What Congress wants to do about health care.
Guides to the current bills
Although you may have heard many of the Democratic-led health care bills lumped together under the term "Obamacare," there are actually a number of different bills working their way through the House and Senate, and none of them comes from the White House. Politifact's Angie Holan has created the best guide I've seen to what's in the bills. The Kaiser Family Foundation offers a super-comprehensive, regularly-updated run-down of all the bills. The New York Times has a nice infographic showing how the various bills will be reconciled. Another helpful New York Times infographic shows where the bills agree and where they differ. When you're done with those, Ezra Klein's "Health Reform for Beginners" series is a wonderful primer.
Summaries of common elements
|Proposal||Summary and Link||Improve effectiveness?||Control costs?||Increase access?|
|Comparative effectiveness rating||The government would research different treatments for the same diagnosis to see which are most effective (and cost-effective). Some of the most vehement opposition to current health care overhaul efforts stem from this proposal, and the fear that it would lead to "rationing" of care in the health care system. Here's a dispassionate analysis of CER from noted health care economist Uwe Rheinhardt.|
|Independent advisory commission||Every year, an independent advisory group of medical professionals (called MedPAC) gives Congress lists of recommendations on how to improve Medicare. But different interests typically manage to scuttle many of the recommendations before Congress enacts them. One proposal on the table would give MedPAC more teeth, helping its reforms make it past the political system. Because Medicare is such a significant program, changes in Medicare can have a ripple effect through the entire health-care system. Here's an interview with Rep. Jim Cooper who has proposed legislation to strengthen MedPAC.|
|Public option||One of the most controversial options under consideration has been the creation of a government-run health insurance program that would compete with private insurers. Many warn that the inclusion of this proposal will enjoy certain advantages that come from being an arm of the government (most notably, no need to make a profit), making it more attractive to consumers and slowly killing off private alternatives. Most of the plans under consideration limit access to the public option to Americans who can't get coverage through their employer. Here's a New Republic editorial in favor of the option, and here's a nice run-down of the different flavors of the proposal.|
|Health insurance co-ops||This alternative to the public option would set up nonprofit cooperatives in each state (states could band together to form regional co-ops) those without access to employer-subsidized insurance could join. The state-by-state nature of this makes it more palatable to some who dislike the public option. Here's a solid article from Time describing the proposal in more detail.|
|Individual mandate||This is the feature that the insurance industry likes. It's likely that the final bill that emerges from Congress will include a requirement that every American purchase health insurance. For those of you paying attention, this is a big flip-flop from President Obama, who campaigned against individual mandates during his run for office.|
|Employer mandate ("pay-or-play")||Here's where the health care proposals often lose corporate America. One idea for helping the government pay for health care is to require employers to either offer their workers coverage or contribute toward the cost of their care. (Businesses with few enough workers would be exempt from the requirement.) Small businesses especially decry this proposal, but Wal-Mart has endorsed it. Some wonks also don't like the proposal because it solidifies the role of employers in paying for health insurance, instead of detangling health insurance from employment. Here's a detailed explainer from the Kaiser Family Foundation.|
|Taxing employer benefits||This provision has the unions up in arms, but Congressional Budget Office chief Doug Elmendorf considers it the single best way to keep the costs of health care under control. Take it away, Kaiser: "Right now, employer contributions for health insurance are not taxable as income for employees, unlike their wages. This in effect means that the government is subsidizing a portion of the cost of health insurance, since the benefits are provided tax-free. This tax exemption costs the federal government an estimated $245 billion per year. Changes to the tax treatment of health insurance would both raise revenues for reform and change incentives in the health system. ... In addition, without an open-ended tax subsidy, employers and employees might move towards less generous plans (e.g., with higher cost sharing) that would likely result in workers and their dependents using less health care but also paying more out of pocket for their care."|
|Health insurance exchanges||Health care wonk Ezra Klein considers this the most important, under-attended component of reform legislation. The exchanges would be insurance markets that providers would have to meet minimum benefit standards to enter. Americans without coverage through an employer (or, in stronger versions of the proposal, Americans who don't like their employer-provided plans) could shop for a plan in the exchanges, comparing their different benefits side by side. Read Ezra Klein for more on the proposal.|
|Insurer regulations||These new requirements for insurers are central to the President's pitch for changing the US health care system. Obama insists that the final bill will prohibit insurers from: 1) Refusing customers with pre-existing conditions, 2) Charging exorbitant amounts for out-of-pocket expenses, 3) Dropping coverage for the seriously ill ("rescission"), 4) Charging customers differently based on their gender, 5) Placing lifetime limits on the amount of money they'll pay out per patient, 6) Kicking children out of family plans before the age of 26, and 7) Refusing to renew a policy because the customer got sick. More on this from the Washington Post.|
|Insurance subsidies||All of the bills under consideration include some government subsidy for the poorest Americans to purchase care, but they differ as to how poor someone has to be to qualify. Here's a stellar New York Times article on the issue, with a wonderful infographic to match.|