Recent Changes

8. Put your closing arguments here.
1796: Conclusion
Throughout
Throughout this discussion S. 1796.
The
The positive points state lines.
Another
Another positive point they don’t.
AnotherAnother point is where needed.
Depending
Depending on where our country.

8. Put your closing arguments here.
Group 15 – S. 1796: Conclusion
Throughout this discussion our points have been made clear and we cannot deny the fact that health care in this country needs reform. The proper way to do it has been the debate for some time. We stand behind our chosen bill S. 1796.
The positive points have been laid out. The bill will reduce the number of Americans insured there is no question of that. The mandate of insurance for all Americans will help in their fight to pay medical bills and keep costs down. The poor Americans that cannot afford insurance will be given generous subsidies from the government to help them become insured and stay insured. Also, Americans would be able to choose from many different insurance plans and pick the best one out of competitive marketplaces across states, which would open up access to care by allowing the sale of insurance across state lines.
Another positive point is that there won’t be a government-run public option and the private market will expand into a private insurance exchange for everyone to choose what insurance would fit them best. Prices would decrease because of the competitive market and create a more well-rounded expense to care. The less government control we have the better off we are and we could take care of any problems within the states exchange. Employers won’t be mandated to provide insurance coverage to their employees, but clearly they will want to, avoiding the fee or penalty that will be brought against them if they don’t.
Another point is that it offers Medicaid expansion. Medicaid has shown to be a great deal of help for all Americans at any age, so there is no doubt that we would want to expand it to cover more Americans where needed.
Depending on where you stand in your thinking of health care as a right or a privilege is to each his own, however health care as of right now doesn’t help anyone. We feel that the less government the better and creating more competition among private insurance companies will help the high rising costs. We need to act now on health care reform, but make sure what choice you choose will fit the overall need of our country.

Group 8: Second Negative
Group 8: Second Negative
Julie Galante, Jaclyn Grass, Kim Nguyen, Amal Qureshi and Kimberly Weaver

Great job Group 15 in constructing your second affirmative. We all see the need for health care reform in the United States. Our current system is the most expensive in the world per capita, yet is rated 37th in quality by the World Health Organization. As the cost of health insurance increases more people find themselves unable to afford insurance creating a vicious cycle of escalating numbers of uninsured people and higher premiums.

The biggest problem with the employee contribution part of the proposed legislation is the fact that S. 1796 defines a large employer to be anyone with as little as 50 employees. Large employers who fail to meet the health insurance coverage requirements will be assessed a penalty. It also requires employers with 200 or more employees to automatically enroll employees into health insurance plans offered by the employer. The fees employers will have to pay would most likely come out of the employees’ salaries, staff reductions, or a raise in product or service costs. The Congressional Budget Office Director, Douglas W. Elmendorff, said that “if employers who did not offer insurance were required to pay a fee, employees’ wages and other forms of compensation would generally decline by the amount of that fee” (S. 1796-America’s, 2009). With the current state of the economy, employees are already not receiving raises and if employers are forced to participate in certain health insurance plans, employees will face even more of a deficit in their wages. According to Congressional Budget Office estimates, an employment-based plan will cost about $13,000 for an American family of 4. Although plans and terms vary, the employer may pay in some plans about 70 percent. Compare this to a family of four in Japan, who has a social insurance plan in which all citizens are required to have insurance, and pays a total annual premium of about $3360 with the employer paying more than half. The employer will have to contribute a lot more than what employers in other nations do.

There are many Americans who believe that with a public option, they will not have the freedom to choose whether or not they want insurance and their cost of health care will rise if a public option is passed. But what most of these people do not realize is that currently costs are shifted over to those who are insured from those who are uninsured and underinsured and cannot afford to pay for their health care. There are currently over 45 million people who are uninsured and those paying monthly health insurance premiums partially pay for their medical bills because these costs are shifted in part to the insurance premium payers. Over 30 million people are underinsured placing them at high financial risk, which often result in a huge personal sacrifice when a major illness occurs. In those situations in which these medical bills go unpaid they too are partially shifted to the premium payers.

One very controversial part of S. 1796 is about the controversial topic of abortion. The proposed legislation mandates that at least one plan in every state cover abortion. The other bills, H.R. 676, H.R. 1200, H.R. 3200, S. 703, and S. 1679, do not have this in their proposed legislations. If the government subsidizes a plan that offers abortion, American’s healthcare premium dollars will go towards those abortions. Many people are against abortions and would be very upset if American’s health care premium dollars would be spent on abortions. There would be too much controversy if this legislation were passed.

Another big negative aspect of S. 1796 is that subsidies provided to those in need will be fewer than the subsidies provided to the same individuals in the proposed H.R. 676, H.R. 1200, H.R. 3200, S. 703, and S.1679. The subsidies are there to help low and middle-income people purchase health insurance. The premium credits will be tied to the second lowest-cost silver plan in the area and will be provided on a sliding scale basis from 2% of income for those at 100% FPL to 12% of income for those between 300-400% FPL under S. 1796. It limits availability of premium credits and cost-sharing subsidies through the exchanges to U.S. citizens and legal immigrants who meet income limits.



References:

Gurney, M. (2009). Who Pays for the Uninsured? Retrieved December 6, 2009 from: http://justanothercoverup.com/?p=686

Kaiser Family Foundation. (2009). Focus on Health Reform – Side By Side Comparison of Major Health Care Reform Proposals. Retrieved December 6, 2009 from: http://www.kff.org/healthreform/upload/healthreform_sbs_full.pdf

S. 1796—America’s Healthy Future Act of 2009 (2009). Retrieved December 6, 2009, from the Home School Legal Defense Association website: http://www.hslda.org/Legislation/National/2009/HealthyFuture09/default.asp

The Congressional Research Services' Summary of S.1796, The America's Healthy Future Act of 2009. (2009). Retrieved December 6, 2009 from the Political Bridge website: http://thebridge.typepad.com/thebridge/2009/11/the-congressional-research-services-summary-of-s1796-the-americas-healthy-future-act-of-2009the-prop.html

Group 8: First Negative
It was accidently posted on the main discussion page.

6. Put your second affirmative constructive here.
Group 15 - Second Affirmative Constructive
healthcare reform.
Benefit of Co-ops
not easy.
· Employer responsibility for providing employee insurance
insurance coverage.
·
· Reducing the uninsured Americans
Although you are correct in stating that the S. 1796 bill will leave 25 million people uninsured, you didn’t mention the fact that 1/3 of these uninsured people are illegal immigrants. So the overall number of insured Americans will increase from 83% to about 94% of people having health insurance coverage (“America’s Healthy”, 2009). Not only will there be an increase in the number of insured Americans there will be a revamping of Medicaid eligibility guidelines that will allow more people to qualify for Medicaid coverage. The fact that more people will have insurance coverage will reduce the number of individuals that visit emergency rooms for their current health care coverage now that we all wind up paying for in the long run. These individuals take away from people that are truly in need of emergency care and the ability to reduce this abuse of a healthcare system can’t only lead to positive gains.
References
4. “Estimated Effects of the Revenue Provisions of H.R. 3200, The “America’s Affordable Health Choices Act of 2009,’” Fiscal Years 2010 – 2019, JCX-31-09. (2009, July 14) Retrieved from http://jct.gov/publications.html?func=startdown&id=3570.
5. Holahan, John and Allison Cook. “Changes in economic conditions and health insurance coverage, 2000-2004: coverage among adults worsened, but increases in public insurance kept children’s coverage rates high.” Health Affairs 24.3 (Jul-Dec 2005): 498(10).
from http://www.lewin.com/content/publications/Peterson_Finance_Report.pdf.
7.
7. America’s Healthy from http://74.125.93.132/search?q=cache:G2j0ecuLgdIJ:en.wikipedia.org/wiki/America%E2%80%99s_Healthy_Future_Act+%2225+million+non-elderly+uninsured+1/3+illegal+immigrants+s.+1796%22&cd=2&hl=en&ct=clnk&gl=us.
8. September 30, 2009. Out-of-Pocket Health Care Costs Could Increase More Than 35 Percent in Every State by 2019. The Robert Wood Johnson Foundation. Retrieved on December 5, 2009 from http://www.rwjf.org/pr/product.jsp?id=49149.

6. Put your second affirmative constructive here.
Group 15 - Second Affirmative Constructive
There is a general agreement that our current healthcare system has some serious issues that need to be addressed. Healthcare costs have been rising dramatically; they have tripled in the last 19 years. If the current healthcare system is allowed to continue on this path there will be no end in sight to these increased costs. According to the Robert Wood Johnson Foundation (2009), over the next decade out of pocket healthcare costs for an individual are projected to rise more than 35%. There are estimations that businesses employees’ healthcare costs will double in the next 10 years and there could be approximately 66 million uninsured Americans. These estimates are based on worse case scenarios, yes, but can we afford to risk the chance and gamble with our lives and the future of healthcare for us, our children and our children’s children? There are a lot different views on what needs to be done to address this National issue but one thing is clear, there is a need for healthcare reform. If action isn’t taken soon there could be serious consequences that would jeopardize efforts to stabilize and improve the economic recovery of the United States. America needs increased stabilization and recovery to maintain its Global appeal. Now is the time to act and the America’s Healthy Future Act of 2009 (S. 1796) is the amendment that is capable of delivering much needed healthcare reform.
Benefit of Co-ops
While S. 1796 does not call for provisions to provide health care coverage for American’s by way of a public option, it’s this lack thereof that strengthens this bill over H.R. 676, H.R. 1200, H.R. 3200, S. 703, and S. 1679. If the public health insurance option is realized, a negative financial effect will hamper American citizens, after the appropriated $2,000,000,000 for the establishment of the option is spent. After said funds are expensed, patients will be responsible for the funding the Exchange-participating insurance option through premiums (Rangel et. al, 2009). This creates a serious issue as premiums will rise, creating a financial burden if well-know upward trends continue with respect to health care costs. This claim is backed on the notion that payment rates for the public option will be based on payment rates under parts A and B of Medicare, which is currently having financing problems itself (Orszag, 2009). Similar legislation has shown taxing one set of individuals to provide for the health care needs of others is not financially effective. For instance, studies indicate the Medicare program, which is financed partly by payroll taxes, is unsustainable given its current financial outlook. Most of this financial burden will fall on the shoulders of high income individuals. The Joint Tax Committee estimates that such enactment would result in $81 billion in raised taxes in 2019 alone. This is a considerable figure give that the surtax would only have an effect on a meager amount of American patients. The Joint Tax Committee reports only 1.2% of taxpayers would be subject to the tax, leaving 98.8% of taxpayers unaffected by the surcharge. This leaves a big tax burden on a small amount of Americans, who are assessed this surcharge involuntarily to contribute towards the cost of providing healthcare to those Americans without coverage (“Estimated Effects” 2009). You asked: Why not give qualified American’s the choice of a public health insurance plan or a private insurance plan? The answer is simple; it is not financially feasible given the reasons above. Furthermore, consider the fact that other government attempts to provide health care for American’s are currently struggling, hence the need for such reform. Continuing, these enacted attempts (Medicare and Medicaid) only provide access to a defined population of American’s, with that said it is unfathomable to think of the obstacles the government would encounter providing access to health care through a public option. History has shown such task is not easy.
· Employer responsibility for providing employee insurance
Some securitize S. 1796 as it contains provisions to impose an exercise tax on employers who fail to offer health insurance coverage requirements for full-time employees, claiming it would create a negative financial impact, however such tax on employers will greatly decrease the number of uninsured. The number of uninsured American’s is reported to have increased by six million individuals between 2000 and 2004, as a primary result of declining employer sponsored health care coverage (Holahan & Cook, 2005). According to Sheils & Haught (2009) the costs to these employers would be approximately $300 per worker but in the long run this fee would pale in the costs of the lost time and productivity for employees being out sick for illness that could have been managed by the routine preventative services that are offered through health insurance coverage.
· Reducing the number of uninsured Americans
Although you are correct in stating that the S. 1796 bill will leave 25 million people uninsured, you didn’t mention the fact that 1/3 of these uninsured people are illegal immigrants. So the overall number of insured Americans will increase from 83% to about 94% of people having health insurance coverage (“America’s Healthy”, 2009). Not only will there be an increase in the number of insured Americans there will be a revamping of Medicaid eligibility guidelines that will allow more people to qualify for Medicaid coverage. The fact that more people will have insurance coverage will reduce the number of individuals that visit emergency rooms for their current health care coverage now that we all wind up paying for in the long run. These individuals take away from people that are truly in need of emergency care and the ability to reduce this abuse of a healthcare system can’t only lead to positive gains.
References
1. Rangel, Waxman, Miller G., Stark, Pallone, and Andrews. House of Representatives, United States House Committee on Ways and Means. (2009). America’s affordable health choices act of 2009’’. (H.R. 3200). Washington, DC: Retrieved from http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf.
2. Industry Scan. “Medicare’s financial outlook worse than previously predicted.” Health Care Financial Management 55.9 (Sep 2001): 20.
3. Orszag, Peter H. "Beyond Economics 101, Insights into Healthcare Reform from the Congressional Budget Office" Healthcare Financial Management. 63.1 (January 2009): 70 (5)
4. “Estimated Effects of the Revenue Provisions of H.R. 3200, The “America’s Affordable Health Choices Act of 2009,’” Fiscal Years 2010 – 2019, JCX-31-09. (2009, July 14) Retrieved from http://jct.gov/publications.html?func=startdown&id=3570.
5. Holahan, John and Allison Cook. “Changes in economic conditions and health insurance coverage, 2000-2004: coverage among adults worsened, but increases in public insurance kept children’s coverage rates high.” Health Affairs 24.3 (Jul-Dec 2005): 498(10).
6. Sheils, J. & Haught, R. October 30, 2009. Long-Term Cost of the America’s Healthy Future Act of 2009; As Passed by the Senate Finance Committee. The Lewin Group. Retrieved on December 5, 2009 from http://www.lewin.com/content/publications/Peterson_Finance_Report.pdf.
7. America’s Healthy Future Act. Wikipedia. Retrieved on December 5, 2009 from http://74.125.93.132/search?q=cache:G2j0ecuLgdIJ:en.wikipedia.org/wiki/America%E2%80%99s_Healthy_Future_Act+%2225+million+non-elderly+uninsured+1/3+illegal+immigrants+s.+1796%22&cd=2&hl=en&ct=clnk&gl=us.

Group 8: First Negative
Group 8: First Negative
Julie Galante, Jaclyn Grass, Kim Nguyen, Amal Qureshi and Kimberly Weaver

There is a big necessity for health care reform in the United States. The costs of health care are rising at an alarming rate and there are many uninsured and underinsured Americans. S. 1796 does not provide the best solution for health care reform in the United States because it does not address all the key issues.

S. 1796, does not have a public option while H.R. 676, H.R. 1200, H.R. 3200, S. 703, and S. 1679 all include a public option while leaving. A private insurance system would still be in place under most of the bills with a public option. A public option would give those who cannot afford health insurance a cheaper option than the private health insurance market. It would also reduce the cost of healthcare. The Congressional Budget Office has indicated that many hospitals negotiate higher payments with private insurers as a form of price discrimination to maximize profits. They demand higher reimbursements from health insurers because they can. A public option would not have these profit-maximizing incentives. Some say that a public option would hurt the private insurance market but the Congressional Budget Office found that a public option would not overtake private health insurance. They found that it might help the insurers a little. Most people would not even have access to the new public plan. Under H.R. 3200, the public option would be offered through new insurance exchanges open only to those who buy coverage on their own or work for small companies. Yet even within that pool of 30 million people, only 1-in-5 would take the public option. Why not give qualified American’s the choice of a public health insurance plan or a private insurance plan?

Under S. 1796, employers would not required to provide insurance to all employees, but they would be more inclined to do so because an excise tax would be imposed on employers who fail to meet health insurance coverage requirements with respect to their full-time employees. Imposing the penalty on employers would place a large burden on employers to provide health insurance. The proposal requires businesses with more than fifty employees to pay fees going towards subsidies. The maximum possible fee would either be $400 per full-time employee or the average cost of the subsidies a firm's employees take in multiplied by the number of those receiving them.

Under S. 1769, subsidies would be provided to those in need but this bill contains fewer subsidies to help low and middle-income people buy insurance than do H.R. 676, H.R. 1200, H.R. 3200, S. 703, and S.1679. S. 1796 aims to reduce the number of uninsured Americans but it is estimated that by 2019, there would still be approximately 25 million of the non-elderly uninsured. The other proposed health care reforms would not leave as many Americans uninsured because they all offer a public option.

References:

America’s Healthy Future Act (2009). Retrieved December 2, 2009, from Wikipedia website: http://en.wikipedia.org/wiki/America%E2%80%99s_Healthy_Future_Act

OpenCongress Summary (2009). Retrieved December 2, 2009 from Open Congress website: http://www.opencongress.org/bill/111-s1796/show

Rockefeller, J. D. (2009). Finance Committee Report of the America’s Healthy Future Act of 2009. Retrieved December 2, 2009, from Politico website: http://www.politico.com/static/PPM138_091019_additional1.html

Study: Public Option May Benefit Insurers (2009, November 1). Retrieved December 2, 2009, from CBS news website: http://www.cbsnews.com/stories/2009/11/01/health/main5483872.shtml

3. Put your choice of bill and first argument for the bill here.
1st Affirmative Constructive for S.1796
We, group 15, support the S.1796 [ America ’s Healthy Future Act of 2009]. The bill, like many of the healthcare reform bills proposed this year aims to aid the millions of uninsured and underinsured while containing the growth of medical costs. It is sponsored by Democrat Max Baucus, coining it as the Baucus Bill. We support this bill because while it tackles reform, which this country is in need of, it does so with provisions that make it adaptable, not with drastic measures that put fear into Americans. We’d like to address the key changes that we favor from the Baucus Bill that would improve our healthcare system. In no particular order, they are the following:
· Reducing the number of uninsured Americans
Currently 15% of Americans are uninsured for healthcare. This 15% is not insured for all the same reasons. Some can’t afford coverage, some can afford it but feel they will never need it so they choose not to purchase it, some that can afford it are denied purchasing power due to their own pre-existing conditions, and the list goes on. For whatever their reasons, these people struggle with getting the proper care and navigating their way through the healthcare system. Having no coverage leaves them with less access and lesser quality care than those that have coverage. Reduced access and quality can be seen when providers (not including those in emergency rooms of hospitals) deny or delay treatment of patients that are uninsured, or when patients are in need of a procedure to heal a condition but instead are given medication to suppress their symptoms.
According to an article in the Huffington Post, the number of people that don’t have access to healthcare is nearing 50 million, and Baucus’ plan would lower that population by about 30 million people in a 10-year period, according to congressional budget experts (Espo, 2009)
This would reduce the number of people that seek all of their medical care through emergency rooms which is a significant cost to the system, particularly for the cases that reach maximum severity before treatment is sought. His initiative would require all individuals to get insurance or else they would have to pay a penalty. The penalty would be set at a maximum of $950 per individual per year. One might wonder how low-income individuals will afford this penalty. They’re already low-income and if they had $950 they would use it for other daily necessities. This brings us to the next initiative.
· Subsidies for buying insurance
The bill would provide financial assistance until 2013 [when the bill would be enacted] and after that it would “provide sliding scale credits for purchasing insurance for people earning between 133% and 300% of the federal poverty level," as noted in an article posted on the political forum Opencongress.org. (Shaw, 2009) This would be beneficial for many college students that only work part/full time jobs that aren’t working in their field of study yet. It is also beneficial for those that are in the working middle class, seeing as how $14,404 marks 133% of the federal poverty level and $32,490 marks 300% of the federal poverty level, the maximum amount of income one can make before being ineligible for subsidies. And these numbers are just for a single person. For a family of 2, the maximum income for the household can be $43,710 while still qualifying for subsidies.
As anyone can see, eligibility for subsidies is quite generous and this provision would help the poor and middle class afford health coverage. We see this as an advantage for many Americans because these numbers provide a cap to healthcare expenditures for citizens. Currently, healthcare expenditures account for nearly 17% of one’s income, whereas these subsidies as well as other initiatives will lower the cap to 13%.
· Establishing an insurance exchange
This exchange would be a marketplace where individuals and small businesses could shop and compare health plans. They would be able to opt into a private health plan. The process would be standardized to minimize the confusion and complexities that usually accompany the insurance enrollment and buying process. A key factor noted by the RAND corporation is ‘Participating insurers would have to charge the same price for the same products inside and outside the Exchange. Plans participating in the Exchange would be subject to regulatory oversight by states.’ (RAND, 2009)
And unlike many health insurance plans that sometimes dominate an entire state because it is the only plan offered in the area, the exchange would extend to a national level. Some of us that have moved from one state to another have found that a health plan that we were previously satisfied with is not available in the state that we moved to. With this plan, people in Seattle , Washington could have the same plan as someone in Birmingham , Alabama . Another advantage of the bill is that it would allow people to keep the insurance plans that they already have if they are satisfied with them, and it will not require the plans to change to the new government standards. Of course, these plans will not be able to be offered to new clients.
· Employer responsibility for providing employee insurance
The Baucus plan would not require employers to provide insurance, but they would be more inclined to do so because a penalty would be imposed if they did not. The penalty would be in the form of a payroll tax that would be calculated based on annual revenue of the employer organization. Small businesses that didn’t offer employees insurance wouldn’t have to pay as much as larger businesses that didn’t offer insurance. In addition, an employer would have to pay taxes into the Insurance Exchange if standards show that the employer doesn’t offer insurance with adequate coverage or affordability. This inadequacy will be determined if the benefits offered don’t meet certain criteria (government standard), or if employees are forced to use subsidies because they can’t afford the employer’s insurance. Employers would be able to deduct insurance premiums from their business as a business cost, but they would not be allowed to deduct these fees (taxes) as business costs.
· Medicaid Expansion
Baucus would make changes to the current eligibility standards to the Medicaid program. Eligibility would be more liberal, accepting everyone at and below 133% of the federal poverty level. Currently there are many more stipulations that are accounted for to qualify for Medicaid such as consideration of assets, disabilities, dependent children, and being a pregnant woman. We favor this provision because there are many working Americans living in the United States that have very limited income and struggle to make ends meet, yet they are not eligible for Medicaid because they don’t fulfill some of the criteria. A recent article released just a couple of months ago noted a specific example of the Medicaid restrictions: “In 43 states, adults without dependent children “are ineligible for Medicaid no matter how low their income.” (Volsky, 2009)
References:
1. Espo, David. (2009) Health Care Bill: Baucus Senate Legislation Finally Unveiled. The Huffington Post. Retrieved on November 27, 2009, from
http://www.huffingtonpost.com/2009/09/16/health-care-bill-baucus-s_n_288218.html
2. Senator Finance Committee Chairman Max Baucus (D-MT), Call to Action: Health Reform 2009. Washington, D.C.: U.S. Congress, November 12, 2008. Retrieved on November 29, 2009 from http://www.randcompare.org/options/mechanism/baucus_call_to_action_phase_2
3. Shaw, Donny (2009) Choose Your Own Senate Health Care Adventure. Open Congress for the 111th United States Congress.Retrieved on November 28, 2009 from http://www.opencongress.org/articles/view/1277-Choose-Your-Own-Senate-Health-Care-Adventure
4. Volsky, Igor. (2009) Baucus: Medicaid Expansion Will Not ‘Cost States Nearly As Much As Was Originally Feared’ The Wonk Room:The Center for American Progress Action Fund is a nonpartisan organization. Retrieved from http://wonkroom.thinkprogress.org/2009/09/14/baucus-medicaid-expansion-will-not-cost-states-nearly-as-much-as-was-originally-feared/