Health Reform 1 Running Head: HEALTH REFORM Senate H.R. 3590 vs. House H.R. 3962 Lyndsay B. Reed North Georgia College & State University
Health Reform 2 Abstract In a comprehensive approach to expand our access to healthcare coverage, both H.R. 3590 and H.R. 3962 propose that we require most citizens have health insurance and coverage. The Patient Protection and Affordable Care Act would like to require most individuals to preserve minimal coverage, having to pay a penalty if not done, while America s Affordable Health Choices Act would like to limit yearly out-of-pocket money spent on medical charges and impose a penalty only on those who do not have adequate healthcare coverage. While ensuring this coverage, both H.R. 3590 and H.R. 3962 hope to expand Medicaid and Medicare, as well as establish and support community-based and national health prevention and promotion groups for our citizens. Of the implications that each bill has to offer, what bill will be more beneficial to our American citizens?
Health Reform 3 Senate H.R. 3590 vs. House H.R. 3962 Since Barack Obama s election in November of 2008 and the beginning of his presidential journey in January of 2009, he has been attempting to form a bill for health care reform to successfully provide medical coverage for all Americans. Attributable to the effort he put forth during his first year as our President, both H.R. 3590 and H.R. 3962 were formed for our healthcare system in hopes that our country would accept and agree to the terms of coverage for all. The first bill passed by the Senate in December of 2009 was the Patient Protection and Affordable Care Act, which was later combined with America s Affordable Health Choices Act that was passed in November of 2009 by the House. After carefully reviewing each bill, Obama proposed that ideas from both bills be incorporated into one to ensure quality assurance for everyone. Though each of these bills may have their similarities about healthcare coverage, its financing, and a noticeable improvement in the delivery of healthcare, both bills contain many disparities as well. By outweighing the pros and cons and analyzing what each bill has to offer, we will find which one is more beneficial to healthcare as a whole and our citizens. When the Patient Protection and Affordable Care Act was passed by a vote of 60 to 39, the Senate promised a number of immediate benefits for American citizens that they would see within its first year of authorization. The two main promises made were lowering costs and extending and providing affordable health coverage to many Americans. They also promised to improve the care given to seniors, provide preventive care to individuals with no charge, and lower the costs of prescription drugs and small businesses through tax credits. Prohibiting any type of discrimination and eliminating limits set on the amount of coverage one can receive over a lifetime were also promised to the American citizens (Senate Democrats). Along with their immediate promises, there are also many other points stated in their bill.
Health Reform 4 The Senate is requiring that each citizen have qualifying health coverage, even if it is the minimal amount. If an individual does not have coverage, they will have to pay a penalty of up to $750 per year or up to 2% of one s household income, increasing yearly according to one s cost of living. It is advantageous for each American to have authorized health coverage, but I do not feel that those without coverage should be penalized; however, if they are, I believe that it is best if done according to their annual living expenses. Although this seems like a large cost to Americans and can be a disadvantage, there are a few exceptions to the rule: individuals that are above 100% of the poverty level, those who are incarcerated, and any individuals with religious protests, to name a few, are not required to pay these fees. I feel that these exceptions to the rule are needed, especially to better meet the needs of our citizens and their personal situations. The Senate also ordered that employers provide their employees with coverage through an exchange, making exceptions for the smaller employers to ensure coverage of any additional financial costs. They think four separate, state-based exchanges would be more beneficial for these citizens and smaller businesses under this favorable requirement. Whether the businesses contain more than 200 employees or less than 50, they must be provided with at least a minimal amount of coverage. Together with the individual mandates and employer requirements, the Senate also requires the validity of both an individual s income and citizenship status in deciding their eligibility for the federal premium credits offered. I feel that these validations are necessary to ensure that a person receives these credits if and only if they meet the requirements and earn them. If earned, these credits can have nothing short of a positive effect on each individual. As for the changes in Medicaid and its expansions, the Senate is forming a new group considered to be eligible for Medicaid. Those included in this group are children, parents, adults without
Health Reform 5 children, and pregnant women. Starting at an eligibility level of 133% above poverty level in 2010, the level of those covered by Medicaid will increase in percentage over the years as the population increases. I feel that this increase in coverage for those receiving Medicaid will be beneficial, especially as the population and those in need of this assistance continues to grow. However, I do feel that their should be some sort of limit set to the amount of Medicaid an individual receives if they are not currently able to support themselves or their families (Compare Side). The changes the Senate hopes to make in Medicare are restructuring payments over a four year period to improve the quality and coordination of patient care. They also hope to establish an advisory board composed of people who will work to reduce the amount Medicare spent to help achieve more financial stability. Overall, reducing Medicare payments is a goal that, with the help of this bill, the Senate thinks we can achieve. I feel that providing Medicare to those who deserve it should be mandatory, but this will only happen if we work toward becoming more financially stable, especially with our current economy. If the members of the advisory board can help us to find this financial stability, these changes could be very good, especially for the future of our younger and middle-aged adults. Lastly, in my opinion, an important section of H.R. 3590 is the coverage of abortion. The Senate has incorporated into their bill to allow states to forbid any plans participating in the exchange from providing coverage for abortions, except in cases in which the mother is in danger, or rape or incest has occurred. They also hope to veto any plans participating in the exchanges from any type of discrimination that may occur due to their objection to abortions. I am in total support of this situation because I am pro-life. I agree that providers should not be discriminated for choosing life over death, and the only exceptions for choosing abortion should
Health Reform 6 be if it can cause danger to the mother, or if an individual has been raped or involved in incest. Although there are many pros and cons to the Patient Protection and Affordable Care Act, this coverage is by far one of the best requirements this bill has to offer and definitely the best pro in my opinion about this bill (Focus on Health). In comparison, America s Affordable Health Choices Act was passed by a House vote of 220 to 215. They too, just like the Senate, offered a number of immediate reforms and benefits to ensure that they would have supporters on their side. A few of those reforms included providing coverage for any individuals who were previously uninsured or denied any type of coverage in their past, as well as promising those young adults who were uninsured that they could now stay on their parent s insurance until they turn 26. I know this can seem very beneficial to most, because I know that I currently do not have insurance and could benefit greatly from this reform. However, I do feel that allowing things such as this allows our young adults to mooch off their parents instead of growing up and becoming an adult. With acceptance of this bill, other benefits include quality inpatient and outpatient services, as well as mental health, substance abuse, and behavioral health treatments. They have also determined that well visits for children will include their medical, dentistry, vision, and hearing screenings. Though some may feel that this bill has already offered more benefits than H.R. 3590, there are still many other valid points made in their bill (Affordable Health). The Senate, like the House, is requiring that citizens maintain reasonable healthcare coverage. If these citizens do not have an acceptable amount of coverage, they will penalize them with a tax equal to 2.5% of their income. The Senate states in their bill that acceptable forms of insurance include grandfathered individual and employer coverage, certain government coverage (Medicare, Medicaid, and coverage provided to military and veterans), and
Health Reform 7 coverage obtained through an exchange or employer offer coverage (Compare Side, 2010). In comparison to the individual mandate for citizens, the employer mandate requires that each employer with a payroll of at least $500,000 provide their employees with coverage. However, if the payroll is less than $500,000, they are exempt from this requirement of coverage. If the employees decide to turn down the coverage offered by their employer, they can attain coverage through an exchange. Again, just like the Senate, the House requires a solid confirmation of an individual s income and citizenship to ascertain their eligibility to receive the premium credits offered. Nonetheless, while the House offers these federal premium credits, they also offer cost-sharing credits. The combined value of these credits is definitely more beneficial to our citizens than the premium credits offered alone. The House has also agreed to cover the same individuals for Medicaid, including those with disabilities. They are also agreeing to pay in full for those who have recently been chosen to receive this coverage for at least their first two years. While paying for this coverage, the government has also promised to pay for newborns up to 2 months of age if they do not have any other type of coverage. I feel that this is one of the best choices of coverage under Medicaid that H.R. 3962 has to offer. When children come into this world, it is because of a choice made by two other people. If those people are not able to properly provide for them and do not have coverage, this is a way that these children can still receive the care they need until their families are able to provide for them on their own. Though some may not agree with this idea, I believe it is the best circumstance for babies less fortunate than others; they deserve the best just like any other individual. The changes the House hopes to see made in Medicare include closing the donut hole and promoting quality primary care. Both of these are positive outcomes that will not only improve
Health Reform 8 the patient s care experience, but also the doctor s reputation and their relationships with their patients. This bill also offers to provide prescriptions at a discounted price, eliminating the cost of normally expensive preventive resources, allowing more access to health promotion facilities that will provide individuals with care (Affordable Health). Though some of these changes may be small, they can be very beneficial if individuals do their part. These changes will only become a problem if people begin to take advantage of the resources they are being provided with, in return, dwindling down the finances that we have. When covering abortion, the House would like us to prohibit any subsidy from buying insurance that will cover abortions, except for cases in which it should be offered: endangering the mother, rape, or incest. Along with this, they also state that individuals may buy additional coverage and pay completely out-of-pocket to have an abortion. To me, it seems that they are tying to take both sides, pro-life and pro-choice, to make it easier for many to support this bill. I know if I didn t have a specific view on abortion, that I would probably go with this bill if I were just voting on abortion coverage since it s supporting both sides. As you ve seen above, H.R. 3962 is similar to H.R. 3590 in many ways, but it does differ in others too. It is now time for us to see how vote buying and lobbying has affected these bills, as well as what implications these bills have to offer nursing, the States, and most importantly, the American people. After studying the Patient Protection and Affordable Care Act and America s Affordable Health Choices Act, I was able to find a number of implications these two bills would have for nursing. As nurses, either one of these bills are going to affect our careers, salaries, and profession as a whole in both positive and negative ways; therefore, we have got to be prepared for change no matter what bill is chosen. If we prepare ourselves for this change, we can be more innovative and start that change by moving in the right direction. What we need to focus
Health Reform 9 on are our patients and developing services that will better meet their needs and provide them with quality care. We have also got to take into account that in order for either one of these bills to be successful in providing coverage and care for all, we have got to have plenty of nurses willing to serve the population. If we become involved with our coworkers and nursing associations, we can be a part of the changes that are made and voice our opinions. If we want to have a say, we need to get involved and prepare ourselves to provide care for all of these individuals; we have got to step up our game! I could make a list that would last for days of the implications that these two health reform bills could have on the States and the American people; nonetheless, one of the more important implications for the States encompasses relieving their budgets of rising healthcare costs, a goal of both H.R. 3590 and H.R. 3962. For Georgia, two ways in which we can achieve this is by reducing employment premiums and uncompensated care. For the employment premiums, coverage will expand immediately, and those states providing early retiree benefits will furnish a relief of up to $1,200 per family. Also, as uninsured individuals begin to gain coverage, this uncompensated care will slowly begin to reduce overtime; thus, relieving our state budgets of rising healthcare costs (Health Insurance). As for the American people, there are a number of implications that can occur as well. A few of the implications I have found after studying these bills include lower healthcare premiums, guaranteed coverage for those with preexisting conditions, possible protection of Medicare benefits for our senior citizens, offering coverage to those in small businesses, and closer doctor-patient relationships. Some implications that may pose worry are the funding for abortion that H.R. 3962 offers, a lack of entitlement expansions, and a failure to reduce the deficit. Though some implications are positive and some
Health Reform 10 are negative, we need to look at the big picture and see the impact these results, as well as the impact that both vote buying and policy lobbying can have on our lives (GOP Solutions). Vote buying and policy lobbying are both ways in which others can persuade individuals to vote for specific things. Vote buying occurs often and is a deal made when others agree to vote for a specific law or bill and receive something for that vote in return. With indecisiveness and wavering support of the new reforms, special deals and vote buying are beginning to occur. In order for these states to be saved from financial destruction, the Senate has to decided to step up and do the best they can to change the attitudes of these individuals. They plan to do so by offering a few states a special exemption with federal money to cover the increased Medicaid costs, while leaving those states not covered by these costs to fin for themselves. These vote buying compromises have deemed successful in both Louisiana and Nebraska, securing the votes of Senators Ben Nelson and Mary Landrieu. Policy lobbying, just like vote buying, is an attempt to influence government officials and the ideas and thoughts they put into bills. This occurs daily on the steps of the capital and in the streets of every state; others fighting for and voicing their opinions on specific topics, doing all they can to make the change they want to see occur. Though I feel that vote buying should not be done and is unfair to those who do not benefit in any way, I believe lobbying should be done for those in office to hear the voices of our country s citizens and make changes that will benefit everyone (GA Governor). I feel that I could spend days evaluating points mentioned in H.R. 3590 and H.R. 3962, comparing the positive and negative outcomes of each bill. However, I believe both bills have points to review and ways in which they can assist us in improving our current healthcare systems. Both H.R. 3590 and H.R. 3962 promise to lower costs and provide coverage for all individuals. However, I do not agree with the fact that people can stay on their parent s
Health Reform 11 insurance until age 26. This requirement, supported by the House, allows young adults to continue mooching off their parents and not taking the necessary steps to continue life in the real world. These bills also require small businesses to provide coverage to their employees, which is very beneficial to employees. Though each plan differs in small ways, I agree with this coverage being provided. As for Medicaid, I am siding with H.R. 3962 because they are providing coverage to those with disabilities, as well as newborns for the first 2 months of their lives if they do not have any coverage; two offers that H.R. 3590 does not offer. When discussing Medicare, the Senate focuses on becoming more financially stable and providing quality care, while the House wants to close the donut hole, promote doctor-patient relationships, and offer more preventive resources to the American citizens. Overall, I feel that all of these implications can be helpful to us presently and in our future. On abortion coverage, I am no doubt siding with the Senate who prohibits any coverage for abortion outside of those times deemed necessary. Since I am prolife, this choice was very easy for me to make because I do not agree that abortion should be financed. Though I would like to spend more time reviewing these bills and evaluating each point and areas of coverage, I have taken a stand and sided with both the House and Senate on varying issues. Overall, I feel that we need to come to an agreement on a number of issues proposed in both H.R. 3590 and H.R. 3962 by combining the more beneficial points from both bills. By choosing to support what will be more favorable to more individuals, we will be able to provide medical coverage for all with the best financial plan to do so, and have a more positive effect on their lives and their future. If we are able to successfully incorporate ideas from both the Patient Protection and Affordable Care Act and America s Affordable Health Choices Act, we should be
Health Reform 12 able to ensure quality assurance for all Americans: better healthcare coverage, more financial stability with lower costs, and a vast improvement in healthcare delivery. What do you say America, what is your stand? References The Henry J. Kaiser Family Foundation. (2010, February). Focus on health reform: side-by-side comparison of major health care reform proposals. Retrieved March 8, 2010, from http://www.kff.org/healthreform/upload/housesenatebill_final.pdf. House Republican Conference. (2010). GOP solutions for america. Retrieved March 10, 2010, from http://www.gop.gov/solutions/healthcare. Purdue, S., Gov. (2010). GA governor demands investigation into vote buying for health care bill. Retrieved March 10, 2010, from http://www.thepostemail.com/2009/12/26/gagovernor-demands-investigation-into-vote-buying-for-health-care-bill/.
Health Reform 13 (2009, December 24). Senate democrats lead historic passage of the patient protection and affordable care act. Retrieved March 8, 2010, from http://democrats.senate.gove/ newsroom/record.cfm?id=321145&. (2010, January 7). Compare Side-by-side comparison of the coverage provisions of the two major congressional health care reform proposals. Retrieved March 9, 2010, from http://www.randcompare.org/sites/default/files/docs/pdfs/111thcongress-side-by- Side-1-7-10.pdf. (2010, March 12). Health insurance reform and georgia: the case for change. Retrieved March 10, 2010, from http://www.healthreform.gov/reports/statehealthreform/georgia.html. (2010, October 29). Affordable health care for america act (h.r. 3962): provisions impacting vulnerable children, youth, and families. Retrieved March 9, 2010, from http://www.cwla.org/advocacy/cwla_health_reform_bill_summary.pdf.