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Five Things You Don't Know About the Senate Health Care Bill

5 years ago
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If you've been following the health care debate closely, you probably know the basics of the Senate Finance Committee's version of health care reform -- like the fact that it was debated by the "Gang of Six"; that it has something called "co-ops" in it; and that it is the only version of the five Congressional reform bills that does not have a public option.

The bill also tells insurance companies they can't drop you or deny you coverage if you're sick; creates an individual mandate that requires you to get health insurance; skips the employer mandate that the House uses to require business to cover workers; and is mostly paid for by charging hefty fees on insurance companies (who could pass these costs on to you) and charging penalties from all you non-complying insurance-skippers out there.

You've also read about the insurance industry's recent case of heartburn over the shrinking penalties for the young, healthy and uninsured Americans they want desperately to get into the system to boost their bottom lines.

But beyond the headlines you've seen lie reams of fine print that you haven't seen. Here are five things you probably don't know about the bill that the committee passed earlier today by a vote of 14 to 9.

1. Congress would be covered.

After months of hearing constituents ask why Congress gets premium health care coverage on the taxpayers' dime, Sen. Charles Grassley (R-Iowa) added an amendment to the bill that says all members of Congress and Congressional staffs will have to buy their health care insurance in the state-based exchanges that the Finance Committee's bill creates. When his amendment passed, Grassley said, "The more that Congress experiences the laws we pass, the better the laws are likely to be." Here's hoping.

2. You can buy insurance across state lines, sort of.

Some consumers would be able to buy their insurance across state lines, if their states agree, because the Finance Committee's bill green-lights regional exchanges in addition to state-by-state models. Sen. Jack Reed (D-R.I.) explained to Politics Daily that if you live in a big state like California, you probably won't get the chance to shop around. But people in states with small populations like Rhode Island could be packing up the car for a health insurance shopping spree in a state next door.

3. Small businesses get fully reimbursed to cover employees for four years.

If you've ever run a small business or worked for one, you know that getting health care through a mom and pop shop is almost impossible because mom and pop just can't afford it.

But the Finance bill says that all businesses with 10 employees or fewer, with an average employee salary of $20,000 or less, can get a 100% tax credit to offer coverage to their workers for the first four years of the new system. Other small businesses would also get would incentives, while truly big businesses -- those with 200 or more employees -- would rack up penalties that show up on their tax returns if they don't cover their people.

Also, businesses with 100 employees or fewer will be able to buy insurance coverage for their employees through the state-level insurances exchanges, finally giving them access to pooled rates that larger employers already enjoy.

4. Sex-ed gets a half-billion dollars.

Prevention of all sorts of conditions, including obesity, heart disease and diabetes, gets a major boost in funding through the bill. But the one preventative measure that will really catch your eye is the $50 million that is set aside annually for abstinence education for five years, plus another $75 million annually for pregnancy prevention and "Personal Responsibility Education for Adulthood Training." That's a lot of birds and bees.

5. Reforming health care will cost you, but not reforming it will cost you more.

The Congressional Budget Office estimates the bill will cost about $830 billion over 10 years, but Republicans warn the bill's costs could balloon once it's fully implemented, especially if unemployment remains high or more companies drop their employees from coverage. And even CBO director Douglas Elmendorf warns that his own numbers, promising shrinking deficits, are subject to change, while The Washington Post accused Baucus over the weekend of playing a "shell game" with reform, since his bill hits a mark below the president's $900 billion cut-off for the cost of reform, but does so by not counting known increases in Medicare costs after next year.

But the alternative of doing nothing could be even uglier, because just as health care costs are getting more expensive in the country, more Americans need more of it (we're looking at you and your knee replacements, baby boomers). The Congressional Budget Office estimates that without reform, the average cost per capita of health care will grow from $8,300 today to $13,000 in eight years, continuing exponentially from there. Because health care will cost more, the CBO predicts wages will also stagnate and 9 million more Americans will become uninsured. Overall, the agency says rising costs for health care represent the single greatest challenge to ever balancing the federal budget again.

A bonus fact: None of this really matters.

So sorry to break the news, but if these solutions appeal to you, enjoy them while you can. If they bother you, then don't get too worked up just yet.

The real decisions about what ends up in health care reform will be made at two junctures in the future. First, when the two Senate bills are combined by Sen. Harry Reid and the Democratic chairmen of the committees behind closed doors, and again in the conference committee, where House and Senate members fight to get their version of health care accepted and passed (we'll call this the "public option smackdown").

Stay tuned...

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