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Health reform timeline

Assuming the bill passes (edit: woot!)
One thing which might get more coverage later is that most of the big reforms don't kick in until 2014. AFAIK this is mostly for a stupid "who'se the biggest cheapskate?" reason: Obama in some speech had said a ten year cost less than $900 billion, said number being pulled out of thin air (or sounding less scary than the magic threshold of a trillion), and Congress took that as a hard cap for some reason. Despite the fact that the *net* cost is less than zero, since the bill has tax increases and cost containment measures to pay for itself. Somehow it became important that the size of outlays, even when paid for, be less than than $900 billion. And the only way to do that was to delay starting subsidies until 4 years into the 10-year period, so people will continue to risk death or medical bankruptcy so that some phantom of deficit hawks and fiscal conservatives can be satisfied.

http://www.kff.org/healthreform/sidebyside.cfm has lots of comparison options, most concisely http://www.kff.org/healthreform/upload/housesenatebill_final.pdf which I have just gone through for RPG.net to pick out the major elements and when they happen. Now I'll share them with you!

Employer mandate: Jan 1, 2014
Medicaid expansion (of eligibility to all adults with income <133% poverty level, and compensation increasing to Medicare levels): Jan 1, 2014
tax credit for small businesses (<25) providing insurance: starts in 2010 tax year
temporary reinsurance plan for age>55 employees: 90 days after enactment
tax for not having insurance: starts in 2014, scales up
increase in taxes funding Medicare (on high-income people): Jan 1, 2013

excise tax, on plans over $10,200 for individuals and $27,500 for families, said thresholds being increased for high-risk profession employees by $1650 and $3450, and possibly increasable for age/sex reasons: Jan 1, 2018. Yes, twenty-eighteen

tax on pharm companies: 2011
tax/fees on health insurance sector, increasing by rate of premium growth: 2014

guaranteed issue and community rating, the heart of individual insurance reform: Jan 1, 2014

Sick people get something though:
Establish a temporary national high-risk
pool to provide health coverage to individuals
with pre-existing medical conditions. U.S.
citizens and legal immigrants who have a
pre-existing medical condition and who have
been uninsured for at least six months will
be eligible to enroll in the high-risk pool and
receive subsidized premiums. Premiums for
the pool will be established for a standard
population and may vary by no more than
4 to 1 due to age; maximum cost-sharing
will be limited to the current law HSA limit
($5,950/individual and $11,900/family in 2010).
Appropriate $5 billion to finance the program.
(Effective within 90 days of enactment until
January 1, 2014)

medical loss ratio floors and rebate requirements: 2011
premium increase review process: 2010
dependent coverage up to age 26 for all policies: 6 months after enactment
no lifetime limits on coverage; no rescission except in case of fraud; no pre-existing condition exclusions for children: 6 months after enactment
no annual limits: 2014. Prior to 2014, annual limits "only as determined by the Secretary"

website for coverage options and standard policy information format: July 1, 2010; and 60 days after enactment


So the immediate or short-term help is no lifetime limits on coverage in any plan; no rescission in individual plans (unless they can spin your mistakes or withheld information as fraud); no exclusion for children; premium review and later loss ratio floors; a national pool for people with pre-existing conditions. Not sure what "a standard population" means for the pool: will premiums be set as for healthy people, with the difference being provided by the government, or will they be averaged over all the sick people in the pool?

Only immediate benefit for health individuals is that if they buy a plan, it'll presumably be harder to kick them off of it when they use it. And the premium review process might help too; not clear how much teeth it will have.


Edit: Newt Gingrich likens it to civil rights. So, in a less ironic way, does John Lewis:

"In a closed-door caucus for Democrats before the vote, Rep. John Lewis,
a Georgia Democrat and veteran of the civil rights movement who
reportedly faced racial epithets from protesters outside the Capitol on
Saturday, reminded his colleagues that they were acting on healthcare on
the 45th anniversary of the civil rights march from Selma to Montgomery
in Alabama. Lewis was beaten in an infamous confrontation with police
during the first of those marches."

wiki: The third march, which began on March 21 and lasted five
days, made it to Montgomery, 54 miles (87 km) away.

Comments

( 4 comments — Leave a comment )
jordan179
Mar. 22nd, 2010 07:20 am (UTC)
So the immediate or short-term help is no lifetime limits on coverage in any plan; no rescission in individual plans (unless they can spin your mistakes or withheld information as fraud); no exclusion for children; premium review and later loss ratio floors; a national pool for people with pre-existing conditions.

Yes, that should nicely clear out many of the insurance companies providing health insurance, increasing the health care crisis and making it harder to repeal the legislation before 2014. Of course, some people may needlessly die in consequence of this between 2010 and 2014 but, hey, they probably weren't very important people anyway ...
mindstalk
Mar. 22nd, 2010 07:49 am (UTC)
Your tears of confused and impotent rage are sweet to me.

"Unimportant" people -- like science fiction authors and webcomic artists -- dying? That's the current system.
mmegaera
Mar. 22nd, 2010 11:38 pm (UTC)
Thanks for the timeline. And, yes, woot! is the correct response, IMHO.
lyceum_arabica
Mar. 23rd, 2010 02:46 pm (UTC)
Yes, thanks for the summary :-) First really good news I've heard in a while.
( 4 comments — Leave a comment )

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