What does health-care law do for you?
Okay, weâ€™ve caught our breath and health-care reform passed the first major hurdles. With the president signing it into law, we all really want to know: Whatâ€™s in it for us? Whatâ€™s the downside? Whatâ€™s the future?
Hereâ€™s a basic primer:
The cost of the bill will be $940 billion over 10 years, or what was spent on the recent wars over six years. You be the judge which is money better spent. However, unlike war, this bill will reduce the deficit by $143 billion over the same period and is estimated to reduce the deficit (the planned spending we have to do for Medicaid and Medicare) over the subsequent 10 years by $1.2 trillion dollars. My guess is that figure will be amended, downwards. But as long as it is not in the red, thatâ€™s still positive news.
Thirty-two million uninsured Americans will now get health care â€” they will buy it, or be subsidized to buy it. Why is this good for the nation? Because under the law, an emergency has to be treated even if it is at the taxpayersâ€™ expense. If everyone has health insurance (like car insurance), Medicaid and emergency non-paid treatment deficits should plummet. And remember, out of your rent or property tax or state tax, you are paying for your stateâ€™s emergency uninsured treatments. Big time: $31 billon in New York state, $8.5 billion for Connecticut. Last year it was $311 billion nationwide (that we know of; some hospitals never get paid).
If someone does not get health insurance (providing they can afford it or havenâ€™t just been laid off or have gotten sick and cannot work), they will pay a fine to help cover the taxpayer already forking out for their free emergency treatment. The fine will be about $695. Thatâ€™s $1.90 a day to stick the rest of us with their medical bills in times of emergencies.
If you are self-employed or uninsured, you will be able to join state-based exchanges (paid for by Congress until 2015 and thereafter by your state taxes) in which you will have the power of many to negotiate health insurance payments. Just like members of Congress, you too will be eligible to buy insurance as if you were part of a vast group â€” spreading the load and reducing premiums compared to a single family buying coverage. How much will you save? The CBO estimates premiums, same coverage, could be 40 percent cheaper, per month, per family, just like Congress.
If you are a small business, from 2014 you will be able to band together and bulk buy as well.
The poverty level is currently pegged to about $18,700 per couple or $22,500 per family. If a family makes less than 133 percent of that ($29,925) they get Medicaid for free.
If they make 133 percent of that or up to 400 percent of that ($90,000) per family, they will get a check from the government to help pay for insurance. How much? Well, what happens is that they will get a subsidy based on the difference of what health insurance costs and a maximum of about 4 percent of their income.
So if you make, as a family, $90,000 you would only have to pay $250 a month and the government would pay the rest for you and it would show on your policy as a discount (tax-free). And if you are working for less than that (as a family) and already get health insurance, the government will pay any medical â€œdeductionâ€ from your wages above 9.4 percent of your wages.
The same sorts of calculations work for individuals and couples with no dependants (but the poverty level is lower, of course). Oh, and states will now have to cover childless adults in Medicaid (if they qualify) from 2014, but the Feds will reimburse the states for the first two years.
Now, Medicare â€¦ Slowly, surely, they want to close the gap between what Medicare pays for expensive drugs and what they really cost you. By 2020, there will be no â€œholeâ€ there anymore. If you have a gap before then, you will get $250 a year. From 2011, Medicare patients will get a 50-percent discount on brand name drugs.
Now some really important stuff: From right now, you cannot be cut off for a pre-existing condition. From six months after signing, all children cannot be turned away by insurance companies based on pre-existing conditions. And from 2014, that goes for the rest of us, too. And your dependents can stay on your policy by law until they go solo or reach the age of 26. Thatâ€™ll help the military, too.
Some no-noâ€™s: First, illegal immigrants are not eligible for Medicaid. Period. Even if they use their own money, they cannot join a health exchange. They have to go solo.
Second, no federal money, not a dime, will be spent on abortions or abortion coverage except in the case of rape, incest or if the health of the mother is in jeopardy. If your policy includes abortion medical coverage costs, then you have to be billed and make a separate payment for that insurance. And states can opt out of allowing such coverage in the exchanges they will set up.
There is no employer mandate. However, employers with more than 50 employees (not so small) must provide health insurance or pay a fine of $2,000 per worker each year, but only if that worker receives federal subsidies to purchase health insurance. So, if you get a subsidy, you gotta get insurance.
OK, where is some of the money coming from? Well, from 2012 unearned income will pay Medicare Payroll Tax just as we all do, providing your unearned income is greater than $250,000 per year per family ($200,000 for a single person). If it is, you will pay 3.8-percent tax on this unearned income. And if you are rolling in it and have a â€œCadillacâ€ insurance policy that costs over $27,500 per family (or over $10,200 for one person), you will pay a special excise tax of 40 percent to help pay for people less fortunate. Oh, and if you go get a tan at a tanning business, expect to pay 10 percent more.
Medicare Advantage is toast. Thatâ€™ll save about $500 billion over the next 20 years. Straight out of the pockets of the insurance industry. Ouch.
So, whatâ€™s next? A battle royal. This column pointed out that the United States is a federal republic (it says so in the Constitution), and yet some states object to Congress telling them what to do (they didnâ€™t complain on â€œNo Child Left Behindâ€ but that was their partyâ€™s policy). With Sen. Boehner raving on that â€œthis is a federal democracy,â€ with Texas removing Thomas Jefferson from textbooks (heâ€™s too liberal for them, never mind he wrote the Declaration of Independence), and Tea Party folks intimidating Congressmen and women by spitting, using profanity and issuing threats, the nay-sayers feel they have support.
So, the following states have agreed to fuel the fire and have announced they will fight this to the Supreme Court, a Supreme Court which is, as they say, slightly right off the chart: Florida, South Carolina, Alabama, Nebraska, Texas, Pennsylvania, Washington, Utah, North Dakota and South Dakota. Oh, and Virginia. If this continues, there is no knowing where it will all end. Neither did it for Lincoln, but he stuck to his principles. So should we.
Peter Riva, formerly of Amenia Union, lives in New Mexico.