SENATE BILL: The New Atlasian Healthcare Act (Law'd)

[Sbane]

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Sponsor: MoPolitico

I propose this amendment. I struck out Section 1d since a later part of the bill already had co-insurance in it. That would be Section 2a. I also made some changes to it. I think those making less than 250 times the poverty level should have to pay 10% since it disincentives overuse of health care. I also made sure there are limits to how much people pay out of their own pockets for incomes greater than 250 times the poverty level. An angioplasty costs 25k these days and having someone making 50k pay half of that would be wrong. In addition we should encourage preventative care and that will be completely covered by the government with no cost sharing required by anyone.

[Sbane]

Also I am a little unclear on the funding mechanism. Is the tax on your health care benefits or your overall income?

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I will gladly sponsor this bill, with my changes of course, if MoPolitico doesn't show up.

[Sbane]

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I am highlighting the changes made to the original law passed in 2009 including the two amendments that have been added on and the parts that have been struck out.

[Sbane]

This would be the maximum they they would need to pay for coinsurance when using services payed for by the government insurance program. If they purchase supplemental insurance for services not covered by the government plan, they might need to pay more out of their pocket for the premiums, co-payments or co-insurance for those services.

[Sbane]

Well, the way this would work is that you pay coinsurance on the amount that is billed in your name. And all that coinsurance cannot exceed a certain amount of your income per year. If you buy insurance to help you cover that coinsurance (which would be likely for incomes above 150k I would think), it does not really affect the amount after which the government pays 100%.

So someone making 300k a year would not have to pay anything after they have paid 25% of their income for the year, $85,000. And that $85,000 would have to be coinsurance paid for services gotten under the government plan. It does not matter if you purchase insurance where they pay the rest after you spend 10 or 20k a year. The premiums you pay for that insurance would not be included in the $85,000.

[Sbane]

Well, the way to remedy that would be to add lots of steps down from 90% to 50% and onwards to 10%. Maybe we should do that? This still only hurts people on the margins. And the point sort of is that as people earn more, they should be able to put aside more of their income for healthcare costs.

[Sbane]

That is my understanding at least.

You understand well, Yankee.

[Sbane]

This does hit the rich way more. They have to pay 90% of their healthcare costs and their cap is at 25% of income, which would mean $62,500 and up. Also taxes are being raised on them as well.

[Sbane]

Are you looking at making changes to the healthcare payroll tax along with this?

Yes, this bill raises the tax on the top bracket to 5.5%.

[Sbane]

So just to get this straight, the tax is only on the health insurance benefits themselves?

Hmm, I'm a little confused on this myself. Is this only a tax on whatever supplemental health plans people buy? Or is it like an excise tax on health services?

[Sbane]

So I guess it is a tax on health insurance. In that case, it wouldn't seem to be anywhere near enough to cover the benefits provided. Though I think tax receipts should increase with the new changes in effect since I think upper income Atlasians will purchase insurance to cover against losses of more than a certain amount.

[Sbane]

I would recommend getting Shua's feedback on the extent of the amount.

are you asking me to calculate something?

No, but I was recommending that Sbane ask you to.

Uh..yeah. Shua, can you please calculate how much the tax on health insurance will bring in if these changes are implented? Thanks!

[Sbane]

That is what I would expect since most people still won't purchase insurance. The main funding for this comes from the payroll tax and general funds.

Also can you calculate how much this cost sharing will save the government?

[Sbane]

Is that per year?

[Sbane]

I think we need to look carefully at complementary and alternative medicine. Is there strong evidence that chiropractic services don't work? I would say the results are mixed as of now, but any evidence to the contrary will be appreciated. Speaking of herbal remedies, it really matters what we are talking about. Lots of herbal remedies do work....indeed many conventional medicines are just the purified active ingredients in the herbal products.

[Sbane]

Well, I certainly don't agree with Scott about supporting services which do not perform better than placebos. That being said, excluding some of the out there theories of why spinal manipulation works, SMT seems to perform similarly to other therapies used for lower back pain. And outside of lower back pain, the evidence for effectiveness of SMT is pretty weak. Since SMT could be considered for the treatment of lower back pain, I don't know if we should get rid of those services. Remember that we have been providing these services for years and we should have a good reason to get rid of it. You can introduce an amendment to strike that out of the bill. I will be abstaining.

[Sbane]

I would support covering cochlear implants. Not sure about speech-language pathology though. I read the wiki and couldn't find anything worth supporting....but maybe you can change my mind. Is this working with people who stutter, have lisps and other speech disorders?

[Sbane]

I would support covering cochlear implants. Not sure about speech-language pathology though. I read the wiki and couldn't find anything worth supporting....but maybe you can change my mind. Is this working with people who stutter, have lisps and other speech disorders?

Precisely.  There's no reason why we shouldn't cover SLP if we're covering mental health issues... if Atlasia's progressed to the point that we realize that mental problems aren't just a "character flaw" and deserve treatment and help, why shouldn't we do the same for people who stutter or have even more serious language impairments?

Ok, yeah that sounds like something worthwhile of funding. Though I should ask, is there evidence of these therapies working?

Also Nathan, can you further explain why you don't support cochlear implants? Just not believing in disability is hardly adequate.

[Sbane]

I need to understand a bit more about Deaf culture. Are they saying that being deaf is alright? I mean it's definitely fine and they are just normal human beings but I would think being able to hear, or being able to hear better would be preferable......

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Well, I'm baffled why one would not want to have all five senses but regardless I support funding deaf schools. Maybe in a separate bill though, lest we go down the path of the US congress.

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Well, it would help deaf people in the workplace and school one would imagine. I understand why from the perspective of someone who is deaf it might not seem like a loss, but I think it's apparent they would benefit in the larger society if they were able to hear.

[Sbane]

Abstain

[Sbane]

No, you should go for it!

[Sbane]

Well, this is mostly just amendments to that. Do we need to repeal it? If needed then yeah we should do that before we pass this.