# Health Care Reform Bill Questions - 1 year later **URL:** \ **Category:** Great Debates\ **Created:** [March 22, 2011, 6:10am UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580 "2011-03-22T06:10:21Z")\ **Posts on this page:** 18\ **Page:** 1
**Author:** ![Alzarian](https://avatars.discourse-cdn.com/v4/letter/a/ad7895/32.png) [@Alzarian](https://boards.straightdope.com/u/Alzarian)\ **Post date:** [March 22, 2011, 6:10am UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/1 "2011-03-22T06:10:21Z")
I got into a rather interesting debate about a year ago with a friend of mine as to what would happen as a result of the healthcare reform bill being passed. He didn’t have a lot of faith in it, and made a prediction about what would happen in a year. Well, it is just about a year later, and I want to look at his prediction and see what came true, and what didn’t, and what is still unclear. His prediction: Those of us who oppose this Bill will be proved correct within a year when premiums continue to rise, benefits are reduced, taxes go up, the deficit rises, our bonding rating is cut, and inflation begins to surge. Within a year, Democrats will be passing supplemental Bills that weren’t part of the original Bill (Because they knew the CBO score would find these exceeding $1 trillion) as a “fix”. That will contribute immediately to the deficit. Then the Democrats will start raising taxes on gas, cable, telephone, liquor, soda, etc. === So, was he right? 1. have premiums continued to rise, 2. have benefits been reduced, 3. have taxes go up, 4. did Democrats pass supplemental Bills that weren’t part of the original Bill as a “fix”, 5. has the deficit risen (as a result of the passing of supplemental bills to “fix” the bill), 6. has our bonding rating been cut, 7. has inflation begun to surge, 8. Did the Democrats raise taxes on gas, cable, telephone, liquor, soda, etc. Factual answers with some sort of proof would also be helpful. Thanks for any assistance! ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [March 22, 2011, 11:47am UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/2 "2011-03-22T11:47:45Z")
Most of the bill doens’t take effect until 2014. Health insurance premiums have been jumping 10-30% a year for the last several years. However there were some consumer protections that were implemented in 2010 which raised rates 1-3%. Taxes go up on medicare for incomes above 250k. I don’t know if they go up for other people via the health care bill. The deficit was massive long before health reform. The goal of health reform is to lower the deficits over 75 years since most of those deficits are health related. By and large it is too soon to say. As far as our bond rating, deficit and inflation, those things, if they do happen, will happen due to the recession. Health reform wouldn’t make a difference. ---
**Author:** ![Mr.Moto](https://avatars.discourse-cdn.com/v4/letter/m/9de0a6/32.png) [@Mr.Moto](https://boards.straightdope.com/u/Mr.Moto)\ **Post date:** [March 22, 2011, 1:57pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/3 "2011-03-22T13:57:37Z")
The 1099 issue did have to be fixed in subsequent legislation. In addition many companies and governments are being permitted administrative waivers from certain aspects of the health care law because the costs would be prohibitive or other competitive issues came into play. So that aspect of the prediction is true, though that wouldn’t have been a hard one to predict. ---
**Author:** ![wevets](https://avatars.discourse-cdn.com/v4/letter/w/e9a140/32.png) [@wevets](https://boards.straightdope.com/u/wevets)\ **Post date:** [March 22, 2011, 2:05pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/4 "2011-03-22T14:05:43Z")
CPI in the United States stood at 2.108% in February 2011 CPI in the United States stood at 2.144% in February 2010 Source: [Inflation in United States - current and historic American consumer price index (CPI)](http://www.global-rates.com/economic-indicators/inflation/consumer-prices/cpi/united-states.aspx) It should be noted that between 2010 and 2011 there was a big dip in CPI, bottoming out in June at 1.053%, and that CPI is not a perfect measure of inflation. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [March 22, 2011, 2:10pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/5 "2011-03-22T14:10:28Z")
> [@](#): > > did Democrats pass supplemental Bills that weren’t part of the original Bill as a “fix” I believe they will have to do this. The assumption is that there will be significant cuts to Medicare, and that is where the extra spending for Obamacare is coming from. > [@](#): > > Altogether, ObamaCare cuts $818 billion from Medicare Part A (hospital insurance) from 2014-2023, the first 10 years of its full implementation, and $3.2 trillion over the first 20 years, 2014-2033. Adding in ObamaCare cuts for Medicare Part B (physicians fees and other services) brings the total cut to $1.05 trillion over the first 10 years and $4.95 trillion over the first 20 years. > > These draconian cuts in Medicare payments to doctors, hospitals and other health-care providers that serve America’s seniors were the basis for the Congressional Budget Office’s official “score”—repeatedly cited by the president—that the health-reform legislation would actually reduce the federal deficit. [Cite.](http://online.wsj.com/article/SB10001424052748703649004575437311393854940.html) Regards, Shodan ---
**Author:** ![Great\_Antibob](https://avatars.discourse-cdn.com/v4/letter/g/e47c2d/32.png) [@Great\_Antibob](https://boards.straightdope.com/u/Great_Antibob)\ **Post date:** [March 22, 2011, 2:19pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/6 "2011-03-22T14:19:14Z")
> [@Shodan](#): > > I believe they will have to do this. Perhaps, and that’s certainly a valid debate topic. But the factual answer is that, as of one year later, it hasn’t happened, nor have many of the other predictions. Of course, it’s not outside the realm of possibility they all occur within 2-5 years of passage of the bill. Though, at that point, it will be much harder to point to the health care bill as the sole cause. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [March 22, 2011, 2:47pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/7 "2011-03-22T14:47:32Z")
Obamacare won’t be fully implemented until 2014, as \*\*Wesley Clark \*\*points out.I don’t think it makes a lot of sense to talk about the effects after it is passed. So the OP’s friend is wrong, but not in any way that makes any difference. Regards, Shodan ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [March 22, 2011, 3:04pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/8 "2011-03-22T15:04:53Z")
My health insurance premium went from $0 to $10 bimonthly, but the cost to my employer went down by roughly $790 over a year. For whatever that’s worth. ---
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [March 22, 2011, 3:21pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/9 "2011-03-22T15:21:44Z")
> [@Shodan](#): > > I believe they will have to do this. The assumption is that there will be significant cuts to Medicare, and that is where the extra spending for Obamacare is coming from. > > [Cite.](http://online.wsj.com/article/SB10001424052748703649004575437311393854940.html) > > Regards, > Shodan Your cite is an opinion piece that is highly prejudicial in its framing. Since that’s fair game: [http://www.washingtonpost.com/blogs/ezra-klein/post/column-explaining-health-care-reform/2011/03/10/ABB7IUCB\_blog.html](http://www.washingtonpost.com/blogs/ezra-klein/post/column-explaining-health-care-reform/2011/03/10/ABB7IUCB_blog.html) > [@](#): > > The big offsets in the health-care law slow payment increases to certain classes of providers (which means, ultimately, doctors) who participate in Medicare ($240 billion), cut payments to private insurers that participate in Medicare but cost more than the basic Medicare program does ($140 billion), an increase in the Medicare tax paid by high-income folks ($210 billion) and a new tax on very expensive health-care plans ($20 billion, although much more than that between 2020 and 2029), and so on. All in all, the legislation is expected to save or raise about $100 billion more than it spends in the first 10 years. You can see all the offsets and expenses in a simple table here. > > The cost controls will occur over a longer period and are more speculative. Medicare, for instance, is going to experiment with paying hospitals a flat sum for all successful care associated with a particular condition. This will mean that doctors make more money when they do less and are successful at it, rather than making more for doing more, as is the case now. The tax on expensive health insurance plans is meant to drive people — and employers — to seek plans that better control costs. Of course Ezra Klein, who wrote my cite, has the advantage of not being a venomously partisan, like the two dudes who wrote yours. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [March 22, 2011, 4:59pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/10 "2011-03-22T16:59:59Z")
> [@Mr.Moto](#): > > The 1099 issue did have to be fixed in subsequent legislation. In addition many companies and governments are being permitted administrative waivers from certain aspects of the health care law because the costs would be prohibitive or other competitive issues came into play. Also the CLASS Act is likely to be repealed, since it’s fundamentally unsound, actuarially speaking, and was included in the bill mostly because it was a useful accounting gimmick. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [March 22, 2011, 5:03pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/11 "2011-03-22T17:03:53Z")
In what sense is it “fundamentally unsound”? It doesn’t define the premiums, only the minimum benefits. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [March 22, 2011, 5:19pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/12 "2011-03-22T17:19:46Z")
> [@Really\_Not\_All\_That\_Bright](#): > > In what sense is it “fundamentally unsound”? It doesn’t define the premiums, only the minimum benefits. If the premiums for an insurance product get too high (relative to the benefit), then a disproportionate percentage of the people who are willing to pay for it are those who are pretty sure they need it, which tends to drive the prices even higher, and so on. One of the most fundamental principles of actuarial science is spreading risk, and avoiding adverse selection. I’ve not followed the CLASS Act issue in that depth, but apparently it has severe problems along these lines - the American Academy of Actuaries has been harping about it for well over a year, at least. Apparently the Obama administration belatedly agrees as well. See: [http://blogs.reuters.com/prism-money/2011/02/24/obama-moving-to-address-flaws-in-public-option-for-long-term-care/](http://blogs.reuters.com/prism-money/2011/02/24/obama-moving-to-address-flaws-in-public-option-for-long-term-care/) ---
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [March 22, 2011, 6:26pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/13 "2011-03-22T18:26:08Z")
> [@Fotheringay-Phipps](#): > > I’ve not followed the CLASS Act issue in that depth, but apparently it has severe problems along these lines - the American Academy of Actuaries has been harping about it for well over a year, at least. Apparently the Obama administration belatedly agrees as well. See: [http://blogs.reuters.com/prism-money/2011/02/24/obama-moving-to-address-flaws-in-public-option-for-long-term-care/](http://blogs.reuters.com/prism-money/2011/02/24/obama-moving-to-address-flaws-in-public-option-for-long-term-care/) I don’t see anything in there that mentions repeal of CLASS. The solutions proposed are indexing premiums to inflation, adding penalties if you opt-out and then back in, and adding incentives for employers to participate. As for the OP: 1. No more than before, in some cases less 2. Benefits have increased (the 25-year old provisions, reccision restrictions, a few other consumer protections) 3. I believe there have been a few tax increases 4. The only fix I know of is the 1099 fix 5. I don’t recall if the 1099 fix added to the deficit - I seem to recall hearing it did, but that is was a bit of a conjecture (basically tax avoidance) 6. No 7. No 8. No ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [March 22, 2011, 6:49pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/14 "2011-03-22T18:49:21Z")
> [@Jas09](#): > > I don’t see anything in there that mentions repeal of CLASS. That was not the intent of that cite. See: [http://www.mcknights.com/congressman-to-introduce-bill-to-repeal-class-act-after-hearing-discussion-of-strengths-flaws-of-long-term-care-insurance-program/article/198613/#](http://www.mcknights.com/congressman-to-introduce-bill-to-repeal-class-act-after-hearing-discussion-of-strengths-flaws-of-long-term-care-insurance-program/article/198613/#) If it won’t be repealed, it will need to be significantly changed, which is the same thing for purposes of this thread. > [@](#): > > 1. I don’t recall if the 1099 fix added to the deficit - I seem to recall hearing it did, but that is was a bit of a conjecture (basically tax avoidance) You have it backwards. The 1099 rule was counted as a budget savings in the original CBO estimates. You can call that conjecture and not count it, if you like. But you can’t count the budget savings from the rule, and then refuse to remove them when the rule is repealed because it’s conjecture. ---
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [March 22, 2011, 7:29pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/15 "2011-03-22T19:29:52Z")
> [@Fotheringay-Phipps](#): > > The 1099 rule was counted as a budget savings in the original CBO estimates. You can call that conjecture and not count it, if you like. But you can’t count the budget savings from the rule, and then refuse to remove them when the rule is repealed because it’s conjecture. Agreed. So I guess you could be extremely generous and count that fix as a $17.1 billion increase in the deficit, even though the bill that repealed it included other savings to offset (IIRC). Of course it still doesn’t meet the OP criteria, because it wasn’t passed by Democrats (it was bi-partisan). As for CLASS, I am skeptical it will be repealed. Reforms seem much more likely, and I doubt we’ll see much of that until it gets closer to implementation anyways (or perhaps even after, when the impact of the actuarial projections becomes more tangible). And again, it doesn’t count for the OP’s list because it hasn’t happened yet. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [March 22, 2011, 7:56pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/16 "2011-03-22T19:56:46Z")
> [@Jas09](#): > > Agreed. So I guess you could be extremely generous and count that fix as a $17.1 billion increase in the deficit, even though the bill that repealed it included other savings to offset (IIRC). I don’t think the repeal has been finalized yet, unless I’ve missed something - last I knew the House and Senate had passed competing versions of the repeal. > [@](#): > > Of course it still doesn’t meet the OP criteria, because it wasn’t passed by Democrats (it was bi-partisan). Nothing that got passed since January is going to be passed without Republican support, so that’s pretty much a technicality. > [@](#): > > As for CLASS, I am skeptical it will be repealed. Reforms seem much more likely, and I doubt we’ll see much of that until it gets closer to implementation anyways (or perhaps even after, when the impact of the actuarial projections becomes more tangible). Possible. The longet it gets put off the likelier it is that it will be reformed versus repealed - it’s very hard to uproot this type of program once it gets established. As noted above, the popularity of this part of the bill was because of its accounting gimmick aspect - since the CBO was limited to a 10 year projection window, this enabled HCR supporters to project a money-losing backloaded plan as a money winner. (Also, IIRC it had some emotional appeal, since Ted Kennedy had championed it.) Once we get to the point where the program is in use and costing money each year it will be a lot more tempting for budget cutters to revamp it. > [@](#): > > And again, it doesn’t count for the OP’s list because it hasn’t happened yet. True, although the 1 year time frame is somewhat arbitrary, and inapropriate for a program whose main aspects don’t take affect until 2014, as others have noted above. ---
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [March 22, 2011, 8:31pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/17 "2011-03-22T20:31:10Z")
I think I agree on all of that. I had for some reason thought the Senate and House reached a compromise, but that appears not to be the case. I slightly disagree with the notion that it’s an accounting gimmick, but I can see how it could be viewed that way. In my opinion any forceast over 10 years might as well be called a gimmick as well - there is just no way to realistically predict the budget situation on that kind of time scale, and government agencies of all types have been failing at it for a long time. Clearly the majority of the claims made by the friend of the OP were exaggerated and did not come to pass. Also just as clearly, no verdict can be reached on the efficacy of “Obamacare” until after the majority of the provisions to into effect. All we have now is the same arguments for and against with the same competing claims and the same varied predictions (Sen. Coburn had one today at NRO that could have very easily been written before the bill even passed). Time will tell if it even gets implemented - much rides on the 2012 elections and whatever action SCOTUS does or does not take. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [March 22, 2011, 9:07pm UTC](https://boards.straightdope.com/t/health-care-reform-bill-questions-1-year-later/575580/18 "2011-03-22T21:07:15Z")
> [@Jas09](#): > > I slightly disagree with the notion that it’s an accounting gimmick, but I can see how it could be viewed that way. In my opinion any forceast over 10 years might as well be called a gimmick as well - there is just no way to realistically predict the budget situation on that kind of time scale There’s a big difference between difficult to predict on the one hand and obviously and deliberately skewed on the other > [@](#): > > government agencies of all types have been failing at it for a long time. Almost always on the low side, too. > [@](#): > > Also just as clearly, no verdict can be reached on the efficacy of “Obamacare” until after the majority of the provisions to into effect. And possibly not after that as well. If the exchanges are a disaster in 2014, then people will still say give them time. If they start out OK, other people will doom their long-term prospects. [FWIW, many professionals don’t think the exchanges will offer cost-effective coverage. One emerging strategy - being pushed by my firm, among others - is for employers to offer a bare-bones low cost plan with low contributions, so that the employer pays no penalties, and charge employees full cost for any buy-up to a better plan, and possibly charge full cost for dependent coverage as well. One component of this and similar schemes is that high-cost employees will opt for coverage on the exchanges and healthier employees will remain in the employer plans.] I once saw a WW1 historian noting that how scholars and writers allocated “fault” for the war after it happened was primarily determined by what their ideology (or nationality) was beforehand. So I don’t think things like this ever get settled definitively. At this point, the rash of waivers doesn’t speak well for the law as passed, IMHO, but I agree that you can’t make any firm conclusion based on the evidence to date.