“Gee, I hope this works”

Ruth Marcus BELIEVES in the new health care reform law.  But she points out that no one knows exactly what it will do:

If I were a member of Congress, my floor speech before casting a yes vote would have boiled down to:

Gee, I hope this works.

One of the astonishing aspects of the health-care debate is how little is actually known about the implications of a change this far-reaching. Everyone has a theory, and a model to match, but even some of the most fundamental questions remain the subject of debate.

On the most basic of all — does having health insurance lead to better health? — the evidence is solid but not unanimous. The Institute of Medicine, reviewing the literature in 2009, found that “the body of evidence on the health consequences of health insurance is stronger than ever before. . . . Simply stated: Health insurance coverage matters.”

But a study that same year by Richard Kronick, a former health-care adviser to President Bill Clinton, found “little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the United States.” . . .

To take another example, one common assertion has been that the uninsured end up getting health care — just more expensive health care, in emergency rooms and when conditions have worsened, with the costs passed on to the rest of the population. The notion that the tab is being picked up one way or another makes intuitive sense.

A new National Bureau of Economic Research paper by Michael Anderson, Carlos Dobkin and Tal Gross questions this assumption. The researchers examined health-care consumption by 19-year-olds who had just been dropped from their parents’ coverage. They found that not having insurance resulted in a 40 percent reduction in emergency room visits — “contradicting the conventional wisdom that the uninsured are more likely to visit” the emergency room and a 61 percent drop in hospital admissions.

“Overall, these results suggest that an expansion in health insurance coverage would substantially increase the amount of care that currently uninsured individuals receive and require an increase in net expenditures,” the authors write. Emergency room visits could increase by 13 million annually, and hospital admissions by 3.8 million, they project. . . .

Will younger adults, who account for about half the population of uninsured non-elderly adults, sign up for coverage — or will they pay the fine instead? How will that decision affect premium levels and the adequacy of federal subsidies?

Will the expansion of coverage create a shortage of health-care providers and result in higher prices, or will, for example, higher Medicaid payments for primary-care doctors stem an exodus of doctors from the program? Will employers add coverage because workers facing the mandate to obtain insurance will press for it, or will they drop it because it will be cheaper to pay the penalty and let employees fend for themselves?

Will increased coverage of preventive care save money because diseases will be caught earlier — or will the added cost of widespread screening exceed the economic benefits? The Congressional Budget Office has concluded that, “for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.”

via Ruth Marcus – A generous dose of caution on health reform – washingtonpost.com.

We don’t even know the regular consequences of this new health care system.  Let alone the unintended consequences.

Obamacare is the law of the land

The President has signed the healthcare reform bill.  It is now the law.

How do you think this will shake out? Some conservatives feel glee, thinking they will now trounce the Democrats for pushing through this unpopular proposal. Democrats, though, are going on the offensive, launching a big PR campaign to win over the public.

Another view I’ve heard is that the public will actually like the provisions that go into effect early (see below). The big taxes and expense, the surge in insurance premiums, and the possible disruptions in health care won’t kick in until 2014 and so won’t trouble the current administration all that much. And once the system gets going, so the theory goes, Americans will become as dependent on it as they are Social Security and no one will dare tamper with it.

What do you think will happen?

What goes into effect now

The major parts of the new health care reform law won’t go into effect until 2014 or later, with some kicking in during 2012.  But some measures go into effect either now or in a few months:

Indoor tanning salons will charge customers a 10 percent tax beginning today in just one of the changes Americans will see as a result of the U.S. health-care overhaul signed into law by President Barack Obama.

Insurers will be required by September to begin providing health coverage to kids with pre-existing illnesses and allow parents to keep children younger than 26 on their plans as the clock has begun ticking on many of the law’s provisions. Medicare recipients will receive a $250 rebate for prescription drugs when they reach a coverage gap called the donut hole if the Senate passes and the president signs companion legislation approved March 21 by the U.S. House.

Within 90 days, the law will provide immediate access to high-risk insurance plans for people who can’t get insurance because of a pre-existing medical problem, Harris said. These high-risk pools will be funded by $5 billion in federal grants.

Companies led by Minnetonka, Minnesota-based UnitedHealth Group Inc., the largest health insurer, will be banned within six months from dropping a person’s coverage because of severe illness and from limiting lifetime or annual benefits.

Participants in Medicare, the U.S. government’s health coverage for those 65 and older, are expected get a $250 rebate toward prescription drugs once their benefits run out — a coverage gap know as the “doughnut hole.” The benefit is part of the package of amendments to the legislation now pending in the Senate. Drugmakers led by New York-based Pfizer Inc. will have to offer discounted drugs to Medicare recipients next year, according to an analysis of the legislation by the Kaiser Family Foundation, a nonprofit group based in Menlo Park, California. . . .

Insurers also will have to reveal how much of members’ premiums they spend on medical care, as opposed to executive salaries or other administrative costs. Next year, they’ll owe a rebate to customers if the insurers spend less than 80 percent on benefits for people in individual or small-group plans. . . .

The legislation also creates an Independent Payment Advisory Board to suggest cuts in spending by Medicare, the government health program for the elderly and disabled, that could threaten payments for drug and device-makers.

via Health-Care Overhaul Changes to Start Taking Effect This Year – Bloomberg.com.

The health care bill passed

In a straight up vote (not using the “deem and pass” dodge), the final tally was 219 for to 212 against. It took 216 to win.

The difference was the 6 pro-life Democrats who agreed to vote for the bill if the President would sign an executive order forbidding federal money in the program going to pay for abortion. (See post below.)

Now the Senate must pass some reconciliation elements, but since the House passed the Senate bill and since the President will sign it, this is essentially a done deal.

Did you watch the debate? What I saw was quite telling. What did it tell you?

What’s in the Health Care bill

For a useful summary of the provisions of our new national health care system, see  A look at the health care overhaul bill – washingtonpost.com.  Here are some highlights:

COST: $940 billion over 10 years, according to the Congressional Budget Office.

HOW MANY COVERED: 32 million uninsured. Major coverage expansion begins in 2014. When fully phased in, 95 percent of eligible Americans would have coverage, compared with 83 percent today.

INSURANCE MANDATE: Almost everyone is required to be insured or else pay a fine. There is an exemption for low-income people. Mandate takes effect in 2014.

INSURANCE MARKET REFORMS: Starting this year, insurers would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions, and from canceling policies because someone gets sick. Parents would be able to keep older kids on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear. Major consumer safeguards would also take effect in 2014. Insurers would be prohibited from denying coverage to people with medical problems or charging them more. Insurers could not charge women more.

MEDICAID: Expands the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014. The federal government would pay 100 percent of costs for covering newly eligible individuals through 2016. A special deal that would have given Nebraska 100 percent federal financing for newly eligible Medicaid recipients in perpetuity is eliminated. A different, one-time deal negotiated by Democratic Sen. Mary Landrieu for her state, Louisiana, worth as much as $300 million, remains.

TAXES: Dramatically scales back a Senate-passed tax on high-cost insurance plans that was opposed by House Democrats and labor unions. The tax would be delayed until 2018, and the thresholds at which it is imposed would be $10,200 for individuals and $27,500 for families. To make up for the lost revenue, the bill applies an increased Medicare payroll tax to the investment income and to the wages of individuals making more than $200,000, or married couples above $250,000. The tax on investment income would be 3.8 percent. . . .

EMPLOYER RESPONSIBILITY: As in the Senate bill, businesses are not required to offer coverage. Instead, employers are hit with a fee if the government subsidizes their workers' coverage. The $2,000-per-employee fee would be assessed on the company's entire work force, minus an allowance. Companies with 50 or fewer workers are exempt from the requirement. Part-time workers are included in the calculations, counting two part-timers as one full-time worker.

SUBSIDIES: The proposal provides more generous tax credits for purchasing insurance than the original Senate bill did. The aid is available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.

This seems like we’ll be spending an awful lot of money for not all that much. We go from 83% of Americans with health insurance to 95%, a gain of 12%? More people will be getting government money. Does a family of four making $88,200 really need a subsidy? Isn’t that a really good salary? (Most college professors don’t make anywhere near that, and yet they do OK.) I’m curious what percentage of Americans will go on at least a partial dole. Quite a lot, I’d think.

And it doesn’t go into effect until 2014! So why all the urgency in the rhetoric and in the push to get this passed?

Other thoughts about what this bill would do?

Passing Health Care without voting for it

Our Democratic leaders are resolved to pass the health care reform bill no matter what.  Even if it doesn’t have the votes.  Here is the latest strategy:

After laying the groundwork for a decisive vote this week on the Senate's health-care bill, House Speaker Nancy Pelosi suggested Monday that she might attempt to pass the measure without having members vote on it.

Instead, Pelosi (D-Calif.) would rely on a procedural sleight of hand: The House would vote on a more popular package of fixes to the Senate bill; under the House rule for that vote, passage would signify that lawmakers “deem” the health-care bill to be passed.

The tactic — known as a “self-executing rule” or a “deem and pass” — has been commonly used, although never to pass legislation as momentous as the $875 billion health-care bill. It is one of three options that Pelosi said she is considering for a late-week House vote, but she added that she prefers it because it would politically protect lawmakers who are reluctant to publicly support the measure.

“It's more insider and process-oriented than most people want to know,” the speaker said in a roundtable discussion with bloggers Monday. “But I like it,” she said, “because people don't have to vote on the Senate bill.”

via House may try to pass Senate health-care bill without voting on it – washingtonpost.com.