Early Retiree Insurance Program Under New Health Law

This temporary program under the new health care law helps early retirees pay medical bills. The program works through employers who have to apply for the program. The program starts in June and is a bridge until 2014, when retirees can purchase coverage through the health insurance exchanges, which will be set up by then. Kaiser Health News has a good roundup on this program.
From the White House:

FACT SHEET: The Early Retiree Reinsurance Program

Rising costs have made it difficult for employers to provide quality, affordable health insurance for workers and retirees while also remaining competitive in the global marketplace. Many Americans who retire without employer-sponsored insurance and before they are eligible for Medicare see their life savings disappear because of exorbitant rates in the individual market. The Early Retiree Reinsurance Program will provide much-needed financial relief for employers so retirees can get quality, affordable insurance starting this year.

Quality, Affordable Care for Early Retirees

The percentage of large firms providing workers with retiree coverage has dropped from 66 percent in 1988 to 31 percent in 2008.
The Affordable Care Act provides $5 billion in financial assistance to employers to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare.
Employers can use the savings to either reduce their own health care costs, provide premium relief to their workers and families or a combination of both.
Relief for Businesses

This temporary program will make it easier for employers to provide coverage to early retirees.
Employers who are accepted into the program will receive reinsurance reimbursement for medical claims for retirees age 55 and older who are not eligible for Medicare, and their spouses, surviving spouses, and dependents.
Health benefits that qualify for relief include medical, surgical, hospital, prescription drug, and other benefits that may be specified by the Secretary of Health and Human Services, as well as coverage for mental health services.
The amount of this reimbursement to the employer plan is up to 80% of claims costs for health benefits between $15,000 and $90,000. Claims incurred between the start of the plan year (often January 1) and June 1st are credited towards toward the $15,000 threshold for reimbursement. However, only medical expenses incurred after June 1, 2010 are eligible for reimbursement under this program.
For example: If an individual incurs costs of $30,000 between the start of the plan year and June 1, and $40,000 after that date. The amount which may be reimbursed is $40,000 – the costs above the $15,000 threshold that occur after June 1.
If a plan incurs $90,000 or more in expenses before June 1, it is treated as having met the $15,000 threshold and is eligible for reimbursement for costs incurred after June 1.
These limits apply and claims are filed for individual’s costs. Firms cannot add two or more individuals together to attain the threshold.
Both self-funded and insured plans can apply, including plans sponsored by private entities, state and local governments, nonprofits, religious entities, unions, and other employers.
Bridge to 2014

HHS will begin the Early Retiree Program on June 1, 2010, in advance of the June 21 start date required by the Affordable Care Act, allowing more claims to qualify for reinsurance payments for plans this year.
Eligible employers can apply for the program through the Department of Health and Human Services. Applications will be available by the end of June.
To receive assistance, plans must have their applications approved, document claims, and implement programs and procedures that have or have the potential to generate cost savings for participants with chronic and high-cost conditions.
Plans will be subject to audits to assure fiscal integrity.
The Early Retiree Reinsurance Program will assist these employer plans and individuals with the cost of health care coverage and health care.
The program ends on January 1, 2014 when early retirees will be able to choose from the additional coverage options that will be available in the health insurance exchanges.

Healthcare Reform Benefits Timeline: What and When

An excellent timeline that explains what's coming and what year it kicks in:

PREPARED BY COMMITTEES ON WAYS & MEANS, ENERGY & COMMERCE, AND EDUCATION & LABOR, APRIL 2, 2010 1

HEALTH INSURANCE REFORM AT A GLANCE IMPLEMENTATION TIMELINE

2010

Immediate Access to Insurance for Uninsured Individuals with a Pre-Existing Condition. Provides eligible individuals access to coverage that does not impose any coverage exclusions for pre-existing health conditions. This provision ends when Exchanges are operational.

Small Business Tax Credit. Initiates the first phase of the small business tax credit for qualified small employers for contributions to purchase health insurance for employees. The credit is up to 35 percent of the employer’s contribution to provide health insurance for employees. There is also a credit of up to 25 percent
for small nonprofit organizations.

Eliminating Pre-Existing Condition Exclusions for Children. Bars all employer plans and new plans in the individual market from imposing pre-existing condition exclusions on children’s coverage.

Prohibiting Rescissions. Prohibits abusive practices whereby health plans rescind existing health insurance policies when a person gets sick as a way of avoiding covering the costs of enrollees’ health care needs.

Eliminating Lifetime Limits and Restricting Use of Annual Limits. Prohibits all health plans from placing lifetime limits on coverage, and prohibits the use of restrictive annual limits in all employer plans and new plans in the individual market.

Covering Preventive Health Services. All new group health plans and plans in the individual market must provide first dollar coverage for preventive services.

Extending Dependent Coverage. Requires all plans in the individual market and new employer plans that provide dependent coverage for children to continue to make that coverage available up to age 26; for existing employer plans, this applies only to young people not offered their own employer-provided coverage.

Reducing the Cost of Covering Early Retirees. Creates a new temporary reinsurance program (until the Exchanges are available) to help offset the costs of expensive claims for employers and retirees, for health benefits for retirees age 55-64.

New, Independent Appeals Process. Requires that any new group health plan or new plan in the individual market implement an effective internal and external appeals process for coverage determinations and claims.

Improving Consumer Assistance. Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals.

Improving Consumer Information through the Web. Requires the Secretary of HHS to establish an Internet website through which residents of any State may identify affordable health insurance coverage options in that State.

Cracking Down on Health Care Fraud. Requires enhanced screening procedures for health care providers to eliminate fraud and waste in the health care system.

Rebates for the Part D “Donut Hole”. Provides a $250 rebate for all Part D enrollees who enter the donut hole. Currently, the coverage gap falls between $2,700 and $6,154 in total drug costs.

Improving Public Health Prevention Efforts. Creates an interagency council to promote healthy policies at the federal level and establishes a prevention and public health investment fund to provide an expanded and sustained national investment in prevention and public health programs.

Strengthening the Quality Infrastructure. Additional resources provided to HHS to develop a national quality strategy and support quality measure development and endorsement for the Medicare, Medicaid and CHIP quality improvement programs.

Extending Payment Protections for Rural Providers. Extends Medicare payment protections for small rural hospitals, including hospital outpatient services, lab services, and facilities that have a low-volume of Medicare patients, but play an important role in their communities.

Establishing a Patient-Centered Outcomes Research Institute. Establishes a private, non-profit institute to identify national priorities and provide for research to compare the effectiveness of health treatments and strategies.

Ensuring Medicaid Flexibility for States. A new option allowing States to cover parents and childless adults up to 133 percent of the Federal Poverty Level (FPL) and receive current law Federal Medical Assistance Percentage (FMAP) will take effect.

Non-Profit Hospitals. Establishes new requirements applicable to nonprofit hospitals beginning in 2010, including periodic community needs assessments.

Expanding the Adoption Credit and Adoption Assistance Program. Increases the adoption tax credit and adoption assistance exclusion by $1,000, makes the credit refundable, and extends the credit through 2011. The enhancements are effective for tax years beginning after December 31, 2009.

Encouraging Investment in New Therapies. A two-year temporary credit subject to an overall cap of $1 billion to encourage investments in new therapies to prevent, diagnose, and treat acute and chronic diseases. The credit would be available for qualifying investments made in 2009 and 2010.

Tax Relief for Health Professionals with State Loan Repayment. Excludes from gross income payments made under any State loan repayment or loan forgiveness program that is intended to provide for the increased availability of health care services in underserved or health professional shortage areas. This provision is effective for amounts received by an individual in taxable years beginning after December 31, 2008.

Excluding from Income Health Benefits Provided by Indian Tribal Governments. Excludes from gross income the value of specified Indian tribal health benefits. The provision is effective for benefits and coverage provided after the date of enactment.

Establishing a National Health Care Workforce Commission. Establishes an independent National Commission to provide comprehensive, nonbiased information and recommendations to Congress and the Administration for aligning federal health care workforce resources with national needs.

Strengthening the Health Care Workforce. Expands and improves low-interest student loan programs, scholarships, and loan repayments for health students and professionals to increase and enhance the capacity of the workforce to meet patients’ health care needs.

Special Deduction for Blue Cross Blue Shield (BCBS). Requires that non-profit BCBS organizations have a medical loss ratio of 85 percent or higher in order to take advantage of the special tax benefits provided to them under Internal Revenue Code (IRC) Section 833, including the deduction for 25 percent of claims and expenses and the 100 percent deduction for unearned premium reserves.

Indoor Tanning Services Tax. Imposes a ten percent tax on amounts paid for indoor tanning services in lieu of the tax on cosmetic surgery. Indoor tanning services are services that use an electronic product with one or more ultraviolet lamps to induce skin tanning. The tax would be effective for services on or after July 1, 2010.

Holding Insurance Companies Accountable for Unreasonable Rate Hikes. Creates a grant program to support States in requiring health insurance companies to submit justification for unreasonable premium increases starting in plan year 2010, and insurance companies with excessive or unjustified premium increases between
2010 and 2014 could be prohibited from participating in the new Health Insurance Exchanges.

2011

Bringing Down the Cost of Health Care Coverage. Health insurers, including grandfathered plans, must annually report on the share of premium dollars spent on medical care as opposed to profits or administration and provide consumer rebates where less than 80 to 85 percent of dollars are used for benefits.

Strengthening Community Health Centers and the Primary Care Workforce. Provides funds to build new and expand existing community health centers, and expands funding for scholarships and loan repayments for primary care practitioners working in underserved areas.

Increasing Reimbursement for Primary Care. Provides a 10 percent Medicare bonus payment for primary care physicians and general surgeons.

Increasing Training Support for Primary Care. Establishes a Graduate Medical Education policy allowing unused training slots to be re-distributed for purposes of increasing primary care training at other sites.

Improving Health Care Quality and Efficiency. Establishes a new Center for Medicare & Medicaid Innovation to test innovative payment and service delivery models to reduce health care costs and enhance the quality of care provided to individuals.

Improving Preventive Health Coverage. Provides a free, annual wellness visit and personalized prevention plan services for Medicare beneficiaries and requires new plans to cover preventive services with little to no cost sharing. Creates incentives for State Medicaid programs to cover evidence-based preventive services with no cost-sharing, and requires coverage of tobacco cessation services for pregnant women.

Improving Transitional Care for Medicare Beneficiaries. Establishes the Community Care Transitions Program to provide transition services to high-risk Medicare beneficiaries.

Expanding Primary Care, Nursing, and Public Health Workforce. Increases access to primary care by adjusting the Medicare Graduate Medical Education program. Primary care and nurse training programs are also expanded to increase the size of the primary care and nursing workforce. Ensures that public health challenges
are adequately addressed.

Increasing Access to Home and Community Based Services. The new Community First Choice Option, which allows States to offer home and community based services to disabled individuals through Medicaid rather than institutional care, takes effect on October 1, 2011.

Transitioning to Reformed Payments in Medicare Advantage. Freezes 2011 Medicare Advantage payment benchmarks at 2010 levels to begin transition. Continues to reduce Medicare Advantage benchmarks in subsequent years relative to current levels. Benchmarks will vary from 95% of Medicare spending in high-cost
areas to 115% of Medicare spending in low-cost areas. Changes are phased-in over 3, 5 or 7 years, depending on the level of payment reductions.

Discounts in the Part D “Donut Hole”: Provides a 50 percent discount on all brand-name drugs in the donut hole and begins phasing in additional discounts on brand name and generic drugs to completely close the donut hole by 2020 for all Part D enrollees.

Reporting Health Coverage Costs on Form W-2: Requires employers to disclose the value of the benefit provided by the employer for each employee’s health insurance coverage on the employee’s annual Form W- 2.

Standardizing the Definition of Qualified Medical Expenses. Conforms the definition of qualified medical expenses for HSAs, FSAs, and HRAs to the definition used for the itemized deduction. An exception to this rule is included so that amounts paid for over-the-counter medicine with a prescription still qualify as medical expenses.

Increased Additional Tax for Withdrawals from Health Savings Accounts and Archer Medical Savings Account Funds for Non-Qualified Medical Expenses. Increases the additional tax for HSA withdrawals prior to age 65 that are not used for qualified medical expenses from 10 to 20 percent. The additional tax for Archer MSA withdrawals not used for qualified medical expenses would increase from 15 to 20 percent.

Cafeteria Plan Changes. Creates a Simple Cafeteria Plan to provide a vehicle through which small businesses can provide tax-free benefits to their employees. This would ease the small employer’s administrative burden of sponsoring a cafeteria plan. The provision also exempts employers who make contributions for employees under a simple cafeteria plan from nondiscrimination requirements applicable to highly compensated and key employees.

Pharmaceutical Manufacturers Fee. Imposes an annual, non-deductible fee on the pharmaceutical manufacturing industry allocated according to market share and not applying to companies with sales of branded pharmaceuticals of $5 million or less.

2012

Encouraging Integrated Health Systems. Implements physician payment reforms that enhance payment for primary care services and encourage physicians to join together to form “accountable care organizations” to gain efficiencies and improve quality.

Linking Payment to Quality Outcomes. Establishes a hospital value-based purchasing program to incentivize enhanced quality outcomes for acute care hospitals. Also, requires the Secretary to submit a plan to Congress by 2012 on how to move home health and nursing home providers into a value-based purchasing payment system.

Reducing Avoidable Hospital Readmissions. Directs CMS to track hospital readmission rates for certain high- volume or high-cost conditions and uses new financial incentives to encourage hospitals to undertake reforms needed to reduce preventable readmissions, which will improve care for beneficiaries and rein in unnecessary health care spending.

2013

Payments to Primary Care Physicians. Requires that Medicaid payment rates to primary care physicians for furnishing primary care services be no less than 100% of Medicare payment rates in 2013 and 2014. Provides 100% federal funding for the incremental costs to States of meeting this requirement.

Administrative Simplification. Health plans must adopt and implement uniform standards and business rules for the electronic exchange of health information to reduce paperwork and administrative burdens and costs.

Encouraging Provider Collaboration. Establishes a national pilot program on payment bundling to encourage hospitals, doctors, and post-acute care providers to work together to achieve savings for Medicare through increased collaboration and improved coordination of patient care.

Limiting Health Flexible Savings Account Contributions. Limits the amount of contributions to health FSAs to $2,500 per year, indexed by CPI for subsequent years.

Eliminating Deduction for Employer Part D Subsidy. Eliminates the deduction for the subsidy for employers who maintain prescription drug plans for their Medicare Part D eligible retirees.

Increased Threshold for Claiming Itemized Deduction for Medical Expenses. Increases the income threshold for claiming the itemized deduction for medical expenses from 7.5 to 10 percent. Individuals over 65 would be able to claim the itemized deduction for medical expenses at 7.5 percent of adjusted gross income through
2016.

Additional Hospital Insurance Tax for High Wage Workers. Increases the hospital insurance tax rate by 0.9 percentage points on an individual taxpayer earning over $200,000 ($250,000 for married filing jointly). Expands the taxable base to include net investment income in the case of taxpayers earning over $200,000 ($250,000 for joint returns).

Medical device excise tax. Establishes a 2.3 percent excise tax on the sale of a medical device by a manufacturer or importer. Exempted from the tax are eye glasses, contact lenses, hearing aids, and any device of a type that is generally purchased by the public at retail for individual use.

Limiting Executive Compensation. Limits the deductibility of executive compensation under Section 162(m) for insurance providers if at least 25 percent of the insurance provider’s gross premium income from health business is derived from health insurance plans that meet the minimum creditable coverage requirements. The deduction is limited to $500,000 per taxable year and applies to all officers, employees, directors, and other workers or service providers performing services, for or on behalf of, a covered health insurance provider. This provision is effective beginning in 2013 with respect to services performed after 2009.

Fee for patient-centered outcomes research. Annual fee becomes effective on insured and self-insured plans to fund the patient-centered outcomes research trust fund.

2014

Reforming Health Insurance Regulations. Implements strong health insurance reforms that prohibit insurance companies from engaging in discriminatory practices that enable them to refuse to sell or renew policies due to an individual’s health status. Health plans can no longer exclude coverage for treatments based on pre-existing health conditions. It also limits the ability of insurance companies to charge higher rates due to heath status, gender, or other factors. Premiums can vary only on age (no more than 3:1), geography, family size, and tobacco use.

Eliminating Annual Limits. Prohibits all employer plans and new plans in the individual market from imposing annual limits on the amount of coverage an individual may receive.

Ensuring Coverage for Individuals Participating in Clinical Trials. Prohibits new health plans from dropping coverage because an individual chooses to participate in a clinical trial and from denying coverage for routine care that they would otherwise provide just because an individual is enrolled in a clinical trial. Applies to all clinical trials that treat cancer or other life-threatening diseases.

Establishing Health Insurance Exchanges. Opens health insurance Exchanges in each State to individuals and small employers. This new venue will enable people to comparison shop for standardized health packages. It facilitates enrollment and administers tax credits so that people of all incomes can obtain affordable coverage.

Ensuring Choice through a Multi-State Option. Provides a choice of coverage through a multi-State plan, available from nationwide health plans under the supervision of the Office of Personnel Management.

Providing Health Care Tax Credits. Makes premium tax credits available through the Exchange to ensure people can obtain affordable coverage. Credits are available for people with incomes above Medicaid eligibility and below 400 percent of poverty who are not eligible for or offered other acceptable coverage. They apply to both premiums and cost-sharing to ensure that no family faces bankruptcy due to medical expenses again.

Ensuring Choice through Free Choice Vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an Exchange plan.

Promoting Individual Responsibility. Requires most individuals to obtain acceptable health insurance coverage or pay a penalty of $95 for 2014, $325 for 2015, $695 for 2016 (or, up to 2.5 percent of income in 2016), up to a cap of the national average bronze plan premium. Families will pay half the amount for
children, up to a cap of up to a cap of $2,250 per family. After 2016, dollar amounts are indexed. If affordable coverage is not available to an individual, they will not be penalized.

Promoting Employer Responsibility. Requires employers with 50 or more employees who do not offer coverage to their employees to pay $2,000 annually for each full-time employee over the first 30 as long as one of their employees receives a tax credit. Precludes waiting periods over 90 days. Requires employers who
offer coverage but whose employees receive tax credits to pay $3,000 for each worker receiving a tax credit up to an aggregate cap of $2000 per full-time employee.

Increasing Access to Medicaid. Medicaid eligibility will increase to 133 percent of poverty for all non-elderly individuals to ensure that people obtain affordable health care in the most efficient and appropriate manner. States will receive increased federal funding to cover these new populations.

Small Business Tax Credit. Continues the second phase of the small business tax credit for qualified small employers.
Quality Reporting for Certain Providers. Places certain providers – including ambulatory surgical centers, long-term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, PPS-exempt cancer hospitals and hospice providers – on a path toward value-based purchasing by requiring the Secretary to implement quality measure reporting programs in these areas and also pilot test value-based purchasing for each of these providers in subsequent years.

Health Insurance Provider Fee. Imposes an annual, non-deductible fee on the health insurance sector allocated across the industry according to market share. The fee does not apply to companies whose net premiums written are $25 million or less.

2015

Continuing Innovation and Lower Health Costs. Establishes an Independent Payment Advisory Board to develop and submit proposals to Congress and the private sector aimed at extending the solvency of Medicare, lowering health care costs, improving health outcomes for patients, promoting quality and efficiency, and expanding access to evidence-based care.

Paying Physicians Based on Value Not Volume. Creates a physician value-based payment program to promote increased quality of care for Medicare beneficiaries.

2018
Excise tax on high cost employer-provided health plans becomes effective. Tax is on the cost of coverage in excess of $27,500 (family coverage) and $10,200 (single coverage), increased to $30,950 (family) and $11,850 (single) for retirees and employees in high risk professions. The dollar thresholds are indexed with inflation, and employers with higher costs on account of the age or gender demographics of their employees may value their coverage using the age and gender demographics of a national risk pool.

Read Reuters timeline on health reform implementation here. I dare you to find a death panel or cuts to hospice, as one Florida doctor, who turns away Obama supporters, has charged.
Here's CNN's timeline.

Doctor Warns Obama Supporters to Go Away

Jack Cassell's sign

Would you put your health in the hands of a doctor who was so petty, a doctor who can't control his impulses? I wouldn't. Apparently, he's a lame doctor. At healthgrades.com, 232 people voted on his care. Out of five stars, he gets on average one and a half. The guy's probably bad at what he does and is looking for a place to pin blame. He says it would be unethical to turn people away but isn't it unethical to hang such a sign in your office?

A doctor who considers the national health-care overhaul to be bad medicine for the country posted a sign on his office door telling patients who voted for President Barack Obama to seek care "elsewhere."

"I'm not turning anybody away — that would be unethical," Dr. Jack Cassell, 56, a Mount Dora urologist and a registered Republican opposed to the health plan, told the Orlando Sentinel on Thursday. "But if they read the sign and turn the other way, so be it."

The sign reads: "If you voted for Obama … seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years." Read more at Orlando Sentinel

This lowlife actually appears on camera. Here's another addition, Cassell appears on a radio show and he doesn't even know what's in the bill. Of course he doesn't. This is about deep rooted bigotry. People like Jack Cassell don't recognize as bigotry because they know no better.

Update April 4: Here is Cassell defending his sorry self to Anderson Cooper. Cassell defends himself like a five-year old would. He talks about the healthcare timeline. Here it is. He'll probably stay in business because he lives in a rightwing area.

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The Long History of Healthcare and Questions Answered

Marketplace's Tess Vigeland talked to a healthcare historian. Does this sound familiar?

Opponents of the reform effort came up with a strategy. This was in the years leading up to World War 1. America was about to go battle with Germany. And Germany had been the first country to pass universal health care.

DUBIN: And they used this anti-German feeling as a way to attack compulsory health care as some insidious plot to undermine the American government and the American people.

WARNER: So they called them the dirtiest word you can call an American, which is a European.

DUBIN: Right, and only in this time, there were various, "Germans," and "Prussians" and "doing the Emperor of Germany's work."

This became the pattern. When reformers tried to restart the debate in the 20s, they were called socialists.

DUBIN: Right and in Harry Truman's era they called them Bolsheviks and communists. And that's the whole history of health care reform is, champions, they lose, someone picks it up again, champions it, they lose.

Until the day comes when they win. Read more at Marketplace

Healthcare has a long and tangled history of reformers trying to get it done, and alas, it is done. Well, first steps anyway. It's interesting that those who have tried to reform healthcare have been called names throughout history. Some people will always stand in the way of change because change is scary.
In addition to the history of healthcare, this episode of Marketplace also had some more details on the new healthcare law and how it affects you, including information on the exchanges that we've heard so much about. It's becoming more apparent to me that this really is a big deal, even beyond its historical relevance. Listen to the whole program:

Obama Signs Healthcare and Education BIll March 30

Updated with video

Update: Obama signed the bill with one of many pens and the bill is now law!!!

Jill Biden introduced Obama, who is set to sign the reconciliation bill, which includes the health fixes and the student loan reform. Obama is speaking at Northern Virginia Community College. The event started at 11:05 am eastern.

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Obama's Weekly Address March 27

Transcript

Obama Signs Healthcare Part 2 in Virginia March 30

Update March 30: Watch video of Obama signing the bill/speaking here.

Update March 29: Obama will speak at 11:05 am eastern. Jill Biden will also be in attendance. The event will be audio streamed at WhiteHouse.gov and it's likely to be live streamed at msnbc.com.

This is the second part of healthcare, the so-called reconciliation bill that just passed the House yesterday. The bill also has the student loan reform, which begins July 1, 2010:

On Tuesday morning, March 30th at Northern Virginia Community College, President Obama will sign the Health Care and Education Reconciliation Act of 2010, which delivered a significant down payment on the President's ambitious agenda to make higher education more affordable and help more Americans earn a college degree.

Reconciliation Done Healthcare Done

Healthcare is done and done. Tonight the House passed the fixes in a reconciliation bill, which also includes student loan reform. Republicans tried hard to obstruct but they didn't get very far this time. John Dingell is pleased:

My dad is smiling. In the end, nothing could stop this

Obama is expected to sign the reconciliation bill soon:

The House of Representatives cleared the final hurdle in Congress' overhaul of the nation's health care system, passing a health care reconciliation bill by a 220-207 vote.

In Iowa, the president challenges Republicans to campaign on repealing new law.

The amendment bill, which included the fixes made to the Senate version of the health care bill, will now go to President Obama for his signature.

The Senate passed the legislation this afternoon by a 56-43 margin after defeating 41 amendments offered by Republicans.

Three Democrats, including Sens. Blanche Lincoln and Mark Pryor of Arkansas and Sen. Ben Nelson of Nebraska -- all of whom voted for the original Senate health care legislation -- voted against the reconciliation bill. ABC

Pelosi's last healthcare gavel!

Nancy Pelosi Speaks on Recent Violence

Nancy Pelosi obviously did a little reprimanding in the House. She says it's inappropriate for Congress members to cheer on bad behavior. See Cantor's response here.

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Constitutional Scholar Says Health Lawsuits Frivolous

So what republicans are doing is wasting our money.

Obama Speaks in Iowa March 25 Live Stream

Watch Obama's visit to an Iowa City bookstore here. Full video:

Benefits of Healthcare Reform

Here is a compilation of what the law does. I'll add more when I find good sources of information:
This year, these changes will go into effect:

This year, children with pre-existing conditions can no longer be denied health insurance coverage. Once the new health insurance exchanges begin in the coming years, pre-existing condition discrimination will become a thing of the past for everyone.
This year, health care plans will allow young people to remain on their parents' insurance policy up until their 26th birthday.
This year, insurance companies will be banned from dropping people from coverage when they get sick, and they will be banned from implementing lifetime caps on coverage. This year, restrictive annual limits on coverage will be banned for certain plans. Under health insurance reform, Americans will be ensured access to the care they need.
This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary subsidized high-risk pool.
In the next fiscal year, the bill increases funding for community health centers, so they can treat nearly double the number of patients over the next five years.
This year, we'll also establish an independent commission to advise on how best to build the health care workforce and increase the number of nurses, doctors and other professionals to meet our country's needs. Going forward, we will provide $1.5 billion in funding to support the next generation of doctors, nurses and other primary care practitioners -- on top of a $500 million investment from the American Recovery and Reinvestment Act. More at the WH

The NYT has a great interactive on how different people (married, single, uninsured...) will be affected under the new law.
Starting in 2014, there will be a fine for not having healthcare insurance. Currently, we all pay a large fine. That's because our tax dollars pay for the people who don't have insurance (see video below). The Kaiser Family Foundation is a terrific source of nonpartisan healthcare news.

What is the fine for not having insurance?

Under the House's reconciliation package, the figures are $95 or 1% in 2014, $325 or 2% in 2015, and $695 or 2.5% in 2016. In both versions of the legislation, the penalties would go up by the cost-of-living adjustment after 2016. WSJ

How much will it cost to buy if you don't have insurance?

If you decide to buy your own plan, you will be able to purchase it through a new state-based exchange that should start up in 2014. These plans will be sold at four levels of richness, ranging from a bronze plan that covers 60% of the benefit costs to a platinum plan that covers 90%. These plans will all cover the essential health benefits, a package that is supposed to include maternity, hospital and prescription coverage, among other areas. They will also have out-of-pocket costs capped at a level tied to health-savings account plans, which this year is $5,950 for an individual and $11,900 for a family.

There will also be a catastrophic plan available to people under 30 and those exempt from the insurance mandate.

Depending on your income level, you may be eligible for government help buying a plan. Under both the Senate bill and the reconciliation package, Medicaid will expand to cover people under 133% of the federal poverty level and under the age of 65, which is about $29,000.

For those making between 133% and 400% of poverty, which is around 88,000 for a family of four, there will be subsidies to help pay premiums and cover cost-sharing expenses. The credits will be designed so that the amount people pay toward premiums is capped at a certain percentage of their income. In the underlying Senate bill, this ranges from 2% for those at the poverty level, to 9.8% for those between 300 and 400%. Under the House's reconciliation package, the subsidies are a bit richer, with the contributions capped at 9.5% of income for those between 300 and 400% of poverty. Read more at the WSJ.

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15 Newspapers That Snubbed Healthcare Passage

The 15 newspapers that didn't put healthcare passage on the front page. Mt Airy News chose a story about the Boy Scouts. The Peru, Indiana newspaper led with cattle:

Benton County Daily Herald, Bentonville, Arkansas
Spring snowstorm.

Northwest Arkansas Times, Fayetteville, Arkansas
"Overnight accumulation leaves Northwest Arkansas roads slippery."

The Morning News, Rogers, Arkansas
Spring snowstorm.

Stars and Stripes, Washington, D.C.
NCAA “bracket busters.”

Palm Beach Daily News, Palm Beach, Florida
"Census Forms Arriving in the Mail."

Tampa Bay Times, St. Petersburg, Florida
A story on Hollywood's suddenly feeble leading men pegged to Ben Stiller's "Greenberg" character.

Commercial-News, Danville, Illinois
Photos of a maple syrup open house.

Herald-Press, Huntington, Indiana
School staff reduction.

Peru Tribune, Peru, Indiana
A local cattle show.

Wabash Plain Dealer, Wabash, Indiana
Fatal car crash at intersection kills two.

Cecil Whig, Elkton, Maryland
Fire destroys home and runaway emu found.

AMnewyork, New York City
Teen subway mugging.

The High Point Enterprise, High Point, North Carolina
"Bus seat belts not likely."

The Mount Airy News, Mount Airy, North Carolina
"Boy Scouts learn skills at Merit Badge College."

Bluffton Today, Bluffton, South Carolina
Construction of a new middle school gym.

Read more at The Wrap

Healthcare Passage and Signing Photos

Obama with Pelosi and her grandson March 20
A very happy Obama, Kathleen Sebelius and Nancy Pelosi
Obama plays HORSE with a staffer in between healthcare meetings
Obama reads his BlackBerry
Big hug from Hillary on news that the House passes the bill
Obama signs healthcare bill

Obama speaks at the Dept. of Interior today
Obama checks his Blackberry before his speech at the Interior
Obama's signature on healthcare



Obama and Nancy-Ann DeParle, who handled healthcare policy.

Obama and Dennis Kucinich aboard Air Force One

Rush Limbaugh Fudges on Costa Rica

If I cared, I'd almost feel embarrassed for him:

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How Fickle are Americans? Now They Like Healthcare

Now, all of a sudden, according to the infamous polls, Americans like healthcare, when just two days ago, people supposedly hated it. Just replace fickle with ignorance. I don't mean that in a derogatory way. I just mean that most people haven't done the research to know anything about healthcare, and after the horrible job the media did of reporting on healthcare, it's no wonder no one knows anything. The media only recently started reporting some of the contents of the bill and how it might affect people. Up until that point, all we heard about was the tea party. If people have learned anything at all, it's from the talking heads of their political view point. This is why polling is meaningless and making important decisions based on polls is absurd.

Americans by 9 percentage points have a favorable view of the health care overhaul that President Obama signed into law Tuesday, a USA TODAY/Gallup Poll finds, a notable turnaround from surveys before the vote that showed a plurality against it.
By 49%-40% those surveyed say it was "a good thing" rather than a bad one that Congress passed the bill. Half describe their reaction in positive terms, as "enthusiastic" or "pleased," while about four in 10 describe it in negative ways, as "disappointed" or "angry." USA Today

The Unfinished Business is Done

Many Americans only seem to care that today, Joe Biden may have cursed (no, he didn't swear out loud intending for people to hear), failing to see the bigger picture, distracted from the positive impact of what just happened. This brings it home:

The late senator's widow, Vicki Reggie Kennedy, spent hours on Sunday at the simple white cross at Arlington National Cemetery marking where her husband was laid to rest only seven months ago. Ted Kennedy's youngest son, Rep. Patrick J. Kennedy (D-R.I.), visited on Monday morning and left a hand-written note that read: "Dad, the unfinished business is done." WaPo

If you're tiring of hearing of the tea party revenge, the attorneys general revenge, the republicans revenge, here's some praise for Obama.

Attorneys General Suits Against Health Law Politically Based

Just more political grandstanding, more waste of our tax dollars, and of course, most of the media is playing up the controversy instead of telling us the truth:

However, a wide variety of experts and scholars across the political spectrum say opt-out state laws are a political exercise with no legal effect.

"The notion that a state can just choose to opt out is just preposterous," says former Reagan administration Solicitor General Charles Fried. "One is left speechless by the absurdity of it."

Fried says similar attempts at "so-called nullification" led to the Civil War.

Conservative scholar and former federal appeals court Judge Michael McConnell agrees that states' opt-out laws are legally meaningless.

"If the mandate is constitutional," he says, "then the state statutes are pre-empted" — they are trumped by federal law. And "if the federal law is unconstitutional, the state laws are unnecessary." NPR

Obama Signs Health Bill March 23 Video

Updated with Obama's remarks. Below is Joe Biden's introduction:


Watch CBS News Videos Online
Bart Stupak yelled out "yes we did!" when Obama said that many democrats have taken their lumps.

A rundown from the White House of what health reform brings:

Let's start with how health insurance reform will expand and strengthen coverage:

This year, children with pre-existing conditions can no longer be denied health insurance coverage. Once the new health insurance exchanges begin in the coming years, pre-existing condition discrimination will become a thing of the past for everyone.
This year, health care plans will allow young people to remain on their parents' insurance policy up until their 26th birthday.
This year, insurance companies will be banned from dropping people from coverage when they get sick, and they will be banned from implementing lifetime caps on coverage. This year, restrictive annual limits on coverage will be banned for certain plans. Under health insurance reform, Americans will be ensured access to the care they need.
This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary subsidized high-risk pool.
In the next fiscal year, the bill increases funding for community health centers, so they can treat nearly double the number of patients over the next five years.
This year, we'll also establish an independent commission to advise on how best to build the health care workforce and increase the number of nurses, doctors and other professionals to meet our country's needs. Going forward, we will provide $1.5 billion in funding to support the next generation of doctors, nurses and other primary care practitioners -- on top of a $500 million investment from the American Recovery and Reinvestment Act.
Health insurance reform will also curb some of the worst insurance industry practices and strengthen consumer protections:

This year, this bill creates a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer.
This year, discrimination based on salary will be outlawed. New group health plans will be prohibited from establishing any eligibility rules for health care coverage that discriminate in favor of higher-wage employees.
Beginning this fiscal year, this bill provides funding to states to help establish offices of health insurance consumer assistance in order to help individuals in the process of filing complaints or appeals against insurance companies.
Starting January 1, 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Insurers in the large group market will be required to spend 85 percent of their premium dollars on medical services. Any insurers who don't meet those thresholds will be required to provide rebates to their policyholders.
Starting in 2011, this bill helps states require insurance companies to submit justification for requested premium increases. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance exchanges.
Reform immediately begins to lower health care costs for American families and small businesses:

This year, small businesses that choose to offer coverage will begin to receive tax credits of up to 35 percent of premiums to help make employee coverage more affordable.
This year, new private plans will be required to provide free preventive care: no co-payments and no deductibles for preventive services. And beginning January 1, 2011, Medicare will do the same.
This year, this bill will provide help for early retirees by creating a temporary re-insurance program to help offset the costs of expensive premiums for employers and retirees age 55-64.
This year, this bill starts to close the Medicare Part D 'donut hole' by providing a $250 rebate to Medicare beneficiaries who hit the gap in prescription drug coverage. And beginning in 2011, the bill institutes a 50% discount on prescription drugs in the 'donut hole.'

Republicans Hold a Press Conference Today to Near Empty Room

AP photo of Mike Pence and Cathy McMorris Rodgers discussing health legislation at a press conference today. By the way, health reform is now law. This is what John Boehner tweeted:

With the stroke of a pen, President Obama has signed away another share of Americans' freedom. We will take it back.

Such grownups. As Obama signed health reform, Newt Gingrich's tweet links to a site that shows a photo of Obama, Pelosi and Reid and Armageddon. This morning, he accused Obama as being part of the Chicago mob. Michael Steele says that Pelosi needs to be fired. Fox News had this to say:

Mark this day: Everyone agrees with Joe Biden. What did he say to president at health insurance bill signing? "This is a big f---ing deal.”

To which Gibbs tweets back:

And yes Mr. Vice President, you're right...

When are the republicans going to grow up? Either grow up or get out.

Here's the actual press conference, where Pence announces republicans are going to continue to waste our tax dollars by doing nothing but opposing and stamping their feet. Remember Waterloo?