H.r. 3200 America’s affordable health choices act of 2009

H.R. 3200 AMERICA’S AFFORDABLE HEALTH CHOICES ACT OF 2009

111th Congress

Topics of Discussion

Common Acronyms and Vocabulary

A Brief History Healthcare Reform

Summary of the Bill

Topics of Discussion (Continued)

Importance of the Bill Support and Opposition

Support Millions Uninsured Financial Hardship of Medical Bills

Oppose Loss of Freedoms Cost

Controversies Death Panels Abortion Funding Illegal Immigrants Medicare Competition Tea Party Protesters

Topics of Discussion (Continued)

Anticipated Effect of the Bill Effect on Groups

Self-Insured Employer Insured Non-insured

The Deficit Issue Conclusion Bibliography

Common Acronyms and Vocabulary

America’s Affordable Health Choices Act of 2009

Acronyms and Vocabulary

AMA American Medical Association Astroturfing: as it applies to healthcare reform, a

euphemism referring to a strategically planned movement by an organization but masked to appear as an ordinary, grassroots movement (1). The Tea Party protests have been suspected of this.

Community Rating: requires health insurance providers to offer policies within a region without underwriting and at the same cost to everyone regardless of health (i.e. a healthy 21 yr. old will pay the same amount as a 70 yr. old with a history of health problems so long as they are in the same region)

Comparative Effectiveness Research: the direct comparison of existing health care interventions to determine which work best for which patients and which pose the greatest benefits and harms (2). Some fear this, in addition to specific inclusions in the bill, will result in ‘death panels’.

CER

Acronyms and Vocabulary (Continued)

CBO

DHHS

HMO

Congressional Budget Office Dept. of Health and Human Services Health Maintenance Organization:

a managed care organization who contracts doctors and medical facilities to treat patients based on their guidelines and restrictions.

Public Option: one of the controversial facets of the current bill which allows the public to opt into government funded health insurance thus directly competing with private sector companies.

Risk Pooling: spooling of resources by insurers across a wide area, increasing the likelihood that a high demand from one customer will be offset by low demand from another.

A Brief History


A Brief History of Healthcare Reform (1854-1945) (3)

1854

1912

1932

1933-

36

1945

Franklin Pierce vetoes national mental health bill on the grounds that health care is a private issue.

Health care reform becomes a coordinated movement, Theodore Roosevelt favored by supporters.

Franklin Delano Roosevelt favors national health insurance as part of Social Security Act but does not add it as special interest opposition may have jeopardized its passage.

New Deal Roosevelt dies in office, Truman outlines plan based on

Roosevelt policy and presents to Congress. Includes voluntary national health insurance paid by income taxes, the Wagner Murray-Dingell Bill, which is defeated by congressional conservatives backed by the AMA among others.

A Brief History of Healthcare Reform (1964-2009) (3)

1964

1965

1973

1992

2000

2007

2009

Great Society initiative forwarded by President Lyndon B. Johnson.

President Johnson signs Medicare into law. HMO’s are created during the Nixon administration. Democratic nominee William J. Clinton included

universal healthcare in his platform for presidency but was unsuccessful in implementing any such program during his presidency (1993-2001).

Republican nominee George W. Bush pushes for further privatization including in his platform tax and other incentives.

Democratic nominee Barack Obama includes universal healthcare in his platform.

President Obama assumes office in January and H.R. 3200 America’s Affordable Health Insurance Act of 2009 is introduced in July by Rep. John Dingell (D) (Note of interest: John Dingell’s father was a House Representative who supported the Truman bill, Wagner Murray-Dingell Bill, which included his name).

Summary of the Bill


Summary of the Bill (4)

This is a basic

overview and

contains a limited selection

of elements based on those I

consider to be the

most impactful

.

Private insurance is mandated for most adults above the poverty line with a sliding scale tax penalty for those who do not purchase insurance.

Minimum coverage standards required by employers with a payroll over $500,000 and a penalty tax on those employers who do not comply.

Additional tax on individuals with a gross income exceeding $280,000 and couples with adjusted joint income exceeding $350,000.

Summary of the Bill (4) (Continued)

This is a basic

overview and



consider to be the

most impactful

.

Annual out-of-pocket maximums of $5,000 for an individual and $10,000 for a family.

Medicaid expanded for low-income individuals and families for preventative care.

Pre-existing condition exclusions are prohibited. Coverage of an individual can only be cancelled if

there is evidence of fraud.

Summary of the Bill (4) (Continued)

This is a basic

overview and



consider to be the

most impactful

.

Risk pooling to guard against catastrophic risks such as floods, earthquakes, etc.

Requires community rating, guarantee of issuance and renewal.

Increases Medicaid payments to physicians for primary care.

Reduces Medicare payments to hospitals with excessive re-admissions.

Based on private industry averages with three levels of coverage and premiums sufficient to finance the benefits and administration costs.

Summary of the Bill (4)

(Continued)

This is a basic

overview and



consider to be the

most impactful

.

Creates administrative standards to reduce costs, improve services and the ability to accurately determine a total financial estimate at the point of service.

Prioritizes eventual implementation of best practices in benefits delivery.

Creates National Prevention and Wellness Strategy. Development of quality measures for benefits

delivery in the United States by the Secretary of the DHHS.

Surgeon General to head a new committee called the Health Benefits Advisory Committee.

Importance of the Bill


Importance of the Bill

49 million Americans, equaling 15.9 percent of the population, have no insurance(6).

The United States is the only industrialized country without a nationalized health care plan.

According to the World Health Organizations report, World Health Statistics 2008, the United States spends a far higher percentage of our gross domestic product on health care equaling 15.2 percent. This is in stark contrast to countries with socialized medicine such as the United Kingdom at 8.2, Canada at 9.7, Germany at 10.7 and France at 11.2 percent (7).

According to a study by Harvard Medical School and Public Citizen, a nonprofit consumer advocacy organization, administrative costs associated with the current system equate to about $286 billion a year in overhead and paperwork. Some argue that by allowing some form of universal health coverage the United States could dramatically reduce these costs.

The only industrialized country who spends more on health care is the Marshall Islands.

Support and OppositionSupport

According to Ben Cohen, whose article “10 Reasons We Need a Public Option,” appeared in The Huffington Post online on August 24, 2009, says the following: “Passing health care reform with a public option means millions of

currently uninsured people will get access to comprehensive coverage at an affordable rate (5).” Currently 49 million Americans do not have health care insurance, that is about

15.9% of the population (6). The U.S. Congressional Budget Office estimated the bill would reduce the number of uninsured by approximately 16 million or 32 percent (8).

Todd Stottlemyer, President of the National Federation of Independent Business, is quoted in Robb Mandelbaum’s article, “Health Care Reform’s Strange Bedfellows”, posted on CNNMoney.com on the August 10, 2009 : “The status quo is unacceptable," he said. "It will result not

only in personal family bankruptcy but in a nation of bankruptcy.(8)" According to their study entitled “Illness and Injury as Contributors to

Bankruptcy” Himmelstein, Warren, Thorne and Woolhandler indicate 46.2 percent of debtors met at least one of the study’s criteria for major medical bankruptcy (10).

Support and Opposition (continued)

Support

In his article titled, “An Antitrust Exemption for Insurers? That’s Not the Real Problem” on November 2, 2009 in the Los Angeles Times, Micheal Hiltzik notes the lack of marketplace competition in the insurance industry could be tied to premium increases (14). Some hope the public option of health care reform will address this issue: “…health premiums have soared over the last decade -- up by

131% for family coverage from 1999 to 2009, according to the Kaiser Family Foundation.” According to the Kaiser Family Foundation, the average cost of insurance

premiums of employer sponsored plans increased from $5,791 in 1999 to $13,375 in 2009.

In Hiltzik’s article, Leemore S. Dafny, a health economist at the Kellogg School of Management at Northwestern states, "Competition in the health insurance industry is insufficient. It's becoming less competitive over time and it's causing higher premiums than we otherwise would see.” James C. Robinson notes in his 2003 study of insurance consolidation, “Together

the Blues plans and the three national non-Blues carriers [United, Aetna and CIGNA] control more than 60 percent of the market in thirty-four states and more than 70 percent of the market in twenty-three states.(14)”


Opposi

tion

In his article, “5 Freedoms You’d Lose in Health Care Reform” on CNNMoney.com, Shawn Tully says the following freedoms will be lost (11): Freedom to choose what’s in your plan:

“Standard benefits packages” required by many states is a major reason for the rise in healthcare costs. “Every group, from chiropractors to alcohol-abuse counselors, do lobbying to get included.”

Freedom to be rewarded for healthy living: “…it forces young people, who typically have lower incomes than older workers, to

pay far more than their actual costs, and gives older workers, who can afford to pay more, a big discount.”

The bill would ban charging different premiums based on health, “…the bills would bar rewarding people who pursue a healthy lifestyle,” which Tully likens to car insurers charging the same rates to safe drivers as to chronic speeders with a history of accidents.

Freedom to choose high-deductible coverage Approximately 5 million employees are covered by plans compatible with health

savings accounts, “…the bills threaten to eliminate one part of the market truly driven by consumers spending their own money.”

“HSA users are far more cost-conscious than customers who are reimbursed for the majority of their care.”

CONTINUED ON NEXT SLIDE


Opposi

tion

Freedom to keep your existing plan: Employers regulated by the Employee Retirement Security Act of 1974

(generally large employers such as GE and Time Warner) have a 5-year grace period after which they would have to offer government approved plans.

Insurers who offer plans to small employers and individuals will be forced to offer only “qualified” plans after the legislation passes. Those currently covered can keep their plan so long as none of the terms change. “Since these plans generally change their policies every year, it’s likely that millions of employees will lose their plans in 12 months.”

Freedom to choose your doctors: Americans who buy through the new exchanges will be assigned a ‘medical

home’ which is similar to an HMO. “You’re assigned a primary care doctor and that doctor controls your access to specialists.”

The Congressional Budget Office, who analyzes the costs of legislation, found the following: Over 10 years the proposal would cost $1 trillion and 36 million

Americans, a reduction of only 3 percent to 11 percent of Americans, would still be without health care (12). Several propositions have been made to pay for H.R. 3200. Imposing a surtax

on high earners (13), cutting Medicare payments to hospitals (12), taxing a portion of employer-provided health benefits (13) among others; none of which are popular nor will they fully pay for the plan.

Death

Panels

and

Ab

ort

ion

Death Panels As it pertains to H.R. 3200, death panels refer primarily to end of

life treatment, specifically physician reimbursement for counseling about living wills. Supporters of H.R. 3200 defend the bill by saying coverage and

treatment will be provided to everyone and no one will be turned away; this is simply another service.

Opponents of the bill are concerned that paying physicians, who in a reform environment will be pressured to reduce costs, could result in the subtle dissuasion of the disabled, elderly and terminally ill patients from seeking expensive therapy or end-of-life treatments.

Abortion Funding The Hyde Amendment restricts the use of federal funding to

abortions performed in instances of rape, incest or if the mother’s life is in danger. Supporters consider the amendment a necessary compromise in order to

pass health care reform; individuals can purchase supplemental insurance to cover abortion services. Others support limited access, are anti-abortionists and everything between.

Opponents fear individual who have private insurance covering abortion services, risk losing the coverage if their policy is switched to a government sponsored plan.

Controversies (15)

Illeg

al Im

mig

rants

and

C

om

peti

tion

Illegal Immigrants H.R. 3200 includes language which states illegal immigrants are

not eligible for benefits. Supporters point to the bill, which does not extend benefits to illegal

immigrants. Opponents also point to the bill stating there is nothing in the bill

which would enforce this. Note: As emergency rooms can not deny care, illegal immigrants who

require medical attention often put a burden on this resource. Unpaid services rendered in the emergency room often end up trickling down to American tax-payers anyway.

Competition Supporters of the public option have two arguments. One being that

the program would be based on industry averages so there wouldn’t be direct competition with private insurers; others claim competition is what the industry needs.

Opponents of the bill are fearful that a public option would make it difficult for private insurers to compete.

Controversies (15)

(Continued)

Medic

are

and P

rote

sts Medicare

Supporters of H.R. 3200 state Medicare benefits are not being reduced, rather the bill reduces future increases in spending (16).

Opponents say they want protect the existing Medicare program structure.

Tea Party Protesters Tea Party Protesters, who focus primarily on government

spending, have been very vocal at town hall meetings pertaining to health care reform. Supporters of H.R. 3200 view the protests as everything from

legitimate outrage to protests orchestrated and/or are supported by the insurance industry in order to derail health care reform, specifically the public option. The euphemism ‘astroturfing’ was coined to describe the camouflaging of this support under the designation of a grassroots movement.

Opponents of H.R. 3200 say the protests are a grassroots movement to pressure government to cut spending versus increasing it, which the new bill will most likely do.

Controversies (15)

(Continued)

Anticipated Effect of the Bill


Anticipated Effects of the Bill (6)

Self Insured

14 Million

5%

Uninsured

49 Million

16%

Medicaid /

Medicare

81 Million

26%

Employer

Insured

164 Million

53%

Self-Insured This group of Americans is most likely to see lower costs due to:

▪ Refusal of insurance coverage will be prohibited.

▪ The creation of the insurance exchange.

▪ Competition attributed to the public option.Employer InsuredThis group will not see much change in premiums, as a matter of fact:

▪ Initially premiums may continue to increase.

▪ They may not have the option of buying coverage through the exchange if they pay less than 11% to employment- based coverage.

▪ High-income earners ($280,000 for singles and $350,000 for couples) will see a surtax up to 5.4% for the highest earners.

Uninsured This group of Americans will fall into one of three categories ▪ If an individuals income is 133% of the poverty limit, they may qualify for Medicaid.

▪ An individual with qualifying income could receive a subsidy to assist in pay for health insurance.

▪ Most of the remaining population will be required to have insurance or pay a penalty.

The D

efici

t Is

sue

Price Tag of H.R. 3200: $1.1 trillion over the next 10 years (17)

Current Deficit: $11.9 trillion

Public Support (18)

In Favor: July: 38% October: 34%

Oppose: July: 44% October: 47%

Congress still has a long way to go in order to pass health care reform. The House was able to narrowly pass their bill on November 7th by a margin of 220-215. Though a monumental victory it still faces the Senate where it will be merged with their bill and no less than 60 votes are needed to pass it. With only 57 senators supporting a public option, included in H.R. 3200, and several threatening to filibuster any bill that contains one, it remains to be seen if any hybrid version between the House and the Senate will ever reach President Obama’s desk.

Anticipated Affects of the Bill (Continued)

Conclusion and Bibliography


Next

Ste

p…

the S

en

ate

Congress still has a long way to go in order to pass health care reform. The House was able to narrowly pass their bill, H.R. 3200 which this presentation has defined, on November 7th by a margin of 220-215.

Although a monumental victory it still faces an uphill battle in the Senate where it will be merged with their version of the health care reform bill and a vote of no less than 60 in favor is required to pass it. With only 57 senators supporting a public option, which is included in H.R. 3200, and several threatening to filibuster any bill that contains one Majority Leader Harry Reid has confessed he’s been unable to secure the extra votes he will need(19).

What started as a powerful campaign platform for President Obama has come to be viewed by many citizens as another example of excessive government spending. Unprecedented economic hardships, obscene corporate bailouts and skyrocketing national debt has left the American public wary and unhappy. Some sense the final bill is too expensive while some feel it does too little; others argue it is overly inclusive while the opposition argues it doesn’t really address the problems with our current system.

It remains to be seen if any version of the House and the Senate health reform bill will ever reach President Obama’s desk. While he has vowed to pass legislation many are beginning to sense health care reform, for Obama’s administration, has the potential to become his swan song…or Waterloo.

Conclusion

Bibliography:(1) "Astroturfing -." Wikipedia, the free encyclopedia. Ed. Wikimedia. Wikimedia. Web. 11 Nov. 2009. <http://en.wikipedia.org/wiki/Astroturfing>. (2) "Comparative Effectiveness -." Wikipedia, the free encyclopedia. Web. 11 Nov. 2009. <http://en.wikipedia.org/wiki/Comparative_Effectiveness>. (3) Legel, Lee. "The history of health care as a campaign issue | Physician Executive | Find Articles at BNET." Find Articles at BNET | News Articles, Magazine Back Issues & Reference Articles on All Topics. BNET. Web. 11 Nov. 2009. <http://findarticles.com/p/articles/mi_m0843/is_3_34/ai_n27871607/?tag=content;col1>. (4) "H.R. 3200." THOMAS (Library of Congress). Library of Congress. Web. 11 Nov. 2009. <http://thomas.loc.gov/cgi-bin/bdquery/z?d111:HR03200:@@@D&summ2=m&>.(5) Cohen, Ben. "10 Reasons We Need a Public Option." The Huffington Post. 24 Aug. 2009. Web. 11 Nov. 2009. <http://www.huffingtonpost.com/ben-cohen/10-reasons-we-need-a-publ_b_266771.html?view=screen>.(6) Sahadi, Jeanne. "What health reform might mean for you - Jul. 21, 2009." Business, financial, personal finance news - CNNMoney.com. CNNMoney.com, 22 July 2009. Web. 15 Nov. 2009. <http://money.cnn.com/2009/07/21/news/economy/health_care_reform/index.htm>. (7) World Health Statistics 2008. Rep. World Health Organization. Web. 11 Nov. 2009. <http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf>. (8) "History of health care reform in the United States -." Wikipedia, the free encyclopedia. Wikimedia. Web. 11 Nov. 2009. <http://en.wikipedia.org/wiki/History_of_health_care_reform_in_the_United_States>. (9) Mandelbaum, Robb. "Health care reform's strange bedfellows - Aug. 10, 2009." Business, financial, personal finance news - CNNMoney.com. CNNMoney.com. Web. 11 Nov. 2009. <http://money.cnn.com/2009/08/10/smallbusiness/nfib_health_reform.fsb/index.htm>. (10) Himmelstein, David U., Elizabeth Warren, Deborah Thorne, and Steffie Woolhandler. Illness And Injury As Contributors To Bankruptcy. Illness And Injury As Contributors To Bankruptcy. MarketWatch. Web. 11 Nov. 2009. <http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.63v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=medical+bankruptcy&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT>.(11) Tully, Shawn. "You'll lose 5 key freedoms under Obama's health care plan - Jul. 24, 2009." Business, financial, personal finance news - CNNMoney.com. CNNMoney.com. Web. 12 Nov. 2009. <http://money.cnn.com/2009/07/24/news/economy/health_care_reform_obama.fortune/index.htm>.(12) Andrews, Wyatt. "How Will We Pay For The Health Care Plan?" Online News Site. CBS. CBSNews.com, 16 June 2009. Web. 12 Nov. 2009. <http://www.cbsnews.com/stories/2009/06/16/eveningnews/realitycheck/main5092484.shtml>.(13) Sahadi, Jeanne. "CBO: Health reform bills moving the wrong way - Jul. 16, 2009." Business, financial, personal finance news - CNNMoney.com. CNNMoney.com, 16 July 2009. Web. 15 Nov. 2009. <http://money.cnn.com/2009/07/16/news/economy/health_care_reform/index.htm>. (14) Hiltzik, Michael. "An antitrust exemption for insurers? That's not the real problem." Newsweek. 2 Nov. 2009. Web. 12 Nov. 2009. <http://bx.businessweek.com/george-kaiser-family-foundation/view?url=http%3A%2F%2Fc.moreover.com%2Fclick%2Fhere.pl%3Fr2304758694%26f%3D9791>.(15) "America's Affordable Health Choices Act of 2009 -." Wikipedia, the free encyclopedia. Wikimedia. Web. 15 Nov. 2009. <http://en.wikipedia.org/wiki/America%27s_Affordable_Health_Choices_Act_of_2009>. (16) "Obama claims Medicare benefits will not be cut under the health care bill." St. Petersburg Times. 11 Aug. 2009. Web. 13 Nov. 2009. <http://www.politifact.com/truth-o-meter/statements/2009/aug/14/barack-obama/obama-claims-medicare-benefits-will-not-be-cut-und/>. (17) "Health Care Reform." NY Times. 9 Nov. 2009. Web. 13 Nov. 2009. <http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/health_care_reform/index.html?inline=nyt-classifier>.(18) Mixed Views of Economic Policies and Health Care Reform Persist. Mixed Views of Economic Policies and Health Care Reform Persist. The Pew Research Center for the People and the Press, 8 Oct. 2009. Web. 14 Nov. 2009. <http://people-press.org/report/551/>.(19) Stone, Daniel. "Why the House Health Bill Probably Won’t Matter." Newsweek. 9 Nov. 2009. Web. 14 Nov. 2009. <http://blog.newsweek.com/blogs/thegaggle/archive/2009/11/09/why-the-house-health-bill-probably-won-t-matter.aspx>.

Documents

H.r. 3200 America’s affordable health choices act of 2009