The Immediate Changes

24 Mar
A Medicare card, with several areas of the car...
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From Nancy Pelosi’s blog:


  • SMALL BUSINESS TAX CREDITS—Offers tax credits to small businesses to make employee coverage more affordable. Tax credits of up to 35 percent of premiums will be immediately available. Effective beginning for calendar year 2010. (Beginning in 2014, small business tax credits will cover 50 percent of premiums.)


  • BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE—Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010. Effective for calendar year 2010. (Beginning in 2011, institutes a 50% discount on brand-name drugs in the donut hole; also completely closes the donut hole by 2020.)
  • FREE PREVENTIVE CARE UNDER MEDICARE—Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective beginning January 1, 2011.
  • HELP FOR EARLY RETIREES—Creates a temporary re-insurance program (until the Exchanges are available) to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64. Effective 90 days after enactment.


  • NO DISCRIMINATION AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS—Prohibits health plans from denying coverage to children with pre-existing conditions. Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to adults as well.)
  • NO RESCISSIONS—Bans health plans from dropping people from coverage when they get sick. Effective 6 months after enactment.
  • NO LIFETIME LIMITS ON COVERAGE—Prohibits health plans from placing lifetime caps on coverage. Effective 6 months after enactment.
  • NO RESTRICTIVE ANNUAL LIMITS ON COVERAGE—Tightly restricts new plans’ use of annual limits to ensure access to needed care. These tight restrictions will be defined by HHS. Effective 6 months after enactment. (Beginning in 2014, the use of any annual limits would be prohibited for all plans.)
  • FREE PREVENTIVE CARE UNDER NEW PLANS—Requires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles. Effective 6 months after enactment.
  • NEW, INDEPENDENT APPEALS PROCESS FOR NEW PLANS—Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions. Effective 6 months after enactment.
  • MORE FOR YOUR PREMIUM DOLLAR—Requires plans to put more of your premiums into your care, and less into profits, CEO pay, etc. This medical loss ratio requires plans in the individual and small group market to spend 80 percent of premiums on medical services, and plans in the large group market to spend 85 percent. Insurers that don’t meet these thresholds must provide rebates to policyholders. Effective on January 1, 2011.
  • NO DISCRIMINATION BASED ON SALARY—Prohibits new group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. Effective 6 months after enactment.


  • IMMEDIATE HELP FOR THE UNINSURED WITH PRE-EXISTING CONDITIONS (INTERIM HIGH-RISK POOL)—Provides immediate access to insurance for Americans who are uninsured because of a pre-existing condition – through a temporary high-risk pool – until the Exchanges up and running in 2014. Effective 90 days after enactment. (Beginning in 2014, health plans are banned from discriminating against all people with pre-existing conditions, so high-risk pools would phase out).
  • EXTENDING COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS’ INSURANCE – Requires health plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy, at the parents’ choice. Effective 6 months after enactment.


  • COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for nearly doubling the number of patients served over the next 5 years. Effective beginning in fiscal year 2010.
  • MORE PRIMARY CARE DOCTORS—Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals. Effective beginning in fiscal year 2010.
  • HEALTH INSURANCE CONSUMER ASSISTANCE—Provides aid to states to establish offices of health insurance consumer assistance to help consumers file complaints and appeals. Effective beginning in FY 2010.
  • A NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled. Effective on January 1, 2011.

And in 2014, once the exchanges have formed, more insurance reforms go into effect, including:

  • CAP ON OUT-OF-POCKET EXPENSES for private health plans

30 Responses to “The Immediate Changes”

  1. Ward March 24, 2010 at 7:23 am #

    Looks like Nancy forgot to mention the billions of dollars’ worth of new taxes that take effect today. And she forgot the billions in grants to inner city schools to support programs to improve students’ self image–an urgently needed “health care reform”.
    But the Chief Executive won’t likely be impacted by the 10% tax imposed on customers of tanning salons, so, no biggie.

  2. Steve March 24, 2010 at 8:03 am #

    You’re right Ward, she did. I’d just like to qualify that statement by reminding you that households making over $250,000 a year will be paying for a good deal of this through higher payroll taxes. And before anyone starts to complain about that, which is inevitable, I would direct them to the article below:

    “For most of the last three decades, tax rates for the wealthy have been falling, while their pretax pay has been rising rapidly. Real incomes at the 99.99th percentile have jumped more than 300 percent since 1980. At the 99th percentile — about $300,000 today — real pay has roughly doubled. ”

    • Fat Tony March 24, 2010 at 8:59 am #

      You conveniently forget that the top earners are already paying the vast majority of the taxes in this country. At what point is enough enough and you get to enjoy the fruits of your labor. I saw the idiot downstate Congressman Jerry Nadler talk about $250K being rich and that if Obama’s tax increasess hit New York harder because we have more people making $250K, more rich people, then so be it.

      And I thought what a friggin moron. We are high wage/high cost state and anyone with common sense knows that $250K in this state doesn’t go nearly as far as most other places. But that’s OK, we will further hammer New York small business owners and those who work hard and then demagogue them as being rich.

      Further, I can’t believe more people aren’t offended that the federal government will make you get insurance or fine you. Doesn’t this seem even the slightest bit un-American to anyone but me?

      I consider myself to be reasonable and willing to engage those with other opinions and agree to disagree. But I have to be honest and say I do indeed view this as government overreaching and another step toward European socialism and it has made me really, really angry. I can’t wait to join other in punishing ALL Democrats at all levels this fall and am living to make Obama a one-termer.

      Seriously, I can’t even tell you what I’m so angry about this, I just know viscerally I am.

      • Alan Bedenko March 24, 2010 at 9:16 am #

        Well, lets examine that for a second. In order to fund these good things that come out of this law, there will be a 0.9% increase in your Medicare payroll tax – from 1.45% to 2.35% (married family of four earning $300,000 with employer-driven insurance used as an example).

        From 1993 – 2002 – a period that saw incredible economic growth and turned the Reagan/Bush deficits into a surplus – the highest federal income tax rate was 39.6%. It was reduced to 38.6% in 2002 and 35% in 2003.

        I don’t think a 0.9% in the Medicare withholding rate, plus 3.8% on investment income is cause for alarm about “European socialism” or any other formulation of socialism. Returning to Bush/Clinton era tax rates isn’t the second coming of Pol Pot or Rosa Luxemburg.

      • Brooks March 24, 2010 at 9:53 am #

        Alan is now clinging to tax code analysis base on information from everyone’s favorite economist… Dr. Rosy Scenario.

      • Christopher Smith March 24, 2010 at 10:47 am #

        I’m in the 28% income tax bracket for both income and capital gains. My effective federal tax rate, after all deductions, has averaged between 5-7% of my total income between 2005-2009. This year, due to an excessive amount of tax credits, I’m getting the biggest refund I have ever received. Help, help, I’m being oppressed!

  3. Brooks March 24, 2010 at 8:26 am #

    Plus, as promised, our premiums will fall by up to $2,500 by January. More coverage, less cost.
    Unless we were lied to…

    • STEEL March 24, 2010 at 8:45 am #

      The next most expensive system in the world covers ALL of the people and is half the cost of the US system. That sheaper better system also does not bankrupt any of its citizens in order to provide care. That system also does not ration care as our does. That system does not have any corporate run death panels (insurance companies). What exactly is it that you find good about the our system?

      • Brooks March 24, 2010 at 9:01 am #

        This unsustainable bill found passage behind accounting and emotional gimmicks… The inevitable VAT tax is just around the corner, enjoy.

      • Matt M March 24, 2010 at 9:59 am #

        How was our health insurance system sustainable prior to this bill? My health insurance premiums have had double digit increases every year, which is a burden not only on my wallet but my employer’s as well. Health insurance costs have now become the #1 reason for personal bankruptcies in this country. When insurance companies lose those monies owed due to bankruptcies, the cost is then placed upon the rest of their paying “customers”. This is not going to solve all health care problems, but it is a stepping stone towards bettering the lives of all americans.

        Regarding the issue of mandating health insurance, I was watching NBC Nightly News the other day and they stated that you would only get fined if your income is $100,000 or greater. I have not yet been able to verify this but even if it is true, the first year this would go into effect is 2014.

  4. Mike In WNY March 24, 2010 at 10:14 am #

    This week I have had an appointment with two different doctors. Both are firmly of the opinion that the health care legislation will be much more harmful than good.

    • STEEL March 24, 2010 at 10:39 am #

      The next most expensive system in the world covers ALL of the people and is half the cost of the US system. That cheaper better system also does not bankrupt any of its citizens in order to provide care. That system also does not ration care as our does. That system does not have any corporate run death panels (insurance companies). What exactly is it that you find good about the our system?

      • Christopher Smith March 24, 2010 at 10:45 am #

        Umm, we love it because it’s the BEST SYSTEM IN THE WORLD! I will not have the black man’s big, throbbing socialist muslim package crammed down my throat.

      • STEEL March 24, 2010 at 11:48 am #

        The latest right wing talking point is that the bill is bad because it was passed using long standing senate rules. Well it must be bad because these are the same rules the right has used in the past.

        The fact that the only thing they say is wrong with the bill is that it was passed using the senate rules that were designed to pass bills says a lot about the right wing’s policy position

        It is basically the same bill passed by right wing darling Mitt Romney in Mass
        It is basically the same bill promoted by the right during Clinton
        It is a bill filled with a right wing wish list
        It is a bill which does not have single payer (as hoped for by the left)
        It is a bill without a public option (as hoped fr by the left)
        It is a bill which eliminates insurance company death panels (does the right want these back?)
        It is a bill which allows parents to insure their adult children (is the right against this?)
        It is a bill which gives tax credits to small companies( is this the part that the right is against?)

        It must be the part that gives the elderly some help with drugs. They don’t say this directly but they are constantly complaining about socialized medicine so I can only assume they would not only get rid of our new health care system but would also like to eliminate medicare entirely for the elderly. This must be the part they are against right? Nope! the only part the right is now against is the fact that the bill was passed using long standing rules of the senate – rules set up by the senate and often used by the right to pass bills.

    • Christopher Smith March 24, 2010 at 10:43 am #

      Well, Mike In WNY’s anecdotal research proves this bill is bullshit! If only we had called him sooner, we could have stopped this Maoist march to socialism! Also, my GP and ortho supported it, so there’s that.

      • Mike in WNY March 24, 2010 at 12:01 pm #

        Yes, there are doctors in both camps.  I guess we should just leave it up to individuals to decide if and what type of medical coverage is in their best interest.

      • jesse March 24, 2010 at 12:19 pm #

        Hey, if you retards can drive the passage of this debacle with your shitty anecdotal stories, Mike can use a few to fire back.

      • Eric Saldanha March 24, 2010 at 1:22 pm #

        I guess we should just leave it up to individuals to decide…

        We did….it was called the 2006 and 2008 Congressional elections and the 2008 Presidential election.

      • Jon Splett March 24, 2010 at 1:43 pm #

        Well Mike, as an individual, I’ve decided universal government health care is the best option. Other individuals such as myself elected leadership that represented us in Washington where the people we elected began the process of moving us towards that.

        For a group who harps on how great the constitution is, libertarians sure like to bitch and moan about what happens when people make use of the representative democracy it created.

      • Christopher Smith March 24, 2010 at 2:24 pm #

        Libertarians don’t believe in representative democracy. Hell, Jim Ostrowski doesn’t even believe the Constitution is a valid document. He lives by the moral code implied in the Declaration of Independence and has invested himself in the Scientology of economics, praxeology. It’s not that we disagree on the rules of the game with libertarians, they simply wish for a completely different game. Which is why it’s completely pointless to debate anything with them.

      • Mike In WNY March 24, 2010 at 2:31 pm #

        I have no problem with a representative democracy that stays within the confines of the Constitution. Currently, the Constitution is a worthless piece of paper that is violated on a regular basis.

        And yes Steel, Bush did violate the Constitution too, so you don’t have to chime in with “where was the outrage for the first 8 years of this decade”.

      • STEEL March 24, 2010 at 3:38 pm #

        Well? Where was the outrage during the Bush years ? Where were the teabaggers then? Where were the brick throwers? Where was your hero Glen and Rush?

      • Gabe March 24, 2010 at 3:42 pm #

        Yeah Steel, kind of funny how “the size and scope of government” only becomes a major issue when the other party is in power.

      • STEEL March 24, 2010 at 3:52 pm #

        Right wingers and libertarians are all about freedom and liberty as long as you do, say and believe as they want you to.

      • Mike in WNY March 24, 2010 at 8:26 pm #

        The size and scope of government has been a problem when either party is in power. The proper method for creating federally controlled health care would be via an amendment to the Constitution.

      • Brooks March 24, 2010 at 8:37 pm #

        The Constitution is a formality to these Entitlementarians…

      • Gabe March 24, 2010 at 3:36 pm #

        More on the whole libertarians hating democracy thing:

        Quite a fascinating read.

    • BrianS March 24, 2010 at 6:38 pm #

      Did one of those doctors have ink blots on his desk?

  5. Gabe March 24, 2010 at 3:39 pm #

    Oh and, predictably, all the greed-worshipers showed up in these comments to spam their factory-churned talking points. Oink, oink, oink. I hear the fully-hydrogenated horseshit oil gives each rhetoric chip an inconceivable shelf life.

  6. Brooks March 24, 2010 at 5:14 pm #

    These economic policies can not be sustained. Hyper-inflated spending on entitlement programs will only exacerbate the unsustainability…

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