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KHN’s Eric Pianin Discusses The House Health Overhaul Bill

House Democrats released their health care reform bill called “America’s Affordable Health Choices Act of 2009.” Kaiser Health News Correspondent Eric Pianin discussed the bill with Jackie Judd.

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Jackie Judd: Before we get the specifics, can you set the scene for us?

Eric Pianin: There was a major turnout of the House Democratic leaders from Speaker Nancy Pelosi on down. Everyone was arrayed around the lectern with a big banner behind them saying “Quality Affordable Health Care For The Middle Class,” and everybody was evoking the historic significance of this moment. Many people deferred to John Dingell, the legendary House member whose father, a former member of Congress, first started the effort for universal health insurance 60 years ago during the Truman Administration. So, it was a big moment as they unveiled the House Democratic plan for extending health care coverage to nearly 50 million uninsured Americans.

JJ: What is the overview of the bill? What are the headlines from it?

EP: The big question leading up to this was “how much will this cost?” and that’s probably one of the few questions they didn’t really answer. The Congressional Budget Office is still trying to estimate what this plan will cost over ten years. We may know something more later today or later in the week.

But the critical provisions of this include creation of a health insurance exchange and a new public health insurance option, which would be a government-generated source of health care insurance for uninsured Americans and would provide guaranteed coverage and insurance market reforms. It would set a floor on the level of coverage for those who seek insurance in this new exchange and it has a series of other provisions important for middle- and lower-income Americans, including providing a sliding scale of credits for lower income people who need help in purchasing the insurance. It puts a cap on annual out-of-pocket spending; it expands Medicaid and improves on Medicare in some ways. So, it’s really a major reform of the health insurance industry, and it also includes many of the provisions that are essential to liberal Democrats in Congress, and probably the most important one being the creation of this public option – this government-created source of new insurance that can compete with the private industry.

JJ: Just to clarify, it does include an individual mandate. That is, everyone who can afford it, by government standards, will have to have insurance. And also requires, except for the very, very smallest of businesses, most businesses to offer their employees coverage in some way.

EP: Precisely. Many of the architects of this legislation feel that it’s critical that some pressure be applied to individuals to take part in this program, to take advantage of this insurance program that’s being created. And also, pressure on employers to either create or offer insurance to their workers, or if they don’t, to contribute to a pool that would create insurance availability in this new exchange. Just to show how serious they are about it, I notice that one of the changes from the initial draft to this latest version of the bill is to increase the penalty that individuals would pay for not taking part in the exchanges, up from 2 percent to 2.5 percent [additional tax on modified adjusted gross income].

JJ: The chief way that this would be financed is a surtax on the wealthiest, is that correct?

EP: That’s correct. The Ways and Means Committee, chaired by Charles Rangel, D-N.Y., late last week came up with a proposal for a sort-of sliding scale surtax on the wealthiest Americans. They say this would affect, perhaps, 1.2% of all Americans who make the highest incomes. The tax could range from one percent of people’s adjusted income for those making between $350,000 and $500,000 to up to 1.5 percent of those making between $500,000 and $1 million a year.

JJ: The unveiling of this bill was delayed from late last week because there was some opposition from certain groups in the House, including the Blue Dog Democrats, largely fiscally conservative members of Congress, many of them from more rural areas. So, what is in this bill that appeases them, or are they not appeased?

EP: There’s definitely efforts made within this latest draft to appease them. Perhaps the most obvious one is the exemption from the mandate for smaller businesses and smaller employers. This was added at the last minute, to try to placate the more conservative Democrats, the so-called “Blue Dog” Democrats, who are very concerned that these employer mandates could kill off smaller businesses in their districts. Many of them are from rural districts and are concerned about struggling businesses during the recession. So I think this was probably the main ‘peace offering’ to the Blue Dogs. But the leaders – Pelosi, Steny Hoyer, George Miller and others – are all emphasizing that this is really a big start to a process that won’t really be completely until later this fall. A lot of other changes could be made during the markup of this bill in three separate committees beginning later this week.

JJ: Do they expect to have a vote in the House before the August recess or not?

EP: Pelosi said that there will be a vote in the House before the August recess, and she and Hoyer raised the possibility that even the Senate, which has been struggling to come up with a version of its own might vote as well before the August recess.

America’s Affordable Health Choices Act (bill .pdf)

America’s Affordable Health Choices Act (summary .pdf)