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Since Al Franken (who I like) has declared HCR bill is a "Historic Step Forward", I decided to look at some of the key provisions to see who wins and who loses. The White House spin machine will be making lots of hay once the bill is passed (which seems inevitable now), so you might want to compare the spin against your personal expected gain or loss.

For this analysis, I will assume Insurance companies will act like any for-profit institution and take the path that will maximize company executive pay and shareholder value. We are not talking about Ben and Jerry's here. These are cut throat maximizers of profit -- I'm not expecting any benevolence.

There are clearly a lot of paid shills floating around dKos (paid by lobbyists, etc.). So expect a lot of talking points to be regurgitated in the comments section on all sides of this argument. It is presented for your consideration and to make you THINK before you swallow the Tsunami of spin that is in-coming.

Note: TBD = to be determined


Bill provision: No Public Option
Loophole: None.
Winner: Insurance companies (already exempt from Anti-trust laws) have no competition. Sky-rocketing premiums assured.
This is the "Mission Accomplished" banner for Big Insurance.
Loser: American people victims again of money influence on politicians. Higher costs assured for a monopoly.

Bill provision: Mandated insurance. The bill would require individuals to buy health insurance, with a fine for non-compliance of $95 in the first year that would escalate to $750 by 2016. Parents would be responsible for providing coverage for children up to age 18.
Loophole: None.
Winner: Huge win for Insurance companies earn windfall for mandated insurance. By CBO estimates worth $848 billion over 10 years.
Loser: Consumers. "it uses the power of government, the force of law, to give the greatest gift imaginable to this industry -- tens of millions of coerced customers, many of whom will be truly burdened by having to turn their money over to these corporations -- and is thus a truly extreme advancement of this corporatist model. " -- Glenn Greenwald.

Bill provision: Requiring Insurance companies to spend 85% of premiums on actual health services.
Loophole: May incentivize Insurance companies to recommend extra unneeded procedures. More subsidized patients getting extra procedures could drive added profits.
Winner: Consumer, the promise of lower premiums
Loser: Insurance companies

Note: This will be one to watch. Be assured Insurance companies are looking for a crack in the legal wording to squeeze thru.

Bill provision: End annual and lifetime limits on the dollar value of your benefits.
Loophole: TBD
Winner: Patients with catastrophic illness that require expensive long term treatment. Neutral to Insurance companies.
Loser: Added cost will be passed to Healthy consumers.

Bill provision: Eliminating preexisting condition exclusions for all new medical plans and funding high-risk pools to insure those with preexisting conditions who are currently without insurance.
Loophole: Watch out for DNA and family history as the next frontier preexisting conditions. Let's get creative, shall we?
Winner: Patients with preexisting conditions.
Loser: Patients with preexisting conditions pay up to 3 times more than healthy consumers. Your $14K plan will go to $42K.

Bill provision: Extend health insurance coverage to 30 million additional Americans at an estimated cost of $848 billion over 10 years.
Loophole: TBD
Winner: Poor now covered. Insurance companies earn windfall for mandated insurance.
Loser:  Taxpayers pay the bill to Insurance companies (via the subsidies)
Note: 30 million at average $3,500 per person = $105B per year. Expect rates to rise at current rate of 10%+ per year. So $848B is incredibly low and hard to believe.

Bill provision: Older consumers pay up to 3 times more than younger.
Loophole: Who defines older? Insurance companies of course.
Winner: Insurance companies can now treat age as a pre-existing condition.
Loser: Anyone past age 29 and much worse with each added decade of age.

Bill provision: Deficit reduction. CBO estimates the proposal would reduce the federal deficit by $130 billion over the next 10 years, through 2019.
Loophole: TBD, but hell for a $130B we can fund another war. (sorry could not resist)
Winner: Taxpayer.
Loser: TBD. Where are the savings coming from? If it is by cuts to other programs like Medicare, the program  users will pay for the saving with higher costs.

Bill provision: Discounts for healthy consumers.  Health measured by weight (acceptable BMI body mass), cholesterol, blood pressure, etc. Smoking, drinking.
Loophole: Insurance companies can jack up rates for all then give a discount for good health. Will they be monitoring our grocery store purchases next (because the data exists)? Maybe lifestyle activities (warning, bicycles can be dangerous you know.)
Winner: Healthy consumers. Insurance companies with more leeway to jack premiums.
Loser: Consumers who are overweight or have other factors. Will you boss start thinking that your weight is costing him money. You do need that job don't you?

Bill provision: No abortion coverage. Prohibit the use of federal funds for abortion coverage
Loophole: TBD
Winner: Bible beaters force their beliefs on everyone else. Insurance companies have one less thing to pay for.
Loser: Women. Separation of church and state.    

Bill provision: "Cadillac" plans would face a 40% tax on policies worth more than $8,500 for individuals and $23,000 for families.
Loophole: TBD
Winner: TBD
Loser: Consumers, employees. My garden variety employer HMO plan (which is a good plan but by no means exceptional) meets the "Cadillac" criteria. Expect only very high deductible plans to pass this criteria. And if you are employer covered, expect the employer to pass along this tax.

Bill provision: The Medicare payroll tax on individuals earning $200,000 a year and couples earning $250,000 a year would increase by half a percentage point, from the current 1.45% to 1.95%.
Loophole: TBD.
Winner: Middle class if the tax revenue helps pay the subsidies for the poor. True amount of benefit TBD.
Loser: Earners above these clip levels.

Update: Changed the provision re: Limit Admin expense to 85% of premiums per input from Hawkjt and Ezekial.

Originally posted to CitizenOfEarth on Mon Dec 21, 2009 at 09:01 AM PST.


Will you win or lose with the HCR bill?

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