My Two Cents on Health Care Reform

I've seen and listened to a ton of coverage on this. Living where I do (East Tennessee) I hear a LOT of the conservative viewpoint. This is OK, because I'm basically conservative myself. I've been sort of keeping above the whole health care debate because I'm on the fence about it.

I see a need for health care reform, but I don't think what just happened is the way to go about it.

For posterity, I'm going to put down my thoughts on a basic summation of the bill.  My comments are indented and in blue.  Read on after the break.
Cost:
$940 billion over ten years.

I don't know about you, but I'm so innured to these huge numbers now, they mean nothing to me. If you were to look at me and say "This is going to cost you $1000 a year more," that would mean something to me. Probably why it's shown this way.

Deficit:
Would reduce the deficit by $143 billion over the first ten years. That is an updated CBO estimate. Their first preliminary estimate said it would reduce the deficit by $130 billion over ten years. Would reduce the deficit by $1.2 trillion dollars in the second ten years.

I don't believe this for one minute. Everytime they promise to cut spending, they find a new way to spend more. If it does reduce the deficit, great, but I'm not holding my breath. Regardless, the burden of the costs are going to be on the states, and hence the taxpayers.

Coverage:
Would expand coverage to 32 million Americans who are currently uninsured.

Look, providing insurance to people who are uninsured is a good thing. We provide food to those who need it. My question is, why isn't this being handled the same way? Why can't they just provide vouchers to those who need them, much like handing out food stamps?

Health Insurance Exchanges:
The uninsured and self-employed would be able to purchase insurance through state-based exchanges with subsidies available to individuals and families with income between the 133 percent and 400 percent of poverty level.

400%? Isn't that like $80k? Perhaps that's a gross figure. If that's net income, they should be able to afford their own. I know a lot of people (principly in my family) who are self-employeed (as truck drivers) and have to cover their own insurance costs. These folks make six-figure gross incomes, but after operating expenses for their trucks, they make less than I do. I hope this figure is for adjusted net income, but even then 400% seems a little high.

Separate exchanges would be created for small businesses to purchase coverage -- effective 2014.
Funding available to states to establish exchanges within one year of enactment and until January 1, 2015.

OK, fair enough. A lot of small businesses can't afford to provide insurance for their employees. Heck, a lot of medium businesses struggle with this.

OK, this seems BS. If the Federal .gov is mandating this, shouldn't they fund it? Unfunded mandates will likely get this declared unconstitutional and repealed, but it could take years (and a ton of wasted money).

Subsidies:
Individuals and families who make between 100 percent - 400 percent of the Federal Poverty Level (FPL) and want to purchase their own health insurance on an exchange are eligible for subsidies. They cannot be eligible for Medicare, Medicaid and cannot be covered by an employer. Eligible buyers receive premium credits and there is a cap for how much they have to contribute to their premiums on a sliding scale.

I think this is primarily covered above. Who's paying for the subsidies though (I mean besides you and me)? Is it the Federal .gov or more of a state thing?

Paying for the Plan:
Medicare Payroll tax on investment income -- Starting in 2012, the Medicare Payroll Tax will be expanded to include unearned income. That will be a 3.8 percent tax on investment income for families making more than $250,000 per year ($200,000 for individuals).

Look, taxing the rich is never the answer (though I'm not certain I'd consider $250k rich, especially considering the differences of where people live. $250k in New York is way different than $250k in Knoxville.). The rich bear a huge tax burden already, but guess what? They also drive the bulk of the economy. If you take more money from them, what is their incentive to invest or consume? They should've found a way to keep from raising taxes on anyone. At least Obama is keeping his campaign promise to raise the taxes on those making more than that figure.

Excise Tax -- Beginning in 2018, insurance companies will pay a 40 percent excise tax on so-called "Cadillac" high-end insurance plans worth over $27,500 for families ($10,200 for individuals). Dental and vision plans are exempt and will not be counted in the total cost of a family's plan.

Translation: Consumers will be paying this tax. The insurance companies are not going to eat the costs.

Tanning Tax -- 10 percent excise tax on indoor tanning services.

Uh, ok. Who the hell thought this one up?  Another dumb tax, this time on people who use tanning services. This will likely raise costs at most health clubs, too. I know National Fitness Center offers tanning services, and you can bet they're going to raise rates.

Medicare:
Closes the Medicare prescription drug "donut hole" by 2020. Seniors who hit the donut hole by 2010 will receive a $250 rebate.

I'm not certain what's meant by this, so I won't say anything.

Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs. The bill also includes $500 billion in Medicare cuts over the next decade.

Well, who's going to cover this 50% discount? Tanning beds? Where will the $500b in Medicare cuts come from? This sounds like "We'll throw the seniors a bone by helping to lower prescription costs, but we're going to screw them over by cutting Medicare services." I'm all for affordable prescription drugs. I know my co-pay rises every year (or at least seems to). But that money has to come from somewhere.

Medicaid:
Expands Medicaid to include 133 percent of federal poverty level which is $29,327 for a family of four.

Ok, that's reasonable. I know when I was recently under-employeed, this would've been useful.

Requires states to expand Medicaid to include childless adults starting in 2014.

Again, expecting the states to cover this. I guess this is for adults under the poverty line? I'm for this, but again, who's paying for it?

Federal Government pays 100 percent of costs for covering newly eligible individuals through 2016.

Riiight. Then who pays for it?

Illegal immigrants are not eligible for Medicaid.

As they should not be.

Insurance Reforms:
Six months after enactment, insurance companies could no longer denying children coverage based on a preexisting condition.

Good. I'm all for this.

Starting in 2014, insurance companies cannot deny coverage to anyone with preexisting conditions.

Ditto.

Insurance companies must allow children to stay on their parent's insurance plans until age 26th.

Considering my children don't plan on moving out until they're 30, this is probably a good thing. Seriously, this sounds about right for kids in college. I'm for this one.

Abortion:
The bill segregates private insurance premium funds from taxpayer funds. Individuals would have to pay for abortion coverage by making two separate payments, private funds would have to be kept in a separate account from federal and taxpayer funds.
No health care plan would be required to offer abortion coverage. States could pass legislation choosing to opt out of offering abortion coverage through the exchange.
**Separately, anti-abortion Democrats worked out language with the White House on an executive order that would state that no federal funds can be used to pay for abortions except in the case of rape, incest or health of the mother.

OK, I'm not even going to discuss abortion. I know where I stand on it, you know where you do. Good enough.

Individual Mandate:
In 2014, everyone must purchase health insurance or face a $695 annual fine. There are some exceptions for low-income people.
Employer Mandate:

Another sticking point. Legally they can't do this. I'll get into this a bit more at the end.

Technically, there is no employer mandate. Employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance. Fines applied to entire number of employees minus some allowances.

It might still be cheaper for small companies to not provide health care.

Immigration:
Illegal immigrants will not be allowed to buy health insurance in the exchanges -- even if they pay completely with their own money.

This is fair. If they want to be included, come in the legal way. I know some immigrants (legal) who get pissed about how much illegals get away with. It's time to stop the gravy train.

Here's my bottom line: I hear a lot of conversation on the "right" to health care.  There is no such thing. Even if there were, the Federal government can't give it to you.  If it's a "right", it's God-given, not from the State.  The State can guarantee our rights, but it cannot grant them.  You know you have the right to free speech.  Does this mean that the Federal government has to build you a platform on which to exercise that right?  You have the right to pursue happiness.  Does this mean the Federal government now has to supply you with the means to fulfill your happiness?  No, that's silly.

Even if you grant such a thing as a "right" to health care, all the Federal government is granted to do by the Constitution is to prevent that right from being infringed upon.  That means that no one can reasonably deny you access to health care, not that they have to give it to you if you do not pay for it.

I sincerely think President Obama and the current Congress have considerably overstepped the powers We The People have granted them.  I believe this legislation should be repealed, not because I think it's necessarily a bad thing, but because I fear what this type of over-stepping the boundaries will lead to in the future.