Friday, 15 January 2010 00:00
Since last fall, I have given some 17 PowerPoint presentations dealing with health care and the uninsured to organizations across Long Island. Never have I seen as much confusion and fear coming from such a broad cross section of audiences. It is no wonder, with both House and Senate bills more than 2,000 pages.
While health-care reform has passed both bodies of the Congress, there is a great deal more to do before a final bill will reach President Obama’s desk. Without being partial, I want to outline where we now are.
One of the biggest hurdles will be what to do with government-run health insurance (the public insurance option). The House strongly supports the government plan with the Senate having no such option in the bill.
The next issue filled with controversary across both sides of the political aisle is funding for abortion. Without the Stupak (D-Mich.) Amendment to ban abortion reimbursements, the House could not have passed a bill. The Senate bill is more relaxed allowing abortion coverage to be paid for with private funds. The Conference Committee will have a real challenge with abortion as it tries to reconcile the House and Senate bills.
And believe it or not, the coverage of illegal immigrants has still not been resolved. Both the House and Senate prohibit Federal funds from being used for illegal immigrants, but the Senate bill goes further and does not allow them to participate even if they pay the bill for coverage themselves.
Increasing the number of people covered by Medicaid is another challenge. With many States in dire financial straits, raising the income level to be eligible for coverage under Medicaid will cause more economic woes for taxpayers. In addition, members of both parties are upset about Nebraska’s Senator Ben Nelson getting his State off the hook with Federal taxpayers footing the entire bill. It will be interesting to see how this plays out.
Next, and not without challenges, is who pays the bill? House leaders want a 5.4 percent payroll tax on individuals earning more than $500,000 per year. The Senate version is different. It would raise Medicare’s payroll tax by 0.5 percent on individuals earning more than $200,000. The Senate would also place a tax on high-cost insurance plans – something strongly disapproved by labor unions. There would also be new taxes on medical equipment and sun tanning vendors.
By the way, none of the above coverage, except for taxes, goes into effect until 2014.
Today, expenditures for health care in the United States are some $2.4 trillion each year – four times the annual budget for the Department of Defense! Over the next 10 years, those expenditures are to double.
One final issue relates to senior citizens. There is growing concern about cuts in Medicare – some $500 billion over the next 10 years. With Medicare funds to be depleted by 2017, it is no wonder the concern exists. If you doubt this, here is a quote from the Federal Government’s 2009 Medicare and Social Security Report – “The financial challenges facing Social Security and Medicare pose serious challenges.”
With the House bill passing by only four votes, the effort to pass a reconciled bill will be an interesting challenge. Stay tuned.