it into gear a little quicker than they have been lately.

morgank said...

Obviously something needs to be done about the health care system in our country and although the problem is being focused on I highly doubt that Republicans and Democrats will be able to come to an agreement within the next three and a half months to be able to get this passed by the start of 2010.

rlepak said...

Although reading others comments made me think of things I hadn't the first time I posted, I am still going to go with my first answer and say nothing will get done in the health care reform by the end of the year. Previous presidents have tried, and failed miserably. The insurance companies are a huge industry and have a lot of power and money behind them, a force the government is reckoning with. Second, on a different note, I think Washington needs to shift its ideas away from health care for a little while because it is getting in the way of other large topics such as Afghanistan and renewable energy.

Brandon D said...

i think rlepak has a good idea about washington shifting its ideas away from health care to address other major topics.Only shortly, but it may allow for needed comprimises.

j.polinski said...

I believe this is going to be a substanitally long process and there is no way it will get passed by the end of this year, and maybe not even next year. The debate is going nowhere in my view because the Republicans and Democrats can not agree on anything and they most likely won't end up agreeing on anything relevant to this bill, and i don't think many people will even benefit from this anyway. This is just a huge mess as it is and i don't think it will get much better down the road.