Some of the main points as I understand them:
- Everyone must have insurance; if you choose not to, you pay a $700 fine. Weird and nanny-ish, but is designed to encourage more healthy young folks to add their low costs to the insurance pools (and presumably help fund Federal expenses).
- If you're poor, you get to opt-in to Medicaid. Not sure if you can opt out while avoiding the fine.
- If you make a little more, the Feds help you buy insurance.
- If you're a company with 50 or more employees, you must provide health insurance to them or pay a fine.
- If you're an employee whose workplace doesn't provide insurance or if you don't have a job, state-limited, private insurance will become available through state-based "insurance exchanges."
- Insurance companies must cover young folks under their parents' plans even after they move out (until age 26). I presume this helps keep young people in the insurance pool without having to fine them.
- Insurance companies can no longer deny healthcare based on pre-existing conditions.
- Out-of-pocket Medicare drug expenses will gradually drop.
- Federal money cannot be spent on abortions except in special cases (and because of the subsidies, this means no insurance can cover it). Not sure why this was such a battle: Does current insurance cover abortion? And who gets so many abortions that they need insurance to cover it?
- New taxes on the super-rich and on healthcare plans worth more than many people earn in year will help pay for the reforms.
- Studies show these reforms will save great big gobs of money and reduce the deficit over time.
Summary: A few tweaks to existing rules rather than real reform. That is, we don't get the "Public Option," and we certainly aren't approaching single-payer. We don't get new competition in the health-insurance industry, because they retain state-based dominance rather than the kind of interstate competition one sees in other insurance types. Insurance companies will get richer, plus now they'll cite this law as a reason to raise rates. And it won't help anyone for years to come.
An LJ-friend gives 10 reasons for real healthcare reform. Great ideas, and what reasonable person would argue with this? Still, we won't see such an option as long as the Republican party is able to continue convincing people that enriching insurance companies is our patriotic duty. Oh, and the Repubs are screaming about how they'll make a big deal out this in November. I hope they do, because, seriously folks, what kind of whackadoo thinks this bill is a "Federal takeover" of any kind? If anything, it's a boondoggle for insurance companies.
In short, last night's passage of the bill is a win for Obama - and a loss for the do-nothing Republicans - and that's cool. It's a bunch of much-needed improvements to the current system. It will help a lot of people stay healthier without going broke. And those are all good things. So I applaud.