The Lovely FAQs about Health Care Reform

[Socalgal]

FAQs about health care reform - CNN.com
December 21, 2009 6:17 p.m. EST

(CNN) -- Senate Democrats claimed a major victory this weekend after voting to end debate on their version of the health care bill.

The Senate is on track to hold a final vote on Christmas eve, but there's still a long way to go before a bill is on President Obama's desk.

Here are answers to some frequently asked questions about what's in the House and Senate health care bills and what's next.

Where does the health care debate stand?

The House passed its version of health care reform last month. The Senate, which follows different procedures than the House, is slated to vote on its version of the health care bill before Christmas.

Senate Majority Leader Harry Reid needs a simple majority of 51 votes for final passage. Assuming the bill makes it through the Senate, a conference committee will then need to iron out the differences between the House and Senate versions and merge them into one bill.

Both chambers will then need to pass the revised bill before it is sent to the president's desk.

Why does Obama want health care reform?

The president made health care reform his top domestic priority. He says overhauling the health care system is key to getting the economy back on track.

The president says he wants to reform health care in order to slow the growth of costs for families, businesses and the government. He also wants to ensure that all Americans have access to affordable health care, regardless of their income or medical history.

Who will be covered and how much will it cost?

The House plan is projected to guarantee coverage for 96 percent of Americans at a cost of more than $1 trillion over the next 10 years, according to the nonpartisan Congressional Budget Office.

The Senate plan is projected to cover 94 percent of Americans with an $871 billion price over the next 10 years, according to the CBO.

How will this be paid for?

The House plan imposes a 5.4 percent income tax surcharge on individuals with annual incomes over $500,000, as well as families earning more than $1 million.

The Senate plan increases the Medicare payroll tax on individuals earning more than $200,000 and couples earning more than $250,000 from the current 1.45 percent to 2.35 percent.

The Senate bill also imposes a new tax on insurers that provide so-called "Cadillac" health plans valued at more than $8,500 for individuals and $23,000 for families. The 40 percent tax would be on the value of the plan. In addition, it imposes a 10 percent tax on indoor tanning salon treatments.

Both bills call for cutting hundreds of billions of dollars from Medicare and Medicaid. Republicans say that those cuts will impair Medicare coverage, but Democrats say the savings will come from eliminating waste and fraud.

The House and Senate bills also call for fees on medical device manufacturers.

Do I have to buy health insurance?

The House and Senate bills both require individuals to buy health insurance. The House bill imposes a fine of up to 2.5 percent of a person's income for noncompliance.

The Senate plan imposes a noncompliance fine that starts at $95 in 2010 and escalates to $750 in 2016. It also requires parents to provide health coverage for children up to age 18.

What if I can't afford coverage?

The House and Senate plans both include a hardship exemption for poorer Americans.

Both bills subsidize insurance for a family of four making up to roughly $88,000 annually, or 400 percent of the federal poverty level.

With subsidies, premiums for a family of four at 133 percent of poverty ($29,326.50) would be a maximum of $440 under the House plan, while premiums for a family of four making the highest amount eligible would be a maximum of $10,584.

Under the Senate plan, with subsidies, premiums for a family of four at 133 percent of poverty would be a maximum of $821.14, while premiums for a family making the highest amount eligible would be a maximum of $8,643.60.

I own a business. Do I have to provide coverage for my employees?

The House plan requires companies with a payroll of more than $500,000 to provide insurance or pay a penalty of up to 8 percent of their payroll.

Under the Senate plan, starting in 2013, companies with more than 50 employees would be required to pay a fee per worker if its employees rely on government subsidies to purchase coverage.

What if I have a pre-existing condition?

Both the House plan and the Senate bill would eventually limit total out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.

Both plans also bar insurers from charging higher premiums based on a person's gender or medical history. Insurers can only vary rates based on three things: age, geography and family make-up/size.

What is a health insurance exchange?

"Health insurance exchange" refers to the marketplace of the health insurance options. Obama has defined the exchange as a "one-stop shopping marketplace where you can compare the benefits, cost and track records of a variety of plans -- including a public option to increase competition and keep insurance companies honest -- and choose what's best for your family."

The House bill creates a national health insurance exchange designed to make it easier for small businesses, self-employed and the unemployed to pool resources and purchase less expensive coverage.

The Senate bill creates state health insurance exchanges in all 50 states.

What is a health care co-op?

Nonprofit health cooperatives, or "co-ops," are being proposed as an option to compete with the private sector and as an alternative to a government-sponsored public health insurance option. Co-ops are owned and governed by the same people they insure.

The House and Senate plans both establish "co-ops" and strip insurance companies of an antitrust exemption that has been in place since the end of World War II.

What happened to the public option?

The House bill creates a public option, which is a government-funded, government-run health care option, similar to Medicare. The public option would be a part of an insurance exchange available to people without coverage or unable to afford private coverage.

The Senate bill does not create a public option. Instead, it allows nonprofit private insurers to offer coverage with approval of Office of Personnel Management, which oversees the federal employees' health plan.

What will happen to Medicaid?

The House and Senate bills would both significantly expand Medicaid, the government-run health care plan for the poor.

The House plan extends coverage to individuals earning up to 150 percent of the poverty line, or roughly $33,000 for a family of four.

The Senate plan extends coverage to those earning up to 133 percent of the poverty level, or just over $29,000 for a family of four.

Will abortion treatments be funded with federal dollars?

The House bill prohibits any health plan receiving federal subsidies from offering coverage for abortion.

The Senate plan allows states to choose whether to ban abortion coverage in health plans offered in the insurance exchanges. Individuals purchasing plans through the exchanges would have to pay for abortion coverage out of their own funds.

Will illegal immigrants be covered?

The House bill mandates insurance coverage for illegal immigrants and allows illegal immigrants to enroll in the public option and to buy private coverage in the national insurance exchange, but prohibits government subsidies for such private coverage.

The Senate plan exempts illegal immigrants from the health coverage mandate, and prohibits illegal immigrants from participating in the insurance exchanges.

CNN's Tom Cohen, Kristi Keck and Alan Silverleib contributed to this report.

[The Real Bingo]

I can't wait!

[tony_j15]

The House and Senate bills both require individuals to buy health insurance.

I'd rather have full-blown European health-care than deal with the hassles this shit will create.

[Theophylact]

So would I. But there's no way to get there from here.

[CERuppel]

Boat, Plane, Swim...

[MTAtech]

So would I. But there's no way to get there from here.

The only way is to weaken the filibuster (which has a thread of its own) so a scant minority can't take the rest of the Senate hostage.

[GroundZero3]

So we will have Tricare, the VA, medicaid and now this! Really they cant even handle the VA and tricare and they want to add on another health care department! Makes so much sense to me, why dont they just open up Tricare to everyone young and old. There is no reason create another health department that people have to fight their way through.

[Chuckiechan]

I understand we start paying as soon as the legislation is complete and enacted. My question is, do I pay now for my plan at work, plus the new fees for the one that starts after the 2012 elections? It's my impression that I'll be paying for both.

Cracked me up to hear Harry Reid whining about people dying every 10 minutes with "his" plan, as if people are to ill informed to wonder "If it's so urgent, then why is it starting 4 years out?"

What a mess.

[The Real Bingo]

Cracked me up to hear Harry Reid whining about people dying every 10 minutes with "his" plan, as if people are to ill informed to wonder "If it's so urgent, then why is it starting 4 years out?"

Gotta hand it to 'em, though...they are at least trying to pay for it.

[Chuckiechan]

BTW, paying for illegal aliens is settled law in California.

We had a proposition in California that passed overwhelmingly denying a variety of public services to illegal aliens. The California courts, (don't know if it went to the Supremes) invalidated most of it.

So any illegal gets treatment as needed first, and can be deported if thats what the authorities decide to do. Most of the time they just let them go and they mail a bill to a fictitious address.

[mad1]

Section 9003 of the Senate HR 3590

"Distributions for Medicine Qualified only if prescribed drug or insulin"


(f) Reimbursements for medicine restricted to prescribed drugs and insulin.For purposes of the section and section 105, reimbursement for expenses incurred for a medicine or drug shall be treated as a reimbursement for medical expenses only is such medicine or drug is prescribed (determined without regard to whether such drug is available without a prescription or is insulin.

This section address reimbursements for HSA and Archer MSA's accounts. If you attempted to purchase Pedialyte, Tylenol or other over the counter medicine you will not receive a reimbursement for the purchase of that medicine.

What is the purpose of a HSA if it is limited to doctor prescribed drugs?

[Gomer]

Section 9003 of the Senate HR 3590


This section address reimbursements for HSA and Archer MSA's accounts. If you attempted to purchase Pedialyte, Tylenol or other over the counter medicine you will not receive a reimbursement for the purchase of that medicine.

What is the purpose of a HSA if it is limited to doctor prescribed drugs?

Health Savings Accounts do not "reimburse" you for over the counter medicines as it is. They allow you to pay for OTC's with tax free dollars (as do Flexible Spending Accounts I think).

It's great news to me that the harshest criticism mad1 can bring to bear is that a small fraction of Americans won't be able to buy their Tylenol with tax free dollars any more!

And for what it's worth, no one is keeping track of what people are spending their HSA dollars on anyway. It's a tax shelter that is on the honor system. The IRS can audit you for it, but they're not often going after poor schmucks that have been reduced to HSA health care coverage.

[mad1]

Gomer;

Health Savings Accounts do not "reimburse" you for over the counter medicines as it is. They allow you to pay for OTC's with tax free dollars (as do Flexible Spending Accounts I think).

Generally, distributions from an HRA must be paid to reimburse you for qualified medical expenses you have incurred.

Publication 969 (2009), Health Savings Accounts and Other Tax-Favored Health Plans

It's great news to me that the harshest criticism mad1 can bring to bear is that a small fraction of Americans won't be able to buy their Tylenol with tax free dollars any more!

Allays have to make an attempt to add in a personal attack instead of discussing the issues, standard MO.

And for what it's worth, no one is keeping track of what people are spending their HSA dollars on anyway. It's a tax shelter that is on the honor system. The IRS can audit you for it, but they're not often going after poor schmucks that have been reduced to HSA health care coverage.

Do you have and links to support this?

[MTAtech]

You mean temporarily weaken the filibuster. You'll be screaming for it back when republicans get majority again.

I mean something like this:

Back in the mid-1990s two senators — Tom Harkin and, believe it or not, Joe Lieberman — introduced a bill to reform Senate procedures. ... Sixty votes would still be needed to end a filibuster at the beginning of debate, but if that vote failed, another vote could be held a couple of days later requiring only 57 senators, then another, and eventually a simple majority could end debate. Mr. Harkin says that he’s considering reintroducing that proposal, and he should. link

[Gomer]

Allays have to make an attempt to add in a personal attack instead of discussing the issues, standard MO.

What was the personal attack? Are you even slightly serious? There wasn't even a shade of one there LOL.

Do you have and links to support this?

What you linked to pertains to HRAs. They are different than HSAs. Maybe you should give reading the rest of the document you linked to a shot. Health Savings Accounts do not "reimburse" you for over the counter medicines as it is.

Links? I could get you some... our you could make an effort yourself to try to understand what the hell you are talking about before you go spouting off about it.

I have an HSA. When I hear the word "reimbursed", I understand it to mean that someone else pays me for expenses I have incurred. For example, if I have to pay for a hotel, my employer would reimburse me for it.

All an HSA is is a bank account into which I put my own money. The deposits to this account are tax deductible. The meager interest that the account accrues is non-taxable.

When I have health care expenses, I can go and get money out of the account. The bank doesn't provide any oversight of what I spent the money on. I am not required to submit any receipts to anybody to get the money out of the account. It's on the honor system. When I file my taxes all they want to know is how much I put in, and how much I took out. The only time there is any oversight over what is spent on what is if you get audited.

[mad1]

What you linked to pertains to HRAs. They are different than HSAs. Maybe you should give reading the rest of the document you linked to a shot. Health Savings Accounts do not "reimburse" you for over the counter medicines as it is.

My error on the link, here is the correct information.

Distributions From an HSA
Qualified medical expenses.
However, even though non-prescription medicines (other than insulin) do not qualify for the medical and dental expenses deduction, they do qualify as expenses for HSA purposes.

Links? I could get you some... our you could make an effort yourself to try to understand what the hell you are talking about before you go spouting off about it.

Do you expect me to find the links to support your comments, not my job? Do you have any supporting documentation for you comments?

[tony_j15]

I understand we start paying as soon as the legislation is complete and enacted. My question is, do I pay now for my plan at work, plus the new fees for the one that starts after the 2012 elections? It's my impression that I'll be paying for both.

the legislation states that you must purchase health care. If you are already enrolled on a plan through your work then nothing changes.

[Gomer]

My error on the link, here is the correct information.
Do you expect me to find the links to support your comments, not my job? Do you have any supporting documentation for you comments?

You are the one that is trying to tell me how HSAs work. You want links?
Google - How does an HSA work

All the statement you posted means:

However, even though non-prescription medicines (other than insulin) do not qualify for the medical and dental expenses deduction, they do qualify as expenses for HSA purposes.

Is that I can use before tax dollars to buy OTC's. That is not in dispute. What was your point?

What point is it that you are trying to make about HSAs in general?

I HAVE AN HSA! Do you think I am lying to you about how it works?

"Do you expect me to find the links to support your comments, not my job?"

I expect you to have knowledge of what you are talking about before you go spouting off about it.

[Chuckiechan]

All an HSA is is a bank account into which I put my own money. The deposits to this account are tax deductible. The meager interest that the account accrues is non-taxable.

When I have health care expenses, I can go and get money out of the account. The bank doesn't provide any oversight of what I spent the money on. I am not required to submit any receipts to anybody to get the money out of the account. It's on the honor system. When I file my taxes all they want to know is how much I put in, and how much I took out. The only time there is any oversight over what is spent on what is if you get audited.

Not in California. There is a procedure where you "bill" your HSA account and include receipts for covered items - co pays and non-prescription items.

Health Savings Accounts do not "reimburse" you for over the counter medicines as it is. They allow you to pay for OTC's with tax free dollars (as do Flexible Spending Accounts I think).

When you buy qualifying medicines - cold pills for example, on my receipts it says HSA eligible.

You send the receipt in and get paid back out of your HSA.

It's not as simple as a savings account by a long shot.

[Gomer]

Not in California. There is a procedure where you "bill" your HSA account and include receipts for covered items - co pays and non-prescription items.


When you buy qualifying medicines - cold pills for example, on my receipts it says HSA eligible.

You send the receipt in and get paid back out of your HSA.

It's not as simple as a savings account by a long shot.

It certainly is in Michigan! And I am sure you would agree that what goes on in CA tends to be the exception, not the norm.

Do you consider it to be "reimbursement" when you get your own money out of the bank? It's a withdraw, not a reimbursement.

And again... all the change in law that mad1 pointed out means is that the fraction of people with HSA/FSA are not supposed to pay for OTC meds w/ pretax $$$.