Will Reducing Part-Time Hours Avoid the Large Employer Mandate?

Download PDF Report >>> ACA Large Employer Mandate

SUMMARY

There has been much discussion about employers reducing hours for part-time workers to less than 30 hours per week.  The argument is this will exempt employers from penalties under the ACA because penalties apply only to “full-time” workers not offered health insurance.

However, a careful reading of the Act suggests that only for purposes of assessable employer penalties, that “full-time” definition is overridden. What does apply is an aggregate 40 hour week. For instance, two part-time employees working 20 hours would equate to one full time employee.

Depending on the aggregate number of hours of part-time “non-seasonal” employees, and on whether or not a company offers health insurance to any of its employees, a company can be penalized between $2,000 to $3,000 per year per un-insured employee if the number of full-time workers PLUS full-time equivalent workers is 50 or more.  In conclusion, switching from full-time to part-time workers of equal total hours worked may not avoid the ACA employer mandate.

REFERENCE

The discussion includes line references in [bold brackets]. These refer to excerpts from the Affordable Care Act regarding employer shared responsibility. The full path to this excerpt is “TITLE I, Subtitle F, Part II, Section 1513”. For reference, each line in the excerpt is numbered, and key discussion points refer to the Act by those line numbers in [bold brackets].

Website formats do not show these line numbers so a PDF file needs to be downloaded which does show these line numbers in the ACA excerpt. The download link appears both at the beginning and at the end of this analysis.

DISCUSSION

The Affordable Care Act has been shrouded in controversy since well before it even was signed into law in March, 2010. Since then, little has improved. The House of Representatives has passed 38 (and counting) laws to repeal the Act. With the Supreme Court having ruled, a continuing emphasis has been made to circumvent provisions considered onerous.

One of the ways getting media attention is companies cutting back on the hours of part-time employees to insure that they work less than 30 hours per week. 30 hours is the point at which an employee is defined as full-time [lines 78-79] and counts toward the large employer mandate.

Small employers remain exempt from penalties as regards offering health insurance. Large employers, though they have a one year penalty delay, must offer health insurance. An important definition in ACA is that of “large employer.” The ACA does not simply define any large employer, but rather defines an “applicable large employer” [lines 41-44] for which the ACA mandate provisions specifically apply.

For instance, an employer would NOT be considered large if its workforce was [a] less than 50 full- time employees for at least 8 months, and [b] not more than 4 months per year in which [c] seasonal employees cause employment to rise above 50 [lines 44-50]. Agricultural workers bringing in the harvest and extra retail clerks during Christmas are examples of seasonal workers that would not trigger employer liability.

The issue is over smaller companies that have just over 50 full-time employees.  Should they reduce hours of some employees to have less than 50 workers? Apparently, some companies are doing so to avoid the ACA mandate. But that may not work if they employ many part-time workers.

Two examples serve to test this issue. Call these companies “ACME1” and “ACME2”. Each has 35 full-time workers (30+ hours per week) and 60 part-time workers at 20 hours per week each. They differ only in that ACME1 does not offer health benefits for anyone [lines 9-11] while ACME2 offers benefits to its full-time workers [lines 22-24].

Under ordinary worker definition, neither ACME is a “large employer”.  But ACA uses a different definition to determine “applicable large employers” that are subject to the liabilities and penalties of ACA. For “applicable large employers”, the definition of full-time employees INCLUDES the aggregate number of hours of part time employees per month divided by 120, [lines 63-68] which average is 30 hours per week, the minimum for full time employee..

For each ACME, the aggregate hours/month of 60 part-time workers is 4,800 (60 workers x 20 hours/week x 4 weeks) or 40 (4,800 total hours/120 ACA aggregate) full-time equivalents each. Adding 40 full-time equivalents to each ACME workforce results in 75 “full-time” workers. That is above ACA’s 50 worker cutoff and each would be defined as an “applicable large employer”.

Each of these employers is then liable for an assessment under the ACA, but their penalties are different. Both the penalty rate and the employee penalty count are different.

The liability rate for ACME1 that did not offer health insurance [lines 8-11] is $2,000/year [lines 38-39] applied to ALL its employees [lines 16-18]. The liability rate for ACME2 that did offer insurance to full-time workers [lines 19-24] is $3,000/year [lines 29-31] but applicable only to the full-time equivalents of its part-time employees.

The ACA does allow an exemption of 30 employees when determining the assessment liability [lines 56-61]. ACME1’s employee count would be 45 “full-time” employees (35 actual plus 40 full-time equivalents less 30 exemptions). Applied for a full year, the penalty is $90,000 (45 * $2,000).

The 30 employee exemption applicable to ACME2 has a different effect. The 35 full-time employees are excluded. That seems to leave the 30 count exemption to apply to the full-time “equivalents”.  Just like ACME1, the aggregate count of these full-time equivalents is 40. With an exempting 30 of these employees leaves 10 liable to penalty. Applied for a full year, the penalty is $30,000 (10 * $3,000).

In conclusion, switching from full-time to part-time workers of equal total hours worked may not avoid the employer’s responsibility for offering its workers health insurance.

Download PDF Report >>> ACA Large Employer Mandate

 

Senate Gridlock – the Filibuster Factor 2012

Download PDF Report >>> Filibuster Trends 2012

SUMMARY

For decades, filibusters served Congress well as a method for the minority to put some checks on the majority. But the nation’s founders never envisioned this turn of events. The constitution requires the VP to break Senate vote ties clearly indicating that 51 % is a majority. Republicans recent reliance on the filibuster has effectively raised the votes needed to pass to 60%, a super majority. Using the filibuster to wrestle power back is not a recipe to reduce people’s frustration with gridlock.

ANALYSIS

This is a mid 2012 post updating earlier posts that record actual data through summer 2012. Americans of all political persuasions are more and more frustrated with the gridlock that has almost brought Washington to a standstill. This analysis focuses only on the Senate and the filibuster.

The Senate posts filibuster data back to 1919. Records track three items.

  • First, cloture motions to end debate which occur when a minority of senators threaten or actually filibuster. That sometimes ends the filibuster.
  • Second, once a motion has passed, there is a cloture vote.
  • Third is recording the cloture vote. If the vote succeeds, cloture is invoked and the filibuster is overridden.

When a filibuster is overridden, then the Senate still has to vote on the actual bill. But then, only a simple majority or 51% is required for the legislation to pass.

cloture motions

Republicans’ use of filibuster has reached unprecedented levels with no signs of abating. But it was not always so. In the graph above, only 56 cloture motions were filed over 52 years from 1919 through 1970. At just over one per year, filibusters were rarely used. 420 cloture motions were filed over the next 22 years, from 1971 to 1992, a sharp increase to 19 per year.

1993-1994 saw Republicans’ “Contract with America” that escalated partisanship to higher levels. From 1993-2006, motions nearly doubled to 36 per year. Cloture motions took an even more dramatic upturn in 2007 when Republicans lost control of the Senate. Cloture motions again jumped sharply through mid 2012 to average nearly 70 per year. Clearly, filibuster has become the weapon of choice for Senate Republicans.

Republicans accuse Democrats of filibustering, and there is some truth to that. But as the graphs show, Republicans (red bars) initiated each spike and have now taken filibustering to an absurd new level. Virtually every major piece of legislation now runs the filibuster gamut. Motions to end filibusters is only the first part. The senate then needs to vote and this occurs about 75% of the time. Of those times when no vote is taken, either a compromise is reached or the bill is withdrawn.  The graph below shows the trend in cloture votes taken.

cloture votes

Americans hold Congress in low esteem because of gridlock. Americans want achievement, but that requires both parties to compromise. Neither party is blameless but neither is the blame 50/50. The frequency of filibuster and threats of it does not reflect well on Republicans’ acting in good faith.

Credit Republicans with discipline. They threaten any of their own party who don’t tow the party line and vote out of office those who compromise, not in the general election but in the Republican primaries. While that increases the effect of their filibuster threats, it is essentially a negative strategy. They’re short on their own ideas. They’re adamant about their own ideas while they just say “NO” to all Democratic ideas.

cloture invoked

As the above graph shows, those filibustering do not always get their way. Since 1960, filibusters have been overridden less than 45% of the time. However, in the past 5 ½ years with Republicans filibustering, overriding those filibusters has succeeded almost 60% of the time.

For decades, filibusters served Congress well as a method for the minority to put some checks on the majority. But the nation’s founders never envisioned this turn of events. The constitution requires the VP to break Senate vote ties clearly indicating that 51 % is a majority. Republicans lost majority through the ballot. Their reliance on filibuster has effectively raised the votes needed to pass to 60%, a super majority. It’s ironic that Republicans should blame Senate Democrats for not passing legislation, even though Democrats are in a majority. Using the filibuster to wrestle power back is not a recipe to reduce people’s frustration with gridlock.

Download PDF Report >>> Filibuster Trends 2012

Source Document shown below: http://www.senate.gov/pagelayout/reference/cloture_motions/clotureCounts.htm

filibuster history

Individual Mandate not necessary – But will you like the alternative?

Download PDF Report >>>Individual Mandate Alternative

SUMMARY

Of all the issues in the Patient Protection and Affordable Care Act (ACA or PPACA), one that has drawn an extraordinary amount of attention is the Individual mandate. Looked at in isolation, it may seem like an overreach. However, a broader view indicates why this provision or similar was included at all.

It is included because another section of ACA prohibits Health Insurers from rejecting people with pre-existing conditions as they do now. Some medical conditions may be avoidable, but the vast majority of pre-existing conditions occur through no fault of the individual. Insurance of all types is to spread risk, and the more skewed the risk the greater the need for insurance. Health costs are extremely skewed making health insurance vital to a modern economy.

ACA mandated that everyone buy insurance and that makes sense. However, the objection is forcing people to buy from a private company. There are several options to resolve that. One is to create a government-run insurer. That would eliminate forcing people to buy from a private insurer. A second is to make payment for any service obtained by an uninsured person a loan similar to student loans that could not be discharged for any reason. They would carry interest and be payable in full no matter the circumstances.

DISCUSSION

The percent of people with pre-existing conditions is small and to the majority of folks without such a condition, it may seem like a trivial matter. However, the number of people with pre-existing conditions is in the millions, and the cost to them has been and can be horrific. Medical expenses for these people have led to thousands of bankruptcies as health care costs sapped all their savings and more.

Insurers soon will be required to insure ALL persons regardless of medical condition. There is the very real risk of some people will avoid buying insurance, and then when they have an injury, or find they have a chronic condition like asthma or diabetes, they would only buy health insurance AFTER they know they have a medical condition.

One would think that any notion of personal responsibility would have all persons get insurance in order to spread health costs risks over the greatest population. The more people that buy insurance, the lower the cost per person. However, experience has shown that some people will NOT buy insurance if they feel they will not get sick or injured.

Fortunately, many employers offer health insurance for their employees, and by law, health insurers covering insurance through work (group insurance) MAY NOT exclude people with pre-existing conditions after some limited period of time, usually less than a year. However, the same did not apply to individuals until health care reform.

Note that employed individuals usually have access to health insurance.  Full time employees, that is. With rising costs, what have many employers done including some of the largest?  They have reverted to greater use of part time employees who do not enjoy the same privilege and access to health insurance as do full time employees. This is putting more pressure on reforming individual insurance plans.

People do not just dream up laws in a vacuum. Most fall into two categories. One is responses to maintain clean food, air and water, or help disadvantaged people, often the result of some abuse (social laws). The second are financial laws, like taxes or efforts to reduce taxes via special treatment for some (loopholes). ACA addresses the former by adding a financial provision, the individual mandate.

Everyone who works pays into social security and Medicare. Since Medicare is health insurance, there already is a mandate for working individuals to buy health insurance from the government. The only distinction is that Medicare is government-run insurance, while the ACA mandate applies to buying insurance from private companies.

ALTERNATIVE ONE

In the state run insurance exchanges to which any health insurer can join, add a government-run health insurer. Then the individual mandate does not require buying from a private insurer. However, if an individual decided against all private insurers they would have to buy the government-run insurance plan, just like Medicare and clearly legal.

However, politics intervened. Draft legislation DID INCLUDE a government-run insurer. They called it the “Public option”. It would operate on the same level field as private insurers and not be subsidized in any way. Private and government insurers would compete for business. Still, critics objected, and politicians stripped this provision from the final bill.

Why the objections?  Perhaps it was fear of competition.  To understand the public option, all one has to do is look at Medicare. Different in that it would cover people under 65 years old. In addition, women over 65 do not get pregnant, so there would be some differences in coverage.

What few know is government manages Medicare entirely through private health insurers. Insurers use a term Medical Loss Ratio (MLR) do describe how much of a premium dollar goes to pay health care costs. For Medicare, the MLR is over 95% meaning over 95 cents per premium dollar goes for health benefits. For private insurers, not so much. Their average MLR is in the low 80% range, and for individual insurance, which Medicare is, the MLR is even lower. How can private insurers compete with someone whose costs are less than one quarter of their own?

The honest answer is they cannot, at least not as currently structured. However, where does the constitution guarantee private enterprise continued profitability or even existence? “Destructive renewal” is a term used by business to explain competition that virtually by definition requires companies to fail as other more efficient companies market their goods and services for less; or whose new goods and services make prior ones obsolete (think cassette tapes).

It is worth noting that private health insurers used to have MLR’s in the mid 90%, but that was 30 years ago when nearly all insurers were non-profit.  Over time, for-profit insurers became more prevalent, and as they did, they had to show a profit for their investors. Some admin efforts were devoted to marketing. Some to reducing costs. Some to profits. The net effect, however, is that far fewer dollars went for health care costs and more went for overhead and profits. Yet some of these same companies administer Medicare contracts for less than 5 cents on the dollar. What is apparent is that insurers could cut back on what it now costs them to weed out people with pre-existing conditions, but more efficiency are needed to compete.

ALTERNATIVE TWO

Set the ground rules for individual insurance similar to that of group insurance obtained through work. If a person elects not to purchase insurance, and gets sick or injured, a person could still buy insurance but the law would allow pre-existing exclusions to extend for one year. Also like group insurance, if a person previously had health coverage, and not more than 60 days elapsed without coverage, then the person could buy health insurance with no waiting period.

This alternative needs to have a bit more teeth to be effective. This is because there is a law that hospitals have to treat EVERYONE, regardless of ability to pay, and a healthy person could delay for years purchase of health insurance. They would only buy insurance when they get sick.

The current Medicare drug program provides a template for solving this issue. If a senior fails to purchase drug insurance, the premium continues to rise for as long as one remained uninsured. One can apply a similar index to health insurance. But how does one provide assurance of payment? Since the person required services, it should be legal to require the person to purchase insurance to pay for those services, and if the person is unable or unwilling to pay, the government could advance a loan similar to student loans.

That loan would bear interest, need to be paid over time (though shorter than for student loans), and could not be discharged by bankruptcy. If not paid by retirement, payments would be deducted from that person’s social security, just like student loans.  Gone is the mandatory requirement. Replacing it is an automatic loan that the individual must repay in full with no exits.

Since the government would initially pay the hospital, it also could determine the ability to pay of the person getting treatment. If that person was indigent, they could be put on Medicaid, and no medical loan would be created.  If the person’s income were within the subsidized amount, they would have been eligible for had they carried insurance, the loan would be reduced by the amount of the subsidy. Since the hospital is paid in full, there would be no cost shifting to those who bought insurance.

ALTERNATIVE THREE

As noted above, a law requires hospitals to treat EVERYONE, regardless of ability to pay. One could rescind that law and force everyone to either have insurance, pay for service, or be denied service. But few would be willing to take that backward step. From a practical standpoint, this is not a viable option.

Download PDF Report >>> Individual Mandate Alternative

Words Have Consequences

Download PDF Report >>>  Words Have Consequences

Download ACA PDF file >>> Affordable Care Act

Download HIPAA PDF file >>> Public Health Service Act

Illinois appears to follow guidelines for enrolling individuals into the state’s Affordable Care Act’s (ACA) pre-existing condition insurance plan, but Illinois’ interpretation of  the  ACA’s wording may be questioned. In its interpretation, Illinois does not allow enrollment if a person has insurance coverage even though it excludes pre-existing conditions.

A virtually contradictory interpretation can be found on the federal government’s website HealthCare.gov.  The federal government sets conditions of who is eligible to apply to the government for pre-existing condition insurance plans in states that opted out of participation. To apply, you will need to provide a copy of one the following documents:

  • A denial letter from an insurance company licensed in your state for individual insurance coverage (not health insurance offered through a job) that is dated within the past 6 months.  Or, you may provide a letter dated in the past 6 months from an insurance agent or broker licensed in your state that shows you aren’t eligible for individual insurance coverage from one or more insurance companies because of your medical condition.
  • An offer of coverage from an insurance company licensed in your state for individual insurance coverage (not health insurance offered through a job) that is dated within the past 6 months. This offer of coverage has a rider that says your medical condition won’t be covered.
govt pre-existing condition insurance apply

It is not logical that if a state runs the program, it can exclude people, while if the federal government runs the program, those same people could be included in the plan.

This analysis explores in more detail how Illinois and by extension, other states may have come to the conclusion they did and why that may not be the correct interpretation.

Illinois Pre-existing Condition Insurance Plan (IPXP)

To qualify for insurance in IPXP, a person must meet three conditions that seem to mirror the text of the Affordable Care Act. The Affordable Care Act (ACA) established eligibility criteria for federally funded high risk pools like the IPXP.  The pertinent wording of the Affordable Care Act that states in section 1101 (d).  An individual shall be deemed to be eligible … if such individual:

  1. Is a citizen or national of the United States or is lawfully present in the United States
  2. has not been covered under creditable coverage (as defined in section 2701(c)(1) of the Public Health Service Act as in effect on the date of enactment of this Act) during the 6-month period prior to the date on which such individual is applying for coverage through the high risk pool; and
  3. Has a pre-existing condition

These same provisions in IPXP require that
To enroll, a person must:

  1. Be a U.S. citizen, national, or legal resident;
  2. Be uninsured for 6 months; and
  3. Have a preexisting condition.”

The IPXP application specifically notes regarding item 2, “that if you currently have insurance coverage that doesn’t cover your medical condition, you are not eligible for IPXP”.

This raises the question of how Illinois adopted their meaning of ACA’s wording. Words have consequences and so it is important to determine what the Public Health Service Act (HIPAA) actually said and meant by its use of the phrase “creditable coverage” and did Illinois misinterpret it?

Public Health Service Act (HIPAA)

HIPAA’s opening paragraph sets forth its purpose: “… to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery …”

HIPAA contains five main components or “Titles”, the first of which is “HEALTH CARE ACCESS, PORTABILITY, AND RENEWABILITY”.  That title is divided again into two subtitles, “Group Market” and “Individual Market”.

In general, under Individual Market Section 2741(a)(1) health insurers may not decline coverage to or impose any pre-existing condition exclusion on “eligible individuals”.  However, Section 2741(a)(2) allows states to implement an “acceptable alternative mechanism”.  One acceptable alternative is a state managed high risk pool which Illinois has, so private health insurers in Illinois may deny coverage or include pre-existing exclusions in their policies since an alternative is available.

However, the act does not change the definition an “eligible individual” which is one who (a) has 18 or more months of “creditable coverage” and (b) whose most recent prior “creditable coverage” was under a group health plan.

CREDITABLE COVERAGE DEFINED

HIPAA defines “creditable coverage” in Section 2701(c)(1) to mean with respect to an individual, coverage of the individual under any of the following:  a group health plan; health insurance coverage; or… any of 8 other government health insurance plans.  “Such term does not include coverage consisting solely of coverage of excepted benefits (as defined in section 2791(c))”.

GROUP HEALTH PLAN DEFINED

Creditable coverage refers to coverage in a “group health plan” that also needs definition. A group health plan Sec. 701(a)(1) means an employee benefit plan that provides payment for medical care directly through insurance, reimbursement, or otherwise.  In short, what most people think of as basic group health insurance.

EXCEPTED BENEFITS DEFINED

Creditable coverage also introduces another concept – “excepted benefits”. Including this definition allows a contrast to group health plans that provide creditable coverage.  Given the number of excepted benefits, of which only a sample is shown below, it is clear that HIPAA intended only a few basic types of basic health benefits to be considered creditable coverage.

Excepted benefits as defined in Section 2791(c) includes but is not limited to:

  • Coverage only for accident, or disability income insurance, or any combination thereof.
  • Coverage issued as a supplement to liability insurance.
  • Liability insurance, including general liability insurance and automobile liability insurance.
  • Workers’ compensation or similar insurance.
  • Limited scope dental or vision benefits.
  • Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.
  • Coverage only for a specified disease or illness.
  • Medicare supplemental Insurance.

Combining references and definitions from HIPAA, to be eligible for ACA’s pre-existing condition insurance plan, prerequisite #2 requires an individual to:

  • have 18 or more months of a group health plan that provides payment for medical care, AND
  • have not been covered for 6 months under either a group health plan or a health insurance coverage

Now if an adult person is unemployed, has recently graduated or lost a job, that individual is not likely to be covered by a group health plan. Such individual, however, may be insured under individual health insurance coverage of which there are several types, of which one of the more common is “short-term limited duration insurance.”

INDIVIDUAL HEALTH INSURANCE COVERAGE

Section 2791 (b) (5) states: The term ‘individual health insurance coverage’ means health insurance coverage offered to individuals in the individual market, but does not include short-term limited duration insurance. Oops.  This means that HIPAA considers one of the more common forms of individual health insurance not to be insurance at all.

PULLING IT ALL TOGETHER IN ILLINOIS

Recall from the beginning of this essay, the IPXP application form specifically states “that if you currently have insurance coverage that doesn’t cover your medical condition, you are not eligible for IPXP”. This requirement is NOT one of the ACA requirements.  And ACA in turn, references HIPAA that pointedly declares “short-term limited duration insurance” does NOT constitute insurance coverage at all. Conclusion: Illinois may have incorrectly defined short-term limited duration insurance as health insurance which definition specifically contradicts HIPAA definition.

CONCLUSION

It is clear that both the intention as well as the wording of the ACA  and HIPAA acts allow persons who once had but were later denied health coverage or who have coverage but with pre-existing exclusions, to apply for and receive coverage under the ACA pre-existing condition insurance plans.

Allegedly, enrollment in state ACA pre-existing condition insurance plans has been running behind projections. Is it possible states are restricting enrollment in a manner similar to Illinois?  It is something worth investigating further.

Disclaimer: While having extensive years of legal experience demonstrated in this analysis, the author is not a licensed attorney. What has not been verified is whether later amendments to the HIPAA changed any of the provisions mentioned above.

 Download PDF Report >>>  Words Have Consequences

Download ACA PDF file >>> Affordable Care Act

Download HIPAA PDF file >>> Public Health Service Act

Attacks Can’t Obscure Health Law’s Valuable Benefits

Download PDF version Report>> Attacks cant obscure benefits-Huff Post

Huffington Post Posted: September 23, 2010 09:04 AM
http://www.huffingtonpost.com/andrew-kurz/attacks-cant-obscure-heal_b_735873.html

Attacks Can’t Obscure Health Law’s Valuable Benefits

After decades of trying, health care reform is finally a reality. The Affordable Care Act (ACA) is sweeping in scope (it has more than 300 sections) and takes four years to implement. Critics say Americans don’t want it, but if that’s true, it’s only because of false claims by those who do not know what its provisions are or who are being spun by people who have an economic or political interest in blocking the law.

Health reform provides coverage to millions of people while correcting many current and serious defects. It isn’t perfect, but it has countless positive elements being ignored by critics. One key example is Section 2718, “Bringing down the cost of health care coverage,” which takes effect today (September 23). It brings sorely needed cost-control mechanisms while retaining health insurers’ ability to innovate. The provisions of section 2718 are eminently reasonable, and if the atmosphere were not so politically charged, they would receive strong bipartisan support.

Insurance accounting used to be straightforward. The hospital sent a bill. The insurer paid most of it, and forwarded the balance to you or your employer. With the advent of for-profit insurers, which now dominate the industry, accounting and classification of costs have become creative enterprises. Continue reading

Affordable Care Act – Table of Contents

Download PDF Report >>> Senate bill TOC

The Affordable Healthcare Act for All Americans is without a doubt, a large and complex piece of legislation at just over 2,400 pages.  But how big is 2,400 pages when wide margins, lines numbered, text double spaced, large font,  multiple levels of indent, and more than a few references to other documents?  The sample page below (standard 8.5 inch wide paper) is indicative of the 2,400 page document. The actual content is but a small fraction of a page. AHA legal text sample

Aside from the claims of too lengthly and complex, Republicans argued that this was a Democratic bill rammed through congress.  Interestingly, AHA includes more than 160 Republican amendments accepted during the month-long mark-up through just one committee (HELP), one of the longest in Congressional history.

Critics have claimed it’s a government takeover of our health system.  It may be news to those critics but half of the health system is already government-run.  And the great bulk of the reform bill deals with steps to improve existing government systems that has hardly drawn any attention.  The following provides a quick breakdown of the law sections.  The PDF report that can be viewed/downloaded shows the entire table of contents.

There are 10 “Titles” or major topics in the bill.  Only the first, at 374 pages, less than one sixth of the entire bill deals with changes to how the private sector handles health care. Yet, this is the section that has garnered nearly all the criticism. The bulk of Title I deals with prohibiting abuses by the insurance industry, which, if you ask on an issue by issue basis, most people will agree with the new provisions. Nothing in the bill involves a “takeover” of private insurers.

The next three Titles [II,III,IV] deal with improving Medicare and Medicaid programs and comprise 852 pages, one-third of the bill.  These Titles address reduction of waste, fraud and abuse, and pilot new payment methods towards a “results” oriented method common in most other industrialized countries.  There are few objections to this section.

Title V, at 256 pages, addresses anticipated shortages of primary physicians and other healthcare workers due to services that will be required by aging baby boomers.  This is totally opposite the “death panels” that ration healthcare that unfortunately got too much press for a falsehood.

Title VI uses 323 pages to improve transparency and integrity, yet more efforts to reduce waste, fraud and abuse in both the public and private health sectors. Who objects to efforts like this?

Title VII  improves Access To Innovative Medical Therapies, with focus on lowering the cost of drugs

Title VIII addresses ‘‘Community Living Assistance Services and Supports Act’’ or CLASS Act. This title The purpose of this title is to establish a national voluntary insurance program for purchasing community living assistance services and supports.  Moving people from higher cost hospitals and nursing homes to assisted living lowers costs, a laudable goal.

Title IX includes the revenue provisions that include provisions to raise revenue to pay for the expanded coverage.

The final Title X addresses 1) Medicaid and CHIP, 2) Support for pregnant and parenting women, and the major section 3) Indian health care improvements.  None are controversial issues.

Title I——-Quality, Affordable Health Care For All Americans [374 pages – 14%]

Title II——Role Of Public Programs [221 pages – 8%]

Title III–—Improving The Quality And Efficiency Of Health Care [501 pages – 19%]

Title IV–—Prevention Of Chronic Disease And Improving Public Health [130 pages – 5%]

Title V——Health Care Workforce [256 pages – 9%]

Title VI–—Transparency And Program Integrity [323 pages – 12%]

Title VII-—Improving Access To Innovative Medical Therapies [65 pages – 2%]

Title VIII—Class Act [53 pages – 2%]

Title IX—–Revenue Provisions [93 pages – 3%]

Title X——Strengthening Quality, Affordable Health Care For All Americans [373 pages – 14%]

.

Download PDF Report >>> Senate bill TOC