What’s All This About Healthcare Reform?
1) The bill mandates individuals be insured. A $600 annual fine (tax) will be collected by the IRS if
individuals are not covered. Why is this important?
Well, as the system stands, whenever an individual without insurance becomes ill, taxpayers, by law, must
pay for that person’s coverage. For example, many young adults (18-35) do not purchase insurance be-
cause of the low risk of illness and disease. But if an uninsured person is injured (say, in a car accident)
or is diagnosed with a disease and can not pay for treatment, both emergency room costs and hospital
costs must be payed for by the government. By mandating insurance, taxpayers will save billions of dol-
lars a year.
Ok, but is the mandate and fine constitutional, after all, 14 state Attorneys General are suing the
Yes, the mandate and fine are constitutional. As Congress has the power to regulate interstate commerce
(such as, healthcare) and the power to levy taxes (which is how the fine is collected), these two provisions
Sanford Levinson, of the University of Texas Law School, said Americans who choose not to purchase
health insurance can pay a fine. Congress, he said, clearly has the authority to levy taxes and fines.
"As a technical matter, it's been set up as a tax," Levinson said of penalties. "The argument about constitu-
tionality is, if not frivolous, close to it."
Mark Tushnet, of Harvard University, said the central premise relied upon by the law's opponents — that
Americans who choose not to have insurance aren't involving themselves in the nation's commerce — is
"The failure to have health insurance doesn't mean the person won't be consuming health services," Tush-
net said. Once they receive care, he said, they have become involved in commerce and are subject to the
federal government's regulation.
If it is so clearly constitutional, why are 14 Attorneys General suing?
Well, the matter is mostly political. The 14 Attorneys General are either running for governor (Florida,
Michigan, Pennsylvania, Nebraska, Alabama, Colorado, etc.) or are Attorneys General for governors who
are seen as possible Presidential candidates (VA-McDonnel, LA-Jindal) In short, it’s all about politics and
looking good for Republican Party donors and primary voters.
2) The U.S. is swimming in debt. Why do we continue adding to it?
According to the nonpartisan, apolitical Congressional Budget Office, the healthcare bill costs $930 bil-
lion, but is completely payed for and will actually reduce the federal debt (and hence taxpayer’s cost) by
$143 billion over the first 10 years and an additional $1.3 trillion over the following decade. This makes
healthcare reform the largest deficit reducing bill since the 1994 Clinton budget. (http://voices.washing-
3) What does this healthcare reform bill do for Medicare? I heard this bill harms seniors at the ex-
pense of providing insurance to the uninsured.
a) Guarantees basic Medicare benefits and gradually closes the so-called "doughnut hole" in prescription
drug coverage, starting with a $250 rebate this year, and a 50 percent discount for brand-name drugs in
the gap next year.
b) Adds free annual exams and free preventive care.
c) Phases in reductions in government subsidies to private Medicare Advantage plans. With other savings,
that extends Medicare's solvency for a decade.
d) The cost of the reform is funded by reducing fraud, abuse and waste in Medicare, and levying a new
tax on high-end health plans and higher taxes on the wealthy.
So, healthcare reform reduces the cost of prescriptions for seniors, give seniors absolutely free annual
checkups, and pays for Medicare an additional decade:
It gives people on Medicare new access to free preventive services such as screenings for cancer and dia-
betes. Also, by 2020 it will close the "doughnut hole," the gap in Part-D where Medicare stops paying
once a senior has spent more than $2,830 on prescription drugs and resumes when the individual's out-of-
pocket spending has reached about $4,550.
4) I’m a student, how does healthcare reform affect me?
Children will now be able to stay on their parents plan until the age of 27. This will do two critical
things: First, it eliminates children from having to choose between getting their own insurance or paying a
$600 fine when they are not yet established at a decent job. Secondly, it encourages students to attend
graduate school without worrying about having to find a full time job that provides healthcare benefits.
5) What is all this about pre-existing conditions?
More than 13 million American non-elderly adults have been denied insurance specifically because of
their medical conditions, according to the Commonwealth Fund, and the Kaiser Family Foundation says
21% of people who apply for health insurance on their own get turned down, charged a higher price or of-
fered a plan that excludes coverage for their pre-existing condition.
Starting in 2014, the new health care reform legislation makes it illegal for any health insurance plan to
use pre-existing conditions to exclude, limit or set unrealistic rates on the coverage an individual or de-
pendent can receive.
In the meantime, if you have a pre-existing condition, starting in 90 days you should be able to join a na-
tional high-risk pool, which will give those with pre-existing conditions temporary coverage until they
can buy their own insurance in 2014.
It is important to remember that pre-existing conditions affect many Americans of all ages. One of my
close friend’s parents lost their job and hence the insurance the job provided. They tried to do the respon-
sible thing and get their son on health insurance. Every insurance company they called, however, refused
to insurance their son because he had a pre-existing condition --- ADHD. His parents were willing to pay
monthly premiums like everyone else, but insurance companies felt his ADHD medication would be too
expensive to offset what they would be getting in premiums.
How about “rescissions?” What are they all about?
Rescission is the technical term for canceling coverage on grounds that the insurance company was mis-
led. Tales of cancellations have fueled outrage among regulators, analysts, doctors and, not least, plain-
tiffs' lawyers, who describe insurers as too eager to shed patients to widen profits.
"This is probably the most egregious of examples of health insurers using their power and their resources
to deny benefits to people who are most in need of care," said Gerald Kominski, associate director of the
Center for Health Policy Research at the University of California at Los Angeles. "It's really a horrendous
activity on the part of the insurers."
This bill outlaws rescissions. No longer will insurance companies be able to drop patients simply because
they fall ill.
6) Why is the government only helping poor people with insurance? Insurance is expensive for ev-
This is absolutely true and is why the government is helping everyone who makes $88,000 or less a year
pay for insurance:
The size of the subsidy depends on your income, whether you're single or have a family, your age, and
where you live.
Here are a few examples:
• A 40-year old individual making $30,000 a year in a medium-cost area of the country will get an $850
subsidy toward buying a policy, which should cost about $3,500, according to a Kaiser Family Founda-
tion subsidy calculator.
• A 40-year-old in the same city who has a family of four and is making $60,000 will get a $4,220 subsidy
toward a policy that costs $9,435.
You can estimate your own subsidy by using the Kaiser subsidy calculator.
7) I often hear that this plan is bad for businesses, is that true?
Not at all, while business with 50 employees or more will be required to offer health insurance plans to
their workers or face a fine in 2014, small business, starting with the signing of the bill, small business
will get a tax credit worth 35% of health insurance costs to help them pay for insurance costs. The tax
credit is increased to 50% in 2014. This does two critical things: make applying for the jobs more appeal-
ing because they offer health insurance, and allows the business to hire more people by reducing costs.
8) Some say this bill is bad for doctors, how so?
This bill does little to affect doctors since almost all the currently uninsured Americans will be covered by
private health insurance plans. For those uninsured who will be eligible for Medicaid, the government
will actually reimburse doctors slightly more than they do now. Congress is currently working on a bill
that will also slightly increase doctors reimbursements for Medicare payments.
But with 32 million more Americans being insured, how will doctors be able to treat the influx of new pa-
Remember, more insured patients = more profit, so doctors who begin taking on more patients will also
see a rise in their profits. This will allow doctors to hire additional staff to handle the extra burden.
9) Okay, so maybe the healthcare reform bill has some positive changes, but how is it going to be
payed for? Aren’t I going to face huge tax increases?
Wealthier families will pay more in taxes. Starting in 2013, families with annual incomes above $250,000
(and individuals earning more than $200,000) would pay an additional 3.8% income tax, and also face a
0.9% increase in their payroll tax. Expensive, "Cadillac" insurance plans would draw a new tax starting in
2018. A 3.8% tax will also be placed on income earned from investments. Also, a 2.9% tax will be placed
on medical devices such as pacemakers. There will also be a new tax on indoor tanning devices and
In the end, the tax increases aren’t huge at all and affect mainly wealthier Americans.
But still, why should the insured have to pay for insurance for uninsured?
Ignoring the moral and social justice arguments, the insured are already paying for the uninsured. Every
time an uninsured individual goes to the emergency room or gets an operation or stays in a hospital, tax-
payers are paying for their care in two ways: the government picks up part of the tab and hospitals are
charged for the other part and pass those costs onto the insured. By giving people access to preventative
care by insuring them, taxpayers save money in the long run.
10) Will my healthcare insurance costs really decrease with this bill?
When President Obama talks about premiums going down, he usually means they won't go up as much as
they would otherwise. For those their insurance through their employer, they would save about 3% by
2016, according to the nonpartisan Congressional Budget Office, or CBO. People who buy insurance on
their own, but who don't qualify for government subsidies, could actually see their premiums rise by as
much as 10 to 13 percent, but that's largely because they'll be getting beefed-up policies that would pay
for more basic services, especially preventive care. People who qualify for new credits to buy insurance
(those who make $88,000 annually or less) would see the biggest drops.
11) Again, there are some great benefits, but why does the government have to get involved in
healthcare like they do in Canada and Britain?
The government will not take over hospitals or other privately run health care businesses. Doctors will not
become government employees, like in Britain. And the U.S. government intends to help people buy in-
surance from private insurance companies, not pay all the bills like the single-payer system in Canada.
The key parts of the current U.S. system -- employer-provided insurance, Medicare for the elderly, Medi-
caid for the poor -- would stay in place. The government would create health insurance exchanges for
people who have to buy insurance on their own, so they could more easily compare plans and prices.
12) What’s all this about “death panels?” Will the government tell my doctors what treatments I
can and can’t receive?
The proposal does include new boards to make recommendations on evidence-based treatment. But they
won't consider any individual cases or deny procedures for specific patients. The bill also sets minimum
standards for insurance companies, creating a baseline for basic coverage. People will still be able to pick
the plan they prefer.
There is no panel that judges a person's "level of productivity in society" to determine whether they are
"worthy" of health care. The truth is that the health bill allows Medicare, for the first time, to pay for doc-
tors' appointments for patients to discuss living wills and other end-of-life issues with their physicians.
These types of appointments are completely optional, and AARP supports the measure.
The health reform bill also says that a Comparative Effectiveness Research Center shall "conduct, sup-
port, and synthesize research" that looks at "outcomes, effectiveness, and appropriateness of health care
services and procedures in order to identify the manner in which diseases, disorders, and other health con-
ditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically."
The idea here is to make it easier for doctors, health care workers, and patients to find out which treat-
ments are the most effective, as determined by clinical studies and other research. The information will
be posted online and in journals so patients and their doctors can make informed decisions about what
treatments would be most beneficial. (For example, is chemotherapy or radiation or a combination of both
most effective for a particular type of cancer.) No one, however, will be forced or even coerced to follow
the results of the research.
13) I am pro-life and am against abortion or pro-choice but against the funding of abortions with
taxpayer money. Does this bill fund abortion?
The language on abortion, written by an abortion opponent, Democratic Sen. Ben Nelson, Neb., would al-
low companies in the health insurance exchange to offer abortion services, even to people who get federal
subsidies. But to ensure abortion services would be paid through patient premiums, not federal subsidies,
the bill requires that anyone who selects a plan that covers abortion must pay $1 a month toward a segre-
gated fund that would pay for abortion services. One plan in every state exchange must offer coverage
that does not include abortions, so there would be an option for those who morally object to $1 of their
premiums going toward abortion services. Legislators supporting the bill -- along with President Obama
-- insist that segregation of funds stays true to the Hyde Amendment restriction on federal funds for abor-
What about this executive order signed by President Obama?
The bill already spelled out strict payment and accounting requirements to ensure taxpayer money won’t
fund abortions, but Obama's executive order went one step further, putting the president's weight behind
specific measures to ensure that funds are properly segregated. The order mostly restates and reinforces
the intent of the bill.
But even with the executive order, Republican John Boehner said that “for the first time in 30
years, the government will fund abortions.”
While it's understandable that abortion foes opposed a proposal that gives more people the opportunity to
obtain insurance that cover abortions, but it's another thing to say those abortion services would be paid
with federal dollars. The bill states very clearly that public funding through tax credits and government
subsidies for elective abortion services is prohibited. But more than that, the bill sets up a mechanism to
ensure that abortion services offered in the exchange are paid entirely from patient premiums, premiums
paid by people who have chosen a private plan that covers abortion. The executive order puts the weight
of the president's word behind providing a way to ensure two checks go to insurers every month, so that
abortion dollars and federal dollars are not co-mingled. In essence, this bill is abortion neutral: it does not
change the federal law that has been in place for 30 years --- abortions remain legal, but are not paid for
14) What is all this about a health insurance “exchange?”
The exchange is a government-regulated marketplace of insurance plans with different tiers, or levels of
coverage, offered to individuals without health care or to small companies. Presumably, the presence of
government-regulated exchanges will, like any functioning market, bring prices down so that personal
and employer-provided insurance is both comprehensive (ie cannot legally skimp out on necessary care or
otherwise abuse customers) and competitive (ie enough demand will force insurance companies to cut
prices to compete).
What's so great about an insurance exchange?
First off, you can see from the chart above how easy it is to compare plans. Since plans on the exchange
will be transparent, high-quality and "tiered" from the cheapest plan to the one with the most coverage,
reformers hope that it will turn the insurance market into something more closely resembling a real mar-
ketplace where competition for buyers brings down the price of insurance. Second since it's a marketplace
of government-regulated plans, each plan has to clear a high bar set by the feds. That means "preventive
and primary care, emergency services, hospitalization, physician services, outpatient services, day
surgery" ... in other words, pretty comprehensive coverage even at the most basic levels.
15) If the bill does so many good things, why did Republicans oppose it?
Some Republicans had principled opposition to it. They did not like the tax increases and felt that the
government should not regulate private businesses, including insurance companies. More than anything,
however, Republicans opposed the bill for political reasons. As Senator Jim Demint famously said, “If
we defeat it [reform], it will be Obama’s Waterloo.” Republicans have planned all along to spread mis-
truths about healthcare reform, then act as knights in shining armor to oppose it. Even with their opposi-
tion, however, the reform bill contained over 200 Republican amendments, accounting for about 1000
pages of the 2300 page bill. Republicans are now campaigning to repeal it, but with the lies starting to be
revealed, and now that the bill is law and the sky isn’t falling, and it isn’t “the greatest attack on freedom
in American history” as one Republican Congressman said, will the campaign to repeal pick up steam?
16) Finally, my personal view:
This health insurance reform bill was a moral imperative. Each year, 45,000 Americans die simply be-
cause they do not have insurance. They die because, unlike the insured, when they feel a cold coming on,
they can’t go to the doctor. This simple cold could turn into pneumonia, and by the time they get to the
emergency room, its too late. They die because they have chronic headaches, but because they don’t have
insurance, they don’t see a doctor. They get sicker and sicker and when they get to the emergency room,
its revealed they have brain cancer, and only a few weeks to live. Insurance prevents death; this bill
SAVES 45,000 lives each year:
"We're losing more Americans every day because of inaction ... than drunk driving and homicide com-
bined," Dr. David Himmelstein, a co-author of the study and an associate professor of medicine at Har-
vard, said in an interview with Reuters.
Overall, researchers said American adults age 64 and younger who lack health insurance have a 40 per-
cent higher risk of death than those who have coverage. (http://www.reuters.com/article/idUS-
Furthermore, 15,000 Americans lost their insurance every day in 2009 from either losing their job or in-
surance companies dropping sick patients. With this bill, no longer will such an injustice happen. If indi-
viduals lose their job, they won’t have to worry about preexisting conditions getting in the way of getting
new insurance and the exchange will offer competitive, affordable insurance plans.
Yes, taxes will increase for wealthier Americans, and no, I don’t think this is a bad thing. I think it is
slightly petty for wealthy Americans to complain about a 3% tax increase when it will result in millions of
lives being saved. Often, people will throw in my face that I would care about the taxes if I were making
that much money. If am ever fortunate to make $250,000 or more, I would not mind paying slightly high-
er taxes. It is at the core of my beliefs that society as a whole has the responsibility to care for the less
In short, this bill saves lives. It saves money. It’s not a perfect bill. Liberals don’t love it. Conservatives
hate it. But in the end, this bill is the biggest legislative accomplishment in 50 years, and it will positively
affect every American in some way or another.