Healthcare Debate Rages on
By Dr. Mark Lutschaunig, Director of the GRD
The dog days of summer are over, and Congress is set to return from their August recess on September 8. It has been a controversial summer for our elected officials, as witnessed at the many raucous Town Hall meetings throughout the country. Healthcare reform has energized both sides of the debate, resulting in an increase in the number of citizen activists. This is how our democratic process should work. It is an example of the potential for excitement boiling around any issue, especially our own, once our profession becomes more involved in the political process.
The House of Representatives left in August with versions of healthcare reform from three different House committees. Once these three versions are combined, the Democratic leadership will take the bill to the full House, where a rigorous debate will occur. If the Democratic leadership keeps their members in line, the bill will pass easily. However, this is a big "if," as an internal fight between the more conservative Democrats (Blue Dogs) and the liberal branch of the party could scuttle any final bill. In the Senate, the Health, Education, Labor and Pensions (HELP) committee has passed their version of the bill, but the Senate Finance Committee is still trying to develop consensus amongst its members. The Finance Committee bill will help guide the Senate on the spending and funding issues.
The following chart compares the House bill, HELP Committee bill and the proposed Senate Finance bill (although the Finance Committee has not completed their bill):
| |
House Bill |
Senate HELP Bill |
Senate Finance Bill |
| Total Cost |
$1.04 Trillion |
$1.34 Trillion |
Still negotiating-target $900 billion |
| Number of uninsured in 2019 (Currently 47 million) |
17 million |
36 million |
Unknown |
| Government-run insurance (public option) |
Yes |
Yes |
No-The Senate bill would likely create nonprofit, consumer-run insurance cooperatives |
| Individual mandate |
Yes-Individuals must purchase insurance or pay a penalty based on income |
Yes-Individuals must purchase insurance or pay a penalty based on the cost of insurance |
Will likely require individuals to purchase insurance or pay a penalty based on the average cost of insurance |
| Employer mandate |
Yes. Employers must pay 65% of family premiums or pay a penalty based on payroll. Small businesses with less than $500,000 on payroll are exempt. Payrolls up to $750,000 have a reduced contribution |
Yes. Employers must pay 60% of family premiums or pay $750 for each employee who is not offered coverage |
No-will likely include a free-rider provision that would require employers who currently offer coverage to reimburse the government for employees who switch to insurance purchased through an exchange |
| Revenue raisers |
Original proposal: surcharge on families with incomes above $300,000 and individuals with incomes above $280,000
Under consideration: limiting the surtax to singles who earn more than $500,000 and families who earn more than $1 million |
HELP Committee does not have authority over raising revenue |
Considering imposing an excise tax on insurance companies that sell policies in excess of $21,000 a year for family coverage |
| Insurance reforms |
Yes. Bans rejection based on preexisting conditions |
Yes. Bans rejections based on preexisting conditions |
Will likely ban rejections based on preexisting conditions |
| Medicaid expansion |
Yes. Medicaid expanded to cover households earning less than 133% of the federal poverty level |
Yes. Medicaid expanded to individuals earning up to 150% of the federal poverty level |
Will likely expand Medicaid to cover everyone earning under 133% of the federal poverty level |
| Insurance subsidies |
Yes. Available to households earning up to 400% of the poverty level |
Yes. Available to households earning up to 400% of the poverty level |
Will likely be available to households earning up to 300% of the poverty level |
Source: Washington Post Online (www.washingtonpost.com) August 5, 2009
The Governmental Relations Division will continue to monitor the healthcare reform debate, and will monitor potential impacts on small business owners. If you would like to get involved and voice your opinion, the AVMA Government Action Center has contact information for your Representatives and Senators. If you are interested in becoming more involved in the political process, sign up for the Congressional Advocacy Network, and become part of our governmental relations team.
For more information, please contact Dr. Mark Lutschaunig.
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= AVMA/SAVMA Members Only
