Now that the bill has passed the House, I figured I would give you guys who didn't know too much about the bill a run-down. Please note that we didn't pass universal health care, or make any kind of significant changes to the health care system in America. Basically, the liberal left has nothing to brag about and the conservative right has nothing to cry about.

1. The plan is not a government takeover of health care like in Canada or Britain. The government will not take over hospitals or other privately run health care businesses. Doctors will not become government employees, like in Britain. And the U.S. government intends to help people buy insurance from private insurance companies, not pay all the bills like the single-payer system in Canada. The key parts of the current U.S. system -- employer-provided insurance, Medicare for the elderly, Medicaid for the poor -- would stay in place. The government would create health insurance exchanges for people who have to buy insurance on their own, so they could more easily compare plans and prices.

2. Insurance companies will be regulated more heavily. They will be told the minimum services they must cover, including preventative care. They will have to pay out a certain percentage of premiums for patient care. By 2014, when the exchanges open, insurers won't be able to deny customers for pre-existing conditions.

3. Everyone will have to have health insurance or pay a fine, a requirement known as the individual mandate. The government intends to cap premiums for people who make below a certain income. For people who buy insurance on the exchanges, a family of four making $88,000 would have a cap of 9.5 percent of their income. Lower incomes would have lower caps. The fine for not having insurance would be a minimum of $695 per person per year, with exemptions for financial hardship and other special cases.

4. Employers will not be required to buy insurance for their employees, but large employers may be subject to fines if they don't provide health insurance. But Congress wanted to encourage employers, especially large employers, to offer insurance. So they created a fine for employers with more than 50 workers: If those employees buy insurance on the exchanges and qualify for a low-income credit from the government, then the employer would have to pay a fine. Fines are calculated based on the number of employees; for large firms, the fines could be significant.

5. The vast majority of people will not see significant declines in premiums. When President Obama talks about premiums going down, he usually means they won't go up as much as they would otherwise. For the 4-out-of-5 who get their insurance through their employer, the savings would land in the 0 to 3 percent range by 2016, according to the nonpartisan Congressional Budget Office, or CBO. People who buy insurance on their own, but who don't qualify for government subsidies, could actually see their premiums rise by as much as 10 to 13 percent, but that's largely because they'll be getting beefed-up policies that would pay for more basic services, especially preventative care. Low-income people who qualify for new credits to buy insurance would see the biggest drops.

6. The plan might or might not bend the curve on health spending. Critics say there aren't enough provisions to reduce waste or fraud, but the Democrats say they're not being given enough credit for new cost-saving pilot programs that could be rapidly expanded. The most recent estimate of the plan, released Thursday by the CBO, said that it would spend $940 billion over 10 years. But new taxes, penalties and cost savings would offset the spending, according to the CBO, so that overall the plan pays for itself, dropping the deficit by slightly $138 billion over 10 years. Obama has said the plan will save more than $1 trillion in the second 10 years, but that estimate, according to the CBO, is highly speculative.

7. The government-run Medicare program will keep paying medical bills for seniors, but it will begin implementing cost controls on health care providers, mostly through penalties and incentives. The legislation would reduce payments for hospital-acquired infections or preventable hospital admissions. For Medicare Advantage, the federal government intends to reduce extra payments, taking away subsidies to private insurance companies. Insurers will likely cut benefits in order to not lose profits. The bill does not address the "doctor's fix," and expected proposal that Congress usually passes to prevent the doctor's Medicare payments from severe cuts.

Medicaid, a joint federal-state program for the poor, will cover all of the poor, instead of just a few groups the way it currently does. Right now, to qualify for Medicaid, a person has to be poor and also disabled, elderly, pregnant or a child. Under the new plan, all poor adults would qualify.

9. The government won't pay for elective abortions. But under the Senate plan, people will be able to buy insurance that covers abortion on the new health insurance exchanges, as long as the insurance company pays for the services with patient premiums, not taxpayer subsidies. Medicaid has an exemption for cases of rape, incest, or the life of the mother.

10. No one is proposing new benefits for illegal immigrants. Some House members had hoped that illegal immigrants would be able to buy insurance with their own money through the new exchanges, but that now appears unlikely.

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Thanks for the info. No its not the greatest plan ever, but its a step in the right direction in my opinion. At least you cannot be denied for something you cannot control!

Although it's not flawless, I think the fact that it was passed is one step forward, and hopefully something better can be past at a later date. :)

Medicaid needs reform. They only pay providers 50% of what the hospital or doctor's office bills them for. And I don't see how you can only be on Medicaid if you are poor and also disabled, elderly, pregnant, or a child. Because I work in the ER everyday & there are many young adults that are on Medicaid and are perfectly capable of having a job. They just choose not too. Also, I'm sorry but opening up that door that you just have to be poor to get Medicaid is just ridiculous we already have too many people on it that aren't doing anything to get off of it. I thought it was supposed to be a temporary solution? It just puts more people on it to abuse it like I see most of the people who are already on it.

And why are we even concerned about illegal immigrants health care? They need to get legal citizenship & pay taxes like I do & everyone else does before I can even be concerned about them. I think we need to be more concerned about our own elderly citizens who have paid into our Medicare system their whole life to only be let down when Medicare says their diagnosis wasn't severe enough for the test they had done. So they have a $5,000 hospital bill that they have to pay out of their social security which let's be honest isn't shit today.

Like everyone said it's not perfect but it's an improvement.

Pertaining to #7, what is considered "poor"?

Ah, that was supposed to be #8.

"Poor" will probably consist of people making under a certain income a year.

Isn't it under $500,000 a year?

Under $500,000 a year is poor, Kelly? lol

There was something about under $500,000 something lol.

I agree with Expecting Baby #3. This isn't a solution, but it's a start. Insurance companies have gotten away with too much for too long.

The abortion thing frustrates me, because he issued an executive order assuring that healthcare reform will not change the restrictions barring federal money for abortion. Yet NOW the pro-lifers are all going "oh well, we just don't believe he'll stick to it... he can withdraw it if he wants". He just cannot win with these people. I can only hope that with time they will see that he has stuck to his word on that one.

I also still can't understand people who are against the bill, and all the good it can do, entirely on the abortion issue (particularly when the bill doesn't actually say anything about subsidising abortions!). People are already dying because they can't get insurance e.g. becaue of pre-existing conditions. This bill will save lives. So supposedly those lives are worth less than the lives pro-lifers say they are trying to save (even although being against the bill isn't saving those lives at all, because the bill isn't pro-abortion!)?

It just makes me mad.

On a seperate matter, I was talking to a friend on Facebook last night who is conservative and was being all melodramatic about this bill and the loss of the American Dream etc etc etc. She was trying to claim that under this bill doctors will be required to ask permission from the government before providing a particular treatment. I hunted high and low online to find where this is actually said in the bill (she couldn't tell me), but all I could find was this (and I couldn't find it in it's full context, just quoted on anti-Obama websites)...

Section 3101(p)(1) provides, “Beginning on January 1, 2012 a qualified health plan may contract with –
. . . .(B) a health care provider if such provider implements such mechanisms to improve health care quality as the Secretary may by regulation require.”

The conservatives (including my friend) seem to have jumped on this to claim that it translates into a doctor has to ask either permission to treat you as they see fit... or the payment of the given treatment will only be provided if the government agrees. I don't think this is what it means at all. I think it has more to do with the concept of Clinical Effectiveness, which is already applied here... a body looks at the effectiveness of each drug and then recommends the ones which have an evidence base for effectiveness. Doctors can still choose which of those drugs shown to be effective, to use.

Still, I was wondering if you know anything about this particular section, what it actually means, or if it's even in the current bill?

"Under this provision, the Secretary of Health and Human Services is given authority to impose on doctors and other health care providers any and all regulations she considers meet the vague objective of “improv[ing] health care quality” on penalty of being unable of being part of the providers for any qualified health care plan. These could easily include regulations prohibiting “ineffective” health care, which could be deemed to be a way of improving health care quality. Particularly in light of the defeat of the Enzi amendment to the comparative effectiveness element of the bill, health care judged to inadequately serve the “quality of life,” based on the use of some such measurement as “quality-adjusted life years” could be deemed ineffective and thus prohibited by the Secretary under this provision.

In addition, Amendment 228 offered by pro-life Senator Orrin Hatch (R-UT), and the similar Amendment 229 offered by pro-life Senator Tom Coburn (R-OK), to ensure that taxpayers are not forced to fund assisted suicide were not adopted."

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We have something like that here too. At the hospital where I work, we have two "Clinical Efficiency Coordinators" (one who has a background in nursing, the other in social work), who have a variety of jobs, one of which that they meet with social workers from each unit once a week to discuss discharge planning. These meetings are extremely useful as they ensure that no stone is left unturned for our patients. We don't want to keep a patient hospitalized when there is a brilliant community service that will help the patient with exactly what they need. (These Clinical Efficiency Coordinators do a lot more but I don't particularly want to list all of it).

When these coordinator positions were created, everyone was complaining saying "What do we need that for? We are doing just fine", but people agree now that these people are extremely helpful and make the system much more efficient.

By no means do they tell a physician how to treat a patient!!

You didn't have those before?! I thought all hospitals had them! Or was it because you weren't on an acute unit? We call them Case Mangers/Discharge Planners.

I am on acute care. I didn't describe all of the Clinical Efficiency Coordinators' roles, (essentially to do everything as efficiently -- I need to use another word -- as possible lol) but there was a lot of debate within the hospital when those positions were created because some doctors felt that they were going to have to ask permission for a lot of their treatments.

At our hospital, Case Managers work with patients only once they are discharged, and the Social Workers are the discharge planners while the patient is in the hospital. I'm sure all hospitals have different systems. For example, I know that LPNs have a MUCH MUCH bigger scope of practice in other provinces than they do here. It would be a fascinating area to research -- is "one way" better than another? My dad wants me to pursue a masters degree in Health Administration, but I don't know... I am still counting on winning the lottery (but I need to buy a lottery ticket first!) :-D

I must have missed something, because I thought you were still working on a psychiatric unit and not a medical/surgical unit (which is what I meant by acute). See, our Case Managers are also Social Workers.. they do both of those things. I'm speaking solely on what I know about the hospitals in the Health System that I work in.. it could be completely different out of Community Health Systems's hospitals in the US.

Number three blows...just gotta say. You have to pay a fine if you don't have coverage? Ewww, I am really glad I live in canada.

I think the part of the bill about a fine is ridiculous. There are those of us who are not going to be able to get insurance because we can't afford it and that provision about all poor adults being able to qualify for Medicaid is more than likely (in my own opinion) merely something thrown in there to make people feel better. They're just going to change the way they qualify people for that and if you make too much money then you won't be able to qualify for it. Then you're stuck with a $700 fine that you can't pay. What happens if you can't pay that? Are they going to throw you in jail?

And potentially being stuck with medical bills (which may cost THOUSANDS of dollars, not hundreds) which you can't pay is better is it?

so, if you are poor/can't afford health insurance there are several ways that you can go about it:
1) apply for government subsidies. (if you are unemployed, for example)
2) you will only get fined if you go to the doctor. same thing if you don't have health insurance now, except you would actually get covered and not thrown onto the street (like they do in california).

re: "the spirit"--- i love people like you :D if you go and live in canada, your taxes will be higher but, true! you won't have to pay a "fine". you'll just wait 6 months to get an appointment at any doctor. so, please, go up there!!! our country is overpopulated and theirs is underpopulated! :) seeyoulater,bai.

I live in a country with public health care and I can see a doctor the next day. It doesn't take 6 months. :P

yes. you are a citizen of said country, yes?

I was a tax-paying alien of alberta and it took me 6 months to see a doctor. this is how most of my canadian experience went. I think they have a bias against us yanks, to be honest.

While I completely respect your position on this matter, I have to disagree. I think the fine is a good idea. I know way too many people who "refuse" to take offered health insurance because they don't want to "pay" for it. Yet, when they need/want medical attention, they expect tax payers to foot the bill because they don't have insurance. So, while I understand the hardships of being poor, if someone is offered insurance, I believe they should have to take it unless they are covered under a spouse or another qualifying plan. That's just my opinion.

All I want to say is that I agree with Tam I am. My husband and I both lost our jobs and on unemployment and with his part-time job we couldn't even be qualified for the discounted health insurance in our state! So, for the last year and a half we have paid expenses out of our pocket! After being scammed, I decided to just buy inexpensive health care which blows too. It doesn't even cover if I were to have a child! The health insurance that did would run me $1100 monthly for my family; my work insurance was $700 monthly. Getting health insurance without maternity only costs us $185 a month, and that's at the top of what we can afford...

My understanding is that medicaid will be available to more people under the new system though. Am I correct in thinking that on the old system medicaid wasn't only means tested, but you had to be on low income AND e.g. disabled? So the new system would likely have covered you and your family (when you were both unemployed) with medicaid. That's my understanding anyway.

And the original bill had more provision for getting insurance premiums down (e.g. by having a public option), but Americans apparently didn't want THAT and it was forced out.

I think this is a step forward but there is clearly a long way to go. There's no WAY you guys should be having to pay such an insane amount of money just to be covered for pregnancy/labour care! That is way over what I pay in taxes towards our NHS and here everyone can get perinatal care. Which is how it should be. As someone working on labour ward I am well aware how important it is (for the woman and her unborn baby) to receive proper antenatal care, and to receive appropriate care during and after labour. It really scares me that American women are going without that (one documentary I saw on TV recently actually showed an American woman who's only 'antenatal care' was weighing herself at Walmart! Her story was different though... she'd REFUSED any medical involvement... then of course she ended up with a post partum haemorrhage at home with no medical support!)