It seems to be addressed in this article from AARP. I'm posting this and will look at it more later, no time now. I know some of what you are demanding to know is addressed in here. A lot of other things in here, that might be worth footnoting, and having access to for discussion purposes:
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Health Care Reform and You
It?s down to three key bills and here?s how they would affect you and yours
By: Jim Toedtman | Source: AARP Bulletin Today | Updated November 3, 2009
Congress is closer than it has ever been to the most ambitious health care reforms since Medicare and Medicaid were created in 1965. And few groups have a bigger stake in this overhaul than Americans age 50 and older.
For men and women 50 to 64?those not yet eligible for Medicare?the health care challenges are daunting. They face the prospect of lost jobs, reduced health benefits and the ?sandwich generation? challenge of helping finance health care for both their parents and their older children. The stakes for older Americans insured through Medicare also are significant. Nearly $400 billion of the projected cost of the reforms is to come from savings in Medicare and Medicaid.
Three key bills are in play now.
Two reform bills produced by the Senate Finance Committee and the the Senate Health Education, Labor and Pensions (HELP) Committee will compete for passage in the Senate, with the final debate starting in early November.
The House of Representatives made its proposal public on Oct. 29, and will consider the measure beginning Nov. 1. Senate and House conferees will have to reconcile the differences between the House and Senate bills ? if approved -- and then present the final compromise version for a final vote later this year.
The stakes for American businesses, workers, citizens and retirees are huge. Virtually everyone will be touched by the reforms in these proposals. Here?s how:
? Insurance for individuals
? If you?re insured by your employer, or you own a business
? If you buy your own insurance
? If you own a small business
? If you don?t have insurance
? If you?re covered by Medicare
? If you?re insured by Medicaid
? Financing the plan
? How reform would work: three examples
Insurance for individuals
In all three bills insurance companies could not deny coverage for preexisting conditions or cancel coverage because of illness.
* House bill:
Everyone would be required to have health insurance. Those without coverage would pay a penalty of up to 2.5 percent of their modified adjusted salary but no more than the national average premium for employer-provided insurance, now $4,824 or $13,375 for a family. Families of four making less than $88,200 a year would receive a subsidy to help pay premiums. A family of four earning less than $29,326 would be eligible for Medicaid. Poor families? premiums would be subsidized depending on income.
* Senate HELP bill:
This proposal has insurance requirements and subsidies similar to those in the House bill, but the penalty is capped at $750 per year. A family of four earning less than $33,075 would be eligible for Medicaid. Poor families? premiums would be subsidized depending on income.
* Senate Finance bill:
This measure has individual mandates and subsidies similar to the other bills. Penalties for those without coverage are capped at $950 per person and $3,800 per family. A family of four earning $29,326 would be eligible for Medicaid, adding approximately 11 million to Medicaid?s roles. A temporary high-risk pool is created to insure those with preexisting conditions before the program would take full effect in 2013.
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If you?re insured by your employer, or you own a business
Some 160 million people?53 percent of the population?have health coverage through their employers. They would not lose coverage if they get sick or lose their jobs. But if they drop their coverage, they would face a penalty.
* House bill:
If a company has an overall payroll of more than $250,000, it must cover 65 percent of an employee?s family premiums or pay a fine of up to 8 percent of its payroll.
* Senate HELP bill:
If an employer has 25 or more full-time employees, the firm must offer insurance to, or pay a fee of $750 for, each uncovered full-time employee.
* Senate Finance bill:
An employer is not required to provide coverage for employees. But companies with more than 50 full-time employees would have to pay subsidies of up to $400 for each uncovered worker. The employer would pay a 35 percent excise tax for those who have ?gold-plated? coverage that costs more than $8,000 annually or $21,000 per family.
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If you buy your own insurance
About 15 million people?5 percent of the population?buy their own insurance policy. If you do, you could not lose it even if you get sick.
* House bill:
You would have the option of purchasing insurance at a health insurance exchange, where choices include plans from private insurance and one from the government. Those who don?t purchase coverage would have to pay a penalty of 2.5 percent of their adjusted gross income. Premiums for low-income families would be subsidized.
* Senate HELP bill:
Those who drop their insurance must pay a penalty of $750 per person.
* Senate Finance bill:
Families with income under $66,000 who fail to purchase insurance would face a penalty of $1,500; the penalty would rise to $3,800 for families with income over $66,000.
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If you own a small business
About 62 percent of all companies with fewer than 199 workers offer health benefits.
* House bill:
Smaller companies would get a tax credit if they provide employee health coverage, or employ fewer than 25 people with an average wage of less than $40,000.
* Senate HELP bill:
A firm gets a tax credit if it pays 60 percent of an employee?s health expenses or employs fewer than 50 people with an average wage of less than $50,000.
* Senate Finance bill:
A company would get a tax credit if it employs fewer than 25 workers with an average annual wage less than $40,000 and provides health insurance.
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If you don?t have insurance
About 46 million Americans?15 percent of the population?lack health insurance. The number of uninsured people ages 50 to 64 has grown 36 percent since 2000, to 7.1 million. Men and women in this group face higher premiums because they are older and usually have some health issues.
* House bill:
Everyone would be required to be insured. Those who don?t purchase coverage must pay a penalty of 2.5 percent of adjusted gross income. People could purchase insurance through a health insurance exchange, where choices include private companies and a government option. Poor families? premiums would be subsidized depending on income. This measure would reduce the number of uninsured legal residents from 17 percent to about 4 percent. Insurance firms must provide coverage to all eligible people regardless of any preexisting conditions. Premiums for those over 60 could only be twice as high as those under 60.
* Senate HELP bill:
Insurance premiums could not exceed 12.5 percent of an individual?s income. People could purchase insurance through a health insurance exchange, where choices include private companies and a government option. Those who don?t purchase coverage must pay a penalty of between $1,500 and $3,800. The bill would reduce the number of uninsured legal residents to 3 percent.
* Senate Finance bill:
People could purchase insurance through a temporary insurance pool to provide insurance until the national system of exchanges and collectives can be established. Eventually, people can purchase insurance through a state-based health insurance exchange, where choices include private companies and a government-supported collective. Those who don?t purchase coverage must pay a penalty of up to $1,500, or up to $3,800 for a family. The bill would reduce the number of uninsured legal residents to about 6 percent.
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If you?re covered by Medicare
Some 35 million people?more than 11 percent of the population?are over age 65 and covered by Medicare.
* House bill:
The HHS Secretary would be authorized to negotiate drug prices. Costs of brand-name prescription drugs in the drug plan?s coverage gap?the doughnut hole?would be cut in half, saving beneficiaries an average of $1,700 a year, and the gap closes completely by 2023. The life of the Medicare trust fund is extended by five years. The bill aims to eliminate $170 billion in overpayments to Medicare Advantage programs, which make the cost of those plans 14 percent higher than traditional Medicare. It would provide $15 billion in payments to skilled nursing homes and rehabilitation centers; and provide Medicare coverage for doctors giving end-of-life counseling. House Democrats would address a scheduled 21 percent cut in reimbursements for doctors participating in the Medicare program in a separate bill.
* Senate HELP bill:
Costs of prescription drugs in the drug plan?s coverage gap?the doughnut hole?would be cut in half, saving beneficiaries an average of $1,700, and the gap gradually closed by 2015. The life of the Medicare trust fund is extended by five years. The bill aims to eliminate the overpayments, or subsidies, to Medicare Advantage programs, which make those plans cost 14 percent more per person than traditional Medicare. It cuts $15 billion in payments to skilled nursing homes and rehabilitation centers, and provides Medicare coverage for doctors giving end-of-life counseling. A scheduled 21 percent cut in reimbursements for doctors participating in the Medicare program would be permanently scrapped.
* Senate Finance bill:
Charges in the brand-name prescription drug coverage gap?the doughnut hole ?are cut in half starting in 2013, for the same $1,700 savings a year. The bill would extend the life of the Medicare Trust Fund by four years. It also would eliminate the overpayment, or subsidies, to Medicare Advantage programs, cut $15 billion in payments to skilled nursing homes and rehabilitation centers, and provide Medicare coverage for doctors giving end-of-life counseling. A scheduled 21 percent cut in reimbursements for doctors participating in the Medicare program would be halted for one year. Medicare would now cover annual checkups.
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If you?re insured by Medicaid
Forty-four million people?14 percent of the population?are covered by Medicaid. New plans would expand Medicaid by an estimated 11 million people.
* House bill:
Medicaid expands. Families of four with income under $33,000 would be eligible. Families of four earning $88,000 would pay no more than 12 percent of their income for health insurance. Government subsidies would pay the rest.
* Senate HELP bill:
Medicaid expands. Families of four with income under $33,075 would be eligible.
* Senate Finance bill:
Medicaid expands. Families of four with income under $29,326 would be eligible.
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Financing the plan
* House bill:
Total cost: $894 billion over 10 years. Individuals with income over $500,000 and families with incomes over $1 million would pay a 5.4 percent surtax.
* Senate HELP bill:
Total cost: $645 billion over 10 years. Committee has no jurisdiction for setting fees and taxes.
* Senate Finance bill:
Total cost: $829 billion over 10 years. Costs would be partially funded by $507 billion in cuts from the expected costs of government health programs including Medicare and Medicaid. In addition, $349 billion would come from new taxes and fees on health care insurers, manufacturers of health care devices and clinical laboratories.
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How reform would work: three examples
* Lydia, 52, was recently diagnosed with multiple sclerosis. She switched to part-time work recently because of her diagnosis. She is too young to qualify for Medicare, but makes too much to qualify for Medicaid. But she can no longer afford coverage because of high medical copayments and premiums that have doubled since 2000.
With the health care overhaul, Lydia can?t be denied coverage because of a preexisting condition. She can purchase her coverage through the new health insurance exchange, and her premiums can?t vary because of her illness. They would cost $4,913 under the House plan, and $6,081 under the plan before the Senate Finance Committee. Because her income is low, she qualifies for premium assistance and would pay no more than 5 percent (the House bill) of her income or $1,000 (under the Senate Finance Committee bill). Her total annual medical costs would be $1,933.
* Ingrid, 58, has just been diagnosed with breast cancer and faces the prospect of extensive tests and treatment, including chemotherapy. Her salary is $40,000. She will keep working so that she does not lose her health insurance.
With the health care overhaul, Ingrid cannot lose coverage because of her illness. If she opts to enroll in a new plan through the health insurance exchange, she gets assistance if her premiums exceed $4,800. Then she pays no more than 12 percent of her income. At her income level, her out-of-pocket spending is capped at $4,800. Still, the premiums plus her share of out-of-pocket expenses total about $10,000.
* Jack, 67, is on Medicare. He spends $4,500 on prescription drugs, including medication for high cholesterol and high blood pressure. He has a medigap policy, which supplements basic Medicare coverage, and is enrolled in the prescription drug program. He paid the first $295 of his drug bills, 25 percent of the costs, then he hit the $2,700 threshold. He was then in the doughnut hole and paid all of his drug costs. Had his drug spending reached $6,154, he would have left the doughnut hole, and Medicare then would have picked up 95 percent of the cost. With the health care overhaul Jack?s medigap coverage is unchanged, and his Part B premium remains the same. He gets a free annual checkup. He pays the first $295 of his drug bills and then 25 percent of his drug costs to $2,700. Once in the doughnut hole, prices of brand-name drugs are cut by half, an average savings of $1,700 per enrollee. If his spending exceeds $6,154, Medicare picks up 95 percent of the cost.
