“While polls show Americans remain sharply divided over the Democrats’ landmark legislation, they aren’t clamoring for its repeal.”

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Is this a government takeover of health care?

No, there is no government run health care plan in the bill.  The health care bill does not change how hospitals are run and does not take over any part of the health care industry.

What about the national insurance exchange?  Isn’t that government run?

No, the federal government is not selling insurance.  They are simply creating a virtual location online for private insurance plans to compete on a national level.  The government would create a website where private health insurance plans would sign up to sell their health plans to individuals, families, and small businesses in a national system.  This is similar to what the government already has setup for federal employees.  States will also setup their own exchanges and they can choose to combine their exchanges with other states to form regional exchanges.  Individuals can not sign up for the exchanges if they already have coverage through their employer.  Only about 5% of the population will be eligible to purchase these types of plans.

I already have coverage.  Won’t this bill force me out of my current plan?

No, if you already have coverage you can keep the same coverage.  You can keep the same doctor.  There is nothing in the bill that requires you to make any changes.

Won’t insurance premiums go up since health insurance providers are paying new taxes to pay for a lot of this bill?

No, the nonpartisan Congressional Budget Office stated that for most people premiums would remain the same or slightly decrease.  But when people receive their subsidies, then they will be paying substantially less for their same coverage than without government funding.  Receiving subsidies will decrease premiums by “56 percent to 59 percent” on average.  Hospitals would now not have to pass their unpaid costs from people they treat without insurance onto those that do have insurance.

The CBO has been quoted out of context by some people saying the CBO quoted premiums would go up for some individuals.  The group the CBO was referring to were individuals that had their health care premiums reduced so much that they will decide to get better plans that covered more than they had before for a slightly higher premium than what they previously paid.  If that group kept the exact same coverage, then their premiums would have been decreased also.

Does this bill redistribute wealth?

There are some new small Medicare taxes on the very wealthy to pay for this bill (people making over $200,000 individually and $250,000 as a family), but most of the bill is paid for in other ways.  Our current system is already setup in a similar way by placing a hidden fee on those that currently do have health insurance, which would include the very wealthy.  When someone without insurance goes to the emergency room, for example, they can not be denied care and those costs are passed on to people that come to the hospital that do have private insurance.  The people with insurance have to be charged more because their costs are increased so the hospital can afford to treat people without insurance.  People without insurance should have a personal responsibility to have health care coverage so the rest of society is not paying for their care when they do need medical care.  This bill does that by making people get their own health care policies.  The health care bill is simply taking our current system and making it more effective in the way money is spent and received.  There is no more redistribution of wealth than there already is built into our current system.

People making $200,000 a year or more have a lower tax rate now than they did during the 1980s.  There has been no attack on the very wealthy through wealth redistribution.  From 1932 to 1980 the highest income groups were taxed 63% to 92% of their income and through most of the 1980s under Ronald Reagan the tax rate was around 50% for the highest income group.  Historically, this country has taxed the wealthiest groups double or triple what they are currently taxed.

Isn’t this bill too expensive?  Will it lead to the government going bankrupt?

No, less than half of the bill is new spending.  The health care industry, the drug companies, and the medical device manufactures are paying for a large part of the rest of the bill.  Because they will receive an influx of new customers, they will be making more profits than they were before reform, which is one of the reasons why they worked to get reform passed.

The other half of the bill is paid for through savings in Medicare spending ($500 billion).  These funds are taken from waste that has been a part of the Medicare system for years and they will be cut.  There will be no reductions of benefits to Medicare recipients.  The funds are only from sources that the government should not have been spending money on, such as Medicare Advantage.

The full amount that the bill is spending is $940 billion over 10 years (only $440 billion is new spending).  The plan would reduce the deficit by $143 billion over the first 10 years and over the next 10 years it would reduce the deficit by more than $1 trillion and up to 1.3 trillion because the government would receive more in revenue over that time then it would spend.

The new spending in this bill over a 10 year period is equivalent to approximately what we spent in the Iraq war over a 4 year period.  The spending in this bill is significantly less than the Iraq war and the money is going back into this country instead of another country.

How can new spending reduce the debt?

Only about half of the spending in the bill is new spending.  The other half was already being spent by the government on programs that were not adding any value.  Those funds are being diverted to health care in this bill and part of those funds are being redirected to pay towards the deficit.  The government is taking in more revenue than it’s giving back to tax payers in government subsidies, meaning it can use those extra funds to pay part the country’s debt.

Where does the money come from to pay for this exactly to pay for this bill?

• Reducing Medicare waste – $500 billion over 10 years (diverted from money already being spent elsewhere)
• Medicare tax on high income earners – $210 billion over 10 years
• Tax on high-cost medical plans – $32 billion over 10 years
• Penalties on those who do not purchase health care plans – $17 billion over 10 years
• Penalties for businesses with more than 30 employees that do not provide health care to employees – $52 billion over 10 years
• Health care companies such as drug makers, medical device makers and insurers – $107 billion over 10 years
• Increased penalties for withdrawing from health care spending accounts for non-health related activities – $29 billion over 10 years

Doesn’t cutting funds from Medicare cut benefits to Medicare recipients?

No, there will be no reductions of benefits to Medicare recipients.  The $500 billion in cuts are coming from waste, fraud, and abuse.  An example would be Medicare Advantage.  The federal government pays private insurance companies to run Medicare Advantage plans as an alternative to traditional Medicare.  The government gives them 14% more in payments to run the plans.  The government would be moving those plans back to traditional Medicare to give the consumers the exact same service, but at a lower price that did not add anything additional in care.  This would save $132 billion over 10 years.

The plan would pride additional coverage to Medicare recipients.  It would close the “doughnut hole” in prescription drug coverage.  It would give a one-time, $250 rebate to people who face the drug coverage gap in 2010.  There would be a 50 percent discount on brand-name drugs that will begin in 2011. This will increase to 75 percent on brand-name and generic drugs in 2020, closing the gap in coverage.

This bill also extends the solvency of Medicare by 7 to 9 years, making sure there are more years that we can pay for Medicare.

Does the bill provide funding for abortion?

No.  Under the bill, people will be given a tax credit to purchase health care.  They can purchase the care from any company that they want.  Some of those health insurance providers may offer plans that do cover abortion.  If a consumer purchases a plan that does cover abortion services, they are required to pay out of their own pocket the percentage of the payment that goes towards abortion services.  Health insurance providers are required to keep these funds separate and are legally forbidden to use funds received from federal subsides for abortion services.

There is an argument among conservatives that the bill doesn’t specifically say that community health clinics, that are funded with tax payer dollars, can not perform abortions.   Of course, health clinics do not perform abortions and never have.  They are setup to provide low cost health care such as flu shots and doctor visits to citizens.  They do not even have the infrastructure to perform abortions or surgeries.  The bill does not specifically need to say that these clinics can not provide abortions because it is already written into current law via the Hyde Amendment that tax payer funds can not be used to fund abortions.  The new health care bill does not overturn or change that law in any way.

In fact, research has shown that expanding health care coverage actually reduces abortions.  Pro-life groups such as Catholic hospitals, the Catholic Health Association, and Catholic nuns have endorsed the health care bill for being pro-life.

Won’t this bill hurt small businesses?

No, small businesses with 50 or fewer employees will be exempt from the requirement to provide health insurance to their employees.  Businesses with less than 25 employees will receive tax credits.  Businesses with 10 or fewer employees can receive a full tax credit.

If companies with more than 50 employees decide to not offer health insurance they will pay $2,000 for each employee over the minimum 50 employees (only if the government is subsidizing their coverage).  If they have 51 employees and do not offer coverage, they would only be required to pay for the one employee.  The companies will only be required to do this if the government ends up subsidizing the workers’ health care coverage.

Companies with up to 100 employees will be able to purchase health insurance for their employees through new state based pools and exchanges giving the small businesses the same purchasing power together that larger businesses currently have.

Won’t I be taxed to pay for this bill?

No, most of the new spending to pay for the government subsides is being given by the health insurance providers, pharmaceutical industry, and medical device makers.  Only individuals making more than $200,000 a year, or a married couple making more than $250,000 a year will have a small Medicare Part A  tax rate increase.  Currently, the Medicare payroll tax is 2.9% on all wages with the worker and his employer each paying 1.45%.  The bill, would raise the percentage paid by high-income individuals by 0.9 percentage points, so an individual would pay 2.35% on their wages, up from 1.45%.  People in those tax brackets will also have a 3.8 percent tax on unearned income (dividends, interest, etc).  If you make less than $200,000 a year, there will be no taxes.  These high income earners would only be paying these additional taxes on any income over the $200,000 threshold.  They would not have any additional increase on the first $200,000 or $250,000 they earn.

An adult who does not have health insurance by 2014 would be penalized $95 or 1 percent of income, whichever is greater, so long as the amount does not exceed the cost of a basic health plan.  By 2016, the penalty increases to $695 for an uninsured adult, and up to $2,085 per household, or 2.5 percent of income, whichever is greater.

What are the subsidies?

Most people and families in the U.S. will receive subsidies.  Households making below 150 percent of the poverty line would be eligible for tax credits based on a sliding scale.  A family of four making $33,075 a year will qualify and the health plans would cover 94 percent of the cost of the benefits.  A family of four making $88,200 would qualify, but the health plans would only cover 70 percent of the cost of the benefits.

Also, the subsidies are advanceable, meaning you can claim the credit up front when you are paying your bills.  You do not have the wait until the end of the year to receive your tax credits.  This means your monthly costs for health care are directly reduced every single month, instead of receiving a refund at the end of the year.  The subsidies are also refundable, meaning if you do not owe taxes at the end of the year you can still receive the health care credits back when doing your taxes.

Isn’t regulating health care by the federal government unconstitutional?

No, the Commerce Clause of the United States Constitution allows the federal government to regulate interstate commerce.  Article I, Section 8, Clause 3 of the United States Constitution states that the United States Congress shall have power “To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes”.

Isn’t requiring Americans to purchase health care unconstitutional?

States are granted the authority to opt out of the individual mandate for coverage under the “Empowering States to be Innovative” amendment written into the legislation by Sen. Ron Wyden (D-Ore.).  According to Sen. Wyden, the amendment allows states to setup their own health care system as long as “they can meet the coverage requirements of the bill.”  They can choose to have a mandate or not.  This amendment is designed to encourage states to design a better health care system, if they believe they can, that would be better for their states than the federal system.

Regarding the individual mandate by the federal government itself, the federal government has the authority under the Taxing and Spending Clause to tax its citizens.  The federal government is not requiring citizens to purchase health insurance.  The federal government is imposing a tax on citizens who do not purchase health insurance, which is within its rights under the Constitution.

Article I, Section 8, Clause 1 of the United States Constitution states, “The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States.”

Zachery Roth goes further to explain how the Commerce Clause in the U.S. Constitution allows the federal government to tax citizens who do not purchase health care.

Numerous constitutional scholars say the mandate is well within the scope of what the court has defined as commercial activity — pointing to the 2005 case, Gonzales v. Raich, in which the Supreme Court found that the federal government could criminalize the growth and possession of medical marijuana, even when it was limited to within a single state — California — on the grounds that doing so was part of an effort to control the interstate drug trade.

Erwin Chemerinsky, the dean of the UC Irvine School of Law, noted in an op-ed in Politico last October that health-care coverage is far more closely related to commercial activity, and the national economy, than is the private growth of marijuana. “In 2007, health care expenditures amounted to $2.2 trillion, or $7,421 per person, and accounted for 16.2 percent of the gross domestic product,” he wrote. And, he argued, the Supreme Court has never said that only people who are themselves engaged in commercial activity can be regulated under the commerce clause. For instance, the court found that the Commerce Clause could be used to require southern restaurants and hotels to serve blacks, even though what was at issue was their refusal to engage in commercial activity.

Jack Balkin, a constitutional law professor at Yale Law School, extends that argument. In a recent blog post, he notes that in the Raich case, Justice Scalia found that Congress can use the Commerce Clause to regulate, as Balkin put “even non-economic activities if it believes that this is necessary to make its regulation of interstate commerce effective.” (itals TPM’s) People who don’t buy health insurance, Balkin argues, aren’t simply “doing nothing,” as Rivkin, Barnett et al. claim. They pass on their health-care costs by going to the emergency room, or buying over-the-counter cures. “All these activities are economic, and they have a cumulative effect on interstate commerce,” writes Balkin.

The federal government has never forced Americans to pay for anything like this before.

The federal government imposes many required taxes on its citizens such as Medicare, Medicaid, and social security taxes.  Medicare and Medicaid are even taxes that currently deal with health care and so are very similar to the new taxes that may be imposed on people that do not purchase health care, except those are mandatory taxes that can not be avoided.  People won’t pay for any tax under this bill if they have health care.  States currently require all citizens to purchase auto insurance, which is similar to requiring health insurance at a federal level.

Can’t states sue to stop the health care bill?

The Supremacy Clause in the United States Constitution allows federal laws to supersede any state laws.  So even if states pass laws saying that they will not follow federal law, they are required to by the Constitution.

Article VI, Clause 2 states, “This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding.”

Why did the Democrats force the health care bill through and didn’t involve Republicans in the debate?

There was over a year of debate that involved many Republicans.  Republican ideas were incorporated into the bill.  Republicans worked with Democrats throughout the course of crafting the bill.  The health care bill is very similar to the bills introduced by Republicans during the Nixon administration, in Massachusetts proposed and passed by Mitt Romney, and the Republican alternative health care plans to counter the Clinton health care plan in 1993.

What benefits are immediately starting that will help people?

• Insurance companies will no longer be able deny people under the age 19 coverage because of pre-existing conditions.  In 2014 this will be banned for adults (kicks in the same time as the mandate for coverage to not hurt the insurance companies).
• People can stay on their parent’s insurance plans until they are 26.
• Insurance companies can no longer drop coverage for someone when they get sick , if they are paying their premiums.
• A temporary high-risk pool will be set up to cover adults with pre-existing conditions. Health care exchanges will eliminate the program in 2014.
• Plans must cover checkups and other preventative care without co-pays.
• Insurance companies can no longer put a lifetime cap on benefits.
• Small businesses will be entitled to a tax credit for 2009 and 2010, which could be as much as 50% of what they pay for employees’ health insurance.
• Authorizes early funding of community health centers in all 50 states (Bernie Sanders’ amendment). Community health centers provide primary, dental and vision services to people in the community, based on a sliding scale for payment according to ability to pay.
• Seniors will get a rebate to fill the so-called “doughnut hole” in Medicare drug coverage.
• Any new health insurance plan must now have an appeals process for coverage determinations and claims.
• New screening procedures will be implemented to help eliminate health insurance fraud and waste.
• Medicare payment protections will be extended to small rural hospitals and other health care facilities that have a small number of Medicare patients.
• Non-profit Blue Cross organizations will be required to maintain a medical loss ratio — money spent on procedures over money incoming — of 85 percent or higher to take advantage of IRS tax benefits.
• Chain/Fast food restaurants will be required to provide a “nutrient content disclosure statement” with their food products.
• A temporary program is established for companies that provide early retiree health benefits for people aged 55 to 64.
• The Secretary of Health and Human Services will set up a new web site to make it easy for Americans and small businesses in any state to find information on how to purchase health insurance.
• A temporary two year credit of up to $1 billion will encourage investment in new therapies for the prevention and treatment of diseases.
• Requirement that all insurers must post their balance sheets on the Internet and fully disclose administrative costs, executive compensation packages, and benefit payments.

Bankruptcies

Currently, 75% of all people that are forced into bankruptcy because of medical debt have health insurance.

How do these changes directly impact you?

Use the Washington Post’s health insurance calculator.

Bart Stupak (D-MI) has been working to kill the Democrat’s health care bill because he believes it does not go far enough banning abortion coverage under private insurance plans.  In practice, the more people have access to health care, the lower the abortion rates are.  Bart Stupak is not only working against his pro-life arguments, he’s also attempting to kill a bill that will directly benefit his district.

The House Energy and Commerce Committee released an analysis for every district in the United States and the impact health care reform would have on that specific district.  According to the report, 44,000 people would gain access to health care in Bart Stupak’s MI-1 district alone.  The House Energy and Commerce Committee also details other advantages of health care reform for Bart Stupak’s district below.

• Improve coverage for 364,000 residents with health insurance.
• Give tax credits and other assistance to up to 197,000 families and 17,900 small businesses to help them afford coverage.
• Improve Medicare for 141,000 beneficiaries, including closing the donut hole.
• Extend coverage to 44,000 uninsured residents.
• Guarantee that 10,000 residents with pre-existing conditions can obtain coverage.
• Protect 1,100 families from bankruptcy due to unaffordable health care costs.
• Allow 50,000 young adults to obtain coverage on their parents’ insurance plans.
• Provide millions of dollars in new funding for 41 community health centers.
• Reduce the cost of uncompensated care for hospitals and other health care providers by $102 million annually.

Tea Party protesters are headed to Washington today to voice what many in the group consider their last chance to protest against sweeping changes in the health care system.  Democrats in the House and Senate were encouraged by their leadership to have meetings with the protesters to answer any questions that they might have about health care.  Below is a portion of the email that Democrats received encouraging them to meet with the protesters.

Many polls have been conducted that show most people are in favor of all of the reform changes that are included in the health care bill, but they oppose the bill because of misinformation that the bill is a “government takeover” or that it includes “death panels.”  Once these myths have been addressed and voters learn about the actual language in the bill the polls shows a net increase in approval.  Democrats believe having an honest and open debate about the merits of the bill and confronting the misinformation will ultimately lead to greater public approval, even among the people currently most opposed.

1. Be prepared. Activists are expected to begin arriving around 9am and they have been given instructions to wait in your office until they can have a meeting. Please have an orderly process and enough staff and interns to welcome what could be a very large number of visitors throughout the day:

· Have staff and/or Member time set-aside to visit with attendees in small groups;

· Ask for extra chairs or seating to be brought to your office or the hall in case there are seniors or disabled visitors that need to be accommodated;

· Consider having some light snacks, H2O, and coffee available;

· Ask visitors to leave all signs and banners outside the office.

[...]

3. Listen and communicate in small groups:
· As we learned in August, small groups are typically the best venue for exchanges on this complicated topic.

· Many of the conservative activists are not opposing the actual provisions in the bill, but are instead reacting to a caricature of the reform bill presented by right-wing media outlets. In fact, many conservative and GOP ideas and concerns are addressed in the legislation:

· Reduces the deficit;

· Cracks down on Medicare waste, fraud, and abuse;

· Provides historic tax credit for small businesses and individuals to purchase health insurance;

· Allows consumers to shop for health insurance across state lines via multi-state compacts;

· Inaugurates medical malpractice reforms, (an area where the GOP failed to take any action when in charge of Congress for 12 years).

· Also, don’t assume common myths about this bill have been debunked. Be prepared to explain that there are no death panels, that Medicare is in fact strengthened, and that reform is not a government take-over, but it is an attempt to crack down on the abusive practices of health insurance companies by providing oversight and increasing competition.

Sen. Olympia Snowe (R-Maine) was reported by Politico to be in talks with leading Democrats to restart health care negotiations.  Snowe wants talks to be focused on bipartisan features of the bill that can be passed with both Democrat and Republican votes.  The talks include passing a scaled down version of the health care bill that Democrats have been working to pass. Elements of the bill would be made up of small business tax credits to help them purchase insurance for their employees and the ability for people to purchase health care across state lines.

Snowe spoke out against Democrats attempting to use Reconciliation to pass their more robust overhaul of the nations health care system.  Reconciliation would only require 51 votes in the Senate to pass and would make her input into crafting any new legislation meaningless.

A bill introduced by Senator Al Franken will provide greater access to emergency contraceptives for women in the military.  The bill has bipartisan support with Olympia Snowe (R-Maine) as a co-sponsor for the bill.

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House Democrats are living up to their promise of a more open and transparent government by posting legislation of the final health care bill three days before the final vote.  This will give the American people time to go through the bill before the vote occurs.  Posting bills online allows anyone to quickly search through the document and provides greater access to the information than has been available in previous administrations.

Nancy Pelosi issued a statement saying, “The House Democratic Leadership is committed to having the final health insurance reform legislation online for 72 hours before the House votes, for all Members and the American people to review. We will continue the transparent process this landmark legislation has had for months.”

No, this is no joke.  Rush Limbaugh was recently hospitalized in a Honolulu hospital after complaints of chest pains.  You can watch him praising the hospital that he was admitted to here after his release.  Rush Limbaugh said, “based on what happened to me here, I don’t think there is one thing wrong with the American health care system. It is working just fine, just dandy.”

It was pointed out by the SEIU blog that Hawaii has one of the most progressive health care systems in the country.  All employers are required to provide coverage to any employee that works 20 hours or more a week.  The nurses at the hospital Rush Limbaugh was admitted to are represented by a labor union.  Hawaii is even exempt from many aspects of the current health care bill being debated in Congress because their health care system goes even farther than the federal legislation that could soon pass.

Rush went on to explain that the treatment he received “was the best that the world has to offer.”  If that’s the case, then we better start passing legislation to mirror the example that Hawaii has set for years.