LC 2.5 The Lincoln Single Payer Healthcare Act (General debate)

[Former President tack50]

The Lincoln Single Payer Healthcare Act

An act to establish a regional single payer healthcare system in the region of Lincoln

Section I: Elegibility and benefits
1. A new government program, named the Lincoln Healthcare System, or LHS, shall be created
2. All residents of Lincoln shall be entitled to benefits under this Act
3. No person shall be excluded from participation in or be denied the benefits of the program or be subject to any reduction of benefits established under this Act for discriminatory reasons. These include, but are not limited to age, race, gender, pre-existing medical conditions, etc
4. The enrollment of new individuals in this program shall be automatic upon adquiring the condition of legal resident of Lincoln. The government shall issue a card to all individuals enrolled in this program
5. From the moment this bill is enacted, it shall be unlawful for private insurers and employers to provide or sell benefits that duplicate those of this act. However extra benefits not covered by this act may still be provided by private insurers and employers

Section II: Coverage
1. The government of Lincoln shall pay on behalf of the individuals covered by this program for the following items and services if they are medically appropiate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:

a) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.
b) Ambulatory patient services.
c) Primary and preventive services, including chronic disease management.
d) Prescription drugs and medical devices, including outpatient prescription drugs, medical devices, and biological products.
e) Mental health and substance abuse treatment services, including inpatient care.
f) Laboratory and diagnostic services.
g) Comprehensive reproductive, maternity, and newborn care.
h) Pediatrics.
i) Oral health, audiology, and vision services.
j) Rehabilitative and habilitative services and devices.
k) Emergency services and transportation.
l) Early and periodic screening, diagnostic, and treatment services
m) Long-term care services and support

2. No cost-sharing measures shall be imposed on individuals for the services covered by this Act

Section III: On Healthcare Providers
1. Each health care provider has a duty to act in the exclusive interest of each individual under the care of such provider according to the applicable legal standard of care, such that no financial interest or relationship impairs any health care provider’s ability to furnish necessary and appropriate care to such individual.
2. A health care provider is considered to be qualified to furnish covered items and services under this Act if the provider is licensed or certified to furnish such items and services in the region of Lincoln
3. The government of Lincoln shall establish minimum standards for institutional providers of services and individual health care practitioners.
4. An institutional, individual or privately owned provider may not bill or enter into any private contract with any individual eligible for benefits under the Act for any item or service that is a benefit under this Act.
5. All healthcare providers by the start of the year 2030 shall be public or non-profit providers. The government of Lincoln will work for a smooth transition. The year of application of this section may be extended by the governor.
6. Individuals covered by this act shall be free to choose among all providers and institutions that participate in this Act

Section IV: Payments to Providers
1. Not later than the beginning of each fiscal quarter during which an institutional provider of care (including hospitals, skilled nursing facilities, Federally qualified health centers, home health agencies, and independent dialysis facilities) is to furnish items and services under this Act, the government of Lincoln shall pay to such institutional provider a lump sum.
2. The amount of each payment to a provider described in Section IV.1 shall be determined before the start of each fiscal year through negotiations between the provider and the state director with jurisdiction over such provider.
3. Payments to providers under this Act may not take into account:
a) The provider's marketing
b) The profit or net revenue of the provider
c) Political contributions
4. Providers receiving payment under this Section shall be prohibited from using funds designated for operating expenditures for capital expenditures or profit; and viceversa
5. The prices to be paid for covered pharmaceuticals, medical supplies, medical technologies, and medically necessary equipment covered under this Act shall be negotiated annually

Section V: Relation with the federal Reforming and Regionalizing Public Healthcare Act of 2017
1. The region of Lincoln hereby opts out of the AtlasCare program, as established in Part II, Section 1 of that bill.

Section VI: Enactment
1. This bill shall be enacted on the 1st of October, 2019

Sponsor: tack50

Debate for this bill has started and shall last no less than 72 hours

[Former President tack50]

Ok, so this bill is almost entirely taken from the RL "Medicare for all Act of 2019". I generally don't like taking bills from RL since they are usually too complex for the game, but any healthcare bill is going to be complex anyways. I did try to remove as much complexity as possible in order to make it better to understand. Here's a summary section by section:

Section I establishes elegibility for single payer healthcare (essencially, all people living in Lincoln), establishes that discrimination on access to healthcare is banned, establishes a healthcare card and that access to the LHS shall be automatic and bans private ensurers and employers from duplicating coverage

Section II establishes the services covered by the LHS and bans cost sharing like copayments

Section III:
-Mandates that healthcare providers shall treat patients without regard to their finances
-Establishes some very basic and generic requirements for providing healthcare
-Ensures a transition towards only public and non-profit healthcare providers by the year 2030. I added the option of the Governor waving this if necessary, just in case the transition ends up being too difficult

Section IV pretty much covers how healthcare providers will be paid by Lincoln

Section V establishes that, in order not to overlap with AtlasCare (the public option established in 2017), Lincoln will opt out of AtlasCare.

Section VI establishes that this bill will be enacted on the 1st of October.

Not sure if I missed something in order to get a proper single payer system, but doing something as complex as healthcare can be hard. Who knew healthcare could be so complicated?

[Former President tack50]

Is abortion covered under reproductive care?

Not sure, but since it's "comprehensive reproductive care" I will assume it is covered.

I propose an amendment to this bill

Healthcare shall be controlled by insurance companies, and the only government interference is to protection from discrimination against pre-existing conditions

If this amendment is not added, I will vote NAY

I propose another amendment.

Lincoln taxpayer money should not be used to fund abortions or abortion providers, such as Planned Parenthood

This amendment must also be added, otherwise I will vote NAY

I need more specifics to consider this ammendments. Where would you like them added? And which parts of the bill would you like to remove?

I would assume the 2nd ammendment would be added to Section II and the 1st would be on Section I or possibly Section III?

Here's an example of how an ammendment should ideally look like from a recient federal bill (which is currently about to be tabled)

Off-site chat rooms Regulations Bill

1. Off-site Crimes
A:Conducting official business on off-site chat rooms- This crime shall be considered the conducting or taking part of a formal votes and making of formal motions by any regional assembly or the federal senate or federal  house. Any legislative business conducted by the previous mentioned assembles  shall be considered null and void if done on off-site chat rooms.
BA Spreading liable speech about another Atlasia citizen on off-site chat rooms-  This crime shall be considered the spreading of knowingly false information about a registered Atlasian to at least one other registered Atlasia citizen.
CB.Harassment of other Atlasian citizens on off-site chat rooms- This shall be known as the public posting of vulgar or threatening remarks directed or about another Atlasian citizen.

2.Criminal liability and sentencing procedures- The above crimes shall be tried the same way  as Crimes against Atlasia. The above crimes shall have a maximum sentence of a 1 year voting ban and a 1 year ban on holding office.

3. This bill shall take effect immediately upon passage.

https://uselectionatlas.org/FORUM/index.php?topic=316188.msg6724980#msg6724980

[Former President tack50]

Ok, with 3 ammendments at once, I guess I should consider them one at a time? In that case, the first ammendment considered will lfromnj's; followed by S019 and finally thr33.

To begin with, lfromnj's ammendment is friendly.

Ammendment L 2:01 by lfromnj

An act to establish a regional single payer healthcare system in the region of Lincoln

Section I: Elegibility and benefits
1. A new government program, named the Lincoln Healthcare System, or LHS, shall be created
2. All residents of Lincoln shall be entitled to benefits under this Act
3. No person shall be excluded from participation in or be denied the benefits of the program or be subject to any reduction of benefits established under this Act for discriminatory reasons. These include, but are not limited to age, race, gender, pre-existing medical conditions, etc
4. The enrollment of new individuals in this program shall be automatic upon adquiring the condition of legal resident of Lincoln. The government shall issue a card to all individuals enrolled in this program
5. From the moment this bill is enacted, it shall be unlawful for private insurers and employers to provide or sell benefits that duplicate those of this act. However extra benefits not covered by this act may still be provided by private insurers and employers

Section II: Coverage
1. The government of Lincoln shall pay on behalf of the individuals covered by this program for the following items and services if they are medically appropiate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:

a) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.
b) Ambulatory patient services.
c) Primary and preventive services, including chronic disease management.
d) Prescription drugs and medical devices, including outpatient prescription drugs, medical devices, and biological products.
e) Mental health and substance abuse treatment services, including inpatient care.
f) Laboratory and diagnostic services.
g) Comprehensive reproductive care, excluding abortion except in the case of where the fetus threatens the mothers life or came from a case of rape; maternity, and newborn care.
h) Pediatrics.
i) Oral health, audiology, and vision services.
j) Rehabilitative and habilitative services and devices.
k) Emergency services and transportation.
l) Early and periodic screening, diagnostic, and treatment services
m) Long-term care services and support

2. No cost-sharing measures shall be imposed on individuals for the services covered by this Act

Section III: On Healthcare Providers
1. Each health care provider has a duty to act in the exclusive interest of each individual under the care of such provider according to the applicable legal standard of care, such that no financial interest or relationship impairs any health care provider’s ability to furnish necessary and appropriate care to such individual.
2. A health care provider is considered to be qualified to furnish covered items and services under this Act if the provider is licensed or certified to furnish such items and services in the region of Lincoln
3. The government of Lincoln shall establish minimum standards for institutional providers of services and individual health care practitioners.
4. An institutional, individual or privately owned provider may not bill or enter into any private contract with any individual eligible for benefits under the Act for any item or service that is a benefit under this Act.
5. All healthcare providers by the start of the year 2030 shall be public or non-profit providers. The government of Lincoln will work for a smooth transition. The year of application of this section may be extended by the governor.
6. Individuals covered by this act shall be free to choose among all providers and institutions that participate in this Act

Section IV: Payments to Providers
1. Not later than the beginning of each fiscal quarter during which an institutional provider of care (including hospitals, skilled nursing facilities, Federally qualified health centers, home health agencies, and independent dialysis facilities) is to furnish items and services under this Act, the government of Lincoln shall pay to such institutional provider a lump sum.
2. The amount of each payment to a provider described in Section IV.1 shall be determined before the start of each fiscal year through negotiations between the provider and the state director with jurisdiction over such provider.
3. Payments to providers under this Act may not take into account:
a) The provider's marketing
b) The profit or net revenue of the provider
c) Political contributions
4. Providers receiving payment under this Section shall be prohibited from using funds designated for operating expenditures for capital expenditures or profit; and viceversa
5. The prices to be paid for covered pharmaceuticals, medical supplies, medical technologies, and medically necessary equipment covered under this Act shall be negotiated annually

Section V: Relation with the federal Reforming and Regionalizing Public Healthcare Act of 2017
1. The region of Lincoln hereby opts out of the AtlasCare program, as established in Part II, Section 1 of that bill.

Section VI: Enactment
1. This bill shall be enacted on the 1st of October, 2019

This is the amendment I propose. I think Suburban should be satisfied with this.

Sponsor feedback: Friendly
Status: Added to the bill

Note: The ammendment was very lightly modified for grammatical clarity. Lfromnj, are you ok with the minor grammar change?

The changes amount to a comma being moved and adding "care" to reproductive care, which I guess was accidentally removed. Also adding back Section VI which I assume was accidentally removed.

24h to object to that change?

[Former President tack50]

I propose the following amendment:

Section I: Elegibility and benefits
1. A new government program, named the Lincoln Healthcare System, or LHS, shall be created
2. All residents citizens of Lincoln shall be entitled to benefits under this Act
3. No person shall be excluded from participation in or be denied the benefits of the program or be subject to any reduction of benefits established under this Act for discriminatory reasons. These include, but are not limited to age, race, gender, pre-existing medical conditions, etc
4. The enrollment of new individuals in this program shall be automatic upon adquiring the condition of legal resident Atlasian citizen of residing in Lincoln. The government shall issue a card to all individuals enrolled in this program
5. From the moment this bill is enacted, it shall be unlawful for private insurers and employers to provide or sell benefits that duplicate those of this act. However extra benefits not covered by this act may still be provided by private insurers and employers

I'm hoping this was an oversight. It's not appropriate to offer healthcare benefits to noncitizens, particularly illegal aliens.

Expecting taxpayers to fund healthcare for this group is an unpopular if not fringe position. If you want to do something about catastrophic care so there isn't big emergency room debt, then the only logical way would be taxing remittances, which I imagine has to be at the federal level.

Please consider this amendment, Mr. Speaker.

I agree that illegal aliens should certainly not be given healthcare access, other than emergency one.

However, I see no reason for legal residents of Lincoln to be discriminated on access to healthcare. Unless you are trying to prevent "medical tourism"? That is indeed also something to be prevented. But all legal residents with the exceptions of tourists should be given access to healthcare.

[Former President tack50]

I support lfromnj’s amendment added to this bill

So, I vote AYE on the amendment, but not the bill

Uh, Lfromnj's ammendment was considered friendly (it was a surprisingly reasonable ammendment!). So no need to vote on it.

Also, I will now be moving to the 2nd ammendment proposed, the ammendment proposed by S019. This ammendment is NOT friendly.

Don't take it personal; on the contrary I actually love the job our legislators are doing! Let's just hope all bills see as much debate as this one, but this council is definitely off to a great start It's just the terminology that's used.

Ammendment L 2:02 by S019 / Suburban New Jersey Conservative

Mr. Speaker, I propose the following amendment

The Lincoln Single Payer Healthcare Act

An act to establish a regional single payer healthcare system in the region of Lincoln

Section I: Elegibility and benefits
1. A new government program, named the Lincoln Healthcare System, or LHS, shall be created
2. All residents of Lincoln shall be entitled to benefits under this Act
3. No person shall be excluded from participation in or be denied the benefits of the program or be subject to any reduction of benefits established under this Act for discriminatory reasons. These include, but are not limited to age, race, gender, pre-existing medical conditions, etc
4. The enrollment of new individuals in this program shall be automatic upon adquiring the condition of legal resident of Lincoln. The government shall issue a card to all individuals enrolled in this program
5. From the moment this bill is enacted, it shall be unlawful for private insurers and employers to provide or sell benefits that duplicate those of this act. However extra benefits not covered by this act may still be provided by private insurers and employers

Section II: Coverage
1. The government of Lincoln shall pay on behalf of the individuals covered by this program for the following items and services if they are medically appropiate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:

a) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.
b) Ambulatory patient services.
c) Primary and preventive services, including chronic disease management.
d) Prescription drugs and medical devices, including outpatient prescription drugs, medical devices, and biological products.
e) Mental health and substance abuse treatment services, including inpatient care.
f) Laboratory and diagnostic services.
g) Comprehensive reproductive, maternity, and newborn care, however this shall not include funding for abortions or abortion providers, such as Planned Parenthood.
h) Pediatrics.
i) Oral health, audiology, and vision services.
j) Rehabilitative and habilitative services and devices.
k) Emergency services and transportation.
l) Early and periodic screening, diagnostic, and treatment services
m) Long-term care services and support

2. No cost-sharing measures shall be imposed on individuals for the services covered by this Act

Section III: On Healthcare Providers
1. Each health care provider has a duty to act in the exclusive interest of each individual under the care of such provider according to the applicable legal standard of care, such that no financial interest or relationship impairs any health care provider’s ability to furnish necessary and appropriate care to such individual.
2. A health care provider is considered to be qualified to furnish covered items and services under this Act if the provider is licensed or certified to furnish such items and services in the region of Lincoln
3. The government of Lincoln shall establish minimum standards for institutional providers of services and individual health care practitioners.
4. An institutional, individual or privately owned provider may not bill or enter into any private contract with any individual eligible for benefits under the Act for any item or service that is a benefit under this Act.
5. All healthcare providers by the start of the year 2030 shall be public or non-profit providers. The government of Lincoln will work for a smooth transition. The year of application of this section may be extended by the governor.
6. Individuals covered by this act shall be free to choose among all providers and institutions that participate in this Act

Section IV: Payments to Providers
1. Not later than the beginning of each fiscal quarter during which an institutional provider of care (including hospitals, skilled nursing facilities, Federally qualified health centers, home health agencies, and independent dialysis facilities) is to furnish items and services under this Act, the government of Lincoln shall pay to such institutional provider a lump sum.
2. The amount of each payment to a provider described in Section IV.1 shall be determined before the start of each fiscal year through negotiations between the provider and the state director with jurisdiction over such provider.
3. Payments to providers under this Act may not take into account:
a) The provider's marketing
b) The profit or net revenue of the provider
c) Political contributions
4. Providers receiving payment under this Section shall be prohibited from using funds designated for operating expenditures for capital expenditures or profit; and viceversa
5. The prices to be paid for covered pharmaceuticals, medical supplies, medical technologies, and medically necessary equipment covered under this Act shall be negotiated annually

Section V: Relation with the federal Reforming and Regionalizing Public Healthcare Act of 2017
1. The region of Lincoln hereby opts out of the AtlasCare program, as established in Part II, Section 1 of that bill.
This bill shall also allow insurance companies to choose, what types of insurance that they wish to offer

Section VI: Enactment
1. This bill shall be enacted on the 1st of October, 2019

Sponsor feedback: Hostile
Status: 24 hours for debate on the ammendment; after which a vote shall be opened by the speaker

[Former President tack50]

May I remind everyone that there is no vote on S019's ammendment yet. I will open that vote tomorrow, but unfriendly ammendments require 24h of debate especially if done during the early 72h general debste period.

As for my opposition to the ammendment, it is very simple. If S019's ammendment is passed at that point we might as well throw the bill into the garbage. It nullifies all the aims the bill was trying to achieve.

[Former President tack50]

As for my opposition to the ammendment, it is very simple. If S019's ammendment is passed at that point we might as well throw the bill into the garbage. It nullifies all the aims the bill was trying to achieve.

I stand in agreement with the Speaker. I wholeheartedly oppose this amendment.

My amendment is designed to give people and their insurers control pf their healthcare, rather than the government

I do not think it is a bad amendment, but the bill introduced by the Speaker was flawed and my amendment fixes those flaws

Insurance companies having control over healthcare is the problem.
That's not something we need to add, it's something that needs to end.

The bill without my amendment basically transfers control of healthcare to the government, even if people like their doctor, they will not be able to keep their doctor, if people liek their plan they will not be able to keep it. Plus, how exactly are we supposed to pay for this government takeover pf healthcare? I think people not the government, should decide their healthcare plan.

Indeed, transfering control of healthcare to the government is the point of the bill. Your ammendment may be a legally good ammendment, but it pretty much nullifies the entire bill turning it into the literal opposite of what it's supposed to be. That's why I'm opposing it.

Regarding the finer details, if people like their doctor, they can keep it. Their doctor is going nowhere, they will just go to the hospital with an LHS card issued by the government instead of the card of their private insurer.

Of course, people who like their plan won't be able to keep it though, but that's because we are completely throwing the concept of a "healthcare plan" away. People will go to any doctor and the government will pay the bill. No healthcare plans needed.

[Former President tack50]

After some thinking, I think I'd prefer a lower limit, of say, 4 or 6 months (or abolish it entirely). Who would be the most likely people on temporary visas?

Temporary workers? Students? Who else?

[Former President tack50]

After some thinking, I think I'd prefer a lower limit, of say, 4 or 6 months (or abolish it entirely). Who would be the most likely people on temporary visas?

Temporary workers? Students? Who else?

My main idea is thinking about people stuck in the immigration system waiting for a green card.

Yeah, those should certainly get healthcare as well, but should get a lower limit. You can make an argument for no limit (my ideal) or even illegal inmigrants (based on the fact that preventative care is cheaper than actual healing), but I'm willing to discuss the limit if it's low enough.

[Former President tack50]

After some thinking, I think I'd prefer a lower limit, of say, 4 or 6 months (or abolish it entirely). Who would be the most likely people on temporary visas?

Temporary workers? Students? Who else?

Maybe six months? It seems that's what they have in the UK, so there would be precedent:

"People moving to the UK from outside of the European Economic Area for longer than six months are required to pay the surcharge of £200 per year.[8] The Health Surcharge entitles them to 100% free health care on the NHS."

https://en.wikipedia.org/wiki/Immigration_health_surcharge

I'd personally go with 3 months, which is the maximum length of the tourist visa if I am not mistaken?

Alternatively, maybe make it so all inmigrants other than those on a tourist visa are covered?

[Former President tack50]

Councillors, a vote is now open on the following

Ammendment L 2:02 by S019 / Suburban New Jersey Conservative

Mr. Speaker, I propose the following amendment

The Lincoln Single Payer Healthcare Act

An act to establish a regional single payer healthcare system in the region of Lincoln

Section I: Elegibility and benefits
1. A new government program, named the Lincoln Healthcare System, or LHS, shall be created
2. All residents of Lincoln shall be entitled to benefits under this Act
3. No person shall be excluded from participation in or be denied the benefits of the program or be subject to any reduction of benefits established under this Act for discriminatory reasons. These include, but are not limited to age, race, gender, pre-existing medical conditions, etc
4. The enrollment of new individuals in this program shall be automatic upon adquiring the condition of legal resident of Lincoln. The government shall issue a card to all individuals enrolled in this program
5. From the moment this bill is enacted, it shall be unlawful for private insurers and employers to provide or sell benefits that duplicate those of this act. However extra benefits not covered by this act may still be provided by private insurers and employers

Section II: Coverage
1. The government of Lincoln shall pay on behalf of the individuals covered by this program for the following items and services if they are medically appropiate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:

a) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.
b) Ambulatory patient services.
c) Primary and preventive services, including chronic disease management.
d) Prescription drugs and medical devices, including outpatient prescription drugs, medical devices, and biological products.
e) Mental health and substance abuse treatment services, including inpatient care.
f) Laboratory and diagnostic services.
g) Comprehensive reproductive, maternity, and newborn care, however this shall not include funding for abortions or abortion providers, such as Planned Parenthood.
h) Pediatrics.
i) Oral health, audiology, and vision services.
j) Rehabilitative and habilitative services and devices.
k) Emergency services and transportation.
l) Early and periodic screening, diagnostic, and treatment services
m) Long-term care services and support

2. No cost-sharing measures shall be imposed on individuals for the services covered by this Act

Section III: On Healthcare Providers
1. Each health care provider has a duty to act in the exclusive interest of each individual under the care of such provider according to the applicable legal standard of care, such that no financial interest or relationship impairs any health care provider’s ability to furnish necessary and appropriate care to such individual.
2. A health care provider is considered to be qualified to furnish covered items and services under this Act if the provider is licensed or certified to furnish such items and services in the region of Lincoln
3. The government of Lincoln shall establish minimum standards for institutional providers of services and individual health care practitioners.
4. An institutional, individual or privately owned provider may not bill or enter into any private contract with any individual eligible for benefits under the Act for any item or service that is a benefit under this Act.
5. All healthcare providers by the start of the year 2030 shall be public or non-profit providers. The government of Lincoln will work for a smooth transition. The year of application of this section may be extended by the governor.
6. Individuals covered by this act shall be free to choose among all providers and institutions that participate in this Act

Section IV: Payments to Providers
1. Not later than the beginning of each fiscal quarter during which an institutional provider of care (including hospitals, skilled nursing facilities, Federally qualified health centers, home health agencies, and independent dialysis facilities) is to furnish items and services under this Act, the government of Lincoln shall pay to such institutional provider a lump sum.
2. The amount of each payment to a provider described in Section IV.1 shall be determined before the start of each fiscal year through negotiations between the provider and the state director with jurisdiction over such provider.
3. Payments to providers under this Act may not take into account:
a) The provider's marketing
b) The profit or net revenue of the provider
c) Political contributions
4. Providers receiving payment under this Section shall be prohibited from using funds designated for operating expenditures for capital expenditures or profit; and viceversa
5. The prices to be paid for covered pharmaceuticals, medical supplies, medical technologies, and medically necessary equipment covered under this Act shall be negotiated annually

Section V: Relation with the federal Reforming and Regionalizing Public Healthcare Act of 2017
1. The region of Lincoln hereby opts out of the AtlasCare program, as established in Part II, Section 1 of that bill.
This bill shall also allow insurance companies to choose, what types of insurance that they wish to offer

Section VI: Enactment
1. This bill shall be enacted on the 1st of October, 2019

Please vote AYE, NAY or Abstain.

This vote shall last for 24h or until all councillors have voted

[Former President tack50]

NAY

[Former President tack50]

The vote on Ammendment L 2:02 is now closed:

Aye: 3 (S019, lfromnj, thr33)
Nay: 4 (tack50, Pyro, Adam Griffin, Zaybay)

So the ammendment is rejected

[Former President tack50]

We now get to the final ammendment proposed, which is thr33's ammendment. After much internal debate with myself, I've decided to make it unfriendly. I may introduce a smaller version later putting restrictions only to those on tourist visas, or maybe those on visas below 3 or 6 months.

Plus that way we get a bit more debate and an actual vote, which is always nice.

Ammendment L 2:11 by thr33

Section I: Elegibility and benefits
1. A new government program, named the Lincoln Healthcare System, or LHS, shall be created
2. All legal permanent residents as well as those on visas with 5 years of residence of Lincoln shall be entitled to benefits under this Act
3. No person shall be excluded from participation in or be denied the benefits of the program or be subject to any reduction of benefits established under this Act for discriminatory reasons. These include, but are not limited to age, race, gender, pre-existing medical conditions, etc
4. The enrollment of new individuals in this program shall be automatic upon adquiring the condition of legal permanent resident of Lincoln or surpassing the five year residency threshold for visas holders. The government shall issue a card to all individuals enrolled in this program
5. From the moment this bill is enacted, it shall be unlawful for private insurers and employers to provide or sell benefits that duplicate those of this act. However extra benefits not covered by this act may still be provided by private insurers and employers

Sponsor feedback: Hostile
Status: 24h for debate, after which a vote shall be opened by the speaker

[Former President tack50]

Before we consider S019's ammendment; we need to first vote thr33's ammendment

Councillors, a vote is now open on the following:

Ammendment L 2:11 by thr33

Section I: Elegibility and benefits
1. A new government program, named the Lincoln Healthcare System, or LHS, shall be created
2. All legal permanent residents as well as those on visas with 5 years of residence of Lincoln shall be entitled to benefits under this Act
3. No person shall be excluded from participation in or be denied the benefits of the program or be subject to any reduction of benefits established under this Act for discriminatory reasons. These include, but are not limited to age, race, gender, pre-existing medical conditions, etc
4. The enrollment of new individuals in this program shall be automatic upon adquiring the condition of legal permanent resident of Lincoln or surpassing the five year residency threshold for visas holders. The government shall issue a card to all individuals enrolled in this program
5. From the moment this bill is enacted, it shall be unlawful for private insurers and employers to provide or sell benefits that duplicate those of this act. However extra benefits not covered by this act may still be provided by private insurers and employers

Please vote AYE, NAY or Abstain

This vote shall last for 24 h or until all Councillors have voted

[Former President tack50]

Nay

[Former President tack50]

The vote on Ammendment L 2:11 by thr33 is now closed

Aye: 3 (S019, lfromnj, thr33)
Nay: 3 (tack50, Pyro, Zaybay)
Abstain: 0
Not voting: 3 (Ninja, Griffin, Dipper)

With the Council being equally divided, the governor shall break the tie

[Former President tack50]

After careful consideration on the Amendment's effect on the bill, I vote Nay on this tiebreaker. Nay!

Also, Councillors, make sure to vote everytime you can. There will be consequences for inactivity.

For what's worth, I haven't made any efforts so far to ping Councillors on Discord or send PMs to them. Maybe I should start doing that? Though ideally they should appear by themselves

[Former President tack50]

What exactly are the inactivity consequences

Well, according to the Lincoln constitution, a Councillor who doesn't vote on 4 consecutive pieces of legislation automatically vacates his office. So far we have been interpreting that as 4 final votes though.

There's also of course the fact that if you are inactive it's very likely that you will eventually get recalled or expelled.

I will say that so far the only Councillor in risk of getting recalled is Dipper Josh though (who has only voted once, for Chancellor). Everyone else has been active enough.

[Former President tack50]

After careful consideration on the Amendment's effect on the bill, I vote Nay on this tiebreaker. Nay!

Also, Councillors, make sure to vote everytime you can. There will be consequences for inactivity.

For what's worth, I haven't made any efforts so far to ping Councillors on Discord or send PMs to them. Maybe I should start doing that? Though ideally they should appear by themselves

Given how short the votes are, only 24 hours, you really should Discord DM or Atlas PM all members whenever a vote opens.

Well, the thing is, with so many ammendments and the requirement that they be voted unless they are friendly, I would be pinging people almost daily. Though I guess if it comes to that I could just send messages to everyone

[Former President tack50]

While I do think it's a good idea overall that ammendments are assumed unfriendly; it also doesn't help that we have had a lot of ammendments and that many of them have been deemed unfriendly by the sponsor.

In my entire tenure in the Senate for example we only had 1 unfriendly ammendment out of like 25 in the entire term. Meanwhile a good half of our ammendments have been unfriendly.

I do like the fact that we have had quite a bit of activity though, but I think we have had votes almost daily. Of course on the other hand that means that councillors can log in any time and there will probably be a vote they can vote on, but it also means, combined with the 24h vote times that missing a vote is very easy.

[Former President tack50]

Does anyone else have something to add to the bill. I would personally like to debate whether or not we should include the funding for the bill in the bill itself (which would require some sort of cost estimate) or later in the budget process (which might mean an unexpectedly large deficit later on)

[Former President tack50]

Technically speaking, this bill wouldn't become enacted until FY 2020. Of course, it would still be a massive spending increase. And while calculations for the budget are at an extremely early stage, it does seem to me that Lincoln is very likely to have a big deficit.

I have introduced legislation to partially repeal the balanced budget section of the constitution (allowing budgets to be passed with a deficit through a 2/3 supermajority), but even if we don't pass that ammendment we will probably need huge tax increases to fund this as well as the budget.

[Former President tack50]

Decided to quickly look at funding. Similar proposals to this one are expected to cost 1.5 to 2.5 trillion $ for the entire US in RL.

Assuming the cost is divided by 3, this would cost somewhere between 500 billion to 800 billion $. Looking at 2016's budget, that would apparently double the size of the regional government? (from 565 billion $ to about 1.2 trillion $ taking the middle estimate). We could of course argue that single payer is more efficient (which I would argue as well) but still.

Are 2016's budget numbers artificially low or about right? Because 500 million in expenditures seems somewhat low for the regional government. Then again I guess it's a regional government we are talking about.

Honestly if this bill is going to fail it's going to be because it's a policy that can't be done regionally.

https://uselectionatlas.org/FORUM/index.php?topic=252855.0