Health Care Bill: What does it entail?

I haven’t had much time lately to pay attention to the news, and all the recent changes. So, what does the bill that passed the house today actually entail?

Does it have to go back to the Senate, or onto the President to be signed?

What does the bill actually do? I’m especially interested in any changes dealing with Pharmacy, medications, or Big Pharma… But also want to know other things.

I posted this in GQ, and I would appreciate non-partisan answers. As free of left-wing propaganda, or right-wing rhetoric, as possible.


Given the heated nature of the debate on this, I would like to emphasize this to anyone posting in this thread. Let’s try to keep this in GQ and avoid partisan rhetoric. There are plenty of other active threads in GD and the Pit where you can express your opinions on the matter. Let’s keep responses here factual.

General Questions Moderator

This seems to be a pretty good fact-based article on the bill will do over the next few years:

First, the procedure:
The House passed two separate bills tonight. First, they passed a version of the health care bill identical to that which already passed the (pre-Brown) Senate. Since identical bills have now passed both houses, it now goes to the President’s desk. So that part is now a certainty. Second, they also passed a package of amendments to the bill, to make changes they wanted relative to the bill the Senate had already passed. This package of amendments will now go to the Senate, and might still bounce back and forth between the two houses with more amendments. They’re using a procedure called “reconciliation” for this amendment package, which means that the Senate rules don’t allow it to be filibustered, so ultimately only 50 votes (plus Biden’s tie-breaker) will be needed to pass it. There are currently over 50 senators who have said that they will pass it, so it’ll probably pass that hurdle, but it’s still possible that the Senate parliamentarian (an officer in charge of making sure that the Senate follows the rules it’s set for itself) will rule that some of the changes can’t legitimately be made through the reconciliation process. So most or all of these changes are pretty likely, but not certain.

As for the actual content of the bill, there are three big things:
First, health insurance companies will no longer be allowed to turn away customers because of a pre-existing condition.
Second, since they can’t turn away pre-existing conditions, people would be tempted to not buy insurance at all while they’re healthy, and only buying it after they become sick, which would collapse the whole system. To prevent this, everyone will now be required to have health coverage at all times. If you don’t, you will pay an extra tax as a fine.
Third, since not everyone can afford to comply with the second requirement, the bill also includes means-based subsidies to enable the poor to afford the insurance required of them.

Adding a couple specific questions to the OP, rather than starting a new Thread:

How poor do you have to be to be excused from compulsory purchase of your own insurance / deemed in need of subsidy?
All the time this bun has been in the oven, I’ve heard that the end result still would fall short of insuring all Americans. If those who can afford it are required to purchase insurance, and those who can not afford it will receive a subsidy, then who are the people who will still be left uninsured?

Subsidies will go to those making 400% of the poverty level or less, but I think the subsidies decrease as income rises.

The fine for not having insurance will be $695 or 2.5% of ones income, whichever is higher. Since the bill prevents health insurance companies from excluding those with pre-existing conditions, and that most health insurance cost quite a bit more than the fine, for many people it will simply make more sense to pay the fine, and only buy insurance if they get seriously ill/injured.

Thanks for all the responses so far, I looked at the link that enalzi posted, and there were a couple statements I had questions on, and would like explained.


What does this actually mean? Are they eliminating the doughnut hole in Medicare part D? How are they giving this “rebate”? Will the patient have to pay first, then get it back on their taxes? (hope not, Medicare part D is hard enough to explain already!) How are they planing on closing the doughnut hole, and when does each stage take effect?


How much is this fee? How is is administered?


What do they mean by “medical devices”? Does this include Durable Medical Equipment filled by pharmacies?

Again, thanks for all the answers!

If I"m reading this correctly, other than the option for people who have pre-existing conditions to get health insurance (at the current market rates, in the current way), nothing is going to take effect till 2014 right? Except the ability for people currently not insurable due to pre-existing condition can buy it with 90 days of passage, right?


There are several things in last night’s bill that are to come into effect in the short and medium terms (e.g., tax credits for 2009, insurance exchanges). The Devil household runs on an S-corp, with just the two of us as employees. There are no outstanding issues, but we pay for our own insurance on a monthly basis and are about to do our taxes. There are both backward (we just had The Dude in 2009) and forward-looking areas of interest for us, but there is much more coverage of the political wrangling and partisan prognostications of what the law will/might do than there is pragmatic, if this law passes, you’ll get X, Y, and Z if you meet qualifications 1, 2, and 3-type information.

I realize some things are still up in the air, and that court and procedural challenges have yet to be met for many things, but I’d like to ramp up and get familiar with things as soon as possible. Is there a government or non-partisan information clearing house with good information about what to do now?




I don’t want to hijack this thread too much, but I have a related question.

I’m currently self-employed and buy my own health insurance. Due to a shoulder injury in college (which I’ve had repaired/rehabbed completely :rolleyes:), there is a waiver on my current policy that completely excludes my shoulder from any type of coverage.

Will these types of exclusions be eliminated? If so, how soon?

There’s a simple but somewhat useful interactive tool here.

I found it in this article, also somewhat useful.

I’ll jump on the boat here and ask about this one, from the Reuters article linked above:

As I understand it, based on some documentary about Wal Mart, that company is notorious for not providing insurance for its workers and urging them to seek out government government assistance. IIRC, the way Wal Mart does it is to simply not let anyone work full time.

What does the clause summarized above actually say about full time vs. part time? Is Wal Mart going to keep being able to skirt insuring workers?

My understanding is that under the bill, 2 part time employees are considered 1 full time employee, regardless of hours worked. <WAG>That being said, Wal Mart is currently a huge company. The solution?

Franchises! By having each big box employ 97 workers working 30 hours a week, no Wal Mart store would have to pay the fine, which would amount to an extra $100,000 tax for every 50 employees.</WAG>

I am pretty sure the senate parliamentarian is an advisory role only and they cannot force the senators to do what they say. In general I think the senate does listen to the parliamentarian but they do not have to.

Several state AG’s have already said they’ll start legal challenges. I suspect it’ll go to the Supreme Court before it’s implemented.

Thanks. For tidiness, I wonder if this thread should be merged into the earlier [Health Care Bill: What does it entail?](Health Care Bill: What does it entail?) I’ll leave it up to the mods to decide.


Since these two threads are so similar, I have merged Rhythmdvl’s thread with the earlier one by Hirka T’Bawa

General Questions Moderator

No… you’re right that a lot of the major provisions don’t take effect until 2014 but there’s a bunch of stuff that kicks in this year as well. Small businesses will get tax credits, dependents will be allowed to stay on their parent’s insurance up to the age of 26, there will be $250 tax rebates for anyone in the “doughnut hole”, people can no longer be dropped from their coverage when they get sick (ie. it bans rescissions) and it sets up temporary pools to provide insurance to anyone who can’t get any because of a pre-existing condition, among other things. This PDF briefly outlines all the provisions that take effect this year and when they take effect:

Also some of the cost-saving measures kick in before 2014, hence the Republican criticism that the bill offsets “6 years of spending with 10 years of taxes” (a criticism which is disingenuous because after those periods the bill saves even more money than it spends, and it saves more money than it spends overall).

What the healthcare bill entails:

A basic summary of what the bill entails is this:

  1. Insurance company regulations: The bill implements much more stringent regulations on insurers, banning them from dropping coverage when someone gets sick, forcing them to offer coverage even when someone has a pre-existing condition and forcing them to offer at least a basic level of coverage in all their plans, a level determined by the government (these measures are what prompt the ‘government takeover’ criticism). Healthcare exchanges will be set up to allow people to compare plans and get a good deal.

  2. The ‘Individual Mandate’: Step one can’t be done on its own, because then healthy people wouldn’t buy insurance because they’d know they can just buy it as soon as they get sick (pre-existing conditions can’t matter any more, remember). That would leave insurance companies with only sick people on their books - spending more on treatments than they get in premiums - and they’d go bankrupt. So to avoid this, Obama’s bill institutes the ‘individual mandate’, which requires all citizens to get health insurance or pay a fine every year. This does not apply to illegal immigrants, who are not allowed to buy into the exchanges.

  3. Subsidies: Step two can’t be done on its own either (i.e. forcing people to buy insurance or pay a fine), because a lot of people can’t afford it. To counter this problem Obama’s bill provides generous subsidies to help people to afford health insurance. These funds cannot be used for abortions - the bill does not allow for taxpayer-funded abortions - and illegal immigrants cannot get subsidies.

  4. Cost-saving measures: Finally, a separate problem for the US health care system is that in its current form its spending is unsustainable. Health spending is skyrocketing and entitlement programs, in particular Medicare, will bankrupt the country within about 70 years unless they are significantly reformed. The bill includes a lot of small-scale trial programs to try and save costs, the idea being that we can see what works and what doesn’t on a small scale, and then take what works and expand it later. These measures include an excise tax on ‘Cadillac plans’, a Medicare commission and ‘bundling payments’, where doctors get paid once for someone’s total treatment, rather than at present where they get paid per treatment or scan they recommend, encouraging needless treatments. The bill does not entail cuts to Medicare itself, but it does rein back on Medicare Advantage, which Obama argues contains a lot of wasteful spending. (This is where the Republicans have derived their criticisms about Obama ‘cutting Medicare’.) The bill is projected by the respected, non-partisan CBO to cut the deficit by more than $100 billion over the first ten years, and by $1.2 trillion over the second ten years. Republicans question these figures for reasons which I don’t find very convincing - I can explain them a bit if you like.
    Overall it’s actually a fairly conservative, moderate plan. It closely resembles the successful health care system set up by Mitt Romney in Massachusetts, as well as the plan proposed by Bob Dole in 1993 as an alternative to Clinton’s bill. The majority of Republican criticism has been disingenuous at best and false at worst.

Under this bill, the amount your employer pays for your insurance is going to be included in your W2 starting next year. Is it safe to assume that this will then be included in your income, and therefore subject to income taxes?