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First the government details out what must be covered (pages 104-126) and who pays what part of the individuals out-of-pocket expenses (pages 20-21). Both the state and federal governments are required to go through our tax returns & exchange information to see if any of us qualify for any state or federal program (medicare, medicaid, CHIP, etc), they are required to enroll you in that program (or report your name & SSN to the federal government, so thy can enroll you in their program). I don't know how anyone could possibly say this is not a government take over our health care system.
From pages 29-30 of the bill:
‘‘(a) IN GENERAL.—The plan sponsor of a group health plan (other than a self-insured plan) may not establish rules relating to the health insurance coverage eligibility (including continued eligibility) of any full-time employee under the terms of the plan that are based on the total hourly or annual salary of the employee or otherwise establish eligibility rules that have the effect of discriminating in favor of higher wage employees.
(b) LIMITATION.—Subsection (a) shall not be construed to prohibit a plan sponsor from establishing contribution requirements for enrollment in the plan or coverage that provide for the payment by employees with lower hourly or annual compensation of a lower dollar or percentage contribution than the payment required of similarly situated employees with a higher hourly or annual compensation."
So, employers CAN discriminate against employees in favor of lower wage employees. In fact, as you'll see below, they are encouraged to discriminate against higher paid employees.
Through 2013 insurance companies will be required to report how much they take in in premiums and how much they pay out in benefits. Anything over the government's standards must be paid back to the participants (pages 34-35). I think a lot of people would not have a problem with this - you know those evil insurance companies have been stealing all our money from us. Well, we could debate on that all day, but for right now I'll just say....if the government can do this to insurance companies, why can't they do it to food service companies, construction companies, computer programmers, etc? Where does their power end? I'm not sure why this stops in 2013.
The government will set the standards on how insurance companies do their paperwork and electronic standards for paying service providers (pages 61-79). This will be very expensive for small insurance companies and must be completed by April 1, 2014.
Insurance companies must charge the same premiums to everyone unless you're a tobacco user and based on age, but only by the amount the government allows and age brackets they set (page 81-83). Meaning that everyone's premiums will have to go up in order for the insurance company to stay in business.
Insurance companies cannot turn down anyone for coverage and cannot stop coverage for any reason (page 85-87). Again, many would say this is great, but if a company MUST take on new clients even if they cannot provide them with services, they cannot stay in business.
Employer's are required to have wellness programs for their employees and must report to the government if they provide rewards in the program (page 87-93). It is not an employer's responsibility to make sure you take care of yourself - and this is just another "tax" on employer's that will stifle the job market. If I were an employer, I would do everything possible to not have to report things to the government for a number of reasons (resources it takes to file such paperwork, hassle of being audited, having to adhere to the government's ever changing and confusing regulations, etc). Thus, I would not want to give rewards for the program. If there are no rewards for participating in the program, why would employee's participate? Some would, but most wouldn't. If they wanted to take care of their health, wouldn't they be doing that already? So, if few are participating in the program, what's the benefit?
The government will also set up a wellness program that will be run by the Treasury & Labor Dept Secretaries (page 93). What does the Labor Dept have to do with our health?
The States must set up Insurance Exchanges for purchasing insurance policies, which will be paid for with our federal & state tax dollars (page 130-144). I don't understand why we need to spend money setting up/maintaining exchanges? We don't need exchanges in shopping for auto insurance - that's what the internet is for.
Insurance companies can only do business with health care providers that "utilize a patient safety evaluation system, implement a discharge program for discharge and implement such mechanisms as the Secretary may by regulation require" (page 150). Yep, more government involvement in our health care and those regulations are yet to be determined.
The government will give grants to organizations (including unions, specifically) that inform people about what health plans are available, tax credits, etc (page 152). Can you say, asking for corruption and abuse?
The government will provide loans & grants to States to set up a "community health insurance option", more commonly known as a public option (pages 169-183) and MUST have this public option plan available in the exchange unless the State passes a law prohibiting them. If anyone is in this plan and receives a federal tax credit or cost sharing reduction and the State has a stricter benefits mandate than the federal standards of coverage, the State is required to defray the cost of those benefits. This goes back to the original argument against the "public option". It will put insurance companies out of business and we will all HAVE to go on the public option plan.
There will be a new social program for providing health coverage to those are considered low income, but not low enough to enroll in the current government health coverage program (pages 201-219). Because our current social programs are working so well.
States can decide to let insurance companies from other states into their exchanges - if they make an agreement with that state to do so AND the federal government approves of it (page 221). Again, why do we need more government bureaucracy to purchase insurance across state lines? Oh, and they CANNOT be in effect until 2016.
Tax Credits and Cost-Sharing Reductions will be available for those who's income is 100% to 400% of the poverty line and their income is based on their adjusted gross income (pages 244-262). Here is the poverty guidelines for 2009 (I could not find any for 2010). As you can see, a single individual making over $43,000 a year will be eligible for Federal aid.
| Persons in family | Poverty guideline |
|---|---|
| 1 | $10,830 |
| 2 | 14,570 |
| 3 | 18,310 |
| 4 | 22,050 |
| 5 | 25,790 |
| 6 | 29,530 |
| 7 | 33,270 |
| 8 | 37,010 |
| For families with more than 8 persons, add $3,740 for each additional person. | |
Indians that are at or below 300% of the poverty line will have 100% of their cost-sharing expenses paid for by the US taxpayers (page 263).
Large employers (those with more than 50 full time employees) that have waiting periods exceeding 30 days, but less than 60 days, will pay a fine of $400 for each full time employee to whom the extended waiting period applies. For waiting periods exceeding 60 days, the fine is $600 (pages 345-346).
Large employers that offer an employer sponsored plan and have at least one full time employee that is allowed or receives a premium tax credit or cost sharing reduction will pay a fine of $250.00 per full time employee (not per employee that is allowed or receives a tax credit/cost sharing reduction, EVERY employee - minimum of $12,500) per month (pages 346-353). This amount will increase every year starting in 2015 (adding inflation, I believe). It looks like the point here is to raise wages, which we all know hurts business and only promotes moving jobs & product production over seas. So, the government is using private business to redistribute the wealth. In many situations, it will be more logical to raise someone's wages, rather than pay the government's tax. Raise the wages of someone that hasn't been with company as long as you, someone that doesn't do their job as well as you do, but they have more children than you do, so they have the right to make more than you. Because, as detailed above, tax credits & cost sharing reductions are based on your gross adjusted income - NOT your net income.
In year 2017, the states will be required to pay at least 30.3%* (see note below) of Medicaid for newly eligible individuals. At least 31.3% in 2018. And in January 2019 there will be an increase of 32.3% with a 1% increase every quarter there-after (pages 395-398). But don't worry - it can never go above 95%. They have to make sure they have SOME control over the states.
*NOTE: States that do not pay for health coverage of those at or below the poverty line will be required to pay 34.3% in 2017 and 33.3% in 2018. The 1% & 32.3% increases still apply.
I'm only on page 422, so there is lots more to go through. Will post more as I get through it.
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