Health Care One Year Later

WASHINGTON & SANTA FE, NM (By Chuck Todd, Domenico Montanaro, Ali Weinberg, Carrie Dann, and Kevin Hurd, NBC) March 23, 2011 ― Today marks the one year anniversary of President Obama signing the health care overhaul into law. That debate, the town halls, the process, and the late night votes consumed every bit of the political oxygen for a year and were the subject of heated political rhetoric and spin. But look at what’s happened since in order: the BP oil spill, the Greece riots, Elena Kagan to the Supreme Court, floods in Pakistan, Democrats’ “shellacking” in the midterms, Republicans take control of the House, Rahm Emanuel becomes Chicago mayor, Bill Daley replaces him at the White House, a new press secretary, no more Michael Steele, Tucson, Tunisia, Egypt, Japan, and Libya.

A nation still divided

Back to the health care anniversary … the needle hasn’t moved all that much on the health care bill’s popularity. In the most recent monthly tracking poll conducted by the Kaiser Family Foundation, 42% of respondents said they had a favorable opinion of the bill compared to 46% who saw it unfavorably. In April 2010, just after the bill was signed, the numbers were a similar ― but more favorable ― 46%-40%. In November 2010, when the midterm elections put the politics of health care front and center, those numbers were 42%-40%. The 2010 exit polls, which reflected an electorate that voted to sweep Democrats out of power in the House, showed an equally split country ― with 47% saying it should either be expanded or left as is and 48% saying it should be repealed. Kaiser’s numbers are similar to the ones shown by our NBC/WSJ poll. In March 2010, right before the legislation passed, 46% said they supported passage, 45% opposed. That’s exactly the same breakdown as NBC/WSJ found 10 months later in January 2011 on a different question ― on whether they supported or opposed its repeal.

And still equally confused

Polling indicates Americans continue to be confused about how the bill will impact them, what’s actually in it, what’s been implemented, and whether it’s been repealed. Kaiser shows, as of March, 53% say they are “confused” about their feelings on the law. In April 2010, 55% said they were confused. That dipped to 42% by June, but then spiked back up to 53% by September, dipped again to 43% by December and ticked back up at the beginning of this year; 52% say they don’t know enough about the legislation to understand how it will affect their lives. That’s about the same as April 2010, when 56% said so. Incredibly, almost half in February of this year said incorrectly either the bill had been repealed (22%) or weren’t sure (26%).

Congress ― who’s left

Of the 219 House Democrats who voted for the health care bill, 171 remain. The four House Democrats who voted for the health care bill and ran for Senate all lost. Of the 34 House Democrats who voted no, 14 remain. One, Charlie Melancon (LA-3) ran for the Senate and lost. Of the 56 Senate Democrats who voted for it, 46 remain, 11 of whom won re-election in 2010. Of the three Senate Democrats who voted against it, two remain. Only one ― Blanche Lincoln (AR) ― was up for re-election last year. And she lost. Republicans point out that no Senate Democrats voted against the bill the first time around on the Christmas Eve vote.

Update

Republicans also point out "six of the last eight Senate Dems to decide whether to support the health care bill will either not run for reelection or have been beaten. The seventh will be in a dogfight this year and the eighth will likely be reelected barring something dramatic in Vermont: Lincoln – lost; Ben Nelson – will likely lose; Lieberman – retire; Bayh – retire; Webb – retire; Conrad – retire; Feingold (because it wasn’t liberal enough) – lost; Brown (D •  OH) (because it wasn’t liberal enough) – ??; Sanders (because it wasn’t liberal enough) – ?"

Where it stands in the courts

Nearly two dozen legal challenges have been filed in federal court over the law, NBC’s Pete Williams reports. And while most have been dismissed on technical grounds, five resulted in decisions on the central issue ― whether the law’s requirement nearly all Americans buy health insurance is unconstitutional. The five cases are pending before federal appeals courts, and one may reach the U.S. Supreme court during its next term. In three of those cases, filed in Virginia, Michigan, and Washington, D.C., judges said the law is constitutional. In the other two, brought by the states of Virginia and Florida, judges said Congress exceeded its powers in passing the law. The lawsuit filed by Florida was backed by 25 other states. Adding Virginia, that brings to 27 the number of states challenging the law’s constitutionality. Six more cases are pending in the lower courts.

How is the law affecting you?

There were cries of, “Have you read the bill?” and “What’s in the bill?” which led to a lot of the confusion. Well, here’s some of what’s actually in the bill that’s taken effect already or will this year, per NBC’s Betsy Cline and others:

•  Children allowed to stay on their parents’ health insurance plans until their 26th birthday.
•  A 10% tax on indoor tanning services.
•  Seniors receive a $250 rebate to help cover the so called “donut hole” in Medicare drug coverage
•  Free preventative care covered by Medicare and private plans. (So, when your company says, “Good news, you now get free health care screenings, child well visits, physicals and other preventative care,” that comes from the health care bill.)
•  Nursing mothers to be allowed lactation breaks
•  Insurance companies no longer allowed to discriminate against children with pre-existing conditions
•  Government run insurance plan set up for adults with preexisting conditions who are denied coverage
•  Government run long term care program set up. For those who participate, people pay premiums for five years and then will receive benefits if they need them ― “whether they are 20-somethings in snowboard accidents or 80-somethings with Parkinson’s disease,” the New York Times wrote.
•  Insurance companies barred from placing lifetime caps on benefits
•  Insurance companies barred from dropping patients’ coverage when they get sick
•  Insurance companies must prove they spend 80% to 85% of premium revenue on medical services.
•  Insurance companies required to disclose rate increases (and the reason) of 10% or more
•  Small businesses (with fewer than 50 employees) begin receiving tax credits covering 35% of premiums to help them buy coverage. (This credit jumps to 50% in 2014.)
•  States receive billions in funding for community health centers
•  Drug companies face $2.5 billion in fees (rises in later years)
•  Creation of a government research institute created to examine the effectiveness of medical treatments
•  Establishment of a Medicare Independent Advisory Board, which will be tasked with trying to keep Medicare spending down and submitting legislative proposals to do so. It will first submit recommendations in 2016.

How will it affect you in the next few years?

If most of that sounds good. Republicans will rightly argue the law was front loaded with many of the positive parts. In 2013, new taxes and fees go into effect for individuals making more than $200,000 a year (and families making more than $250,000 a year), on dividends and interest, and on sales of medical devices. By 2014, the individual mandate goes into effect ― if you don’t have insurance, you have to buy it or face a fee. By 2016, that fee will be 2.5% of your income or $695 a year, whichever is more.

Bet you didn’t know

Senate Minority Leader Mitch McConnell’s office yesterday passed around a quote from Starbucks’ CEO, who said, “I think as the bill is currently written and if it was going to land in 2014 under the current guidelines, the pressure on small businesses, because of the mandate, is too great.” It’s true by 2014, businesses with more than 100 employees will have to contribute to buying health insurance for their employees or face hefty fines (if at least one of their employees qualifies for tax credits, but not Medicaid). But, we bet you didn’t know that businesses with fewer than 50 employees never have to buy health insurance for their employees, per the White House.

By the numbers