What’s Next With Health Care (And Why This Process Was Madness)

What’s Next With Health Care (And Why This Process Was Madness)

By MARIAN WANG

Sometimes things are a little clearer in retrospect. Now that health care reform has passed in the House, it seems there are two main questions in people’s minds:

  • What’s next?
  • Why, procedurally, was the legislative process so confusing and painful to watch?

Let’s answer that second question first. To help do that, we’ve drawn up some helpful infographics.

Exhibit A – How, originally, we thought health care legislation would play out procedurally. This is typically how proposed legislation is melded between the two houses.

Exhibit B – How things would’ve worked under “deem and pass [1],” or a self-executing rule. After questions were raised about the constitutionality of “deem and pass,” the House ended up not going that route.

Exhibit C – How it looks like it’s going to happen, after all.

In that last graphic, the yellow marker (5) is where we’re currently at. President Obama reportedly will sign the Senate bill on Tuesday [2], which means that part of health care legislation is law. The House-passed reconcilliation portion, consisting of 153 pages of “fixes” to the Senate bill (compare the two bills with our side-by-side comparison app [3]), will then move to the Senate (6), and if it passes, on to presidential sign-off (7).

As for the “What’s next” question, Kaiser Health News has a good list [4] of some of the provisions that will take effect in 2010. Most of the bigger changes that will affect millions don’t go into effect in 2014.

Marian Wang blogs for the ProPublica news service. This post first appeared on the ProPublica blog. You can write Marian Marian.Wang@propublica.org.

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15 replies »

  1. Linda this bill is full of contradictions like that. Successful common sense things that work are eliminated so as to direct more money through the “system”
    or example if everyone needs $100 a year in preventive care why do they require the carrier to cover preventive care? Why not all save the $120 in premium and pay for our own preventive care…oops $115 now is all they can mark it up.

  2. “I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them” – Thomas Jefferson

  3. Obama is Bush W Jr. Arrogance, misleading, misdirecting, and even worse than Bush, Obama acts like a celebrity and in continuous campaign mode.
    How projective and insulting when he said to McCain at the Blair House, in similar words, “we are not campaigning anymore”.
    Really, Mr Obama? How many consecutive days have you NOT been on TV, radio, or press interviews since this health care issue took off in debate in Aug 2009?
    I’d bet 3 days! He even had his Hawaii trip covered!
    Just watch the apologists and defenders rationalize this!
    And start with his recent Youtube replay of “bills to be passed will be available to the public to review for 5 days before I sign them.”
    What is the time frame in your world, Mr Obama? Minutes are hours, eh? He is just another politician of the mold we have suffered with since the Reagan years.
    And remember, projecters, I am an independent, who was first registered as a Democrat. The republican noose will not go over here, folks!

  4. As portrayed by the victory of the democrats, and the passage of this landmark legislation, it is patently obvious that the divulgence of knowledge and common sense did not suffice to prevent the mass economical carnage and forthcoming mourning that the people of this once great nation will inevitably bear. This healthcare bill will undoubtedly bestow many with promising hopefulness in alleviating their medical burdens, remove the yoke of arduous healthcare insurance protocols, and set many Americans free from the demoralizing hardship that medical care imparts on those that truly need it. For once, those saddled with illness can treat their conditions without enduring radical financial detriments, and receive medical attention in a fashion that will preserve their health concurrent to their financial state. The healthcare reform, as it is seen on this faithful day, brings forth hopeful expectation and a seeming remedy to our nation’s once contemptible healthcare system. Or is it so?
    The healthcare reform budget calls for the imposition of many economically detrimental sanctions, among them extreme tax increases and undue government enforcement ensuring complete compliance of all of the healthcare reform’s taxes, fees, and excessive mandatory employment tax obligations, of which our economy cannot suffice to bear. Our anguished economy cannot afford the costs associated with the healthcare reform; however, the Democratic Party believes so. Will this healthcare reform suffice to the Democratic Party’s expectations? The numbers, figures, and facts speak otherwise. Nevertheless, there will always be people in positive expectation of this healthcare reform, ready to defend it, in the wake of its promising and truly appealing “benefits.” Woe to them that act out of pure bliss instead of using sound logic as the basis for their beliefs. Irrespective of how the Democratic Party positively portrays the healthcare reform, it will inevitably fail on the sole basis of natural process and order. If it cannot work, it cannot work.
    What has been sowed in the unfertile land of illogical and prohibitive notions will be reaped accordingly when natural law fails not in proving the healthcare reform’s true disfunctionality. I expect genuine and harsh condolence to this excerpt, from the many who place their trust in the unquantifiable and irrational provisions of the healthcare reform, but beliefs are difficult to transform even in the wake of the truth as portrayed herein. There is nothing that can be done to change the mentality of those that believe in the fantasy of the healthcare reform for the sake of it, and likewise prevent the certain forthcoming economical ravages of its devastation. Doomed as we are, our only true expectation lies in heeding the knowledge we will gain from this failure, and assure that such mistaken legislative decisions are never again repeated.

  5. What’s not getting enough press is the fact that buried at the bottom of the bill is the impact on FSAs. For those employees that are making a conscious effort to set aside funds to be able to pay for out of pocket costs, the flexible spending accounts will not be reduced to a maximum contribution of only $2,500 (down from $5,000) and will no longer be able to be used for over the counter medications.

  6. Helpful illustration. I have been confused about where the version of the bill approved by the House would go next and have been surprised that this bill could be signed by the President while another version of the bill is to go through a reconciliation process. Still confusing, but this sheds some light.
    Regarding the nutcase commentary above, I have to admit I have never understood the mind of those who write it. The commentary never has a bit of fact to support it. Its tone is strident, tinged with violence and blind fury. What never ceases to astonish me about such commentary is its utter detachment from any reality.
    The reaction is the same no matter how marginal the variation is from presumed extreme right-wing positions on any topic advocated by the Obama Administration or Democratic Congressional legislators. That is certainly the case with this legislation that in essence expands insurance coverage within more or less the same mess of a system that has always existed.
    That is also why Margalit’s, among many others’, comment in another posting is true that opposition to this marginal or – heaven forbid – fundamental reform has nothing to do with the healthcare system itself. It is a generalized reaction based on aggressive (i.e. consciously asserted, not simply passively existing) ignorance, hatred for others, astonishing prejudice and apparently a good dose of stupidity, i.e. an inability or unwillingness to perform the most basic fact-based analysis of a topic.

  7. The reconciliation is a twist of procedure to neutralize the other twist of procedure, the filibuster. If you hate the filibuster you must love reconciliation, if you hate reconciliation, you must love the filibuster. Inappropriate use of both should be prohibited, but while one exists the other can mediate the madness.
    It’s a shame that so many extreme Republicans, as the few comments above, dominate the voice of the party now with their bitter endless eternal anger. I would love to see some positive constructive contributions from Republicans. I would have loved to see my Republican representative to have collaborated to offer all Americans health care. But the party seems to be dominated by blind hate and bitter fear, so unChristian, so unAmerican, so shameful.

  8. I think people calling Obama a socialist is something of the result of reality far outstripping the categories that we have.
    Like George Bush, Barak Obama has overseen a vast increase in Federal spending and power. But both these increases have served private interests rather the public interest which a hypothetical “socialism” would serve. Both the Bush and the Obama expansion have involved the modern private-public-fusion approach. These supposedly, hypothetically improve efficiency but definitely, positively prevent the most impoverished from feeling any less of a whip-hand at their back.
    To the populists and opportunists on the Right, this regime can be called “Socialism” when they aren’t riding in the carriage. Similarly, this same set of policies can be label “Fascism” by opportunists on the Left when they are similarly excluded. This shrill, empty debate excludes all real debate about the general drift of things. It’s not surprising. Permanent government, not really Left or Right, brooks not real opposition, now even less than before. Some fraction of experts are concerned by the unsustainability of this regime. But the top experts ride this like nothing. They’re used to profiting from the disasters around them. When Obama has his Katrina, if health car isn’t already his Katrina, I’m sure the Right will excited but other course neither Left nor Right will recognize our permanent government even then.

  9. they forget to tell you that the bill does not affect them they’re health care is paid for life by us not them they wont have to pay a fine we pay it for them how can someone agree to a bill that doesnt apply to them??????? i guess easy

  10. i think this health bill should be thrown out just as the ones who put it together and the so called president who sign it. what happen to the constitution is the president going to start killing people that dont look like him too>>>> is this a repeat of hitler???? not much different than the way that it started in germany soon they’ll be telling us where to work what we can make how we can spend it and what we can eat impeach the so called butt thats president and put someone in there who knows what they’re doing obama cant even answer a question all he seems to get out is ummmand like ummmm

  11. If your head is being filled by falsehoods as to what this bill is about – this is definitely worth a read – consider this one thought:
    …these are the same Republicans who thought nothing of spending one trillion dollars (not to mention the wasted lives) on that wild goose chase in Iraq, but now act as if spending less than that on healthcare for their fellow Americans is an act of treason.
    http://www.theipinionsjournal.com/index.php/2010/03/obama-delivers-healthcare-reform-to-america/

  12. Oboma, is a cuss word in my house. My thoughts on him is IMPEACH the socialist. Also his flunky Nancy Poluski

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