Tag Archives: taxes

US to Shed 1.5 Million Jobs to Create New Recession

Right Wing Raising the DebtUpdate: 08.09.2011, 4:00 PM. President Obama has now signed the legislation to raise the debt ceiling and avert default. The bill immediately raises the debt ceiling by $400 billion. The additional steps that our country will have to endure to raise the debt ceiling for the balance of next year are described below. “Enough talk about the debt. We have to talk about jobs,” said Democratic Minority Leader, Nancy Peloisi.

Only two days remain in this season’s final episode of the made-for-cable-news mega-series drama, “The Right Wing – Raising the Debt Ceiling”*. The whole world is watching. Whose jobs will be lost? Whose fortunes, real, imagined, hedge, shorted or political, will be wiped out? Who will blink or tear up? Will the T-Party take to the streets or is just too damn hot? Will the golf partners stick to their “deal” for an entire news cycle? What will Sarah tweet? Will a deminted Senator sabotage it all with a last minute filibuster? Can Pelosi be turned to the dark side? Will S&P downgrade the credit rating anyway leading to higher interest and a need for even greater cuts? Will we do this again before Christmas?

The stranger-than-fictional leaders of our government have leaked elements of their surprising planned finale where they use this totally made-up crisis to solve the nation’s, and the world’s, great problems. The markets have already rallied in anticipation. As has the dollar. As have oil prices. The pundits, blogmeisters, and spin doctors have already picked the winners and losers. The bottles of sparkling tea have been chilled.

The drama couldn’t have been cast with a more exciting backdrop:

  • Two official wars (Afghanistan and Iraq), one official unofficial war (Libya), two well-known secret wars (Yemen and Pakistan), revolutions underway or being brutally suppressed in Syria, Egypt, Bahrain, and Saudi Arabia, on-going and potential conflicts in Palestine, Iran and North Korea, and chaos, famine and human tragedy in Somalia and the Horn of Africa;
  • An earthquake, tsunami and nuclear disaster in Japan that will continue for a hundred thousand years;
  • A massacre of white people by a white, right-wing Christian anti-muslim lunatic;
  • Worldwide recession with grave concern for the Euro zone, specifically Greece, Italy, Portugal, Spain and Ireland;
  • A dismal 1.3% US GDP growth last quarter after only .04% first quarter growth;
  • The lowest percentage of Americans working in almost 30 years with 9.2% unemployment (20+% black unemployment) and at least 18.5% overall underemployment – more than 25 million Americans are out of work and glued to their TV sets;
  • More than 50 million Americans without health insurance;
  • 28% of US homeowners are behind on their mortgage, a backlog of six million US homes in foreclosure with more than three million homes already seized, and home prices continuing to decline;
  • Executive pay has risen 23% this year, plus, record earnings continue to be announced by our largest corporations – US companies have now accumulated and horded, depending upon who counts, $20-30 trillion in cash, while spending millions on lobbyists to whine about regulation, taxes and certainty;
  • The wealth gap continues to widen with whites now averaging 20 times the wealth of blacks, 18 times the wealth of Hispanics;
  • US worker productivity is at an all time high, yet real wages are lower than they have been in 41 years;
  • Federal, state and local taxes are the lowest per capita since 1954;
  • The number of government workers has gone down more than 500,000 since Obama took office;
  • And, it is hot, though not officially from global climate change even though the northern hemisphere is trying to endure a record-breaking heat wave.

For those who may have missed an episode, ignore the backdrop (above) – the crisis in America is clearly our deficit. With total government revenues, as a percentage of our economy, at their lowest level in more than 60 years, obviously, the only answer is to cut government spending.

The announced plans include an immediate $400 billion debt limit increase (whew) and $900 billion in spending cuts over the next 10 years. These cuts will be from the annual appropriations of the day-to-day operations of Cabinet agencies (specific cuts will be determined by the Appropriations Committee after annual lobbying and whining by each agency and their related lobbyists), but largely the cuts will be from capping projected inflation-adjusted increases. These cuts do not include Social Security, Medicare or Medicaid.

Another $500 billion debt limit increase would be allowed later this fall, which Congress could only disapprove, which President Obama could veto, which Congress could overturn by a two-thirds vote in the House and Senate (I’m not making this up).

A third installment of debt limit increase of between $1.2 and $1.5 trillion would be available after enactment of the recommendations on November 23, 2011 by a 12-member super Congress (also to be announced) of three members from each party and each chamber.

The super Congress’s report to the mortal Congress could include tax code changes, maybe even revenues, and changes in any other program – including Social Security, Medicare, Pentagon spending. All dependent upon an up or down, no amendments allowed, vote in Congress on December 23, 2011.

Should super Congress not agree (how likely is that?) or the mortal Congress does not act on the recommendations, we’ll face the poison pill of across the board spending cuts to be implemented by the White House including cuts to the Pentagon, domestic agency budgets and farm subsidies… beginning in 2013, after the next Presidential election. However, Social Security, Medicaid, veterans benefits and military pay would not be subject to cuts.

Oh, yeah, the House and Senate are also required to vote, but not pass, which they won’t, a balanced budget amendment to our Constitution. The bill will establish at a cost of $1 billion, a “program integrity” initiative in an attempt to stem abuses in Social Security and federal health care programs. This bill will also preserve Pell Grant funding for 2012-2013 by cutting student loan subsidies. Go figure.

This is one terrific plan.

“The result would be the lowest level of annual domestic spending since Dwight Eisenhower was President,” said President Obama in announcing the deal. “Now, this process has been messy; it’s taken far too long… We’re not done yet.”

“I know this agreement won’t make every Republican happy. It certainly won’t make every Democrat happy,” Senate Majority Leader Harry Reid said.

“Now listen, this isn’t the greatest deal in the world. But it shows how much we’ve changed the terms of the debate in this town… There is nothing in this framework that violates our principles. It’s all spending cuts. The White House bid to raise taxes has been shut down. And as I vowed back in May – when everyone thought I was crazy for saying it,” said Speaker of House John Boehner (R-Oh.).

Senate Majority Whip Dick Durbin (D-Ill.) said, “I would say … that symbolically, that agreement is moving us to the point where we are having the final interment of John Maynard Keynes… So here we are in the horns of a dilemma. In order to avoid the disaster that would occur August 2 if the United States defaulted for the first time in its history, we are being told we have to cut back on government spending and by cutting back on spending, we may also have a negative impact on our economy.”

The head of the Congressional Black Caucus, Rep. Emanuel Cleaver, (D-Mo.) called it “a sugar-coated Satan sandwich.”

Over time, the combined cuts should add about 1.25 million to our unemployment rolls, and could bump unemployment over 10%. The cuts in spending will almost certainly turn our anemic GDP growth into negative numbers putting us back into official recession – this time, an official bipartisan recession. But don’t be fooled that the impact will stop there. The cuts will have dramatic impact on every state. Those laid off will be teachers, law enforcement and regulators. Food and medical care will be cut for our poorest children and their families. Transportation and infrastructure spending will also be cut.

When the series continues, we’ll get to watch who is to blame. How gerrymandered districts will make things even more partisan? How the T-party will get revenge on Boehner? How Obama will seek to mend fences with his base? And how all, but a few of us, will continue suffering and electing these fools? I wish I could change the channel.

 

*A sequel to the popular series, “The West Wing.”

Note: This story was updated at 5:45PM, August 1, 2011 to correct details once the bill was announced.

Rebels Without a Clue

Rebels Without A ClueThe political equivalent of testosterone has the potential of doing something that bullets, bombs, ordinary corruption, conspiracies and daylight failed to do for over 300 years.

Maybe that’s over the top – we’ll see. But the dumbed down, “grass roots” electorate who voted and gave a path to power to weak minded new politicians and reelected old politicians who saw the light of promised, simple solutions to complicated problems, have us – all of us – in a game of chicken over the debt limit that should never have been played.

Those aware, should remember the game of chicken from Rebel Without a Cause. Two testosterone laced teenagers drive toward a cliff with a plan to jump out of the cars they do not own at the last possible moment. The one who jumps first is the chicken. Life to this point was irrelevant. Only the dare was important. The game didn’t have to happen until they decided that it did and then it had to. Only one could win, both could die, but both could survive. In the movie, Buzz, played by Corey Allen, caught his sleeve in the door handle, couldn’t jump out and the car and Buzz go off the cliff into the ocean.

In my metaphor, the Republicans have caught their promise not to raise taxes in the door of their car. Obama has caught the sleeve of revenue vs. fairness in his. Our cliffhanger is only ten days from the edge and it looks as if they are both going off the cliff and taking us with them. Our only hope is they will hit the brakes and save us all. Chicken is not the worst outcome. Going off the cliff is.
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Note: this story has been updated to correct a plot error caught by an alert Dew reader.

Bring Back the Bad Old Days

Bipartisan Congressional leadership meetingOh, how I long for the time when politicians lied to get elected. When a Democrat could run as a hawk and govern as a dove. When a Republican would run as a conservative and it meant they were cautious to change and represented traditional values, not the values of a mob. Oh, for the days when we knew the contract with America was not worth the paper it was printed on.

When getting things done was the goal of both parties and compromise was seen as a victory for each. Incrementalism was the result. Respect was the rule, not the exception. Peace was a goal. Being patriotic included doing what was best for all Americans. Believing in Democracy included supporting majority rule. Laws were meant to protect people. Justice was non-partisan. Giving a leg up to someone less fortunate was an ideal. Educating our young and taking care of the aged were bi-partisan platforms. Delivering jobs in your district was a good thing, because it meant jobs. A time when campaign promises were quickly forgotten to be replaced with the reality of American life. And flip-flops were what you wore on the beach.

Oh, how I long for the time before entertainment news. Before celebrity politicians, pundits and talking points. When extremists didn’t get air time. When politics was dull and before it became a made for TV sport with avid fans* on both sides.

It was Dick Cheney, who said in 2002, “Reagan proved that deficits don’t matter.” It was also Reagan, who proved that raising the debt limit doesn’t  matter – he raised it 17 times in his eight year mythological reign. Bush, Jr. raised it seven times. But now, Obama is President, so it does matter.

It matters, because to win as a Republican, you must, no matter what:

  1. Keep a promise to Grover Norquist never to vote for any additional government revenues, including, but not limited to taxes, fees or ending subsidies;
  2. Keep a promise to the Tea Party to reduce the size of government** and the reach of government regulation;
  3. And keep a promise to Republicans everywhere to defeat President Obama.

Passing a debt limit extension, which has been done 74 times since the law that required it was passed in 1962, may violate promise number three: to defeat President Obama, no matter what.

President Obama did not cause this problem. In fact, he has done more than any President in two generations to help the Republicans keep their promises. Federal, state and local taxes are the lowest per capita since 1955 – well below the high water days of Nixon and Reagan. It is a fact that President Obama has presided over cutting taxes more than any President in history.

But Obama’s help to the Republicans doesn’t stop there. He has secured the Republican promise to reduce the size of government – the number of government workers has gone down by 500,000 since Obama took office.

What more must he do? For the answer, just look back to April when the House Republicans voted to privatize Medicare and increase the costs to seniors an average of $6,000 a year (not a tax). The House Republicans also voted to turn Medicaid, the medical safety net for the poor and disabled, into a voucher system so the states could make Medicaid meaningless (not a tax). Immediately after their votes, House Republicans poll numbers fell off a cliff. They have only one chance to save themselves: force Democrats into drinking the poison tea, too.

Now, we are being held hostage to a crisis totally of Republican promise making – a demand that any agreement to raise the debt limit be matched by permanent spending cuts and include entitlements (not a tax). At least two trillion in additional debt is needed to fund authorized spending through the next election.

Obama, true to his campaign promises saw this as an opportunity to enroll the Republicans to do something meaningful. Why not take the advice of Simpson-Bowles? Cut four to six trillion of the debt by a fair combination of revenue increases and cuts to discretionary and entitlement spending. Nasty compromises required for both parties for the good of the nation to secure our future. No new taxes would be included – just plugging of corporate loopholes, ending of subsidies for corporations who don’t need them, and allowing the Bush tax cuts to finally expire. To protect the fragile economy, neither the revenue enhancement, nor the spending cuts would be immediate. Nor would the entitlement changes privatize Social Security, Medicare or Medicaid — more likely, a means test, and some reimbursement and cost of living changes.

Too bad for all of us. To keep their campaign promises, Republicans won’t do the big deal and may not do any deal. Republicans were gamed last spring by Obama in the continuing resolution deal. The $30-40 billion in cuts turned out to be only a few hundred million – maybe less. Republicans don’t trust Obama – he’s considered too smart for them.

Who will blink and when? The White House told seniors today that they may not get their August 3rd Social Security checks. The pundits are camped in the cable network parking lots. The rhetoric talking points sound as if both sides are going to the mattresses. This is going to be close.

Without an agreement, the Republicans are likely to pass something partisan in the House. Depending on the details, and they are likely to be onerous, it is doubtful that it could even come to the floor of the Senate.

Thursday, Senate Republican leader Mitch McConnell has suggested a back up plan that would give the President new power and release Republicans from having to vote for anything that they have promised not to vote for. Lending authority for the balance of this Presidential term would be granted in three installments of up to $2.4 trillion, provided that the President cut spending by the same amount. Congress’ role would be reduced under special rules such that they would only be able to vote against a Presidential plan. Which of course, Republicans would. Which would then be vetoed by the President. The McConnell plan would give Republicans 100% authority to blame Obama for all of the economic woes, while keeping their agenda of fear in the news, and keep moving the day the world ends as we know it until just before the 2012 election. This plan, is likely a non-starter, as it would be giving the President way more power than Tea Partiers’ are likely to approve in the House.

Scenarios for default are unprecedented and no one really knows how one would play out. The White House may not have the authority to prioritize spending – allowing them to default on some debt to make payroll and pay other bills. At this time, the White House doesn’t plan to use the 14th Amendment, but may anyway. The Supreme Court will surely be called to decide many emergency details.

Should a deal not be done, what happens next is almost too dark to describe — sounding more like apocalyptic fiction than what is so seriously possible.

Inaction by Congress before recessing on August 5th would mean that revenues would only be available to pay 40-45% of our bills (that is 10% of our economy that would be missing in August). Our debt would be downgraded by ratings agencies. Smart money would likely already have made their bets — shorting everything — especially instruments guaranteed by our government — and almost guaranteeing things will get worse quickly. Safe places for cash would be almost impossible to find. The market impact of would be immediate. Everything will begin to go down. At 1000 Dow points down, margins calls will become commonplace forcing the markets lower and increasing computer trading.

The Treasury would be called to make hard and unpopular choices on who to pay with the estimated $172.4 billion of August revenue. Non-essential government workers would be sent home. The parks would close and campers evicted. Payments for Social Security, disability, VA benefits, food stamps, unemployment benefits, Medicaid and Medicare reimbursements, rental assistance, public housing funding, children nutrition programs, Pell grants, state education grants, IRS refunds, military active duty pay, federal employment salaries and others would be at risk. As would contracts for defense, Homeland Security and others.

“Handling allpayments for important and popular programs (e.g., Social Security, Medicare, Medicaid, Defense, active duty pay) will quickly become impossible.” – Bipartisan Policy Center

Here are examples of some of the choices we would have in August from the Bipartisan Policy Center:

Payment scenarious from the Bipartisan Policy Center

Payment scenarious from the Bipartisan Policy Center

The Treasury must also rollover $507.4 billion in debt in August and there may be no takers – interest rates could skyrocket increasing the national debt even more, while reducing funds available to pay bills — and the Fed may have to intervene. Home sales would stop. As markets and currencies tank, people, banks and countries would begin to fail. There will be chaos on all world exchanges and many would be shut down. People would take to the streets. Then it gets really bad.

Even if Congress passes a bill by mid-August, there is great risk that the damage to markets and interest rates would already be so great that we would be thrown back into a deep recession.

More money could be lost in the markets during the first week than is needed for the debt increase. More money could be lost in the subsequent weeks than our national debt. Recession could easily turn into depression. People would jump out of windows. War might be threatened. All because of campaign promises. Oh, how I long for the time when politicians lied to get elected.
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* Short for fanatics.
** Officially, the Pentagon, CIA, NSA, etc. are not included.

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Editor’s note: The post was updated at 7:43 am on July 13, 2011 to correct and provide new details of the Mitch McConnell back up plan as they became available.

Incredibly high fictitious cost of health care

Health care reform doesn’t go into effect for 3 more years, so why is it costing really really big businesses so much right now? In the last month, company after company has announced quarterly earnings and included huge accounting charges for health care costs.

Companies announcing charge offs for health care costs
“Why? For what? And should we be scared shitless?” Glad you asked. First off, except for exercising their Supreme Court given right to paid free speech, which resulted in hundreds of millions of dollars being spent on lobbyists to fight the health care reform bill, it hasn’t cost big business a nickel. Nothing. Nada.

Here’s what has happened. Way back in 2003, under Bush/Cheney, the brain trust in charge of our government at the time, decided to add a prescription drug benefit to those on Medicare. You probably wondered at the time, “what the hell do Republicans care about seniors?” Me, too. I knew they were having a difficult time squandering the Clinton budget surpluses so they could begin starving the states, so the states, in turn, could begin starving the poor. Plus, Bush Inc. had already paid off the campaign money they’d gotten from the super rich, the oil cartels, defense contractors and Wall Street. But they still owed big health insurance, big pharma and big business and thought they might be able to buy some senior votes in Florida, so they hatched this scheme: establish a huge new subsidy to create a private for profit prescription drug insurance plan industry to buy hundreds of billions of dollars of pharmaceuticals at non-negotiable retail and provide a tax subsidy to big business to help them get rid of workers at or nearing retirement age (Medicare Part D) – a real win-win. Even got Ted Kennedy to vote for it. Except for the donut hole, a diabolical stroke of campaign genius that must have Lee Atwater wish he could have come back from hell to enjoy it. But I digress.

The 2009 law gave big business a 28% tax deduction on retiree, or early retiree drug benefits, but it was more than just another corporate tax loophole. It was a tax-free treatment of the government subsidy to pay for companies providing the equivalent of Medicare Part D – the law gave them a subsidy and let them also deduct it from their taxes. Technically, accountants, lawyers and Adam’s house cat* refer to this as “double-dipping.” Republicans and the Chambers of Commerce refer to this as “pro-business.” When the new health care reform law goes into effect in three years, the subsidy will continue, but the tax deduction big business got for spending the subsidy will end.

snake oil“Then the tax deduction was worth billions of dollars?” you might ask. No, not by a long shot. In fact, the loss of the deduction will have almost no affect at all on company valuation or profit, but they’d like us to think it does. The explanation of how they came up with such extravagant numbers and why now, is a wee bit technical. Here goes: accounting rules require companies to recognize the present value today of future cash costs for as long as they offer the drug benefits and make this adjustment by writing down the deferred tax asset balances. Another way of saying it would be, they can pick any number they want and they can do whenever they want. These announcements are big businesses’ way of attempting to influence the off-year elections with the hope that the next Congress will give them back the deduction, which they don’t really use, doesn’t have any impact on jobs, but they are greedy and like to have more of whatever they want than they would ever need and don’t mind scaring the bejesus out of us as sport.

“But these tax deductions were real, so there’s a real cost to the companies’ investors, right?” In most cases, no. Big companies don’t pay taxes in America . That’s why we have those island governments just off our shores. According to the GAO’s most recent data (why it is so old, I have no idea, but I’m guessing that it has something to with providing political cover to those who write tax law), shows that two-thirds of US corporations paid no federal income taxes from 1996 through 2005 (those include the Clinton boom years) and 94% paid less than 5%.

So tomorrow when you read, “Company X earnings down due to health care reform costs,” just smirk and turn (or click) the page.

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*A variation of “Adam’s off ox.” The form commonly used is ‘not to know one from Adam’s off ox,’ meaning to have not the slightest information about the person indicated. The saying in any form, however, is another of the numerous ones commonly heard but of which no printed record has been found. But in 1848 the author of a book on ‘Nantucketisms’ recorded a saying then in use on that island, ‘Poor as God’s off ox,’ which, he said, meant very poor. It is possible that on the mainland ‘Adam’ was used as a euphemistic substitute. The off ox, in a yoke of oxen, is the one on the right of the team. Because it is the farthest from the driver it cannot be so well seen and may therefore get the worst of the footing. It is for that reason that ‘off ox’ has been used figuratively to designate a clumsy or awkward person.” From “A Hog on Ice” by Charles Earle Funk (1948, Harper & Row).

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Note: the post was edited on 4/23/10 to correct a stupid error of fact in paragraph 3. The original post, referred to “George Herbert Walker Bush” which was fortunately caught by alert reader/writer/commenter, Cliff Green.

Health Care: When You'll Get Yours

Updated 3/19/201o to include the House Reconciliation Bill & CBO estimate.

The Democrats say it is going to pass – maybe this week. For those of you who haven’t had a chance to read all 2,009 pages (depending on which version you count) of the Senate’s Patient Protection and Affordable Care Act (AKA: HR 3590) and or even the 74 page summary – and, the 153 page House Reconciliation Act of 2010 (AKA: HR 4872), I thought you might like to know what’s in it for you. And when.

There are some really important things in the combined bill including, according to the CBO, covering an estimated 95% of our citizens – 32 million more than have insurance right now. It corrects many wrongs too long overlooked. It is a good start. Better than nothing, but miles short of wonderful. It isn’t a pretty read. It is filled with technical issues. Way too much of it is really about Medicare, Medicaid, tax policy and deals struck with vested interests (private and public interests) to get the bill passed. Way too little of it is about making health care affordable and keeping it that way for people in the middle who trying to stay there.

It is an improvement on the status quo. It will lay important groundwork for modernizing our system and making it more fair. It will reduce the deficit (while CBO estimates it will cost $940B over 10 years, it would yield a net reduction of our deficit of $138B and reduce it $1.2T over 20 years). It will save lives. And it will take years, as is typical, for it to be interpreted by our bureaucracy into policy and then by lawyers and accountants into loopholes. It is not – not even close to a government takeover – if anything, it is just the opposite – giving private industry yet another shot to heal itself.

What it may do best will also cause the most political damage to the courageous men and women who worked and vote for it: most of the bill is phased in over four years to minimize cost, allow for industry to prepare, and should it be necessary, to provide time for our politicians to fix obvious problems – but it will probably be too late to save those who will have to fall on the sword during the next election cycle for our future.

The clear winners include: seniors (prescription donut hole and no cost preventative care – note: more is expected to come from reconciliation); those over 55 being forced to accept early retirement; those disabled who need care and their families; the working poor and uninsured; all those under 26, students and especially children (OK, and their parents); small business (insurance choices and tax credits); the health insurance industry and providers (30+ million new paying customers – note: physicians and hospitals did not do as well as insurance and pharma, but I suspect, most will be relieved/happy for their patients); software developers, tech support, data managers, etc.; state governments (healthier citizens, few unfunded mandates and a dramatic reshaping of indigent care – note: reconciliation is expected to provide more help to the states on mandated Medicare changes); deficit hawks (saves taxpayer money and sets framework for future changes); and millions of patient advocates, volunteers, social workers, community health clinics and civic organizations who tirelessly help those less fortunate.

The losers: those making over $250,000 a year (.09% wage tax and 3.8% investment income tax, plus some minor changes in deductions) and especially senior health insurance executives or those with exotic medical and compensation plans; lawyers (fewer bankruptcies); and copier companies, copy paper producers and related products. Mostly the losers are those who can’t wait until 2014 – and probably the Democrats.

Was Going To Happen This Year No Matter What

  • Private health care insurance companies will immediately raise rates as high as possible – they would have whether the bill passed or not. Witness: Anthem of California’s rate hike of up to 39%. Get ready, if being ready helps. It will be ugly. There is almost nothing stopping them now or ever. They are bulletproof. A win-win-win. Without competition the market just can’t correct it, and what competition there will be, is years away.
  • Tens of thousands of employers will react to these rate hikes by either raising employee health care costs or quit providing coverage – they would have whether the bill passed or not. Good luck.
  • Millions of individuals will drop their coverage because they can’t afford it (the Robert Wood Johnson research puts the number expected to join the uninsured in the next 10 years at 18.2 million, bringing the total to 67.6 million without insurance) and play the American version of Russian Roulette betting they will survive long enough for the bill to phase in subsidies and benefits. Most would have dropped their coverage anyway. They will blame it on the economy, the private insurance companies and Washington. They should.
  • States, faced with insurmountable budget shortfalls, will cut reimbursement rates to doctors and hospitals, which will cause thousands of providers to drop Medicaid resulting in hundreds of thousands of people going without any health care (your neighbors will be among them), many of whom will die.
  • The midterm elections will be held before almost anything tangibly good in the bill changes anything. There may be hell to pay.
  • The next presidential election will be held before almost anything tangibly good in the bill changes anything, but after the taxes, fees and requirements go into effect. There may be hell to pay.

Immediate (within 90 days)

  • Those uninsured who have pre-existing conditions, will have access to a national high risk insurance pool (using private providers or via state high risk pools) with financial assistance (limits out-of-pocket costs for coverage through the pool to $5,950 for individuals and $11,900 for families annually – up to $5B in total subsidies). This is temporary and will be transitioned to exchanges in 2014.
  • Will bar preexisiting conditions on children’s coverage.
  • Will create a new reinsurance program to make coverage more affordable for early retirees (55+) – basically, a subsidy for employee-based plans to continue coverage by paying up to 80% of the cost until Medicare.
  • Gradually closes the Medicare prescription drug gap (Part D “Donut Hole”) until it is eliminated in 2020. Effected seniors will receive a $250 rebate in 2010.
  • Increases the adoption tax credit by $1,000 (begins in 2009) and extends them through 2011 (one of those unrelated to health care bones tossed to the anti-women’s right to choose lobby, before the Senate caved totally).
  • Small business (up to 35%) and small nonprofit tax credit (up to 25%) on employer’s contribution to health insurance for employees.
  • A two-year tax credit (2009 & 2010 – capped at $1B) to encourage investment in therapies that prevent, diagnose and treat acute and chronic diseases. This was an attempt to win support of doctors, hospitals and equipment manufacturers.
  • Tax relief for health professionals with state loan repayments – doesn’t affect you and me, but will give tax help to some physicians in underserved areas.
  • Provides funds to build new and expand existing community health centers, and expands funding for scholarships and loan repayments for primary care practitioners working in underserved areas – some of this is new money, most is refunding existing programs.
  • Expands low-interest student loan programs and scholarships for health students and professionals.
  • Excludes the value Indian tribal health benefits from gross income.
  • Requires creation of a web site that will identify affordable coverage by state, tax credits, and other information of interest to small business.
  • Requires another crackdown and more screening on fraud and waste.
  • Creates another council to promote health policies.
  • Provides money to Health & Human Services (HHS) to figure out and quantitatively measure just how wonderful this program is. Or isn’t.
  • Extends payment protections for rural providers who don’t do enough business to make it on their own, but help a lot of people who couldn’t get help otherwise.
  • Creates a private, non-profit institute to identify “national priorities” and compare the effectiveness of health treatments, which is an attempt to create political cover when facing lobbyists who don’t want their pet projects cut.
  • Finally allows states the option of covering parents and childless adults up to 133% of the poverty level (in some states, not typically Southern, it is felt that the poverty level is too low and their least fortunate citizens a more humane program).
  • Establishes standards and community assessments for new nonprofit hospitals which should give some political cover for local government when facing neighborhood activists in cahoots with real estate developers, bond companies, etc.
  • Gives Blue Cross a special tax deduction as long as this non-profit don’t profit by more than 15%, which was designed to get a couple of votes in the Senate. (Note: this will likely be removed in the reconciliation bill.)
  • Imposes a 10% tax on indoor tanning services because their lobby was not as effective as the cosmetic surgery lobby.
  • Codifies and clarifies economic substance doctrine and penalities (again, not health care, allowable, important).
  • Appropriates $500M a year (2010-2014) for the Community College and Career Training Grant program; creates mandatory funding of Pell Grants, funds College Access Challenge Grants and funding for Historically Black Colleges & Universities; and reforms student loans, limits interest rates and reduces income-based repayment amounts (again, not health care, allowable, important).

Six Months After Enactment (and Beginning with Your Insurance Plan Year)

  • Prohibits rescissions (practice of rescinding coverage when a person gets sick as a way to avoid covering costs) – we all should count down the days and hope we aren’t on the rescind list.
  • Eliminates lifetime and restricts “unreasonable” annual limits.
  • Requires first dollar coverage (generally, no deductible) for preventative care.
  • Allows dependent coverage until age 26.
  • Requires creation of an “effective” appeals process for coverage determination and claims and awards grants to states in order to establish consumer assistance programs in response to complaints (boy, that’s going to work in Georgia).

2011 (lower your expectations)

  • Provides a free, annual wellness visit and no-cost sharing preventive services for Medicare beneficiaries.
  • Begins a 50% discount on brand name drugs for seniors in the Medicare prescription drug gap (Part D “Donut Hole”).
  • Creates incentives for states to cover evidence-based preventative services without cost-sharing for Medicare beneficiaries.
  • Requires Medicare coverage of tobacco cessation services for pregnant women (I’m guessing that this isn’t limited to pregnant women over 65).
  • All health plans must file annual reports showing share of premiums going for care and, should their accountants really screw up, they must provide consumer rebates for excessive medical loss ratios.
  • Provides a 10% Medicare bonus payment to primary care physicians and general surgeons (which they would have done anyway so that they don’t have to actually raise reimbursement rates – permanently raising would make it look as if Medicare was in trouble).
  • Establishes a “Center for Medicare & Medicaid Innovation,” which will attempt to create methods to reduce costs while enhancing care and which sounds like such a great idea, but makes every cynic snicker.
  • Provide several important policy changes related to education slots to increase doctors, nurses and care providers, but they are so tediously complicated I suggest you Bing or Google for the details).
  • Ditto on tax code changes related to standard language, small business cafeteria plans and other technical issues which would only pain you to know at this point, unless you are planning to raid your HSA, which you’d better do before the end of 2010. Oh yeah, your W-2’s will now show the value of your health benefit.
  • Begins the transition away from Medicare Advantage – that famously popular program where we, the taxpayers, give insurance companies 15% more to privately manage Medicare which they used to expand benefits by charging recipients even more. Wonderfully conceived experiment.
  • Imposes a non-deductible $2.3B fee (split based on market share) on big pharma in return for “supporting” this bill and our government agreeing not to negotiate prices or re-import drugs for Medicare or Medicaid which would, of course, bring prices way down for individuals who will have to wait four years to see benefit.

October 1, 2011

  • Allows states to offer home and community based services rather than institutional care to disabled individuals through Medicaid.

2012 (lower your expectations even more)

  • Implement payment reforms to gain efficiencies and improve quality.
  • Incentivize quality hospital outcomes and penalize hospitals with the highest readmission rates.

2013 (chances are, this won’t be your year either)

  • Begin paying Medicare physicians based on value instead of volume to promote quality of care.
  • Requires that Medicaid payment rates for primary care services be no less than 100% of the Medicare rates.
  • Mandatory adoption of electronic filing and information exchange (expect everyone to miss that deadline) and establish a pilot program of payment bundling and provider cooperation/coordination designed to save money, and, of course, improve care.
  • Increase the itemize deduction threshold for medical expenses from 7.5% to 10% of adjusted gross income for eligibility.
  • Add a .09% hospital insurance wage tax and a 3.8% investment tax on people making more than $200,000 individuals/$250,000 family.
  • Limits the deductibility of executive (all officers, employees, board members and contract workers) compensation of insurance companies to $500,000 each per year.
  • Sets $2,500 cap on over-the-counter medications for flexible spending accounts (FSAs).
  • Creates excise tax on medical device manufacturers of 2.9% (exempts Class I medical devices, eyeglasses, contact lenses, hearing aids, and any device of a type that is generally purchased by the public at retail for individual use) to raise $2B ($3B in 2012 and beyond).

2014 (finally and outrageous to believe that some of these weren’t done in year one)

  • Insurance companies are prohibited from discriminating based on health status, preexisting conditions, and gender. They still will be able to discriminate based on age, geography, family size and tobacco use, but they are limited to discriminating on rates of no more than three times their lowest rate.
  • Annual limits are eliminated.
  • Insurance companies will be prohibited from dropping coverage of those participating in a clinical trial or denying coverage for routine care.
  • Health exchanges are established in each state (yes, state) to enable people to comparison shop, enroll and determine if tax credits for financial assistance will be available.
  • A multi-state option (really national) will be available offered by private insurance companies and, at least one non-profit.
  • Health care premium tax credits will be available for those above Medicaid eligibility and below 400% of the poverty line (currently $43,320 for individual; $88,200 for a family of four – Alaska and Hawaii are higher). These credits will be for premium and cost sharing expenses and is what will enable most of the uninsured to afford coverage. What does all of this mean? If your income is above the poverty line, but less than 133%, you’ll have to pay 2% of the cost and the tax credit will pay 98%. The scale slides up to 400% of the poverty line and indexed year to year, but basically your share would be: 133% up to 150% – 3.0%; 150% up to 200% – 4.0%; 200% up to 250% – 6.3%; 250% up to 300% – 8.05%; 300% up to 400% – 9.5%.
  • Almost everyone is required to have health insurance or pay a penalty (2014: $95; 2015: $325; 2016: $695 or 2% (increasing to 2.5% in 2016) of income up to national average cap). Families will pay half the amount for children. The only exception is if affordable insurance is not available. Sounds onerous, but they are doing this because it wouldn’t be fair to the insurance companies for an individual to purposely not have insurance, get sick knowing they can get coverage by buying a policy only when they need it – plus, they made a deal with the insurance companies to do this in return for insurance companies agreeing to pay a fee to help offset the costs of the bills.
  • No one receiving a tax credit to buy insurance would be allowed to use it for a policy with abortion coverage. States can ban abortion coverage in plans offered through the exchange. Exceptions would be made cases of rape, incest and danger to the life of the mother.
  • Employers are not required to provide coverage. However, employers with 50+ employees (companies with fewer than 50 employees are except), who do not offer coverage, and have workers who are subsidized by the government, must pay a fee to subsidize those workers – $2,000 annually for each full-time employee (there is no penalty for the first 30 employees, plus, there are a few other caveats based on waiting periods, etc. Bing it). Part-time workers are included in the calculations (two part-time workers equals one full-time worker).
  • The small business tax credit will continue.
  • Workers who qualify for an affordability exemption to the requirement to have coverage, but not for tax credits, can take their employer contribution and join an exchange plan.
  • Medicaid eligibility will increase to 133% of poverty. Childless adults will be included for the first time. For new enrollees, the federal government share will be 100% in 2014, 2015, and 2016; 95% in 2017; 94% in 2018; 93% in 2019; and 90% thereafter (funding the state mandate).
  • Medicare advantage will be eliminated by competitive bidding.
  • Impose fees providers (health insurance companies): $2B ($8B in 2014; $11.3B in 2015 & 2016; $13.9B 2017 and $14.3B after that).
  • There will be more reporting requirements for many providers to measure quality of care as a pathway toward value-based purchasing.

2018

  • Impose the Cadillac excise tax of 40% on employee plans costing more than $10,200 for individuals and $29,327 for families of four (indexed for high cost states, high risk professions and for the elderly).

2020

  • Medicare Part D (prescription drug plan) increases to a 75% discount on brand name drugs for seniors and completely eliminates the “Donut Hole.”

That’s it. Hard to believe, isn’t it? Seemingly, our entire government has spent a year developing that? Every news channel, newspaper and most blogs have spent a year reporting and debating that? Republicans could spin endlessly for a year that this, often in the same sentence, would turn us into Nazi Germany or Stalin’s Russia? Hundreds of millions spent lobbying against that? Democrats could trade all the hope and power that comes once in a generation, for this? Yes.

If it weren’t passed now, we’d just have to go through this again some day not soon enough.

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Acknowledgements:
Information, reference and documents used in this story include those from:

And others too numerous to mention. Thank you.