New Senate Bill Achieves Greater Deficit Reduction, On Track To Pass By Christmas
New Senate Bill Achieves Greater Deficit Reduction, On Track To Pass By Christmas
The Congressional Budget Office’s analysis of the merged Senate health care bill, incorporating the manager’s amendment, concludes that the legislation would cost $871 billion over 10 years, reduce the deficit by $132 billion over 10 years and by $1.3 trillion over 20 years. The bill would extend insurance to 31 million individuals, covering approximately 94% by 2019.
Here is how the new merged bill compares to the earlier version:
| Senate Bill | New Managers Amendment | Difference | |
| Costs | Reduce deficits: $130B/10yrs Cost: $848B/10yrs Spends on subsidies: $447B/10yrs On Medicaid/CHIP: $374B/10yrs On Small Employer Credit: $27B/10yrs |
Reduce deficits: $132B/10yrs Cost: $871B/10yrs Spends on subsidies: $436B/10yrs On Medicaid/CHIP: $395B/10yrs On Small Employer Credit: $40B/10yrs |
Reduce deficits: +$2B/10yrs Cost: +$23B/10yrs Spends on subsidies: -$11B/10yrs On Medicaid/CHIP: +$21B/10yrs On Small Employer Credit: +$13B/10yrs |
| Insured | Uninsured reduced by: 31M Uninsured in 2019: 24M In Exchanges: 25M | Public Plan: 3-4M In Medicaid: 15M |
Uninsured reduced by: 31M Uninsured in 2019: 23M In Exchanges: 26M In Medicaid: 15M |
Uninsured reduced by: No Change Uninsured in 2019: -1M In Exchanges: +1M In Medicaid: No Change |
| Revenue | Mandate penalty: $8B/10yrs Free rider penalty: $28B/10yrs New taxes: $238B/10yrs Excise tax: $149B/10yrs Payroll tax: $54B/10yrs |
Mandate penalty: $15B/10yrs Free rider penalty: $28B/10yrs New taxes: $264B/10yrs Excise tax: $149B/10yrs Payroll tax: $87B/10yrs |
Mandate penalty: +$7B/10yrs Free rider penalty: No Change New taxes: +$26B/10yrs Excise tax: No Change Payroll tax: +$33B/10yrs |
| Medicare and Medicaid |
Total savings: $491B/10yrs Medicare Advantage: $118B/10yrs Medicare Commission (IMAB): $23B/2015–2019 |
Total savings: $483B/10yrs Medicare Advantage: $118B/10yrs Medicare Commission (IMAB): $28B/2015–2019 |
Total savings: -$8B/10yrs Medicare Advantage: No Change Medicare Commission (IMAB): +$5B/2015–2019 |
Some of the changes include:
- Holding Insurers Accountable: Insurers in large group market have to maintain a medical loss ration of 85%. Insurers in the small group market have to maintain a medical loss ration of 80%. Insurance companies who jack up their rates will be barred from competing in the exchange.
- Regulations For Children: Starting immediately children cannot be denied health coverage due to pre-existing conditions.
- Nonprofit Insurers Excluded From Tax: Nonprofit insurers are excluded from the tax on the insurance industry.
- Employers Can Offer Vouchers: Individuals and families under 400% of the federal poverty line who receive employer-sponsored coverage and spend 8-9.8% of their income on premiums, could “convert their tax-free employer health subsidies into vouchers that they can use to choose a health insurance plan in the new health insurance exchanges.
- Changes To Medicare Commission: The Medicare Commission will now examine the effect programs have on National Health Expenditures and will be prohibited from increasing premiums. The committee will make non binding recommendations if the Medicare spending rate is below or on target.
- New Choice Of Coverage From Nonprofits: Individuals could enroll in a national health insurance plan managed by the Office of Personnel Management, the same entity that oversees health plans for Members of Congress.
- Investment In Community Health Centers/Rural Areas: A substantial investment in Community Health Centers and more funding for rural health care providers and training programs for physician and other types of health care providers.
- Expands Small Business Tax Credit: The credits begin a year earlier – in 2010 and small businesses are eligible for up to six years. The wage thresholds for small business tax credits is also increased.
- Satisfying Gun Owners: Does not require individuals to disclose whether they own a gun. Gun ownership cannot be factored into premiums or coverage decisions.
- New Taxes: Increases the payroll tax on high income earners from 0.5% to 0.9%; the tax begins in 2013. A 10% tax is imposed on indoor tanning services and the ‘botox tax’ is removed.
Majority Leader Reid will file three cloture motions tonight and the Senate could pass the final legislation on Thursday, December 24th at 7pm. The Senate is expected to vote for cloture on the manager’s amendment Monday at 1am. The second cloture vote on the substitute is scheduled for Tuesday morning and the final cloture vote on the underlining bill could occur Wednesday afternoon.
Note: my colleague Emma Sandoe of DC Progressive contributed greatly to this post.
13 Responses to “New Senate Bill Achieves Greater Deficit Reduction, On Track To Pass By Christmas”
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Adding $21 billion in Medicaid costs and no change in the number covered by Medicaid. Huh?
December 19th, 2009 at 2:17 pmYour numbers don’t make sense:
43-44 million covered by Exhange/Medicaid/Public Plan under Senate bill
31 million new covereds
24 million remain uninsured.
Manager’s Amendment
41 million in Exchanges/Medicaid (2-3 million less than prior version)
31 million new covereds
23 million uninsureds (1 million less than before)
Unless you changed the total population or numbers covered by employer plans, there should be more 2-3 million more uninsureds, not less.
December 19th, 2009 at 2:23 pmThe health insurance benefit represents 12% of payroll costs. What’s the current mandate penalty?
I see the Wyden dump, shifting health insurance from the employer to the employee, made the bill.
December 19th, 2009 at 2:29 pmOf course guns, cigarettes and booze are risk factors for future health problems. Note the bill allows health insurers to charge a 50% higher premium for certain risk factors.
December 19th, 2009 at 2:31 pmAnd what is the “additional hospital insurance tax” on page 6?
December 19th, 2009 at 2:36 pmMedicaid rolls will balloon before 2014, under the dire economic environment. For there to be a second wave between 2014 and 2016, employers would need to ditch the health insurance benefit on a widespread basis.
December 19th, 2009 at 2:47 pmCBO has specific rounding structures that don’t always appear to make sense. They explain at cbo.gov
December 19th, 2009 at 2:54 pmCBO calls for 150 million people with employer coverage in 2010. 2008 data showed 176.3 million with workplace insurance.
That’s a 26.3 million drop in two years.
CBO projects a small increase in employer coverage from 2010 to 2013. This flies in the face of Census Bureau trend data.
Here’s the kicker. Once the full provisions are implemented, employer coverage will drop 4 million per year from 2016-2019. 15 million will lose workplace coverage under CBO projections.
December 19th, 2009 at 2:55 pmWellPoint and UnitedHealth have an extra year before the tax on for-profit health insurers kicks it.
Nonprofit insurers in Nebraska and Michigan get a special break in the amended bill.
http://www.bloomberg.com/apps/news?pid=20601087&sid=aW0IF2anYguc&pos=2
December 19th, 2009 at 4:41 pmWell one way of saving money would be not to give aid to the racist apartheid state of Israel, so that it can go on ethnically cleansing the Palestinians off their land.
Israeli’s Who fed us false intelligent against Iraq, so that we fought their war. While im glad Saddam is gone, it cost us billions, mind you i will equally be glad when Israel goes,
December 19th, 2009 at 6:41 pmI find it fascinating that, in all of this, the role of the insured – that’s us folks – is not mentioned even one time. Our choices of lifestyle, diet, exercise (or not) are not addressed. Is this to be obvious for us? If it is, many of us, far too many, have been ignoring the message for far too long and we are getting worse at it, not better.
Quite a few small towns and businesses, the few who can offer health insurance, have found it advantageout to themselves and their employees to emphasize personal responsibility and actions to lowering health insurance costs while benefiting the employee in terms of improved quality and meaningful length of life.
Comments? Have I missed something in these 2,500 pages of “legislation”?
December 20th, 2009 at 11:45 amWhat the Obama’s guvernment are going to do to provide health care for fourteen millions illegal aliens once inmigration bill pass the Congress barriers? Where the money needed for that coverage will come from?
December 20th, 2009 at 2:56 pmSure, we have paid into social Security and medicare for most of our lives, and now Obama, Reid, and many others want to pay less to Doctors and Hosp. so they won’t take us in. What a bunch of crap.
December 21st, 2009 at 2:08 am