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The mechanics of individual mandates.
Individual Responsibility. It sounds so practical. Who wouldn't be in favor of that? And the Patriot Act is just so ... patriotic. As you likely know, this is the code word for individual mandates in the various versions of the healthcare/insurance reform/giveaway bills winding their way through that abyss we call our legislative process.
But first, a flashback. The date is Feb. 26, 2008. Cleveland Ohio, democratic debate between Barak Obama and Hillary Clinton. Among heady issues such as a picture of Obama in native Somali garb and quips about pillows that dominated subsequent news coverage, the candidates spent 16 minutes discussing health care reform. Let's remember what then-candidate Obama said on this topic when he was still chasing our votes (excerpted) .
Hmmm, mandates sound horrible don't they - and that evil Hillary wants to force them on you.
What a difference an election makes. Helpfully, the insurance industry heard Obama's critique and stepped up to the plate with a hum-dinger of an answer on how to enforce the mandates they love so much. And how do they plan to collect? Why, through your income taxes of course. Because as you have likely heard: the only two sure things in life are death and taxes, and there is nothing corporate America loves better than a sure thing when it comes to putting people's money in their own pockets.
The House (HR3200) and the Senate (HELP bill) use pretty much the same basic mechanism. There are some differences in implementation though. The major difference being that HR3200 uses a percentage of income, and HELP uses a set penalty. Both accomplish the reporting, collection and enforcement by amending the Internal Revenue Code of 1986. The relevant related information is often spread out in several different subparagraphs/sections, so quotes may represent portions of different sections/paragraphs/subparagraphs (I tried to avoid confusion, but a disclaimer seems appropriate).
HR 3200 includes modifications to the tax code that call for a tax of 2.5% of gross earnings (including some income exempt from income tax)
So unless my rudimentary math skills escape me, for a worker making $35,000 a year the tax for not carrying insurance will be $875. When stacked against a $4824* annual premium, this seems a bargain. For a worker making $75,000 it would be $1875. You get the idea. For those failing to provide insurance for "more than one individual" the maximum penalty is tied the "average family policy" ($13,375*).
Over in the senate, the HELP bill (big .PDF) is a bit harder to pin down. This bill hands much of the power to the Secretary. (Note: the relevant section starts on pg. 160)
Now we move on to paragraph (2) where we get into the meat of what penalties are expected to be levied.
The way I am interpreting this is they have set a hard limit for a maximum penalty at $3000 (4 x $750). The only thing I can figure is they wanted to make the number $3000 look like $750 to a casual reader who did not go in depth into the bill.
Based on the language of the bill, it seems that there isn't an adjustment in the penalty based on income. In other words, it appears that someone making $35,000 will end up paying the same penalty as someone making $75,000 per year for noncompliance: $3000. When stacked against a $4,824* premium this still seems a minor bargain.
The HELP bill does provides some escape clauses not available in HR3200.
Note: HR3200 also provides a loophole "in cases of de minimis lapses of acceptable coverage" which I am construing to be similar to paragraph (1) above and the ability to apply for a "hardship waiver".
The bills create a new filing requirement for all insurance providers. Carriers must provide the insured what can only be described as a "proof of insurance" certificate essentially mirroring the requirements of a W2. It must be provided to the insured by Jan 31.
When it comes to filing requirements and failure to file, HR3200 simply knocks a couple of "ands" "ors" and various punctuation marks out of the relevant tax code and appends language integrating the health coverage penalty tax to the sections that address the same issues for income taxes. So, basically the IRS is given power to come after anyone who does not comply with the requirements of this section of the bill. I assume this activates the full range of traditional attacks employed against tax evaders including garnishing wages and property seizure. The HELP version seems to accomplish the same thing in a more elegant fashion (see below).
In an interesting sleight of hand, the language in both the house and the Senate say that this tax will not count as a tax ... for any purposes that might result in it being termed as a tax increase. At the same time, the language expressly counts the provisions as a lawful tax for any purposes related to determining total tax owed, collection and legal sanction. (HELP quoted here).
HR3200 seems to leave it an open question what the collected tax would be used for. The HELP committee bill specifically designates any funds collected will be dispersed to the insurance carriers to pay for other people's subsidized insurance coverage.
So, there you have it. A general overview of mandate mechanics based on my non-expert analysis of the bills. As you have likely inferred from the tenor of this post, I'm not too impressed. What do you think?
*USA today reports that the average cost of EMPLOYER based individual coverage is $4824, and family coverage is $13,375. Privately negotiated insurance plans are reported to be considerably higher, but my best efforts have not been able to locate a specific average for this demographic.
But first, a flashback. The date is Feb. 26, 2008. Cleveland Ohio, democratic debate between Barak Obama and Hillary Clinton. Among heady issues such as a picture of Obama in native Somali garb and quips about pillows that dominated subsequent news coverage, the candidates spent 16 minutes discussing health care reform. Let's remember what then-candidate Obama said on this topic when he was still chasing our votes (excerpted) .
... the main difference between Senator Clinton's plan and mine is the fact that she would force in some fashion individuals to purchase health care.
Now, Senator Clinton has not indicated how she would enforce this mandate. She hasn't indicated what level of subsidy she would provide to assure that it was, in fact, affordable. And so it is entirely legitimate for us to point out these differences.
And the last point I would make is, the insurance companies actually are happy to have a mandate. The insurance companies don't mind making sure that everybody has to purchase their product. That's not something they're objecting to. The question is, are we going to make sure that it is affordable for everybody? And that's my goal when I'm president of the United States.
On the -- on the point of many adults, we don't want to put in a situation in which, on the front end, we are mandating them, we are forcing them to purchase insurance, and if the subsidies are inadequate, the burden is on them, and they will be penalized. And that is what Senator Clinton's plan does.
Hmmm, mandates sound horrible don't they - and that evil Hillary wants to force them on you.
What a difference an election makes. Helpfully, the insurance industry heard Obama's critique and stepped up to the plate with a hum-dinger of an answer on how to enforce the mandates they love so much. And how do they plan to collect? Why, through your income taxes of course. Because as you have likely heard: the only two sure things in life are death and taxes, and there is nothing corporate America loves better than a sure thing when it comes to putting people's money in their own pockets.
The House (HR3200) and the Senate (HELP bill) use pretty much the same basic mechanism. There are some differences in implementation though. The major difference being that HR3200 uses a percentage of income, and HELP uses a set penalty. Both accomplish the reporting, collection and enforcement by amending the Internal Revenue Code of 1986. The relevant related information is often spread out in several different subparagraphs/sections, so quotes may represent portions of different sections/paragraphs/subparagraphs (I tried to avoid confusion, but a disclaimer seems appropriate).
HR 3200 includes modifications to the tax code that call for a tax of 2.5% of gross earnings (including some income exempt from income tax)
SEC. 59B. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE.This maximum tax penalty will be limited to 100% of the average annual cost of an insurance policy.
(a) Tax Imposed- In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of--
(1) the taxpayer's modified adjusted gross income for the taxable year, over
(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.
[..]
(5) MODIFIED ADJUSTED GROSS INCOME- For purposes of this section, the term `modified adjusted gross income' means adjusted gross income--
(A) determined without regard to section 911, and
(B) increased by the amount of interest received or accrued by the taxpayer during the taxable year which is exempt from tax.
(A) IN GENERAL- The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the applicable national average premium for such taxable year.
(B) APPLICABLE NATIONAL AVERAGE PREMIUM-
(i) IN GENERAL- For purposes of subparagraph (A), the `applicable national average premium' means, with respect to any taxable year, the average premium (as determined by the Secretary, in coordination with the Health Choices Commissioner) for self-only coverage under a basic plan which is offered in a Health Insurance Exchange for the calendar year in which such taxable year begins.
So unless my rudimentary math skills escape me, for a worker making $35,000 a year the tax for not carrying insurance will be $875. When stacked against a $4824* annual premium, this seems a bargain. For a worker making $75,000 it would be $1875. You get the idea. For those failing to provide insurance for "more than one individual" the maximum penalty is tied the "average family policy" ($13,375*).
Over in the senate, the HELP bill (big .PDF) is a bit harder to pin down. This bill hands much of the power to the Secretary. (Note: the relevant section starts on pg. 160)
(A) IN GENERAL.--In the case of any individual who did not have in effect qualifying coverage (as defined in section 3116 of the Public Health Service Act) for any month during the taxable year, there is hereby imposed for the taxable year, in addition to any other amount imposed by this subtitle, an amount equal to the amount established under paragraph (2).
(C) LIMITATION.--The maximum amount imposed under this paragraph with respect to any taxpayer shall not exceed 4 times the amount determined under paragraph (2)(D).
Now we move on to paragraph (2) where we get into the meat of what penalties are expected to be levied.
(A) REQUIREMENT TO ESTABLISH.--Not later than June 30 of each calendar year, the Secretary, in consultation with the Secretary of Health and Human Services and with the States, shall establish an amount for purposes of paragraph (1).This is where they get a bit (intentionally?) confusing. In paragraph (1) they authorize up to 4 times the rate defined in paragraph (2)(D). They also indicate it is a penalty in addition to others defined in this section. Then in paragraph (2) the Secretary is empowered to set a rate for the purposes of paragraph (1). When looking at subparagraph (2)(C) the penalty is limited by subparagraph (2)(D). If you only read paragraph (2), it would seem that the limitation is $750; but paragraph (1) authorizes up to 4 times that amount.
(C) REQUIRED CONSIDERATION.--Subject to the limitation described in subparagraph (D), in establishing the amount under subparagraph (A), the Secretary shall seek to establish the minimum practicable amount that can accomplish the goal of enhancing participation in qualifying coverage (as so defined).
(D) LIMITATION
(i) IN GENERAL.--Subject to an adjustment under clause (ii), the amount established under this subparagraph is $750.
The way I am interpreting this is they have set a hard limit for a maximum penalty at $3000 (4 x $750). The only thing I can figure is they wanted to make the number $3000 look like $750 to a casual reader who did not go in depth into the bill.
Based on the language of the bill, it seems that there isn't an adjustment in the penalty based on income. In other words, it appears that someone making $35,000 will end up paying the same penalty as someone making $75,000 per year for noncompliance: $3000. When stacked against a $4,824* premium this still seems a minor bargain.
The HELP bill does provides some escape clauses not available in HR3200.
(c) EXEMPTIONS.--Subsection (b) shall not apply to any individual--
(1) with respect to any month if such month occurs during any period in which such individual did not have qualifying coverage (as so defined) for a period of less than 90 days,
(2) who is a resident of a State that is not a participating State or an establishing State (as such terms are defined in section 3104 of the Public Health Service Act),
(3) who is an Indian as defined in section 4 of the Indian Health Care Improvement Act,
(4) for whom affordable health care coverage is not available (as such terms are defined by the Secretary of Health and Human Services under sec tion 3103 of the Public Health Service Act), or
(5) described in section 3116(a)(4)(C) of the Public Health Service Act.
Note: HR3200 also provides a loophole "in cases of de minimis lapses of acceptable coverage" which I am construing to be similar to paragraph (1) above and the ability to apply for a "hardship waiver".
The bills create a new filing requirement for all insurance providers. Carriers must provide the insured what can only be described as a "proof of insurance" certificate essentially mirroring the requirements of a W2. It must be provided to the insured by Jan 31.
When it comes to filing requirements and failure to file, HR3200 simply knocks a couple of "ands" "ors" and various punctuation marks out of the relevant tax code and appends language integrating the health coverage penalty tax to the sections that address the same issues for income taxes. So, basically the IRS is given power to come after anyone who does not comply with the requirements of this section of the bill. I assume this activates the full range of traditional attacks employed against tax evaders including garnishing wages and property seizure. The HELP version seems to accomplish the same thing in a more elegant fashion (see below).
In an interesting sleight of hand, the language in both the house and the Senate say that this tax will not count as a tax ... for any purposes that might result in it being termed as a tax increase. At the same time, the language expressly counts the provisions as a lawful tax for any purposes related to determining total tax owed, collection and legal sanction. (HELP quoted here).
(1) NOT TREATED AS TAX FOR CERTAIN PURPOSES.--The amount imposed by this section shall not be treated as a tax imposed by this chapter for purposes of determining--
(A) the amount of any credit allowable under this chapter, or
(B) the amount of the minimum tax imposed by section 55.
(2) TREATMENT UNDER SUBTITLE F.--For purposes of subtitle F, the amount imposed by this section shall be treated as if it were a tax imposed by section 1.
(3) SECTION 15 NOT TO APPLY.--Section 15 shall not apply to the amount imposed by this section. [note: HR3200 states this as, "The amendment made by subsection (a) shall not be treated as a change in a rate of tax for purposes of section 15 of the Internal Revenue Code of 1986."]
HR3200 seems to leave it an open question what the collected tax would be used for. The HELP committee bill specifically designates any funds collected will be dispersed to the insurance carriers to pay for other people's subsidized insurance coverage.
(e) USES.--Amounts collected under this section shall be dedicated to premium credits established under section 3111 of the Public Health Service Act.
So, there you have it. A general overview of mandate mechanics based on my non-expert analysis of the bills. As you have likely inferred from the tenor of this post, I'm not too impressed. What do you think?
*USA today reports that the average cost of EMPLOYER based individual coverage is $4824, and family coverage is $13,375. Privately negotiated insurance plans are reported to be considerably higher, but my best efforts have not been able to locate a specific average for this demographic.
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Well, I'm impressed with all the work you did.
Greatly appreciate. Now, I will go back and print out and review again.
Rec'd.
September 16, 2009 8:20 PM | Reply | Permalink
Thank you for this, kgb.
I am not too impressed either.
Not only is it wrong to be mean to poor people, now it's gonna be legal, too.
There are people in economically depressed pockets all over the country where large employers just do not exist so neither does employer provided health insurance. In these same areas, small business employers barely pay above minimum wage, let along provide health insurance. So, the working poor, making an average $22,000/yr will be penalized for being poor when it comes to tax paying time?
This mandate is just another way to terrorize the poor.
September 16, 2009 8:44 PM | Reply | Permalink
The offsets and subsidies are an important piece of the puzzle that this does not address. But my gut instinct is that this could just turn out to be a defacto tax on the uninsured poor who fail to jump through all the hoops to make it happen.
It really bugs me that the insurance companies are essentially guaranteed premiums (collected after the fact) for services they didn't really provide. After paying the tax hit, those without insurance still won't have it (with less money to spend than before). The plan should at least make the tax penalty go towards an active policy for the individual who is being penalized.
This exercise made me see with clarity: we're getting hit with 10x the taxation vs. single payer, 10x the paperwork, 10x the administrative overhead (for the exchange, penalty enforcement, etc. etc.), and still no real promise of care.
I'm starting to realize the corporations own us now. This legislation is just a symptom.
September 16, 2009 9:37 PM | Reply | Permalink
Denis Kucinich on the healthcare debate/legislation:
September 17, 2009 4:13 AM | Reply | Permalink
Yes, thanks for this. Especially the quote from Obama about Hillary during the campaign. I'm going to copy it and send it to the White House.
We need to keep that quote going. Because he TOTALLY went against his word.
September 16, 2009 9:22 PM | Reply | Permalink
When I read these excerpts, I think to myself "this can't possibly pass". And then I think again. Thanks for putting in the legwork kgb.
September 17, 2009 1:27 AM | Reply | Permalink
A recent debate over my new found status as an unreasonable member of the left-wing fringe really brought something into focus for me. The reason I'm fighting for a public option so hard is because I am so completely afraid of this aspect of the legislation. And nobody is even talking about it except in the abstract.
Not kidding, I'm terrified. The greed holding sway is so huge, I can hardly wrap my head around it. Keep getting the mental image of Middle Earth after years of blissful ignorance waking to find the sun blotted out by the darkness of Sauron; as if life has become one great big literary allusion (yeah, Tolkien geek from way back). It's not just this health thing, it's the bailouts, the energy issues, the mobilized gibbering bands of people robbed of rational thought striking out almost at random in illogical anger, everything.
For Christ sake - they are now going to cash-strapped terminal patients and buying out life insurance policies for pennies on the dollar and packaging them as derivative assets ... is leukemia hot or brain cancer? Doesn't that just motivate investors to NOT find cures for anything and encourage practices that hasten death? Greed is not the same thing as self interest - even for those engaging in it. At what point do we break ... and what happens then?
[/rant] I need a drink.
September 17, 2009 3:01 AM | Reply | Permalink
Meet you in the bar. :) There seems to be some point where we completely slipped the tracks of reality and talking about this rationally, as well as with the electorate's best interests at heart. A part of me just wants to plot a course to some third world country where I can afford to eke out a living, and leave the American half-baked dream to do its' thing. I find it all very depressing. The possibility of having a public debate that's not centered on total bullshit seems to have slipped away, and we've well and truly jumped the shark.
I was appalled when I read the NYT article about bundling life insurance policies. I think we're pretty well f@#ked. Nobody cares or understands what's going on. Kinda a tower of Babel kind of thing.
September 17, 2009 3:59 AM | Reply | Permalink
And hey... You're in good company as a newly minted "unreasonable member of the left-wing fringe". ;)
September 17, 2009 4:02 AM | Reply | Permalink
Join the club. I have moved from a wait and see moderate into a kill the bill leftie... because of the mandates. Mandates are a compromise. They are not a gift. Mandates in exchange for a public option that can insure anyone/everyone at an affordable rate with guaranteed lifetime care.
You shouldn't force people to buy into a system that doesn't serve their interests. That's not liberal or conservative. It's American.
September 17, 2009 7:34 PM | Reply | Permalink
I'm with you k999. Without a public option, the mandate is nothing but a gravy train for the bad guys. I have thought from the minute I heard baucus was negotiating with the republicans that what we get from this could very well be worse than what we already have.
I had a chat with a fellow from Montana whom I met this afternoon while I was walking FDRdog. He said the Montana economy is really suffering because of the housing bust and was in dire straits even before the rest of the country. Although the agricultural sector is O.K., the rest of the the state is hurting, he says. I can't imagine how baucus can get away without supporting a public option under these circumstances. No doubt his income depends on the rich ranchers in addition to the insurance industry.
Somehow health care reform has become a crusade to cut medical costs, not to insure everyone which was the major goal of progressives and the major cost-cutting element of any plan.
September 17, 2009 8:08 PM | Reply | Permalink
Fantastic Post KGB.
You are my go to man for mandates. I have have similar fears regarding the mandate and now you have provided the intellectual underpinnings.
Thanks (i think).
September 17, 2009 8:41 PM | Reply | Permalink
Great post, kgb! Thanks for putting in the work.
September 17, 2009 7:08 AM | Reply | Permalink
Now how about a post showing subsidies for the poor and middle class in both HR 3200 and HELP bills? You do realize that both bills mandate employers with over $250,000 in payroll and over 10 or 20 employees cover their workers or pay a sliding scale tax of 2 to 8% up to $500,000 in payroll and a flat of 8% if they don't cover their employees don't you? There's also $53 billion in tax credits for employers to do so in HR 3200 making it a no brainer for most businesses, big and small, to get on board.
There are subsidies to cover most poor people thru Medicaid and in both HR 3200 and HELP families not covered by employers with incomes up to $88,000 are also subsidized. At $88,000 it's not going to be much, but at $77,000 and $56,000 it makes a real difference.
Finally this line makes you sound like a teabagger kgb999 "The HELP committee bill specifically designates any funds collected will be dispersed to the insurance carriers to pay for other people's subsidized insurance coverage."
Do you really think Democrats are just sticking it to the little guy or are you just trying to con people into believing both these bills are awful? You've done some good research here but it's by no means complete or imo an honest appraisal of the bill.
September 17, 2009 9:24 AM | Reply | Permalink
And yes, I am aware of this. Hence my comment to Flowerchild:
But, it seems to me that we're talking about two different things. You say mandates don't matter because there are subsidies. I disagree. Using the tax code as a coercive penalty is insidious and wrong.
And tax credits for anyone who is just getting by (business or individual) are BULLSHIT. They don't really help in real time. But again, if you want to go through a similar process as this for the subsidies, I would LOVE to see it. I'd even take the two posts into conference and merge them to create an omnibus informative package!
As to this
Yay! Now I'm both a teabagger and a member of the left-wing-fringe. Granola and cordite for life!
Seriously, as best I can tell that's exactly what it does. Tax the non-compliant and use the proceeds to pay for subsidized insurance policies of the compliant - with zero benefit to the person penalized. In what way is this characterization inaccurate? I assume based on your comment you ARE aware of the mechanics of section 3111 of the HELP bill. An honest debate doesn't involve just high lighting the good and pretending the crap doesn't exist. So if it is in essence accurate (even if you don't like the inflection) who's conning whom here?
I notice those promoting this bill as a great thing haven't honestly addressed mandates, which have a huge impact on civil society, AT ALL. It's the invisible issue. Mandates are bullshit and Obama promised we wouldn't have them.
I think it is very important to realize exactly what's at stake if they don't do something to fix the cost of premiums. The public option is weak water to begin with, if that goes the bill needs to die.
September 17, 2009 3:18 PM | Reply | Permalink
I think I just did. We as a nation use tax code carrots and sticks all the time. For some people (money grubbing Republicans mainly) it's the only way to get them to see something is in their enlightened self interest and steer them to do the right thing.
I don't say mandates don't matter. I think they will be important if we're going to get everybody covered. You apparently see more sticks than carrots in that.
I don't care if you're coming from the left or the right that sounds like teabagger stuff to me. You might as well say keep your government hands off my health care and why should I have to pay for all those lazy people who don't buy their own insurance.
The fact is the carrots are such that you'd have to be crazy not to join and the sticks are needed so the obstinate help pay in some way. If you choose not to get insured once the plan is in place because you're still holding out for single payer or Rush Limbaugh's "health insurance for nobody" plan I'm still gonna have to pay your medical bills if you get hit by a bus. This way like it or not you're paying something for the health care you inevitably will need some day.
They are doing a lot to lower the cost of premiums. The real little secret nobody talks about is that the insurance companies will probably fire half their employees, if not more, when their worst practices are outlawed. Providers too because they won't need 2 clerks per doctor to file and fight with insurance company clerks over their claims.
The public option as weak as it is (and I agree with you there) won't be more than an easy to ramp up constant reminder to the health insurance industry that a whole of us would just as soon outlaw them and go to single payer. In and of itself as it's currently proposed in both bills it's not much of a threat.
But the real competition we're forcing on HI companies, doing away with their outragious behavior and the cost cutting on the provider side will force down costs on both sides of the industry. Any insurance co. exec who thinks he can stay profitable with the old cartel model will quickly find himself on the news in court on the wrong side of the law while his competitors take away his customers. Same goes for any doctor who keeps pointlessly referring patients for unneeded tests to the lab he owns.
September 17, 2009 6:05 PM | Reply | Permalink
Tell me how the regulations will be enforced, and tell me how any regulations that hamper an insurance company's ability to conduct its business will hold up in court.
Further, tell me how mandated universal coverage is going to translate into quality care. There are fixes, but what incentive exists to implement them? It seems to me that the MO of insurers is to simply create backlog.
I read your glowing appraisal of HR3200, and some of the legislation is quite marvelous. But that won't be the bill that reaches the President's desk. It will be the Baucus plan with sugar on top.
September 17, 2009 7:49 PM | Reply | Permalink
I do appreciate the thoughtful response. In the area of providing specifics (highlighted against the particulars of the bill) you haven't demonstrated the actual subsidy an individual would be getting to offset the cost of premium that could be compared to the individual tax that a mandated person would be required to pay if their budget is unable to accomplish what the government has determined should be feasible. So in that respect, I don't think you have actually accomplished what you purport to have done. This is, after all about individual mandates, not the employer mandates - who pretty much knocked their responsibility portion out of the Baucus bill.
I strongly disagree with the correctness of your belief that a hypothetical potential loss, not directly borne by any individual (uninsured hit by a bus) justifies a coercive penalty borne by a specific individual. Indeed, the person who may be non-compliant ultimately bears an equivalent portion of any burden that my be incurred by providing them catastrophic care. I further believe that as implemented, using taxation to force every individual in the nation to enter into a contract with a private corporation is unprecedented. This is NOT something we do all the time.
This is simply an unfair statement - and seems to be an intentional misconstruing of my point. You take my disapproval of the penalty mechanism and conflate it to my protesting the subsidy program in it's entirety. And you have not once indicated in what way my statement was inaccurate.And if I do get hit by a bus - the penalties I've paid really don't have any bearing on the fact that it's still the ER plan being used (at least under the HELP version) because the money was spent on premiums and not saved for my own catastrophic care - you STILL end up paying for my care regardless. I'm pretty sure these funds aren't fungible and will be allocated with the budget calculated assuming penalty income as a source of funding. It seems more like cities who end up being able to increase their budget by writing speeding tickets.
If the point is to get people covered, wouldn't it make more sense to put the penalty into pre-paying a policy for the person being penalized? With the way it's written, a person is taxed - $3000 or up to the cost of a policy as a one time hit. They are forced to "chip in" but still have nothing for themselves and less resources to purchase coverage in the following year. This seems likely to produce a cycle where someone who runs afoul of the penalty based on true inability to pay is likely to simply find themselves in a higher tax bracket and still have no coverage. And their income is still calculated by the government as if the penalty had not even occurred (ie $33,000 income - $3000 penalty = $30,000 available to the individual, but for all calculation purposes they are still viewed as having taken $33,000 into their pocket).
Your formulation seems to only envision people with plenty of money in their pocket refusing to buy insurance as an attempt to game the system: the "obstinate". I propose to you that there will be people who simply can't budget what the government believes is reasonable. Which is another aspect of this that bothers me. The government is literally opening the books of the citizens and making budgeting priorities based on generalities that may or may not accurately represent a citizen's actual life.
Your assertions about the insurance companies firing half their people seems to indicate a lack of understanding about the way an insurance company actually works. Every claim will still be handled by an adjuster. Nothing about this legislation changes that. In fact, by dumping millions of people into the system there is going to be a massive increase in the need for those who oversee the process. Additionally, there is the new requirement for annual filings an behalf of every insured individual placed on the insurance company. This requirement exists exclusively to service the individual mandate and provides NOTHING in the way of actual health services. This is going to require carriers to create and staff an entire new division.
I don't think the actual overhead you describe from the medical profession side of it is really exactly as you construe it either. Our biggest clients are insurance companies (vaguely we fall under rehab) and based on our own billing/collection experience, this aspect of the issue appears to be overblown as presented here. Sure there are occasional collection issues, but NOTHING like when I was doing painting/drywall for section 8 housing and tried to get paid from the D.C. Government! We don't fight over surgeries, so there are some apple/orange issues here but we are certainly defined as a provider under HR3200.
And the last paragraph doesn't make sense to me. Most of the outrageous behavior (preexisting conditions, recision, etc.) theoretically keep premium costs down. There is nothing that I saw in any of these bills that would keep them from simply rolling the increased cost of health coverage into premiums. A lot of this has to do with how they handle medical loss ratios, which would be set by the commissioner(HR3200) but are not defined with any hard numbers in the legislation. If they set the ratios within the ballpark of today's expenditures, the influx of people who are actually sick and using services could very well create the conditions for a spike in premiums while staying well within the mandated ratios.
Which brings me to my final point, it seems like the penalties have nice hard numbers and the consumer protections are generally "at the discretion of the Secretary/Commissioner" to be defined after the legislation is passed. I'd really like to see a hard number attached to stuff like the medical loss ratios against the ability for them to say I'd owe 2.5% of my income if I can't/won't participate. But really, we've taken a discussion you don't want to have about specific mechanics of the mandates and sort of meandered into a discussion of the whole bill. Which is fine, but IMO it would be more appropriate on a post where the language of relevant portions of the bill had been highlighted so that we can all be on the same page with the discussion. There is more to it than mandates, but mandates can not be ignored.
I'm in favor of HR3200, but I'm not going to blow sunshine up anyone's ass and pretend it's a really, really great a bill. What I am not willing to accept the Baucus version.
September 17, 2009 7:59 PM | Reply | Permalink
And also, this isn't advertised as a complete assessment of the bill. It's advertised as detailing the mechanics of the individual mandates part of the bill - which I tried to do with meticulous care. I think it's kind of screwed up to change the goalposts to what you wish the subject was and essentially call be dishonest because I didn't reach a bar that was never set.
September 17, 2009 3:31 PM | Reply | Permalink
If the bar you set was to do a hatchet job on Obama and the Democratic health care plan that has the best chance of passing you did an admirable job. Excuse me if I don't admire it.
September 17, 2009 4:01 PM | Reply | Permalink
Not looking for you admiration. But if you want to sling ad hominems and implications of dishonesty - come correct with facts. I added my own "don't like it one bit" flavor, but really did try to be accurate. I'd still be interested in knowing where you think this is factually off base.
IMO, a hatchet job would have been to genuinely teabag the language and post it on RedState. How much you want to bet I could put something together that would go viral through that nut-log factory? Betcha I could make Limbaugh.
I'm trying to highlight the vise they've got our nuts in right now and bring into focus just how tenious the situation is. The democrats started negotiations almost in complete capitulation. For those acting like compromising more is possible without screwing us all, I think we need to discuss all the stakes here.
Will you still support the bill without a public option? I will not. I will use my voice to try and rally support for killing it. This seems to be a common progressive stance. There's always January unless we take something inadequate, then January is meaningless. The next shot with the way it's crafted would likely be 2015 at the earliest.
September 17, 2009 5:22 PM | Reply | Permalink
See my post above, and don't mind me, I'm a dick when I get cranky. I want the public option too but I think we both agree it's little more than a symbol at this point the way it's written in both HR 3200 and HELP. I'd rather see it capture about 10 or 20% of the market than 4% by 2019 like the CBO says it will. But in the meantime by pointing out that CBO certified 4% market capture I'm able to effectively shut up morons who say it's a "government takeover" of health care. And the nice thing about it is if the HI Cos are still dicking around in 2015 the HHS secretary gets to open the public plan up to a much bigger chunk of the public. But that's only if we pass the bill this year. Cuz if we don't you're not going to have a Democratic HHS secretary or president to kick around.
If you think Waxman, Rangel, Miller and Andrews "started negotiations almost in complete capitulation" I think you need to read some health care reform think tank sites or watch more CSPAN vids. Try CPCC or CBHC for instance. There's actually some stuff in the Baucus bill that's more progressive than what's in either of the others. Is Marcy pointing that out?
My point is taking part of any bill with this many moving parts out of context isn't the way to do it.
If you want to see a broad overview I did of the legislation go here:
http://tpmcafe.talkingpointsmemo.com/talk/blogs/markg8/2009/08/selling-hr-3200-to-the-public.php
September 17, 2009 6:30 PM | Reply | Permalink
I actually rec'd that post when you made it. It's quite good. But you must admit it doesn't even acknowledge mandates exist - because they don't help sell the bill. I support HR3200. But as they say in the game shows: that's my final offer.
IMO, taking single payer off the table before the debate even began started at the center, maybe slightly left and it's just gone more pro-industry from there. But yeah, "total capitulation" is a bit of hyperbole.
I really disagree the public option is a symbol. If we get it in place, it is far easier to expand through amendments attached to must-pass legislation than trying to attach a public option in it's entirety. It doesn't necessarily need to wait 5 years. IMO, There are very good reasons to insist on it. HR3200 is a very centrist bill.
Honestly, you've put me into a position (see above) of countering assertions I disagree with instead of a more wonk-like discussion of the actual portion of the bill I highlighted. I don't think I took anything out of context - or at least that wasn't my intent. Is this really that different from your post that doesn't even mention mandates exist? It almost seems like the only way to get your head around a bill with so many parts is to break it down.
September 17, 2009 8:28 PM | Reply | Permalink
If you've got a bowl of cream corn, and someone presents you with a turd ... does it really matter that the turd contains a few kernels of corn that are technically more intact than those in the bowl? Even if what you wish for is corn on the cob, you still aren't going to say "yummie" ... you'll say "that shit stinks get it outta here". (sorry ... but the 4th grader in me isn't :-)
Seriously, I haven't checked in on what she's up to since the morning. I'm kind of waiting to dive in to it myself till they actually do the markup. I really trust the analysis over at EW (they have some posters that are amazingly sharp), so I'm letting them do the legwork on the summary.
The best irony will be if only the progressive parts of the Baucus bill make it out of conference. I still don't know what Obama/Reid's desired outcome is here but they sure do have all the weapons they need loaded and ready.
September 17, 2009 9:12 PM | Reply | Permalink
What I don't get is why Baucus doesn't just give up the bipartisan charade and do what he should have done in the first place. He wrote a great outline of a bill last November, public option and all. Then he and Teddy Kennedy wrote Obama a letter in the spring laying out their combined policy. The HELP Committee wrote their half of the bill and did a good job. Baucus just had to fill in the gaps that by senate rules HELP has no jurisdiction over. On a lot of those sections his committee actually has control over he's tougher than HR 3200. I just hope the outrage doesn't shitcan his whole bill.
For instance I personally don't want to keep subsidizing fatcat CEOs who get $40,000 annual HI plans through the tax code that pay for penis extension surgery if they want. I'd rather tax them the same way the rest of us are.
I guess Baucus clings to that bipartisan charade for the same reason Obama does. The closer we get to a bill the crazier and more obstinate the GOP gets. The polls are in our favor. When our guys write our bill and cut off debate the Republicans will have locked themselves out of the room.
September 18, 2009 12:21 AM | Reply | Permalink
Another problem with the Baucus bill is the way premium caps are indexed. So,
if for a low-income family, it's capped at 5% of income,
and
if the family's real income stays stable over a ten-year period,
Then
At the end of the ten year period their premium cap is set at 10% of income.
Ten percent of income on a family not too far from the poverty level, that's clearly unaffordable. Yet they will face penalties?!
See here
http://www.cbpp.org/cms/index.cfm?fa=view&id=2922
September 17, 2009 10:12 AM | Reply | Permalink
Oh hell, I didn't even get to the Baucus bill. Marcy's been tearing that to shreds over on Empty Wheel since the summary was released.
September 17, 2009 3:24 PM | Reply | Permalink
Great post and an informative response by Markg8. The devil is definitely in the details.
September 17, 2009 1:15 PM | Reply | Permalink
More realistic premium estimates could be gleaned from the package offered to federal employees.
Here's a list of non-postal Federal employee premium rates.
http://www.opm.gov/insure/health/rates/nonpostalhmo2009.pdf
Even with this massive pooling, premiums are rendered affordable only after roughtly seventy percent or more is assumed by the Federal government, and therefore, the taxpayer.
If there is a mandate, everyone deserves the same subsidy Joe Lieberman gets as a Senator.
September 17, 2009 4:29 PM | Reply | Permalink
What I do not understand is this. Since most of the Health insurance companies are monopolies (or nearly so) in most states. Why are we not going after them with the anti-trust laws and breaking them up ? They are certainly more monopolistic than Microsoft or IBM was.
C
September 17, 2009 3:58 PM | Reply | Permalink
Because they are exempt from anti-trust laws.
There have been attempts to repeal the exemption (most recently earlier this year). Needless to say the insurance industry wasn't impressed. And what the insurance industry wants, congress delivers it seems.
September 17, 2009 4:15 PM | Reply | Permalink
Well that's a load of crap, ain't it.
C
September 17, 2009 4:26 PM | Reply | Permalink
I didn't include mandates in that post because I thought they were irrelevant. One of the prime objectives is "everybody in, nobody out". If Glenn Beck and Rush Limbaugh fans want to pretend it's socialism they must avoid while they get to sponge off the rest of us it's gonna cost 'em anyway. Almost everywhere else on the planet health care is paid for via taxes. Here that's the fall back position. But either way everybody pays premiums or taxes.
I agree and even Baucus admitted it was a mistake.
Again, I agree. But talk of expanding it is exactly why Republicans call us dishonest and predict this is the socialist camel's nose under
the tent. I think we'll get a PO but as it's written right now it's not even available to most people and it'll be a very bare bones plan. Insurance companies will be able to offer 4 basic tiers based on cost and benefits. The PO will only offer the bottom rung choice. It may have been written that way so we on the left would view it as a sacrificial bargaining chip for stronger cost cuts and consumer protections elsewhere in the bill. Remember, no one, not even Dean offered a PO in 2004, it only became part of the Edwards, Clinton and Obama plans in 2007. But since June positions have hardened on both the right and the left. They want no reform bill at all and most of us want no bill without the PO. I just don't want the compromise to be a weak bill with a PO that doesn't go into effect until 2013 and hardly anyone can join as a figleaf.
I agree breaking down this bill into it's working parts is valuable. But attacking the bill for mandates is akin to attacking single payer for the taxes we'd have to impose. There is no free health care. If we do this right we'll go from paying 17.5% of our GDP on health care to 8 to 11% like the rest of the developed world. That'll be better for everybody except for that army of outmoded paperwork clerks right out of the movie Brazil, doctors who go into medicine just to get rich and insurance company execs.
September 18, 2009 9:16 AM | Reply | Permalink