Sep 17, 2009 - tax cuts; hails President Bill Clinton â 'Third Way'. ⢠Professionals - college education, medical students, scientists. ⢠Academia - 72% of ...
Democrats on Health Care Reform
by Preeti Zanwar U.S. Health Policy Course University of Texas School of Public Health October 8, 2009
Democratic Party History •
Oldest political party in continuous operation in the US
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Origins D-R Party founded by Thomas Jefferson & James Madison, & opponents of Federalists in 1792. Jeffersonians labeled ‘Democratic’ by opposition Federalists.
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The modern DP arose in the 1830s election of Andrew Jackson.
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Most registered voters of any party (2004): 72 M (42.6% of 169 M registered)
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1st quarter of 2009: 52% identified DP; 39% Republican
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Since 2006 General Elections: Majority party in House of Representatives (257/435) and US Senate (58/100)
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Majority of State Governorships and State Legislatures.
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Barack Obama: 15th Democrat to hold office. Platform: center-left
Who Comprises Democratic Party? • • •
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Civil libertarians - issues as civil rights, separation of church, oppose gun control Conservatives - 15% of registered voters, hold some socially conservative - right wing Centrists - use of military force, war in Iraq, reducing government welfare, tax cuts; hails President Bill Clinton ‘Third Way’ Professionals - college education, medical students, scientists Academia - 72% of full-time faculty members Youth -18-29 years Working Class African Americans Hispanics Asian Americans - made gains starting 1996; in 2006, won 62% vote Native Americans Jewish Americans – 60% of conservative Jews for Obama in 2008 Arab & Muslim Americans - since Iraq War, 39% in 2007)
Progressive Democrats of America: Liberals
Source: Opinions of liberals in a 2005 Pew Research Center study
Democratic and Republic Public View on Health Reform
Presidential Politics and the Resurgence of Health Care Reform Jonathan Oberlander. NEJM 2007. Vol. 357, Iss. 21; pg. 2101
Health Care Reform in America • 1934 -- Private insurance companies begin selling • 1935 – 1st compulsory HI bill: ‘Epstein bill’ Sen. Arthur Capper introduced in Congress. President Franklin D. Roosevelt signs the SSA includes grants for maternal and child health law • 1939 -- Sen. Robert Wagner introduces bill national compulsory HI for all employees and their dependents, to be administered by the states. Benefits: coverage for doctors' services, hospitalization, drugs and diagnostic services. Employer and employee contributions, deposited in a health insurance fund, would cover costs. The bill dies in committee. • 1943 – 1st ‘Wagner-Murray-Dingell’ bill Sens. Robert Wagner and James Murray and Rep. John Dingell. The bill calls SSA, including the creation of a compulsory national HI program to be financed by a payroll tax. Congress takes no action on the proposal.
Health Care Reform in America • 1946 -- Revised Wagner-Murray-Dingell bill introduced in Congress. Senate bill grants to states for medical care for the poor. Neither bill gets momentum. • 1954 -- President D. Eisenhower proposes a federal reinsurance fund for private insurers to broaden coverage, but it goes nowhere. Revenue Act of 1954 excludes employer contributions to health plans from taxable income, creating further incentives for employer-based insurance. • 1965 -- President L. Johnson signs into law the Medicare program for hospital, nursing and physician care for the elderly, and the Medicaid program to assist states in covering the poor and the disabled. Neighborhood health centers are established.
• 1970s -- President Richard Nixon and Sen. Edward Kennedy sponsor competing legislative proposals. Congress debates a number of alternative bills, but soaring inflation, economic recession and rising health-care costs blunt reform.
Health Care Reform in America • 1986 -- Congress passes Emergency Medical Treatment and Active Labor Act to require hospitals to screen & stabilize everyone who uses their emergency rooms regardless of ability to pay. New regulations allow employees who lose their jobs to continue with their health plan for 18 months.
• 1987 -- Census Bureau begins annual estimate of HI coverage. # of uninsured: 31 M (13% of population) • 1993 -- President Clinton & Hillary, then chair of the White House Task Force on Health Reform, craft a detailed plan calling for universal coverage that relies largely on competition between private insurers, with govt. regulation to control costs. The plan fails to garner sufficient support in Congress. • 1997 -- Balanced Budget Act, Congress approves the State Children's Health Insurance Program to cover low-income children above Medicaid eligibility levels. In 2009, President Barack Obama signs an expansion of the law. # uninsured: 42.4 M (15.7% of population)
Health Care Reform in America •
2002 -- President GW. Bush: Health Center Growth Initiative expands # of community health centers serving medically underserved.
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2003 -- Republican-controlled Congress expands Medicare cover prescription drug costs for Medicare beneficiaries through private insurance. The program (Medicare Part D) in effect 2006. HSA allow those in high-deductible plans to set aside pretax dollars to pay for care.
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2006 -- July, Massachusetts: legislation require all residents to obtain coverage. 2008: state's uninsured rate 1/2. Vermont also passes comprehensive reform aiming for near-universal coverage.
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2007 -- President Bush proposes to replace the tax preference for employersponsored insurance with a standard health-care deduction, but Congress does not act on the plan. # uninsured: 45.6 M (15.3% of population).
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2009 -- President B. Obama establishes Office of Health Reform budget proposal outlines 8 principles health reform: $634 B in funding. Congress debating legislation that would set up a govt. run insurance plan to compete with private insurers, provide coverage to the uninsured and try to lower medical costs.
Health Care Reform Proposals • Sen. Max Baucus's bill (America’s Healthy Future Act) • Senate Health, Education, Labor and Pensions Committee's outline or Senate HELP Committee (Affordable Health Choices Act)
• House Democratic bill (America’s Affordable Health Choices Act of 2009) • President Obama's proposal (Obama on Health Care) • House Republican Outline (Patient’s Choice Act)
Who is Covered? • Sen. Max Baucus's bill - Around 95% of Americans. Illegal immigrants would not receive government benefits • Senate HELP Committee's outline - Aims to cover 97% of Americans • House Democratic bill - ~ 94% of non-elderly residents (those not covered by Medicare) would be covered. ~ ½ of 17 million non-elderly residents who remain uninsured would be illegal immigrants.
• President Obama's proposal – wants to cover ALL Americans • House Republican Outline - Aims to make insurance affordable and accessible to all. No estimates about how many additional people would be covered
Cost • Sen. Max Baucus's bill $856 billion over 10 years • Senate HELP Committee's outline ~ $615 billion over 10 years • House Democratic bill ~ $1.5 trillion over 10 years • President Obama's proposal – wants to cover ALL Americans $900 billion over a decade • House Republican Outline Unknown
How it’s going to be paid for? •
Sen. Max Baucus's bill Fees on insurance companies, drug makers, medical device manufacturers and insurers. Tax of 35% on premiums on plans costing more than $8,000 for individuals ($21,000 for families.) Cuts to Medicare and Medicaid. Fee on employers whose workers receive govt. subsidies. Fines on individuals who fail to get coverage.
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Senate HELP Committee's outline The Senate Finance Committee is responsible for figuring out how to cover costs.
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House Democratic bill Revenue-raisers: $544 billion over 10 years from new income taxes on single people making > $280,000/year and couples > $350,000; $37B in business tax increases; $500B in cuts to Medicare and Medicaid; sizable penalties paid by individuals and employers who don't obtain coverage.
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President Obama's proposal - tax high-value insurance plans; most of the cost would be paid for by cuts to Medicare.
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House Republican Outline No new taxes proposed, but Republicans want to reduce Medicare and Medicaid fraud.
Requirements for individuals • Sen. Max Baucus's bill Everyone must get coverage through employer, on their own, or through a govt. plan. • Senate HELP Committee's outline Individuals will have to have insurance, enforced through tax penalties with hardship waivers. • House Democratic bill Individuals must have insurance, enforced through tax penalty with hardship waivers. • President Obama's proposal – Did not propose an "individual mandate" during the campaign. Now Supports an individual mandate as long as hardship waivers are provided. • House Republican Outline No mandates.
Requirements for employers Sen. Max Baucus's bill Not required to offer coverage, but companies > 50 full-time workers would pay a fee if the Govt. ends up subsidizing employees' coverage.
Senate HELP Committee's outline Employers who don't offer coverage will pay a penalty of $750 a year for each full-time worker. Businesses < 25 workers are exempt. House Democratic bill Employers must provide insurance to their employees or pay a penalty of 8% of payroll. Companies with payroll under $250,000 annually are exempt. Employers: 2 yr exemption from the mandate if they can prove the requirements would result in job losses negatively affect their communities. President Obama's proposal - Businesses > 50 workers required to offer their workers coverage or pay a fee. House Republican Outline - No mandates; small business tax credits are offered. Employers are encouraged to move to "opt-out" rather than "optin" rules for offering health coverage.
Subsidies Sen. Max Baucus's bill Tax credits for individuals and families making up to 300% of the federal poverty level $66,150 for a family of 4. Households up to 400% of poverty line could also get some relief. Tax credits for small employers. Senate HELP Committee's outline Available up to 400% poverty level $88,000 for a family of 4 House Democratic bill Individuals and families with annual income up to 400% of poverty level ($88,000 for a family of 4). The subsidies would begin in 2013. President Obama's proposal Low-income people, no specification on what income level is House Republican Outline Tax credits are offered to "low- and modest-income" Americans. People who aren't covered through their employers but buy their own insurance are allowed to take a tax deduction. Low-income retirees < 65 (the eligibility age for Medicare) would be offered assistance.
Benefits package Sen. Max Baucus's bill Govt. set 4 benefit categories: ranging from coverage of 65% of medical costs to 90%. No denial of coverage based on pre-existing conditions. All plans sold to individuals and small businesses would have to cover basic benefits, including primary care, hospitalization and prescription drugs. Senate HELP Committee's outline Health plans must offer a package of essential benefits recommended by a new Medical Advisory Council. No denial of coverage based on preexisting conditions. House Democratic bill New Health Insurance Exchange: to individuals + small employers; could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules. President Obama's proposal No description of specific benefit package that should be offered. Wants to prevent insurers from denying coverage to people with pre-existing conditions; limit premium variation based on age; and stop insurers from dropping people when they get sick. House Republican Outline Insurers would have to allow children to stay on their parents' plan through age 25
Government-run plan Sen. Max Baucus's bill None. Creation of nonprofit, member-owned co-ops to compete with private insurers. Senate HELP Committee's outline Robust new public plan to compete with private insurers. Plan run by Govt. and negotiate payment rates with providers. House Democratic bill A committee recommend "essential benefits package" preventive, mental health services, oral heath & vision for children; out-of pocket costs would be capped. The new benefit package basic benefit package offered in the exchange. Over time become minimum quality standard for employer plans. President Obama's proposal Supports a new public plan. Open to compromise on the issue. House Republican Outline No public plan
How One choose their plan? Sen. Max Baucus's bill Self-employed & small businesses can pick a plan offered through new state-based purchasing pools. No change for people working in larger companies. Senate HELPC Outline Individuals & small businesses can purchase insurance through state-based purchasing pools called American Health Benefit Gateways.
House Democratic bill - new public plan available through the insurance exchanges set up and run by secretary of HHS. President Obama's proposal Small businesses and people without access to affordable insurance through their employer or elsewhere would have access to a new exchange starting in 2013. Illegal immigrants would not be able to shop in the exchange. House Republican Outline No new purchasing exchange or marketplace is proposed. HSA and FS plans to be strengthened.
Changes to Medicaid Sen. Max Baucus's bill Income eligibility levels standardized to 133% of the federal poverty line ($14,400 individual or $30,000 family of 4). Expansion delayed until 2014 Senate HELPC Outline New voluntary insurance program provide modest daily cash benefit to help disabled people stay in their own homes instead of going into nursing homes. House Democratic bill Federal-state insurance program for the poor expanded in 2013 to cover All non-elderly individuals with incomes up to 133% of federal poverty line. President Obama's proposal None specified House Republican Outline People eligible for Medicaid allowed to use the value of their benefit to purchase a private plan.
More on Health Reform from Locals Sept. 17 , 2009 Kenneth Shine, M.D., executive vice chancellor for health affairs of UT Texas System
Charles LeMaistre, M.D., former vice chancellor for health affairs of the UT System and president emeritus of UTMDACC Addressed HC reform and chronic disease prevention smoking and obesity
Health care reform • “Affordable and Quality HC" • Advocate expansion of government intervention • National Health Insurance or Universal Health care in a variety of forms rising costs of modern HI • Representatives John Conyers & John Dingell single payer program of Medicare for ALL. Progressive Democrats: primary goal • Unpaid insurance bills increase costs to the service provider pass the cost HC consumers expansion of HI coverage.
President Obama’s Health Care Reform Proposal Overall approach to expanding access to coverage ● All children to have HI • Employers: offer health benefits to employees or contribute to the cost of new public program • Expand Medicaid and SCHIP • Create National Health Insurance Exchange small businesses and individuals without access enroll in new plan public or private http://www.kff.org/uninsured/upload/Obama_Health_Care_Reform_Proposal.pdf
THE OBAMA PLAN: STABILITY & SECURITY FOR AMERICANS * For FOLKS WHO CURRENTLY HAVE HI Can keep the HI if folks like it Against Law to: Deny coverage for pre-existing conditions Drop coverage when sick Will eliminate yearly and lifetime caps on coverage • Caps on out-of-pocket expenses • * • • *
http://www.whitehouse.gov/issues/health_care/plan/
