Partly due to an extra long Executive Session that delayed the Council Meeting start to about 8:25 PM and a long agenda, the meeting lasted to about 10:45PM. To late to try to organize an impression report. Since I did not see Mark Spivey there I believe that Plaintalker will be the definitive report on the meeting.
I will post something later.
Tuesday, July 21, 2009
HEALTH CARE STATUS #3
Today, I am posting the last four important provisions that have significant differences in the two proposed bills for heath care reformation. Before a final bill is acceptable to both houses there will have to be negotiations and compromises by both houses.
Meanwhile; Michelle Obama has become one of the Obama administration’s most visible surrogates on health care, announcing the release of $851 million in federal financing for health clinics, calling for tougher nutritional standards in the government’s school lunch program and urging Democrats to rally around the president’s efforts to revamp health care.
She has chosen to deliver her recent remarks in more traditional settings for a first lady — at a clinic, a playground and in the White House garden. Her aides say she will promote policy, not make it, and will continue to concentrate on children and families. They say they do not expect her to be accused of overstepping her bounds as Hillary Rodham Clinton was when she tried to remake health care as the first lady.
On Friday, the budget office’s director, Douglas W. Elmendorf, said the bill would add $239 billion to the national deficit over 10 years, partly because of an increase in Medicare spending to avert sharp cuts in payments to doctors. (This is much less than the $591 reported by the joint Senate committees-see yesterday. I will discuss doctor’s payments anon)
Mr. Orszag said taking out those doctor payments with a new policy would make the bill “deficit-neutral” over 10 years. On Saturday, President Obama in a radio address said he would reject any health legislation that would increase the deficit.
The House bill provides subsidies to offset premium costs and out of pocket spending for household below 400% of the poverty level, with those of the lower end receiving more.
SUBSIDIES TO EMPLOYERS: The Senate bill provides tax credits to employers with fewer than 50 full-time workers who pay at least 60% of their employee’s health insurance premium. Credit amounts are based on a few factors, including the size of the employer and the type of coverage provided, and is available for up to three consecutive years.
The House bill provides tax credits to employers with fewer than 25 full-time workers. The credit can be up to 50% of the premium costs, dependent upon the size of the employer and the average wages, and is not offered for employees earning more than $80,000 per year.
EXPANSION OF MEDICAID: The Senate bill; extends Medicaid to all individuals with income up to 150% of the poverty level [$16,245 a person]. Currently Medicare covers millions of low income older Americans, people with disabilities, pregnant women, children and some parents, low income childless adults are generally not eligible.
The House bill; expand Medicaid to all individuals with incomes up to 133% of the poverty level about $14,400.
FINANCING: The Senate; estimated the 10 year cost to be about $1 trillion. The bill does not include financing proposals, because the Health Committee does not have the authority over taxes or Medicare or Medicaid. By Constitution all revenue raising legislation originates in the House.
The House bill estimates the ten-year cost about $1 trillion. To raise $544 million over 10 years by imposing an income surtax of families with incomes over $350,000 and individuals with incomes over 287. Raise much of the remainder by lowering spending on Medicare and other health care savings.
My future postings will deal with the objections from interested and pressure groups to various elements in the bills as they are as of this date. There will be no timetable for their posting. I hope this series has been of some value.
Meanwhile; Michelle Obama has become one of the Obama administration’s most visible surrogates on health care, announcing the release of $851 million in federal financing for health clinics, calling for tougher nutritional standards in the government’s school lunch program and urging Democrats to rally around the president’s efforts to revamp health care.
She has chosen to deliver her recent remarks in more traditional settings for a first lady — at a clinic, a playground and in the White House garden. Her aides say she will promote policy, not make it, and will continue to concentrate on children and families. They say they do not expect her to be accused of overstepping her bounds as Hillary Rodham Clinton was when she tried to remake health care as the first lady.
On Friday, the budget office’s director, Douglas W. Elmendorf, said the bill would add $239 billion to the national deficit over 10 years, partly because of an increase in Medicare spending to avert sharp cuts in payments to doctors. (This is much less than the $591 reported by the joint Senate committees-see yesterday. I will discuss doctor’s payments anon)
Mr. Orszag said taking out those doctor payments with a new policy would make the bill “deficit-neutral” over 10 years. On Saturday, President Obama in a radio address said he would reject any health legislation that would increase the deficit.
THE HEALTH CARE BILLS
SUBSIDIES TO INDIVIDUALS: the Senate plan provides subsidies to offset premium costs for household below 400% of the federal poverty level [$88,200 for a family of 4] with those at the lower end receiving more.The House bill provides subsidies to offset premium costs and out of pocket spending for household below 400% of the poverty level, with those of the lower end receiving more.
SUBSIDIES TO EMPLOYERS: The Senate bill provides tax credits to employers with fewer than 50 full-time workers who pay at least 60% of their employee’s health insurance premium. Credit amounts are based on a few factors, including the size of the employer and the type of coverage provided, and is available for up to three consecutive years.
The House bill provides tax credits to employers with fewer than 25 full-time workers. The credit can be up to 50% of the premium costs, dependent upon the size of the employer and the average wages, and is not offered for employees earning more than $80,000 per year.
EXPANSION OF MEDICAID: The Senate bill; extends Medicaid to all individuals with income up to 150% of the poverty level [$16,245 a person]. Currently Medicare covers millions of low income older Americans, people with disabilities, pregnant women, children and some parents, low income childless adults are generally not eligible.
The House bill; expand Medicaid to all individuals with incomes up to 133% of the poverty level about $14,400.
FINANCING: The Senate; estimated the 10 year cost to be about $1 trillion. The bill does not include financing proposals, because the Health Committee does not have the authority over taxes or Medicare or Medicaid. By Constitution all revenue raising legislation originates in the House.
The House bill estimates the ten-year cost about $1 trillion. To raise $544 million over 10 years by imposing an income surtax of families with incomes over $350,000 and individuals with incomes over 287. Raise much of the remainder by lowering spending on Medicare and other health care savings.
My future postings will deal with the objections from interested and pressure groups to various elements in the bills as they are as of this date. There will be no timetable for their posting. I hope this series has been of some value.
Monday, July 20, 2009
Forum notice.
COMPLAINT DEPARTMENT: As of 11:50 AM nowhere on the city site was a mention of Tuesday's forum. There was a adequate entry at 3:15 PM when I checked but the calender still has the 21st blank. Who is responsible?
HEALTH CARE #9b
There was one program I had mentioned but forgot to make any comment. That is CHIP OR SCHIP (Children's Health Insurance Program) :
The Children's Health Insurance Program is jointly financed by the Federal and State governments and is administered by the States. Within broad Federal guidelines, each State determines the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures. CHIP provides a capped amount of funds to States on a matching basis. Federal payments under title XXI to States are based on State expenditures under approved plans effective on or after October 1, 1997.
The Bush administration would have permitted the program to expire. but the Democrat Congress temporarily extended it until President Obama signed the Re-Authorization Act earlier this year.
Briefly the program is designed to provide insurance coverage for children whose family has no insurance and are not eligible for Medicaid. Each state sets the upper limits for eligibility and benefits. New Jersey will enroll children within a family limit income of $77,175.00. This is only exceeded by New York, all others are lower. However N.J. is 10th in the number of children enrolled. This could be because the program is not as well known as it should be.
Some states are experiencing sever financial problems and are being forced to cut back on the program. California which has the most serious financial problem in the country had almost 1.7 million children enrolled in 2007. This state has had to put a moratorium on enrollment.
The attraction to the states for this program is that the Federal government will pay the states up to 70% of the costs whereas in Medicaid it is only 57%. However, the states need to find funding for their portion of the program
The Children's Health Insurance Program is jointly financed by the Federal and State governments and is administered by the States. Within broad Federal guidelines, each State determines the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures. CHIP provides a capped amount of funds to States on a matching basis. Federal payments under title XXI to States are based on State expenditures under approved plans effective on or after October 1, 1997.
The Bush administration would have permitted the program to expire. but the Democrat Congress temporarily extended it until President Obama signed the Re-Authorization Act earlier this year.
Briefly the program is designed to provide insurance coverage for children whose family has no insurance and are not eligible for Medicaid. Each state sets the upper limits for eligibility and benefits. New Jersey will enroll children within a family limit income of $77,175.00. This is only exceeded by New York, all others are lower. However N.J. is 10th in the number of children enrolled. This could be because the program is not as well known as it should be.
Some states are experiencing sever financial problems and are being forced to cut back on the program. California which has the most serious financial problem in the country had almost 1.7 million children enrolled in 2007. This state has had to put a moratorium on enrollment.
The attraction to the states for this program is that the Federal government will pay the states up to 70% of the costs whereas in Medicaid it is only 57%. However, the states need to find funding for their portion of the program
HEALTH CARE PLANS STATUS #2
A recent joint report from the Congressional budget office and the Joint Committee on Taxation dated 7/2/09 noted that the proposed new bills would only cover an additional 20 million of the 65 million that are either uninsured or lack adequate basic insurance.
This would be at the expense of a national deficit increase of $591 billion from 2010 to 2019. That is after measures to reduce the costs by over $100 million are in place. This is giving some of the Washington hierarchy reason to pause for a second look.
That is one of the factors that may delay any bill from being completed before the August recess.
To return to the present two versions; in the matter of the Insurance Market Place; the Senate would require every state to have an insurance exchange where small employers and individuals uninsured through work or a public program could buy insurance. The Senate bill would also allow states to form regional insurance exchanges.
The House bill is more federally centered by creating a national insurance exchange for the same purpose. It could be open to large employers over a period of time. It would also allow states to opt out and operate their own exchange under federal rules.
It is obvious that the Senate is still concerned with state’s rights and the House is leaning to a national health plan.
In the area of a Public Plan; the Senate would offer a new public plan to compete with the private insurers in the insurance exchange. This public plan would only provide the essential health benefits an is described in their bill.
It is obvious that from all elements of the Health Care industry that serve patients there has been considerable opposition to this plan. Physicians, Home care, Rehab services and especially the Hospitals would suffer economically. We have personally felt the results of reduced cash flow to hospitals. Even if they could stay open, it would be at the expense of reduced care and services.
Sunday, July 19, 2009
PHOTO POTPOURRI 7/ 19/09
I have had some problems with my photo software and a DVD drive that causes system crashes. Also, there has been too much extraneous factors that have been more important to me for posting. Much is in the political sphere and in the Health Care restructuring processand therefore other projects must take a back seat. However, so that you know that I have not given up on posting pictures here are three unrelated photos.
Cook School, 1st Tuesday November 2008. You all got out then, do it again this November
Rural scene Bavaria.
An old castle partly in ruins with vineyards below; Moselle River Germany.
Cook School, 1st Tuesday November 2008. You all got out then, do it again this November
Rural scene Bavaria.
An old castle partly in ruins with vineyards below; Moselle River Germany.
HEALTH CARE PLAN STATUS #1
My original intent was to summarize last year's posting on Health Care in various countries and discuss various options that have been suggested for America. However , the process has moved way beyond a theoretical stage and soonedr or later a definitive bill will b e sent to the Prersident for his signature. Therefore, I now going to post the differences between the p[lans that are for vote in each house and I will also keep up with new developoments including objections for various sectors that will be affected by any plan put into effect.
As of 7/18/09 there are three different health care bills working their way through Congress: The Senate Committee on Health, Education, Labor, and Pensions (HELP) approved its 651 page bill this past week. The Senate Finance Committee is working on a bipartisan bill. The House Democrats in three committees are working on a single plan. Both “Ways and Means” and ‘Education and Labor” committees have approved the over 1000 page House version. The House Energy and Commerce committee must still approve the bill before it can reach the floor for a vote.
Within the past few days there has been an undercurrent in Congress questioning the potential negative impact on employment as well as costs if the bills are past as presently constituted.
The present Senate version requires employers with 25 or more workers to contribute at least 60% of the premium cost for their full time workers. There is a penalty of $750 for each full time worker and $375 for each part time worker not cove red.
The proposed House version requires employers with an annual payroll larger than $$250,000 to contribute 72.5% of the premium for full time workers and 65% for the families. The penalty for the employer with an annual payroll of $400,000.00 is a payroll tax of up to 8%.
In the realm of Individual mandates both require most individuals to have a minimum level of insurance. The Senate b ill exempts American Indians and those who can’t afford insurance e or live in states without insurance exchanges. There is a penalty for non compliance up to $750 a person each year.
The present House bill Exempts those who cannot afford insurance, dependents, and those with religious objections. The penalty is 2.5% of adjusted gross income over a certain level (example; $18,000.00 for a childless couple.)
These are two of at least eight distinct items covered in the bills. I intend to do a few more each posting.
Subscribe to:
Posts (Atom)
