You knew this was coming. 🙂
On Sunday, the House passed H.R. 3590 , the Senate version of the health care bill, along with another bill (H.R. 4872 Reconciliation Act of 2010) to reconcile differences. HR 3590 was signed into law on Tuesday and the reconciliation bill, which the Senate passed yesterday.
Overall my feelings on the bill are mixed but mostly positive. I like the reform elements like preventing rescission and excluding children for coverage for pre-existing conditions. I love that we are moving a little towards preventative care versus prescriptive care, I’d like to see more of that. I’m a little mixed at some of the small business elements where employers are forced to buy insurance, but I think they are palatable because they don’t take into effect unless you have over 50 employees. I’m indifferent to the various Medicare and Medicaid elements that affect doctor payments because I am unfamiliar with how the system actually words (vs. on paper).
A big piece that concerns me are state health exchanges  and how they’ll be implemented. It worries me because the bill requires some people to get insurance but doesn’t necessarily make things more affordable. It’s not clear whether insurance companies are required to participate and not everyone is eligible. It’s a bit too much gray area, you know?
Finally, how will insurance companies respond? If the Anthem Blue Cross rate hike in California  is any indication, insurance companies know that the death spiral  is a very real phenomenon. You don’t raise rates 39% because you think now is a good time to rip people off, you do it because you have no choice. I wonder how insurance companies will respond to the bill before some of its provisions take effect.
As for paying for these changes, we’ll be paying for the changes in the bill by increasing taxes  on single filers earning more than $200,000 (about 1 million people) and couples earning more than $250,000 (4 million couples). While some would cry that this is “spreading the wealth around” (and it is) and un-American, remember that the Bush tax cuts slashed the tax bills of the taxpayers who are now seeing their tax bill increase. Pendulums swing two ways in its search for equilibrium.
What do you think about it? I’ve heard all the philosophical arguments from both sides, how this gives millions of Americans hope that their health won’t be denied or how this is the government telling you how to live your life… and I think philosophical arguments are overblown. Everyone talks about how government keeps spending and how it’s the party in power’s fault because of XYZ… which everyone knows is crap because every politician spends like there is no tomorrow (because if they don’t spend on their constituents, there won’t be a tomorrow for them!).
Let’s ignore these overarching arguments that matter only to politicians and let’s talk about the specifics of the bill that you like or dislike. Do you think putting the Medicaid tax on unearned investment income for those earning more than $200k/$250k is bad? What about penalizing employers who have more than 50 employees and don’t offer health care? What specifically do you like and dislike? The point isn’t to try to change someone’s mind about it but understand what people like and dislike about it and how it personally affects them.