In a meeting with some directors of the Pima County Medical Society in May, Senator Ron Wyden (D-OR) said that his “health care reform” plan was the one with the best chance of passage. It is the first bipartisan bill in 60 years. The Democrats like it, he said, because it covers everyone, and the Republicans like it because there is a role for the private sector. In addition, the Congressional Budget Office (CBO) has scored it as budget neutral.
Since the introduction of the Healthy Americans Act in 2007, Wyden has “built the largest bipartisan coalition of Senators supporting a comprehensive health reform proposal since the days of Harry Truman,” according to his website.
He claims that “tough cost containment measures” would save $1.48 trillion over 10 years and return surpluses to the Treasury within 2 years. The cost of the bill would be $0.8 trillion per year, according to an analysis by Conservatives for Patients’ Rights, which has prepared a concise summary of the various proposals.
“Insurance company profits would come from keeping their customers healthy,” Wyden asserts.
Group coverage, the Federal Employee Health Benefits Program (FEHBP), Medicaid (except for its wrap-around and long term care functions), and the State Children’s Health Insurance Program (SCHIP) would be phased out.
New bureaucracies: These include State Health Help Agencies (HHAs), with a federal fallback plan should states refuse to create them; an advisory committee to report annually on modifications of benefits, etc.; some mechanism to “adjust” the Medicare Part B premium based on whether or not each individual “participates in certain healthy behaviors”; other agencies to calculate payments, monitor individual behavior, set standards as for chronic disease management, check compliance with standards, monitor loss ratios and outcomes of chronic-care management, etc.
Individual mandate. All adults must buy a government-approved Healthy Americans Private Insurance Plan (HAPI) and constantly report on compliance, at every interaction with federal, state, and local government, including at voter registration, motor vehicle departments, or other checkpoints, as well as when filing tax forms. This applies to all legal residents, including non-citizens, although not to illegal aliens.
Penalties. The penalty includes the average monthly premium, plus 15%, for all “uncovered” months. Penalties are not subject to discharge by bankruptcy. This means that the HHA, which receives the penalties, takes precedence over other creditors.
Insurance mandates. Guaranteed issue, community rating, coverage of “wellness” without copayments, annual physicals, a required “health home” (gatekeeper), mental health parity, and reconstructive surgery post mastectomy are all mandatory. Each HAPI plan “shall” make available supplemental coverage for abortion, unless affiliated with a religious institution.
Progressive taxation equivalent. Premium subsidies are phased out incrementally up to 400% of poverty. This means that working harder and earning more is punished by higher mandated health insurance “premiums” (which are the functional equivalent of taxes). People will constantly be reporting on their income status.
School-based clinics. Care must be provided at no cost, or on a reimbursable basis, by school-based clinics, which must provide, “at a minimum,” mental health services, and use electronic medical records by 2012.
Job killer. Every employer “shall pay an employer shared responsibility payment,” which increases for each additional employee in excess of 50. Employers must deduct the individual shared responsibility payment from wages “as and when paid.” This amount is not allowed as a deduction from the employer’s taxable income.
Savings. To offset the costs, Medicare and 90% of Medicaid disproportionate share (DSH) payments are to be “recaptured.” Tax exclusions for health benefits will be limited (sections 661-666). According to section 801, “private insurance companies will be forced to hold down costs and will slow the rate of growth because they are required to offer standardized Healthy Americans Private Insurance plans.” It is also easy to see that prevention, management, reporting, determining best practices, behavior modification, etc., will lead to massive savings even before sickness (or treatment thereof) is completely eliminated.
“Americans want affordable, guaranteed private health coverage that makes them healthier and can never be taken away,” the Act states as a congressional finding.