On March 21, after nearly two years of intense debate, the House of Representatives passed the Senate’s Patient Protection and Affordable Care Act by a vote of 219-212, extending coverage to 32 million Americans who currently lack health care.
The plan also alters insurance for senior citizens and children who currently have coverage.
“For the audience at UCLA, one of the things that will happen immediately is that young people will be able to stay on their parents’ insurance policies to the age of 26, which will be helpful so that they don’t have to run out and get jobs before they can get insurance,” said Henry Waxman (D-Ca), chairman of the House Energy and Commerce Committee.
A subsequent amendment also reformed student loans by increasing Pell Grant scholarship awards to $5,975 by 2017 and shortening the “debt forgiveness timeline” to 20 years.
The bill will make individuals and families eligible for subsidies if they earn up to 400 percent of the poverty line and wish to purchase their own insurance on exchange, whereby private insurers compete in a government-regulated marketplace, in turn bringing down the price of health insurance.
“We will be able to hold down health care costs by transforming the way health care is delivered,” Waxman said.
Other key points found within the nearly 2,500-page bill include the expansion of Medicaid to childless adults and the prohibition against insurers charging some people more for certain medical conditions or dropping policyholders when they get sick,
Effective Jan. 1, 2014, insurers will be prohibited from denying coverage to adults based on pre-existing conditions. Until then, the bill allows such people to join high-risk pools whereby they can receive subsidies up to $5,950 annually.
The exclusion of children with pre-existing conditions will end on Sept. 23.
On more controversial issues, the bill prohibits illegal immigrants from purchasing health care on exchange, and under a subsequent executive order, no federal or taxpayer funds will be allowed to be used to pay for abortions, unless under circumstances such as rape or incest.
Although President Barack Obama signed the bill into law on March 23, the House amended the legislation on March 25 with the 220-211 passage of the Health Care and Education Reconciliation Act of 2010.
“The bill had to be split into two pieces of legislation because the Senate Democrats lost their majority; the only choice we had was to pass the Senate bill as adopted on Christmas Eve,” Waxman said while on the House floor prior to the vote. “The vote tonight will be to make some changes in the Senate bill, to make sure that all states are treated fairly under Medicaid, and to close the gap in Medicare prescription drug coverage by 2020.”
The amendment also increases the tax credit for middle-income families buying insurance, reduces the penalty for failing to purchase insurance from $750 to $675 and spends $250 million to combat waste and fraud.
With an overall cost of $940 billion over the next decade, the Patient Protection and Affordable Care Act increases the Medicare tax for individuals earning more than $200,000 and families earning more than $250,000 from 1.45 percent to 2.35 percent, as well as levying a 3.8 percent tax on unearned income to begin in 2013.
Another provision raises the threshold for deducting medical expenses from 7.5 percent to 10 percent of one’s income.
Other taxes would include a 2018 excise tax on insurance companies of 40 percent for more high-priced insurance plans, referred to as “Cadillac” plans, and a 10 percent tax on indoor tanning.
Even after the passage of the bill and its subsequent amendment, the lengthy debate over health care is far from over.
“This bill is filled with $500 billion in tax increases, job-killing mandates, $500 billion in Medicare cuts, bureaucrat additions, entitlement expansions and backroom deals that will cost taxpayers millions,” said California Republican Darrell Issa in a statement on his Web site. “Experts agree that this bill will lead to higher health care premiums and a growth in long-term health care costs, the exact opposite of its intended goals.”
In Congress, Republicans have vowed to repeal the bill, with many proposing new legislation, such as Issa’s “Access to Insurance for All Americans Act” which would allow Americans to receive the same insurance that members of Congress receive without “job-killing mandates, a massive price tag or a government takeover.”
“It is going to be hard for the right-wing fringe groups to continue to attack the bill and suggest that they will repeal it. People will ask, “˜What do they want to take away?'” Waxman said.
Consequently, shortly after the passage of the bill, attorney generals from 14 states, including Texas, Florida and Pennsylvania filed lawsuits questioning the constitutionality of requiring states to expand their Medicaid programs at higher costs to state taxpayers and mandating that all individuals purchase health care or pay a penalty to the IRS.