Anyone Remember What's In The Health Care Bill?
Since the Senate passed its version of a health overhaul on Christmas Eve, most of the debate has focused on the politics of the effort. By now, many people have forgotten — if they ever knew — what the bill would actually do.
So here's a short refresher.
According to the Congressional Budget Office, the Senate-passed bill would expand coverage to roughly 30 million of the 46 million people in the U.S. who lack health insurance. Most of the remaining uninsured would be undocumented immigrants, who would be ineligible for benefits under the bill.
Insurance Mandates
One of the most popular things the bill would do is ban insurance companies from excluding people or raising their rates, because they have what's known as a pre-existing medical condition.
What's that? Here's how California Democratic Rep. George Miller described his: "I sit here with two artificial hips, a little bit of arthritis, and I have a kidney stone. I'm dead in that insurance market if I have to switch policies or switch companies."
But in exchange for getting insurance companies to agree to accept everyone, the insurance companies need more healthy people to be covered to help spread the risk. So the bill does something that's a lot more controversial: It requires everyone to have insurance.
That's something many Republicans used to support, but don't now. "Never has the federal government said any American had to buy anything. Now, [you] have to buy insurance. If you don't buy insurance, pay the IRS more money," said Sen. Charles Grassley (R-IA) during the Senate's floor debate in November.
Grassley is correct in that the mandate would be enforced at tax time. If you can't prove you're covered, you'll pay a penalty.
Helping Hand
But help will be available. If you're poor, you'll get health insurance for free through the Medicaid program. For the first time, able-bodied adults who are simply low-income would become eligible for Medicaid.
Middle-class people who have to buy their own policies would get government subsidies. And small businesses would get tax credits to encourage them to help pay for insurance for their workers.
Those who have to buy their own health insurance get another leg up — a new marketplace called an exchange. There they could pool their buying power and compare their options.
At the same time, said Senate Finance Committee Chairman Max Baucus (D-MT), "exchanges will make it easier for consumers to choose the most efficient plans. And that will reduce their costs and put pressure on insurance companies to offer lower-cost, higher-quality plans."
Another cost-cutting aspect of the bill is a new focus on paying doctors, hospitals and other health care professionals.
"We ... believe that there should be incentives to provide care based upon best practices, not based upon simply procedures being reimbursed," House Majority Leader Steny Hoyer (D-MD) said at the White House health meeting last month. In other words, the new payment system would be based on how health care professionals do their jobs, rather than just how many tests they order or exams they perform.
Political Deal-Making
But politics has had a lot to do with getting the bill this far. Now House Democrats are being asked to cast a vote for the bill the Senate passed Christmas Eve. And, at least initially, they'll have to approve that Senate bill with no changes.
That means, as Sen. Lamar Alexander (R-TN) reminded everyone at last month's meeting, "It still has the sweetheart deals in it. ... I mean, what's fair about taxpayers in Louisiana paying less than taxpayers in Tennessee? And what's fair about protecting seniors in Florida and not protecting seniors in California and Illinois and Wyoming?"
Alexander was referring to several deals cut by Senate Majority Leader Harry Reid to win the 60 Democratic votes needed to get the bill passed by the Senate.
Of course, here's where this process gets even more complicated. Those so-called sweetheart deals are expected to be cancelled in a second bill. That so-called fix bill will carry the compromises now being made between the Senate and the House. That bill is also likely to alter the way the health care program is paid for.
But that second bill is still being drafted, and House Democrats are skittish about its ultimate prospects. Don't expect a House vote on the Senate bill until they get some assurances about what that second bill will do — and that the Senate can actually pass it.
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RENEE MONTAGNE, host:
For weeks now, all the talk about a health-care bill has been how to get it passed, or not. The Senate passed its version late last year, but less attention has been paid to what's actually in the health-care bill. And by now, it's quite likely that many people either have forgotten or never knew what was in the Senate bill. So we asked NPR health policy correspondent Julie Rovner for a little refresher course.
JULIE ROVNER: The one thing most everyone knows about the health-care bill is that it's big - more than 2,000 pages big. So how its supporters choose to describe it often depends on the audience they're describing it to. Yesterday, for example, President Obama was talking to college students in Pennsylvania, so he highlighted this.
President BARACK OBAMA: If you're a young adult, which many of you are, you'll be able to stay on your parents' insurance policy until you're 26 years old.
(Soundbite of cheering, applause)
ROVNER: But that's actually a relatively minor element of how the bill would change how health care is organized, delivered and paid for. Altogether, an estimated 30 million more people who now don't have health insurance would get it as a result of the bill. One of the most popular things the bill would do is ban insurance companies from excluding people, or raising their rates, because they have what's known as a pre-existing medical condition. What's that? Here's how California Democratic congressman George Miller described his.
Representative GEORGE MILLER (Democrat, California): I sit here with two artificial hips, a little bit of arthritis, and I have a kidney stone. I'm dead in that insurance market if I have to switch policies or switch companies, or look for another chance.
ROVNER: But there's always a trade-off. In exchange for getting insurance companies to agree to accept everyone, regardless of their health status, the insurance companies need more healthy people to be covered to help spread the risk. So the bill does something that's a lot more controversial: It requires everyone to have insurance.
Republicans, like Iowa Senator Chuck Grassley, aren't very enthusiastic about that idea.
Senator CHARLES GRASSLEY (Republican, Iowa): Never has the federal government said any American had to buy anything. Now, have to buy insurance. If you don't buy it, pay the IRS more money.
ROVNER: Indeed, that's how the mandate will be enforced at tax time. If you can't prove you're covered, you'll pay a penalty.
But help will be available. If you're poor, you'll get health insurance for free through the Medicaid program.
Middle-class people who have to buy their own policies will get government subsidies. And small businesses will get tax credits to help pay for insurance for their workers.
Those who have to buy their own health insurance get another leg up: a new marketplace called an exchange. There, they can pool their buying power and compare their options. At the same time, said Senate Finance Committee Chairman Max Baucus...
Senator MAX BAUCUS (Democrat, Montana; Chairman, Senate Finance Committee): Exchanges will make it easier for Americans to choose the most efficient plans. And that will reduce their costs and put pressure on insurance companies to offer lower-cost, higher-quality plans.
ROVNER: Another cost-cutting aspect of the bill is a new focus on paying doctors, hospitals and other health-care professionals. It would be based on how well they do their jobs, rather than just how many tests they order or exams they perform.
House Majority Leader Steny Hoyer explained it like this at the White House health meeting at Blair House last month.
Representative STENY HOYER (Democrat, Maryland): We also believe that there should be incentives to provide care based upon best practices, not based upon simply procedures being reimbursed.
ROVNER: But politics has had a lot to do with getting the bill this far. Now, House Democrats are being asked to cast a vote for the bill the Senate passed Christmas Eve. And, at least initially, they'll have to approve that Senate bill with no changes - as Tennessee Republican Senator Lamar Alexander reminded everyone at the Blair House meeting.
Senator LAMAR ALEXANDER (Republican, Tennessee): And it still has the sweetheart deals in it. I mean, what's fair about taxpayers in Louisiana paying less than taxpayers in Tennessee? And what's fair about protecting seniors in Florida, and not protecting seniors in California and Illinois and Wyoming?
ROVNER: Of course, here's where this process gets even more confusing. Those so-called sweetheart deals, made to win some key votes, are expected to be canceled in a second bill. That will carry the compromises now being made between the Senate and the House. That bill's also likely to alter the way the health-care program is paid for. But that second bill is still being drafted, and House Democrats are very skittish about its ultimate prospects.
Julie Rovner, NPR News, Washington. Transcript provided by NPR, Copyright National Public Radio.
