For consumers, the most confusing part of the healthcare bill may be when—and if—they will see its benefits. Under the Senate bill, a slate of provisions designed to be immediately visible to consumers would kick in six months after the bill takes effect. But those changes wouldn't affect people who stay in employer health plans. For people who buy insurance on their own, the provisions would only have an effect when they buy a new policy. And one of the health bill's most widely debated features—a mandate that most Americans obtain health insurance or pay a fine—won't take effect until 2014.
Coming off a year in which his remodeling and custom home-building company saw two-thirds less business and had to lay off nearly half its employees, David Crane hopes next year brings an economic turnaround. But Crane worries about how much part of the health reform bill might cost him and other contractors. The Senate legislation requires construction firms with at least five full-time workers and annual payrolls of more than $250,000 to offer health insurance coverage to employees or face fines up to $750 per employee per year. Crane Builders employs seven people, and the company had expected to be exempt from the requirement just like many other types of small businesses that only face the requirements if they had at least 50 full-time workers during the previous year.
All the consolidation that took place in the healthcare industry in 2009 could have a surprising benefit for patients: greater strides toward efficiencies in customer service. That's because larger doctor practices that swallowed up smaller ones have deeper pockets to upgrade their information systems and other infrastructures, which the Obama administration is touting as part of healthcare reform and which studies have shown consumers are demanding. These upgrades include transferring medical records from shoe boxes and file cabinets to computer systems, as well as instituting a payment system that insurers increasingly use to tie how much doctors get based on their performance or their adherence to certain quality measurements.
After helping torpedo the Clinton healthcare plan 15 years ago, the pharmaceutical industry has largely held its tongue this time. The reason is it doesn't want to undermine an $80 billion deal with Democrats to help pay for an overhaul that could end up benefiting the industry. But liberal Democrats now have stepped up their fire against that deal, which may force the industry to up its financial ante. One key factor is a last-minute push by liberals to eliminate a gap in Medicare drug coverage that forces some seniors to pay a significant portion of the cost of their drugs.
Some of the biggest employers are warning that a provision in the Senate's proposed healthcare overhaul could lead to cuts in retiree benefits and a sharp reduction in reported earnings next year. Companies including Boeing Co., Deere & Co., MetLife Inc., and Xerox Corp. plan to lobby Democratic leaders to drop the provision, which would change the tax status of payments for retiree health benefits. Democrats identified the change as a way to help pay for the healthcare overhaul. It would raise about $5.4 billion over 10 years—a relatively small slice of the bill's overall cost—according to estimates. The AFL-CIO has joined the corporate giants in an unusual alliance to warn the provision would encourage companies to drop drug benefits for million of retirees.
The health reform votes in the Senate this week showed Democrats unwavering in the march to adopt a far-reaching overhaul of the healthcare system over united Republican opposition. The votes also marked something else: the culmination of more than a generation of partisan polarization of the American political system, and a precipitous decline in collegiality and collaboration in governing that seemed to move in inverse proportion to a rising influence of lobbying, money, the 24-hour news cycle, and hostilities on talk shows and in the blogosphere. Many senators said the current vitriol was unlike anything they had seen.