This is a late night cram session on the House Reconciliation Act. So curl up on the couch and join the study group:
Full text:
http://docs.house.gov/...
summary:
http://docs.house.gov/...
Due to the late hour and my brain's impending shut-down, this diary will just be slap-dash Cheat sheet style. Without further ado....
Premium assistance increase:
Old caps from Senate Bill (max premium out of pocket as % of income):
133% FPL: 2.8%
200% : 6.3%
300% : 9.8%
400% : 9.8%
New caps:
133% : 2.0%
200% : 6.3%
300% : 9.5%
400% : 9.5%
Verdict: Yay I guess. small increase in subsidies.
Premium assistance indexing change One unsavory aspect of HCR is that if insurance premiums increase faster than wage increases, the premium caps will be increased along with it. In other words, the taxpayer/patient has to absorb any insurance increase in the future! Reconciliation adds another item to index against: excessive premium increase relative to CPI inflation. So now taxpayer will be asked to absorb future premium increase in excess of inflation also. But the reconciliation bill tempers it by stipulating that these index measures will only kick in if premium subsidies exceed 0.504% of GDP.
Verdict: The lord giveth and the lord taketh away. The index sucks. But the 'failsafe' clause makes this more into a hedge against future recession because it is a function of the GDP.
Cost sharing caps improved
HCR places a cap on how much cost sharing the patient has to bear for low income patients. Reconciliation sweetens that. Insurance's share of the cost:
100%-150% FPL: formerly 90%, new 94%
150%-200% FPL: formerly 80%, new 87%
200%-250% FPL: formerly none, new 73%
Verdict: good. The out-of-pocket maximum is still too high IMHO. No change on that front.
mandate penalty tinkering
Slight increase in the mandate penalty from 2% to 2.5% of income, but maximum surtax went from $750 to $695.
Verdict: more punishment for the poor, and less for the not-so-poor.
increased penalties for corporations
If a large company fails to provide healthcare, it is fined $2000 per employee, up from $750
Verdict: This seems somewhat at cross purpose with HCR in general. Most reform minded people want to move us away from employment based healthcare. But here we are strengthening the employer mandate. Not a big fan.
tax treatment of adult children
HCR allows adult children up to age 27 to stay in their parents' health plans. Recon bill allow you to deduct the adult child's medical expense just like you do for yourself and your dependents (the adult child insured need not be your dependent). Self employed premium deductions works for the adult child's premium too.
Verdict: good logical change. Somebody is paying attention up there.
Medicaid eligibility remains 133% FPL. BUT recon bill institutes a 5% 'income disregard'. In other words, they take your income, knock off (disregard) 5%, and then see if you are at 133% or below. So in effect this raises the income limit to ~138%.
Verdict: Nice stealth expansion of Medicaid!
Huuuuge section on Medicare donut hole & Medicare Advantage Can somebody please help dig into this? This section just kills me.
Medicaid payment increases! For Primary care, internal medicine, & pediatric doctors, Medicaid payments will be increased to match Medicare. BUT only good for 2013 and 2014.
Verdict: long overdue and extremely necessary change. I wish this could be made permanent instead of only good for 13 and 14 (when the feds is funding Medicaid expansion 100%). Hopefully once it gets its foot in the door, the states will pick up the slack and continue w/ that rate.
Physician owned hospital ban postponed from Aug 2011 to Dec 2011. Verdict: I wonder why?
Big section on rooting out Medicare/Medicaid fraud Too long to read. This is taken straight from Obama's plan I take it. Verdict: I assume it's all good. Republicans maybe assholes, but they done good here.
Excise tax As everyone knows, the limit has been raised to $27500 from $23500, and implementation is delayed to 2018.
Verdict: I am, like Paul Krugman, a fan of the excise tax. Now it is watered down to near meaninglessness. The Unions won. A phyrric vitory.
Investment income Medicare tax a 3.8% Medicare tax is levied on investment incomes!
Verdict: Beautious! Good necessary change. As we become a society of the haves (investment class) and have-nots (paycheck class), any shifting of the tax burden to the investment class is welcome and long overdue.
Calculation of Medicare tax for married filing separately This is p.94 of teh Reconciliation bill. I'm not entirely clear on this one. It seems like married filing separately have to calculate MC tax using 1/2 of combined income??? Am I understanding this section correctly?
Verdict: That would be a good change, in the event that one spouse is well above the FICA cap, and another well under. This change would tax that portion above the FICA cap also.
Taxes levied on Medical device makers, Pharma, & hospitals All these taxes and levies, as far as I can tell, are slightly delayed or relaxed somewhat.
Verdict:I am getting really tired, but if you want to follow the money trail, this is it. If last minute deals are being made it'sright here in this section. So far the corporations are getting an upper hand. Granted the original HCR did levy hefty new taxes on all these corporations.
Elimination of unintended application of cellulosic biofuel producer credit From the summary : "Congress enacted a $1.01 per gallon tax credit for the production of biofuel from cellulosic feedstocks in order to encourage the development of new production capacity for biofuels that are not derived from food source materials. Congress is aware that some taxpayers are seeking to claim the cellulosic biofuel tax credit for unprocessed fuels, such as black liquor."
Verdict: LOLOLOLOL!!!! Who says Congress doesn't have a sense of humor. I LOL'ed at this provision! Oh well, Uncle Buck, you had a good run with your moonshine still. Too bad the revenoo'ers are onto you now!
Grants to community colleges block grant to community colleges w/ stipulation that this can go towards people on unemplyment.
Verdict: This needs to be fleshed out a lot more. This could be a critical change. Right now unemployment is very problematic because in most states (correct me if I'm wrong) if you go to school you are no longer 'looking for work' and you lose your UE benefits. It's a misguided and head-slapping stupid policy. This is an opening to change that. Good start... needs more push.
Direct student loans Huuuge long section on the well publicized 'government takeover of government funded student loans!'. The details are daunting. It all looks good at first glance. Did you know an american student studying abroad can qualify for federal loans? (answer=yes! BUT it will still be handled through a bank unlike in the US)
Verdict: seldom do we see a legislative solution that is such an unalloyed and solid WIN. Love it. Love it.
Community Health Centers I know your eyes are glazing over and your ears are ringing... but guess what, Madame Pelosi has saved the best for the last. On the very, very last page of this 153 page Rubik's cube we find a kiss-on-the-last-pager! Community Health Centers are getting across-the-board funding increases:
2011 formerly $700 million, increased to $1 billion
2012 $800 million to $1.2 billion
2013 $1 billion to $1.5 billion
2014 $1.6 billion to $2.2 billion
2015 $2.9 billion to $3.6 billion
Verdict: Hell yeah! That's what I'm talking about! SMACK!!!! Boner, Coburn, Joe Wilson, Bachmann, et al: Consider yourselves bitch-slapped!