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House passes landmark health care bill

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Specializes in Vents, Telemetry, Home Care, Home infusion. Has 43 years experience.

philadelphia inquirer

posted on sat, nov. 7, 2009

[color=#005266]house narrowly passes landmark health care bill -

david espo

the associated press

washington - in a victory for president barack obama, the democratic-controlled house narrowly passed landmark health care legislation saturday night to expand coverage to tens of millions who lack it and place tough new restrictions on the insurance industry. republican opposition was nearly unanimous.

the 220-215 vote cleared the way for the senate to begin debate on the issue that has come to overshadow all others in congress.

a triumphant speaker nancy pelosi likened the legislation to the passage of social security in 1935 and medicare 30 years later.

"it provides coverage for 96 percent of americans. it offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it," said rep. john dingell, the 83-year-old michigan lawmaker who has introduced national health insurance in every congress since succeeding his father in 1955.

in the run-up to a final vote, conservatives from the two political parties joined forces to impose tough new restrictions on abortion coverage in insurance policies to be sold to many individuals and small groups. they prevailed on a roll call of 240-194.

ironically, that only solidified support for the legislation, clearing the way for conservative democrats to vote for it.

the legislation would require most americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. large companies would have to offer coverage to their employees. both consumers and companies would be slapped with penalties if they defied the government's mandates.

insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. in a further slap, the industry would lose its exemption from federal antitrust restrictions on price gouging, bid rigging and market allocation....

[color=#005266]key details of democrats' health overhaul bill

the house health care bill passed saturday would:

  • require most americans to purchase health insurance or pay a fine.
  • expand health care coverage to 36 million more people over the next decade.
  • require employers with payrolls above $500,000 to provide insurance to their employees or pay a fine.
  • prohibit insurance companies from denying coverage because of pre-existing medical conditions.
  • end premium disparities between men and women.
  • impose a 5.4 percent income tax surcharge on income above $500,000 annually for individuals and above $1 million annually for households.
  • establish a government-run insurance plan to compete with private insurers beginning in 2013.
  • cost $1.2 trillion over 10 years.
  • cut medicare spending by more than $400 billion over 10 years.

hr3962 bill link:

http://www.gpo.gov/fdsys/search/page...ls-111hr3962ih

go to formats text (2713 kb) | pdf (3438 kb) | xml (3499 kb)

Edited by NRSKarenRN

"Require most Americans to purchase health insurance or pay a fine."

I don't understand, I have a friend who makes 10k a year from a part time job while he attends college, He doesn't have health care and sometimes cant even afford to eat on a daily bases, How can are goverment make him buy healthcare with money he doesn't have? And if he had money to pay the fine that they will give him why wouldn't he be buying health care with it or food for him self? This really is geting me upset almost to the point of tears, He also isn't alone in this there are many familys atm just like him even in worse situations with no jobs, no homes, no food, and children, Why are we not making efforts as america to get them settled in some kind of low income apartments and helping them get there lifes back on track, I remember reading that stress is the most common killer, I think they have gone through enough stress now.

GCTMT

Specializes in LTC.

"Require most Americans to purchase health insurance or pay a fine."

I don't understand, I have a friend who makes 10k a year from a part time job while he attends college, He doesn't have health care and sometimes cant even afford to eat on a daily bases, How can are goverment make him buy healthcare with money he doesn't have? And if he had money to pay the fine that they will give him why wouldn't he be buying health care with it or food for him self? This really is geting me upset almost to the point of tears, He also isn't alone in this there are many familys atm just like him even in worse situations with no jobs, no homes, no food, and children, Why are we not making efforts as america to get them settled in some kind of low income apartments and helping them get there lifes back on track, I remember reading that stress is the most common killer, I think they have gone through enough stress now.

The bill will expand Medicaid eligibility, sounds like your friend will qualify.

I'm v. disappointed that the public option has ended up being so weak that it's just enough to be able to say that the public option is in there -- just a "fig leaf," really.

I'm also v. angry about the anti-choice amendment. It will be interesting to see how this continues to develop.

The bill will expand Medicaid eligibility, sounds like your friend will qualify.

This is the part that really gets to me. When you sit down and think about it, it's so pathetic...that it actually borders on brilliance.

I'm in the same boat, more or less. I mean I eat well enough, but I haven't broken 15k this year, and it's certainly not enough to cover my bills. Am I low income? Absolutely. Do I qualify for financial aid for tuition, partial unemployment and probably a host of other government assistance programs? Sure. And yet, i've never felt the need to become dependant on the government to give me everything I'm "entitled" to. I'd just as soon get by on my own on less.

Now here's the beauty of it. The government is fully aware that there are people like me out there, and so they go and pull something like this. They REQUIRE youths to purchase insurance even though we may not be able to afford it, FORCING us to turn to the government for handouts in something that a month ago...we were just fine without.

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

This is the part that really gets to me. When you sit down and think about it, it's so pathetic...that it actually borders on brilliance.

I'm in the same boat, more or less. I mean I eat well enough, but I haven't broken 15k this year, and it's certainly not enough to cover my bills. Am I low income? Absolutely. Do I qualify for financial aid for tuition, partial unemployment and probably a host of other government assistance programs? Sure. And yet, i've never felt the need to become dependant on the government to give me everything I'm "entitled" to. I'd just as soon get by on my own on less.

Now here's the beauty of it. The government is fully aware that there are people like me out there, and so they go and pull something like this. They REQUIRE youths to purchase insurance even though we may not be able to afford it, FORCING us to turn to the government for handouts in something that a month ago...we were just fine without.

I think part of the point is that it is not just fine for people to have no means to pay for expensive healthcare. It is not just fine for a working poor 20 something to become financially destitute because of a ruptured appendix or other unplanned serious malady. It is not ok for young poor families to choose between healthcare and some other necessary expense. It is not ok for someone not to get elective surgery on their shoulder, because they cant afford copays or deductables, and then end up with a frozen joint and chronic pain. We have the best healthcare in the world available in this country...it is just so sad that it costs us more than 15% of our GDP AND access is very much limited.

I think part of the point is that it is not just fine for people to have no means to pay for expensive healthcare. It is not just fine for a working poor 20 something to become financially destitute because of a ruptured appendix or other unplanned serious malady. It is not ok for young poor families to choose between healthcare and some other necessary expense. It is not ok for someone not to get elective surgery on their shoulder, because they cant afford copays or deductables, and then end up with a frozen joint and chronic pain. We have the best healthcare in the world available in this country...it is just so sad that it costs us more than 15% of our GDP AND access is very much limited.

I think a large portion of the contributors to this site are stuck on the train of thought that lack of health care kills people. It doesn't. Cancer kills people. Car accidents kill people. Heart disease kills people. Noone has -ever- died from lack of health care, I promise. Rather, health care is an intervention that saves people. Those that believe in health care reform believe that we have an obligation to save everyone, which is unrealistic. Sadly, over the course of natural events...people can and do die. When it's feasible, we absolutely should step in and lend what aid we can. But the distinction needs to be made. Disease/death/dying is the natural state. But how much should those of us that haven't seen a doctor in 5 years be forced to contribute to paying for this cost?

The question as to whether health care is a right, isn't the issue. Thats like saying "Is it a right to not get cancer, contract infectious diseases, or trip and fall?" The real question, is "Is it legally our obligation to sacrifice to help those who are stricken with such misfortune?" As it is, the uninsured are already guaranteed basic treatment at emergency rooms. But how far beyond that are we obligated to go to assist these people? Months and months of life support? Extensive radiation therapy for cancer patients that may or may not solve the problem? How many thousands, if not hundreds of thousands of dollars can honestly be asked of us?

You can argue that life comes first, and that theres absolutely no dollar price too high for an individual life. But that's not the case. We could shut down the military, we could shut down public works, and libraries and parks and everything else, and direct all that funding to medical research. And we would have had a cure for cancer and aids years ago. But the bottom line is, we are operating under limited resources. Theres only so much to go around.

Personally, I think the last estimate I heard, was that the mandated health care coverage cost about 4k a year, and I'm neither able nor willing to contribute that much to the cause. And I think each individual has the right to decide how far they're willing to go to do their part. You can't financially force people to contribute to whatever cause you deem appropriate, any more then you can force someone to jump into a street fight to defend someone who's being ganged up on. One thing about America is that you have the right to spend your resources as you see fit, even if you so choose to take the selfish route and neglect your fellow man. Thats your choice to make.

Ultimately, I still see this health care reform as a social security clone. The healthy pay into the insurance companies to pay for the treatment of the sick. And then as we age and become sickly, the next generation will then be paying for health care that they don't need so we can have our treatment. I'm currently 25 years old, and I'd trade all rights I have to social security benefits for my entire life for a couple shares of google stock. And I'd be making the right fiscal choice.

GCTMT

Specializes in LTC.

I think a large portion of the contributors to this site are stuck on the train of thought that lack of health care kills people. It doesn't. Cancer kills people. Car accidents kill people. Heart disease kills people. Noone has -ever- died from lack of health care, I promise. Rather, health care is an intervention that saves people. Those that believe in health care reform believe that we have an obligation to save everyone, which is unrealistic. Sadly, over the course of natural events...people can and do die. When it's feasible, we absolutely should step in and lend what aid we can. But the distinction needs to be made. Disease/death/dying is the natural state. But how much should those of us that haven't seen a doctor in 5 years be forced to contribute to paying for this cost?

There are correlative studies suggesting that our health insurance system is killing as many as 45,000 people a year. What are "feasible" interventions? Currently, health insurance companies make that decision. We can't save everyone but modern medicine is built on the premise that we can manipulate nature and those who can pay receive more, and better manipulation than those who can't.

The question as to whether health care is a right, isn't the issue. Thats like saying "Is it a right to not get cancer, contract infectious diseases, or trip and fall?" The real question, is "Is it legally our obligation to sacrifice to help those who are stricken with such misfortune?" As it is, the uninsured are already guaranteed basic treatment at emergency rooms. But how far beyond that are we obligated to go to assist these people? Months and months of life support? Extensive radiation therapy for cancer patients that may or may not solve the problem? How many thousands, if not hundreds of thousands of dollars can honestly be asked of us?

Your definition of health care is incorrect. It's not the absence of illness, it's the treatment (and possible prevention) of illness. The questions you ask are subjective. As we progress, I think Americans are beginning to understand and accept that health care is a right. The question now becomes, how do we as a people provide this right four ourselves and our fellow citizens?

But, you bring up an excellent point, we need to decide what it is that we will cover, and how much, and what we won't cover.

You can argue that life comes first, and that theres absolutely no dollar price too high for an individual life. But that's not the case. We could shut down the military, we could shut down public works, and libraries and parks and everything else, and direct all that funding to medical research. And we would have had a cure for cancer and aids years ago. But the bottom line is, we are operating under limited resources. Theres only so much to go around.

If there's a will to make it happen then there's a way. Every developed nation on the planet finds a way, except ours.

Personally, I think the last estimate I heard, was that the mandated health care coverage cost about 4k a year, and I'm neither able nor willing to contribute that much to the cause. And I think each individual has the right to decide how far they're willing to go to do their part. You can't financially force people to contribute to whatever cause you deem appropriate, any more then you can force someone to jump into a street fight to defend someone who's being ganged up on. One thing about America is that you have the right to spend your resources as you see fit, even if you so choose to take the selfish route and neglect your fellow man. Thats your choice to make.

Taxes are taken out of your paycheck each pay period to pay for Medicare for seniors. While there are some who are undoubtedly upset and being "forced" to pay for it, I think the vast majority of people realize that Medicare is a good program (not perfect) that helps every American 65 or older.

We pay taxes, and we benefit from them, there is no country in the world worth living in that doesn't have a tax system for the public good.

Ultimately, I still see this health care reform as a social security clone. The healthy pay into the insurance companies to pay for the treatment of the sick. And then as we age and become sickly, the next generation will then be paying for health care that they don't need so we can have our treatment. I'm currently 25 years old, and I'd trade all rights I have to social security benefits for my entire life for a couple shares of google stock. And I'd be making the right fiscal choice.

No one is stopping you from investing in google.

Edited by GCTMT

GCTMT

Specializes in LTC.

I'm v. disappointed that the public option has ended up being so weak that it's just enough to be able to say that the public option is in there -- just a "fig leaf," really.

I'm also v. angry about the anti-choice amendment. It will be interesting to see how this continues to develop.

Agreed. In the end, I think everyone will feel like they have compromised. The house had a public option (albeit a fairly weak one) but there is no guarantee the finished product will even have one at all.

Re: abortion. The Stupak Ammendment was redundant given the Hyde Ammendment. But, I hope health care legislation isn't shut-down due to the abortion debate.

Ultimately, I think when the Prez. signs the health care bill, it will be a first step of many we could end up taking in the next 15-20 years. I think eventually we will have a health insurance system with a single-payer framework.

The bill will expand Medicaid eligibility, sounds like your friend will qualify.

People who qualify for Medicaid now don't sign up. Why would they start now?

I'm v. disappointed that the public option has ended up being so weak that it's just enough to be able to say that the public option is in there -- just a "fig leaf," really.

I'm also v. angry about the anti-choice amendment. It will be interesting to see how this continues to develop.

They will be rationing care to approximately half of the population. Women will take a back seat again. Abortion is a right in this country now.

There are correlative studies suggesting that our health insurance system is killing as many as 45,000 people a year. What are "feasible" interventions? Currently, health insurance companies make that decision. We can't save everyone but modern medicine is built on the premise that we can manipulate nature and those who can pay receive more, and better manipulation than those who can't.

Your definition of health care is incorrect. It's not the absence of illness, it's the treatment (and possible prevention) of illness. The questions you ask are subjective. As we progress, I think Americans are beginning to understand and accept that health care is a right. The question now becomes, how do we as a people provide this right four ourselves and our fellow citizens?

But, you bring up an excellent point, we need to decide what it is that we will cover, and how much, and what we won't cover.

If there's a will to make it happen then there's a way. Every developed nation on the planet finds a way, except ours.

Taxes are taken out of your paycheck each pay period to pay for Medicare for seniors. While there are some who are undoubtedly upset and being "forced" to pay for it, I think the vast majority of people realize that Medicare is a good program (not perfect) that helps every American 65 or older.

We pay taxes, and we benefit from them, there is no country in the world worth living in that doesn't have a tax system for the public good.

No one is stopping you from investing in google.

If you don't pay into Medicare you won't get it. That's an issue with this healthcare reform hand out. People can get healthcare without paying anything.

People who qualify for Medicaid now don't sign up. Why would they start now?

I love the way some people on this site keep bringing this up like it explains everything. While I'm sure there are some people out there who qualify for Medicaid but haven't enrolled, it is not an answer for most of the uninsured. States have increasingly restrictive qualifications for Medicaid (they've been cutting back on Medicaid funding for years as their budgets have gotten tighter) -- most people think of Medicaid as "healthcare coverage for poor people," but, in my state (the only state about which I can speak first hand, but I understand that many states have similar situations), there is no way you can qualify for Medicaid unless you are 1) a minor, 2) pregnant (you qualify for the duration of the pregnancy only), or 3) have one of a small number (5 or 6) of specific chronic illnesses. If you don't fit into one of those groups, it doesn't matter how poor you are -- you are simply not eligible. Expanding the Medicaid program would make a big difference for a lot of poor people, including the working poor, in my state.

I love the way some people on this site keep bringing this up like it explains everything. While I'm sure there are some people out there who qualify for Medicaid but haven't enrolled, it is not an answer for most of the uninsured. States have increasingly restrictive qualifications for Medicaid (they've been cutting back on Medicaid funding for years as their budgets have gotten tighter) -- most people think of Medicaid as "healthcare coverage for poor people," but, in my state (the only state about which I can speak first hand, but I understand that many states have similar situations), there is no way you can qualify for Medicaid unless you are 1) a minor, 2) pregnant (you qualify for the duration of the pregnancy only), or 3) have one of a small number (5 or 6) of specific chronic illnesses. If you don't fit into one of those groups, it doesn't matter how poor you are -- you are simply not eligible. Expanding the Medicaid program would make a big difference for a lot of poor people, including the working poor, in my state.

So Medicaid doesn't work, there is no money for it, and yet you want to expand it. How will that work? Where will the money come from? Why have states increasingly become restrictive, maybe because there is no money.

Massachusetts just raised it's sales tax. They had to. To pay for their UHC.

So Medicaid doesn't work, there is no money for it, and yet you want to expand it. How will that work? Where will the money come from? Why have states increasingly become restrictive, maybe because there is no money.

Massachusetts just raised it's sales tax. They had to. To pay for their UHC.

I didn't say I want to expand it -- the proposals to expand it were brought up, you made your pointless, gratuitous comment about people not signing up for Medicaid now, and I commented on the reality of Medicaid in my state and that expanding it would help a lot of people in my state. I want a true, universal single-payer system that covers everyone, paid for by everyone's taxes, but too many members of our Congress are bought and paid for whores of the for-profit healthcare lobby for that to happen anytime soon.

Massachusetts' "healthcare reform" plan isn't working because they didn't go with a public plan, and worked exclusively with the existing private insurance companies, most of which are for-profit. I agree with you (much as it pains me greatly to say such a thing) that we can expect similar results if the US Congress takes the same approach nationally.

I didn't say I want to expand it -- the proposals to expand it were brought up, you made your pointless, gratuitous comment about people not signing up for Medicaid now, and I commented on the reality of Medicaid in my state and that expanding it would help a lot of people in my state. I want a true, universal single-payer system that covers everyone, paid for by everyone's taxes, but too many members of our Congress are bought and paid for whores of the for-profit healthcare lobby for that to happen anytime soon.

Massachusetts' "healthcare reform" plan isn't working because they didn't go with a public plan, and worked exclusively with the existing private insurance companies, most of which are for-profit. I agree with you (much as it pains me greatly to say such a thing) that we can expect similar results if the US Congress takes the same approach nationally.

And that's the crux of the matter. What is being proposed isn't sustainable. So I'm not sure why so many are fighting for a losing system? A system that doesn't work now and won't in the future.

America is not gonna get rid of capitalism or independence any time soon. What we need to do is come up with real solutions. No pre-existing conditions, as long as you pay you get coverage. Let the Americans help each other. Cut some slack, give to charities. When was the last time you can remember that the government has given anyone, other than it's law makers, something for nothing. There has to be taxes involved. That's the nature of government. The government doesn't make any thing to sell. It's a true non-profit entity and there fore has nothing to give it's citizens. It's citizens give to the government and many times they don't get their money's worth.

A local dairy gives 10% of it's profits to charity. Many many big businesses help out.

Our ancestors came to this country with the shirts on their backs. Yes, they stole land that didn't belong to them but they raised barns together, they farmed together and they prospered. Simplalistic story. But I bet you get my drift.

There was a story just recently about one of the Lost Boys of Sudan. He came to this country with nothing. He's a taxpaying citizen today. He didn't even speak the language and he managed to make a go of it.

The clinical manager of my home unit was a Vietnamese boat person. She remembers the voyage. She has a BSN now and a couple of apartment buildings. She's a taxpaying citizen. She probably used some programs to get where she is but she's paid them back.

I honestly really dont care for the people who can afford health care but choose not to get it, I dont think they should be forced into it but then again if they do get hurt they should be expected to pay the large bill for there medical expenses as a result for carlesness this does not mean leave them out to die, As for the people who can not afford it i have no problem helping them, I think it is important to help the less fortunit.

Can someone please educate me on the current plan as to who is going to be paying for it? Is it the tax payers? Buissness owners who make 500k + a year? What is the curent plan as to who they expect to pay for everyone who does not have healthcare who can not afford it? and another question, With this new public healthcare option, Does this mean that current employers have the right to take away the current health care you are on and switch it to the public option? Even if you are contracted to it on your benefits? (wouldn't that be breach of contract)?

There are correlative studies suggesting that our health insurance system is killing as many as 45,000 people a year. What are "feasible" interventions? Currently, health insurance companies make that decision. We can't save everyone but modern medicine is built on the premise that we can manipulate nature and those who can pay receive more, and better manipulation than those who can't.

Our health insurance isn't killing anyone, killing is an active process. I've never seen an autopsy report come back with the cause of death listed as "lack of insurance". The whole point I made in painstaking detail was that over the course of nature, people get sick and die. Lack of insurance has never killed anyone, it just isn't saving as many as some would like.

Your definition of health care is incorrect. It's not the absence of illness, it's the treatment (and possible prevention) of illness. The questions you ask are subjective. As we progress, I think Americans are beginning to understand and accept that health care is a right. The question now becomes, how do we as a people provide this right four ourselves and our fellow citizens?

The only rights any person can have, are the intrinsic ones we were born with. What we can create and do for ourselves. To claim anything beyond that as a right makes the assumption that others owe it to us to serve us. Health care isn't free, someone has to be there putting in the work, and the equipment and supplies are expensive. To claim something is a right, is to claim we're entitled to it free of charge. You can't ask anyone to pay for something their entitled to any more then you can ask them to pay for freedom of religion. So no, as you've stated it...health care can't be a right. Now if you were to say that the ability to purchase health care is a right, well...that's more sensible. But if people have serious or chronic conditions, it only makes more sense that they're going to be paying more in premiums.

If there's a will to make it happen then there's a way. Every developed nation on the planet finds a way, except ours.

Yes, they do. In the whole "Tax the rich, save to the poor" sense. And we're not every other developed nation in the world. If it's really so great over there, why not relocate? Why try to change this country? Why can't we have one country in the world where the individual can live their own lives without being forced to take on the burdens of the misfortunes of everyone around them?

Taxes are taken out of your paycheck each pay period to pay for Medicare for seniors. While there are some who are undoubtedly upset and being "forced" to pay for it, I think the vast majority of people realize that Medicare is a good program (not perfect) that helps every American 65 or older.

I pity seniors only for the fact that they grew up brainwashed by the government's social programs. In another shining example of the government stepping in and taking over what should be individual responsibility, they've convinced generations not to worry about retirement, because once they hit that golden age they can suckle on that golden teat for the rest of their days. And lets face it, SS and Medicare are a joke. It encouraged them to not worry about providing for their own retirements, and is doing a half assed job of providing for our elders. The days of self reliance are long since past.

We pay taxes, and we benefit from them, there is no country in the world worth living in that doesn't have a tax system for the public good.

I can guarantee you that you and I have extremely different views on the definition of "public good".

No one is stopping you from investing in google.

Surprisingly enough, I wasn't giving stock tips. I was pointing out how worthless my SS benefits are. The money I pay into the system now is essentially going down the drain as far as I'm concerned.