Beruflich Dokumente
Kultur Dokumente
What Does It All Do For You?
Okay, we’ve caught our breath and Health Care passed the first major hurdles… with the President
signing it into law, we all really want to know: What’s in it for us? What’s the downside? What’s the
future?
Here’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 6
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 if that figure will be amended, downwards. But as long as it is not in the red, that’s still positive
news.
32 million uninsured Americans will now get health care – 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 taxpayers’ 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 state’s emergency uninsured treatments. Big time. $31 billon in NYS, $8,530
for CT. 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 haven’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 dollars. That’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 – spreading the load, reducing premiums compared to a
single family buying coverage. How much will you save? The CBO estimates premiums, same coverage,
could be 40% 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 of $22,500 per family. If a family
makes less than 133% ($29,925) of that they get Medicaid, free. If they make 133% of that or up to
400% 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% of your income. So if you make, as a family, $90,000 you
would only have to pay $250 a month and the government would pay for 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
do already get health insurance, the government will pay any medical “deduction” from your wages
above 9.4% 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 2 years.
Now, Medicare… 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 “hole” there anymore. If you
have a gap before then, you will get $250 a year. From 2011, Medicare patients will get a 50% discount
on brand name drugs.
Now some really important stuff: From right now, you cannot be cut off for a pre‐existing
condition. From 6 month after signing, all children cannot be turned away by insurance companies
based on preexisting 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. That’ll help the military too.
Some no‐no’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 health of the mother. 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 $2000 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.
Okay, 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% tax on this unearned income.
And if you are rolling in it and have a “Cadillac” 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% to help pay for people less
fortunate. Oh, and if you go get a tan at a tanning business, expect to pay 10% more.
Medicare Advantage is toast. That’ll save about $500 billion over the next 20 years. Straight out of
the pockets of the insurance industry. Ouch.
So, what’s next? A battle royal. This column pointed out that the US is a Federal Republic (it says so
in the Constitution) and yet some States object to Congress telling them what to do (they didn’t
complain on “No Child Left Behind” but that was their party’s policy). With Sen. Boehner raving on that
“this is a Federal Democracy,” with Texas removing Thomas Jefferson from textbooks (he’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‐says 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.