From the site, the info in non-visual form:

2010

In 2010, there will be three major changes to health care:

1. Insurance companies will no longer be allowed to deny coverage to children with pre-existing illnesses.
2. Children would be able to stay on their parents’ insurance policies until they turn 26 years old.
3. Medicare recipients who fall into a specific coverage gap will get a $250 rebate.

Other changes in 2010 include:

* Excise tax on indoor tanning, which will increase the cost of the service.
* Individuals that have not had health insurance for six months will receive a subsidy to enroll in high-risk insurance pools. All new insurance plans sold must exempt preventative care and screenings from deductibles.
* Small businesses with fewer than 25 employees will receive up to a 35 percent tax credit for providing health insurance to their employees.

2011

In 2011, the new health care bill will make changes focused mostly on preparing for later updates. The senior citizens that fall into the “Medicare doughnut hole,” a coverage gap, will get a 50 percent discount on some drugs.

In 2011, a new fee on drug makers will also be implemented to help pay for the upcoming changes. The fine on withdrawing funds from a Health Savings Account for non-medical expenses will increase by 5 to 10 percent. Employers will also need to start including the cost of health care on employee’s W-2 forms.

2012-2013

No major changes will occur in health care in the year 2012 under the new health care bill.

In 2013, many of the new taxes and fees that will pay for the new health care bill will go into effect. These taxes will include new Medicare taxes on individuals who earn more than $200,000 a year. The wage tax, dividends and interest tax, and a small tax on medical devices will also be implemented.

In 2013, the new health care bill will also implement a test system in Medicare in which payments are made based on the quality, rather than quantity of health care services. Health insurers will also be barred from charging different premiums to customers based on gender.

2014

In 2014, the majority of Americans will gain benefits from the new health care bill.

Exchanges will be created so individuals without employer- provided health care or small business can shop for health care coverage- and insurance companies will be barred from denying coverage on the basis of pre-existing conditions.

Medicare will also expand to cover all Americans with income up to 133 percent of the federal poverty level (about $27,000 per year for a family of 4).

Small businesses will also receive a tax credit to help them provide coverage to their employees. The insurance industry will also be required to pay an annual fee to help pay for the exchanges that will cover all citizens that cannot otherwise receive insurance.

In addition to providing subsidies and guaranteeing coverage for most citizens, the new health care bill will also require that most people have health insurance. There will be a fine for not carrying health insurance of some kind. An independent Medicare board will also be created to help curb Medicare costs if the costs rise more quickly than inflation.

2015-2018

In 2015, the new health care bill will simply continue the new coverage, taxes and fees that were created during the previous years.

In 2016, the penalty for individuals who do not purchase health insurance will rise to a $695 minimum.

In 2017, businesses that have more than 100 employees will be allowed to participate in state insurance exchanges if the state government allows it.

In 2018, an excise tax will be imposed on so-called “Cadillac plans” that generally provide more than $27,000.

Happy April Fools!

Created at The Newspaper Clipping Image Generator.

Can I buy last minute health insurance?

It seems as though the 1000-page health care bill is soon to become law. A friend of mine suggested the following strategy:

Consider a family in Massachusetts that earns $100,000 per year. They decide not to pay $20,000 per year for health insurance in 2013 when the bill takes effect (we already have the highest rates in the U.S. (source)). They get fined 2 percent of their income by the IRS, which costs $2,000 per year, plus pay a bit out of pocket for routine checkups. When a family member is diagnosed with cancer and needs treatment, they sign up for health insurance at $20,000 per year. The insurance company cannot deny them coverage based on the preexisting condition that was diagnosed a week before. After the cancer has been treated, they drop the insurance.

What’s the flaw in this strategy?

And here are some replies:

There is absolutely no flaw in that strategy, and you’re by no means the only person to have written about this. There are three plausible hypotheses out there, as far as I can tell: (a) The Democrats are fools, too enamored with their own savior complexes to understand even the most simple manifestation of unintended consequences, (b) The Democrats are crazy like foxes, and know this will bankrupt our health insurance industry, and when that happens we will be forced to have the government step in with single-payer insurance, (c) The Democrats know the bill will be struck down by the courts as unconstitutional (you can’t force private parties into contracts) well before the provisions set in, thereby paving the way for a single-payer system…

Health insurance either needs to be single-payer, or we need a truly free market system. This over-regulated, pseudo-capitalistic, quasi-socialized mess we’ve got now is a disaster. I’m fairly libertarian, but I have to admit that if you’re going to go with the notion that access to a $1M CAT scan machine is somehow a basic human right, then you really need to have a single-payer insurance system.

—————————————————————————————-

One flaw (in the example) is the amounts. A family earning $100,000/year would not be charged $20,000 in premiums; I believe the law caps premiums at something like 8% of income before subsidies kick in and/or the mandate is dropped. So the difference between paying the premium and paying the mandate wouldn’t be so extreme — and maybe not so different from the typical health care expenses for a reasonably healthy family. But the mandate penalty is fairly low so it looks as if gaming the system like this could be advantageous to at least some people. One question will be whether social norms evolve to make doing this taboo — my guess is not, but there will certainly be a big push for it. If it becomes too big a problem, the rules will certainly be revised to forbid it before Blue Cross goes bankrupt.

—————————————————————————————-

You don’t always have warning before incurring large medical costs (car accident, heart attack, etc.). No insurance company will pay for medical care prior to the start of the policy, so that can bankrupt you by itself. Purchasing catastrophic insurance to deal with that might well meet the mandate and even if it doesn’t it certainly alters the cost / fine trade-off significantly.

—————————————————————————————-

The only flaw I can see is that they bothered to pay the fine. The IRS is forbidden from using all normal remedies to collect the fine. No criminal charges, no civil actions, no property liens, no interest or penalties, etc. The only thing the IRS can do is deduct the fine from any tax refunds. (And I suppose send nasty letters.) Your hypothetical family of four doesn’t even have to pay the $2,000 fine if their taxes are set up so that they never have a refund due (which is normal for the self employed). So their savings every year without insurance is the full $20,000.

Of course if you do this, you run the risk that a heart attack or other immediate medical emergency will rack up 5-6 figures worth of medical debt before you or your family can sign you up for insurance. I wonder if the market will respond to this with short term policies that don’t satisfy the IRS requirement, but allow people to game the system.

—————————————————————————————-

It ignores the employer mandate.

This family is earning $100,000 a year. Where is that coming from? Unless both parents have freelance jobs that don’t provide insurance, chances are they are employed somewhere that will be required to provide insurance. Employers are not likely to use this strategy. Except for small businesses (for which health insurance coverage will be subsidized), most businesses perpetually have employees that utilize insurance benefits.

Most individuals who don’t receive insurance through an employer will qualify for Medicaid instead. There would likely still be a small fraction of the population that could take advantage of this last-minute health insurance strategy (e.g. well paid freelancers?). However, any pain the insurance companies might feel because of this loophole will likely be offset by the millions of new customers driven to them by these mandates.

—————————————————————————————-

Maybe we can use this scenario to reason that the insurance companies will make signing up a very lengthy, drawn-out process. Perhaps, they’ll make it take months to get coverage, exactly so they don’t lose out so bad.

—————————————————————————————-

I’ve been reading the Joint Committee Report on Taxation. From what I see there’s little to worry about. The report descibes the penalties if you do not maintain coverage, BUT goes on to say those penalties won’t be enforced.

Direct from the report:

Individuals who fail to maintain minimum essential coverage in 2016 are subject to a penalty equal to the greater of: (1) 2.5 percent of household income in excess of the taxpayer’s household income for the taxable year over the threshold amount of income required for income tax return filing for that taxpayer under section 6012(a)(1);67 or (2) $695 per uninsured adult in the household. The fee for an uninsured individual under age 18 is one-half of the adult fee for an adult. The total household penalty may not exceed 300 percent of the per adult penalty ($2,085). The total annual household payment may not exceed the national average annual premium for bronze level health plan offered through the Exchange that year for the household size…

The penalty applies to any period the individual does not maintain minimum essential coverage and is determined monthly. The penalty is assessed through the Code and accounted for as an additional amount of Federal tax owed. However, it is not subject to the enforcement provisions of subtitle F of the Code. The use of liens and seizures otherwise authorized for collection of taxes does not apply to the collection of this penalty. Non-compliance with the personal responsibility requirement to have health coverage is not subject to criminal or civil penalties under the Code and interest does not accrue for failure to pay such assessments in a timely manner.

Read it for yourself (pages 36-37):

Former Federal Reserve economist and economics professor Arnold Kling doesn’t like the new health care law. From The Daily Caller:

Health care bill woke a sleeping giant

For many Americans, March 21, 2010, is a date that will live in infamy. Unlike Pearl Harbor or the September 11, 2001, attacks, which offended nearly all Americans, the health care legislation only angered a significant proportion of the population. However, those of us who are outraged are motivated to wage a long fight, and our aims go much further than rolling back this one bill.

The health care legislation represents a culmination of a sequence of unpopular major initiatives from Washington. First, there was Henry Paulson’s massive transfer of wealth from the people most hurt by the financial crisis to some of the people most responsible for it. Next, came the massive, ill-conceived stimulus bill, which was not timely, targeted, or temporary but instead a pure power grab by Washington. Health care legislation is merely the latest straw.

The American people are watching their country being transformed from an exceptional, vibrant free economy to a broken European welfare state, and many of us do not like the direction of change. We may not know exactly what is in the health care legislation (does anyone?), but we know its intent to assert government authority over health insurance. We know that it creates a large entitlement, paid for in large part by unspecified future cuts in Medicare.

Thanks to the projected Medicare cuts, the Congressional Budget Office scores the health care legislation as deficit-reducing relative to current law. However, current law is unsustainable. Medicare spending will have to be cut in the future in order to avoid national bankruptcy. By diverting projected Medicare cuts into a new entitlement, this legislation makes the impending budget crisis in Medicare loom sooner and deeper…

The public probably does not understand this budgetary legerdemain, but their instinct is to distrust Congress. In this case, the populist instinct is valid, and the elitist contempt for ordinary citizens is quite unjustified.

In fact, I believe that the elites have so mistreated the American people that we should declare that a state of war exists between America and Washington. Our goals in this war must go well beyond the repeal of this year’s health care legislation. Here is a list of additional goals that I would propose:

1. End the current bailouts and prevent future bailouts. Starting immediately, limit the Federal Reserve to holding only Treasury instruments. The Fed needs to go back to being a central bank, not a piggy bank.

2. Cut the pay of civilian Federal workers by 10 percent. The private sector is making painful adaptations to hard times. The government needs to start doing what any other organization would do when its revenues are down.

3. Restructure entitlements so that the future path of spending is sustainable. Congressman Paul Ryan’s “road map” is an example of what an honest budget would look like. If Democrats would prefer higher taxes to such a road map, then those taxes should be explicitly budgeted, rather than pretending that the funds for future benefits are going to appear by magic.

The point here is that health care legislation was just one battle. The overall war is larger. After Pearl Harbor, Japanese Admiral Yamomoto is reported to have said, “I fear all we have done is to awaken a sleeping giant and fill him with a terrible resolve.” So it should be with us today.

The Brian Lehrer Show has asked listeners to submit haikus about health care reform using Biden’s faux pas as the middle line. Some submissions:

Hey, Blue Cross Blue Shield
This is a big —-ing deal.
But I’m still on hold?

——————————————————————————————————–

No filibuster
This is a big —ing deal
Majority rules!

——————————————————————————————————–

Joe to Obama:
This is a big —-ing deal
Please cover hairplugs

——————————————————————————————————–

Thank you for health care.
This is a big f**ing deal.
I can sleep at night.

——————————————————————————————————–

No health CARE reform
This is a big f&&king deal!
Parasites win big.

——————————————————————————————————–

We’re moving forward.
This is a big —-ing deal.
Public option next?

——————————————————————————————————–

Health reform is law
this is a big f-ing deal
Suck it, Tea Party!

——————————————————————————————————–

Subsidies for junk?
This is a big f&&king deal!
High profits secured!

——————————————————————————————————–

No public option?
This is a big %$@#-ing deal!
Compromises suck!

——————————————————————————————————–

Now we have health care!
This is a big f—ing deal?
Europe got there first.

——————————————————————————————————–

Opportunity
For a real big f&&king deal–
Lost to corporatism.

——————————————————————————————————–

Square Deal, then New Deal,
We finally fix health care
Welcome to First World

——————————————————————————————————–

Emancipation!
This is a big f___ deal!
Leave job, take health care

——————————————————————————————————–

More, Socialism?
This is a big f_ing deal.
New world order care.

——————————————————————————————————–

Wow, we passed our bill!
This is a big ___ing deal
Who needs the GOP?!

——————————————————————————————————–

Time to celebrate
this is a big —-ing deal
beer summit anyone?!

——————————————————————————————————–

Only in U.S.
“This is a big f**king deal”
Is a B.F.D.

Now Frum has lost his job at the American Enterprise Institute, a conservative think tank. Frum posted the news on his web site yesterday.

Frum says AEI told him the dismissal had nothing to do with his editorial. From The Plum Line:

Nevertheless, Bruce Barlett, a former advisor to Ronald Reagan who also fell out of favor with conservatives when he criticized George W. Bush, wrote this on the blog Capital Gains and Games:

<a href="http://capitalgainsandgames.com/blog/bruce-bartlett/1601/groupthink-right-would-make-stalin-proud"David Frum and the Closing of the Conservative Mind

Since, (Frum) is no longer affiliated with AEI, I feel free to say publicly something he told me in private a few months ago. He asked if I had noticed any comments by AEI “scholars” on the subject of health care reform. I said no and he said that was because they had been ordered not to speak to the media because they agreed with too much of what Obama was trying to do.

It saddened me to hear this. I have always hoped that my experience was unique. But now I see that I was just the first to suffer from a closing of the conservative mind. Rigid conformity is being enforced, no dissent is allowed, and the conservative brain will slowly shrivel into dementia if it hasn’t already.

Sadly, there is no place for David and me to go. The donor community is only interested in financing organizations that parrot the party line, such as the one recently established by McCain economic adviser Doug Holtz-Eakin.

I will have more to say on this topic later. But I wanted to say that this is a black day for what passes for a conservative movement, scholarship, and the once-respected AEI.

And a user reply:

Honest to Christ, do you ever think what it’s like for millions of other Americans who over the last 8 years have lost their homes and jobs and retirements and even their sons and daughters as a result of decades of conservative policies and the lockstep GOP backing of the same?

You and guys like Frum helped *push* a walking nightmare on the rest of the country. You and Frum both helped to create this monster. Conservatism and the GOP have adopted that monster and made it their own. Now I see Frum decides he doesn’t like that this creature is not behaving so well — not so much that this is in fact an evil destructive monster, just that it’s not going to help True Conservatism in the long run.

To see the monster Frum helped animate turn on him is only fitting.

And a comment from the Reason blog

I like David Frum but think his grudging embrace of Obamacare and his criticism of Rush Limbaugh are both way off base. I think his views on Obamacare are thought provoking but wrong. I think his criticism of Rush Limbaugh and other conservative talk show hosts that their views are something other than sincerely held is based in David Frum’s personal animosity toward Mr. Limbaugh. Ultimately, this personal attack on Rush is why AEI did the right thing when it fired David Frum.

And from the blog Atlas Shrugs:

What took so long? Frum is a fraudl… His intellectual dishonesty and flawed thinking hurt the right. He’s been kicked to the curb — long overdue, I say. Apparently he laid the blame of the passage of Demcare at the door of the Republicans. Hardly surprising.

Anyone do any defriending or been defriended due to opinions on the health care legislation?

What is the chain of events that connect the Borg — the evil cyber-bio villains of “Star Trek” fame — and health care reform.

The blog a grammar asks and answers this in a post called unsung heroes of healthcare reform.

This morning, for reasons that are PERSONAL and MINE,* I wound up watching “I, Borg,” the 1992 episode of Star Trek: The Next Generation in which the crew picks up a wounded Borg and nurses him back to health. Also they name him Hugh, he becomes friends with Geordi, and over the course of several colloquys about humans, individuality, and friendship, he learns to use the word “I” and concludes that “resistance is … not futile?”

But consider the following chain of events:

1. The deprogramming of Hugh from collective Borg to individual “I,” in this episode, sets the precedent for the 1997 introduction of Seven of Nine, the ex-Borg crew member on Star Trek: Voyager.

2. The 1997 casting of Jeri Ryan as Seven of Nine surely changed the course of her 1999 divorce from Illinois politician Jack Ryan.

3. In 2004, Jack Ryan sought to replace retiring Republican Senator Peter Fitzgerald, and won the Republican primary, but withdrew from the race after details of his divorce were made public, including a bunch of stuff about maybe trying to pressure his wife into swinging or public S&M. “We did go to one avant-garde nightclub in Paris,” he said, “which was more than either one of us felt comfortable with.” (When in doubt, blame the arts and the French; they’re just freaky like that.)

4. His withdrawal left one Barack Obama running basically unopposed, except by Alan Keyes (who doesn’t count because c’mon, Alan Keyes).

5. You can take it from there.

So, after the fashion of the butterfly that flaps its wings and causes a hurricane on the other side of the globe, I — as someone who looks forward to one day purchasing fuller health coverage on a standardized exchange — would like to say KUDOS TO YOU, HUGH THE ADOLESCENT BORG WHO LEARNED TO SAY “I,” for your hand in this historic reform.

Someone collected screen shots of over 200 of them and put them on the Web. Click to see a pretty amazing collection.