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Health Care Reconciliation Bill Summary

March 18, 2010 - by Donny Shaw

The full text of the Reconciliation Act of 2010 has been released, and we’re hustling to covert it into HTML and get it online for easier digging, commenting and permalinking. We’ll have that in a matter of hours. In the meantime, I recommend you read this summary as prepared by the House Rules Committee that describes in plain English how the bill would amend the Senate health care bill and how it would affect current law. Summary posted below the fold.




Title I – Coverage, Medicare, Medicaid and Revenues

Subtitle A – Coverage

Sec. 1001.  Affordability.  Improves the financing for premiums and cost sharing for individuals with incomes up to 400% of the federal poverty level.  Subsection (a) improves tax credits to make premiums more affordable as a percent of income; and subsection (b) improves support for cost sharing, focusing on those with incomes below 250% of the federal poverty level.  Starting in 2019, constrains the growth in tax credits if premiums are growing faster than the consumer price index, unless spending is more than 10% below current CBO projections.

Sec. 1002.  Individual responsibility.  Modifies the assessment that individuals who choose to remain uninsured pay in three ways: (a) exempts the income below the filing threshold, (b) lowers the flat payment from $495 to $325 in 2015 and from $750 to $695 in 2016 and © raises the percent of income that is an alternative payment amount from 0.5 to 1.0% in 2014, 1.0 to 2.0% in 2015, and 2.0 to 2.5% for 2016 and subsequent years to make the assessment more progressive.

Sec. 1003.  Employer responsibility.  Improves the transition to the employer responsibility policy for employers with 50 or more full-time equivalent workers (FTE) by subtracting the first 30 full time employees from the payment calculation (e.g., a firm with 51 workers that does not offer coverage will pay an amount equal to 51 minus 30, or 21 times the applicable per employee payment amount). The provision also changes the applicable payment amount for firms with more than 50 FTEs that do not offer coverage to $2,000 per full-time employee.  It also eliminates the assessment for workers in a waiting period, while maintaining the 90-day limit on the length of any waiting period beginning in 2014. 

Sec. 1004.  Income definitions.  Modifies the definition of income that is used for purposes of subsidy eligibility and the individual responsibility requirement.  The modifications conform the income definition to information that is currently reported on the Form 1040 and to the present law income tax return filing thresholds.  The provision also extends the exclusion from gross income for employer provided health coverage for adult children up to age 26.

Sec. 1005.  Implementation funding.  Provides $1 billion to the Secretary of Health and Human Services to finance the administrative costs of implementing health insurance reform.


Subtitle B – Medicare

Sec. 1101.  Closing the Medicare prescription drug “donut hole”.  Provides a $250 rebate for all Medicare Part D enrollees who enter the donut hole in 2010.  Builds on pharmaceutical manufacturers’ 50% discount on brand-name drugs beginning in 2011 to completely close the donut hole with 75% discounts on brand-name and generic drugs by 2020.

Sec. 1102.  Medicare Advantage payments.  Freezes Medicare Advantage payments in 2011.  Beginning in 2012, the provision reduces Medicare Advantage benchmarks relative to current levels.  Benchmarks will vary from 95% of Medicare spending in high-cost areas to 115% of Medicare spending in low-cost areas.  The changes will be phased-in over 3, 5 or 7 years, depending on the level of payment reductions.  The provision creates an incentive system to increase payments to high‐quality plans by at least 5%.  It also extends CMS authority to adjust risk scores in Medicare Advantage  for observed differences in coding patterns relative to  fee-for‐service.

Sec. 1103.  Savings from limits on MA plan administrative costs.  Ensures Medicare Advantage plans spend at least 85% of revenue on medical costs or activities that improve quality of care, rather than profit and overhead.

Sec. 1104.  Disproportionate share hospital (DSH) payments. Advances Medicare disproportionate share hospital cuts to begin in fiscal year 2014 but lowers the ten-year reduction by $3 billion.

Sec. 1105.  Market basket updates.  Revises the hospital market basket reduction that is in addition to the productivity adjustment as follows: -0.3 in FY14 and -0.75 in FY17, FY18 and FY19.   Removes Senate provision that eliminates the additional market basket for hospitals based on coverage levels.  Providers affected are inpatient hospitals, long-term care hospitals, inpatient rehabilitation facilities, psychiatric hospitals and outpatient hospitals.

Sec. 1106.  Physician ownership-referral.  Changes to December 31, 2010 the date after which physician ownership of hospitals to which they self refer is prohibited and provides a limited exception to the growth restrictions for grandfathered physician owned hospitals that treat the highest percentage of Medicaid patients in their county (and are not the sole hospital in a county).

Sec. 1107.  Payment for Imaging Services. Sets the assumed utilization rate at 75 percent for the practice expense portion of advanced diagnostic imaging services. 

Subtitle C – Medicaid

 Sec. 1201. Federal funding for States.  Strikes the provision for a permanent 100% federal matching rate for Nebraska for the Medicaid costs of newly eligible individuals. Provides federal Medicaid matching payments for the costs of services to newly eligible individuals at the following rates in all states except expansion states: 100% in 2014, 2015, and 2016; 95% in 2017; 94% in 2018; 93% in 2019; and 90% thereafter. In the case of expansion states, reduces the state share of the costs of covering nonpregnant childless adults by 50% in 2014, 60% in 2015, 70% in 2016, 80% in 2017, 90% in 2018.  In 2019 and thereafter, expansion states would bear the same state share of the costs of covering nonpregnant childless adults as non-expansion states (e.g., 7% in 2019, 10% thereafter).

Sec. 1202. Payments to primary care physicians.  Requires that Medicaid payment rates to primary care physicians for furnishing primary care services be no less than 100% of Medicare payment rates in 2013 and 2014 (the first year of the Senate bill’s   Medicaid coverage expansion to all individuals with incomes under 133% of poverty).  Provides 100% federal funding for the incremental costs to States of meeting this requirement.

Sec. 1203.  Disproportionate share hospital payments.  Lowers the reduction in federal Medicaid DSH payments from $18.1 billion to $14.1 billion and advances the reductions to begin in fiscal year 2014.  Directs the Secretary to develop a methodology for reducing federal DSH allotments to all states in order to achieve the mandated reductions.  Extends through FY 2013 the federal DSH allotment for a state that has a $0 allotment after FY 2011.

Sec. 1204.  Funding for the territories.  Increases federal funding in the Senate bill for Puerto Rico, Virgin Islands, Guam, American Samoa, and the Northern Marianas Islands by $2 billion.  Raises the caps on federal Medicaid funding for each of the territories.  Allows each territory to elect to operate a Health Benefits Exchange.

Sec. 1205. Delay in Community First Choice Option. Postpones from October 1, 2010 until October 1, 2011 the effective date of the option established for State Medicaid programs to cover attendant care services and supports for individuals who require an institutional level of care

Sec. 1206.  Drug rebates for new formulations of existing drugs.  For purposes of applying the additional rebate, narrows the definition of a new formulation of a drug to a line extension of a single source or innovator multiple source drug that is an oral solid dosage form of the drug.

Subtitle D – Reducing  Fraud, Waste, and Abuse

Sec. 1301.  Community Mental Health Centers.  Establishes new requirements for community mental health centers that provide Medicare partial hospitalization services in order to prevent fraud and abuse.

Sec. 1302. Medicare prepayment medical review limitations. Streamlines procedures to conduct Medicare prepayment reviews to facilitate additional reviews designed to reduce fraud and abuse.

Sec. 1303. CMS-IRS data match to identify fraudulent providers.  Allows the Secretary of Treasury to share IRS data with HHS employees to help screen and identify fraudulent providers or providers with tax debts, and to help recover such debts.  Provides strict controls on the use of such information to protect taxpayer privacy.

Sec. 1304.  Funding to fight fraud, waste and abuse.  Increases funding for the Health Care Fraud and Abuse Control Fund by $250 million over the next decade.  Indexes funds to fight Medicaid fraud based on the increase in the Consumer Price Index.

Sec. 1305.  90-day period of enhanced oversight for initial claims of DME suppliers. Requires a 90-day period to withhold payment and conduct enhanced oversight in cases where the HHS Secretary identifies a significant risk of fraud among DME suppliers.

Subtitle E – Revenues

Sec. 1401.  High-cost plan excise tax.  Reduces the revenue collected by the tax by 80 percent.   This is achieved by:  delaying the application of the tax until 2018, which gives the plans time to implement and realize the cost savings of reform; increasing the dollar thresholds to $10,200 for single coverage and $27,500 for family coverage ($11,850 and $30,950 for retirees and employees in high risk professions);  excluding stand-alone dental and vision plans from the tax; and permitting an employer to reduce the cost of the coverage when applying the tax if the employer’s age and gender demographics are not representative of the age and gender demographics of a national risk pool.  Under the modified provision, the dollar thresholds are indexed to inflation and the dollar thresholds are automatically increased in 2018 if CBO is wrong in its forecast of the premium inflation rate between now and 2018.

Sec. 1402.  Medicare tax.  Modifies the tax to include net investment income in the taxable base.  Currently, the Medicare tax does not apply to net investment income.    The Medicare tax on net investment income does not apply if modified adjusted gross income is less than $250,000 in the case of a joint return, or $200,000 in the case of a single return.  Net investment income is interest, dividends, royalties, rents, gross income from a trade or business involving passive activities, and net gain from disposition of property (other than property held in a trade or business).  Net investment income is reduced by properly allocable deductions to such income. 

Sec. 1403.  Delay of the annual limitation on contributions to a health FSA.  Delays the provision by two years until 2013.

Sec. 1404.  Brand name pharmaceuticals.  Delays the industry fee on sales of brand name pharmaceuticals for use in government health programs by one year to 2011, and increases revenue raised by the fee by $4.8 billion.

Sec. 1405.  Excise tax on medical device manufacturers.  Delays the tax by two years to 2013 and converts the industry fee to an excise tax on the first sale for use of medical devices at a rate of 2.9 percent.  Exempts from the tax Class I medical devices, eyeglasses, contact lenses, hearing aids, and any device of a type that is generally purchased by the public at retail for individual use.

Sec. 1406.  Health insurance providers.   Delays the industry fee by 3 years to 2014 and modifies the annual industry fee for revenue neutrality.  In the case of tax-exempt insurance providers, provides that only 50 percent of their net premiums that relate to their tax-exempt status are taken into account in calculating the fee.  Provides exemptions for voluntary employee benefit associations (VEBAs) and nonprofit providers more than 80 percent of whose revenues is received from Social Security Act programs that target low income, elderly, or disabled populations.

Sec. 1407.  Delay of elimination of deduction for expenses allocable to Medicare part D subsidy.  Delays the provision by two years to 2013. 

Sec. 1408.  Elimination of unintended application of cellulosic biofuel producer credit. Adds an additional revenue provision.  In 2008, Congress enacted a $1.01 per gallon tax credit for the production of biofuel from cellulosic feedstocks in order to encourage the development of new production capacity for biofuels that are not derived from food source materials.  Congress is aware that some taxpayers are seeking to claim the cellulosic biofuel tax credit for unprocessed fuels, such as black liquor.  The provision would limit eligibility for the tax credit to processed fuels (i.e., fuels that could be used in a car engine or in a home heating application). 

Sec. 1409.  Codification of economic substance doctrine and penalties.  Adds an additional revenue provision.  The economic substance doctrine is a judicial doctrine that has been used by the courts to deny tax benefits when the transaction generating these tax benefits lacks economic substance.  The courts have not applied the economic substance doctrine uniformly. The provision would clarify the manner in which the economic substance doctrine should be applied by the courts and would impose a penalty on understatements attributable to a transaction lacking economic substance. 

Sec. 1410.  Time for payment of corporate estimated taxes.  Provides for a one-time adjustment to corporate estimated taxes for payments made during calendar year 2014. 

Sec. 1411.  No impact on Social Security trust funds.  Provides that Title II of the Social Security Act (the old age, survivor, and disability benefits program (OASDI)) is not amended or modified by the bill.

Subtitle F – Other Provisions

Sec. 1501.  TAA for communities. Appropriates $500 Million a year for fiscal years 2010 through 2014 in the Community College and Career Training Grant program for community colleges to develop and improve educational or career training programs. Ensures that each state receives at least 0.5 percent of the total funds appropriated.


Title II – Health, Education, Labor, and Pensions

Subtitle A – Education

Section 2001. Short Title; References. Provides that this subtitle may be cited as the “SAFRA Act,” and that, except as otherwise provided, whenever an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of the Higher Education Act of 1965.

Part I—Investing in Students and Families

Section 2101. Federal Pell Grants.  Amends the Higher Education Act to include mandatory funding for the Pell Grant.  This provides additional mandatory funding to augment funds appropriated to increase the federal maximum Pell Grant award by the change in the Consumer Price Index.  The mandatory component of the funding is determined by inflating the previous year’s total and subtracting the maximum award provided for in the appropriations act for the previous year or $4860, whichever is greater.  Beginning in the 2018-2019 academic year, the maximum Pell award will be at the 2017-2018 level.

Section 2102. Student Financial Assistance.  This section provides $13.5 billion in mandatory appropriations to the Federal Pell Grant program.

Section 2103. College Access Challenge Grant Program.  This section amends section 786 of the Higher Education Act by authorizing and appropriating $150 million for fiscal years 2010 through 2014 for the College Access Challenge Grant program created under the College Cost Reduction and Access Act of 2007.  Provides that the allotment for each State under this section for a fiscal year shall not be an amount that is less than 1.0 percent of the total amount appropriated for a fiscal year.

Section 2104.  Investment in Historically Black Colleges and Universities and Minority Serving Institutions.  This section amends section 371(b) of the Higher Education Act by extending funding for programs under this section created under the College Cost Reduction and Access Act of 2007 for programs at Historically Black Colleges and Universities and minority-serving institutions through 2019, including programs that help low-income students attain degrees in the fields of science, technology, engineering or mathematics by the following annual amounts: $100 million to Hispanic Serving Institutions, $85 million to Historically Black Colleges and Universities, $15 million to Predominantly Black Institutions, $30 million to Tribal Colleges and Universities, $15 million to Alaska, Hawaiian Native Institutions, $5 million to Asian American and Pacific Islander Institutions, and $5 million to Native American non-tribal serving institutions.

Part II—Student Loan Reform

Section 2201.  Termination of Federal Family Education Loan Appropriations.  This section terminates the authority to make or insure any additional loans in the Federal Family Education Loan program after June 30, 2010.

Section 2202. Termination of Federal loan Insurance Program.  This section is a conforming amendment with regard to the termination of the FFEL program, limiting Federal insurance to those loans in the Federal Family Education Loan program for loans first disbursed prior to July 1, 2010.

Section 2203. Termination of Applicable Interest Rates.  This section makes a conforming amendment with regard to the termination of the FFEL program limiting interest rate applicability to Stafford, Consolidation, and PLUS loans to those loans made before July 1, 2010.

Section 2204. Termination of Federal payments to Reduce Student Interest Costs.  This section makes a conforming amendment with regard to the termination of the FFEL program by limiting subsidy payments to lenders for those loans for which the first disbursement is made before July 1, 2010.

Section 2205. Termination of FFEL PLUS Loans.  This section makes a conforming change with regard to the termination of the FFEL program for federal PLUS loans by prohibiting further FFEL origination of loans after July 1, 2010.

Section 2206. Federal Consolidation Loans.  This section makes conforming changes with regard to the termination of the FFEL program for federal consolidation loans.  This section also provides that, for a 1 year period, borrowers who have loans under both the Direct Lending program and the FFEL program, or who have loans under either program as well as loans that have been sold to the Secretary, may consolidate such loans under the Direct Lending program regardless of whether such borrowers have entered repayment on such loans.

Section 2207. Termination of Unsubsidized Stafford loans for Middle-Income Borrowers.  This section makes conforming changes with regard to the termination of the FFEL program for Unsubsidized Stafford loans by prohibiting further FFEL origination of loans after July 1, 2010.      

Section 2208. Termination of Special Allowances.  This section makes conforming changes with regard to the termination of the FFEL program by limiting special allowance payments to lenders under the FFEL program to loans first disbursed before July 1, 2010.

Section 2209. Origination of Direct Loans at Institutions Outside the United States.  This section provides for the origination of federal Direct Loans at institutions located outside of the United States, through a financial institution designated by the Secretary. 

Section 2210.  Conforming amendments.  This section makes conforming technical changes with regard to the termination of the FFEL program for Department of Education agreements with Direct Lending institutions.

Section 2211. Terms and Conditions of Loans.  This section makes conforming technical changes with regard to the termination of the FFEL program to clarify the terms and conditions of Direct Loans.

Section 2212. Contracts.  This section directs the Secretary to award contracts for servicing federal Direct Loans to eligible non-profit servicers.  In addition, this section provides that for the first 100,000 borrower loan accounts, the Secretary shall establish a separate pricing tier.  Specifies that the Secretary is to allocate the loan accounts of 100,000 borrowers to each eligible non-profit servicer.  The section also permits the Secretary to reallocate, increase, reduce or terminate an eligible non-profit servicer’s allocation based on the performance of such servicer.  In addition, this section appropriates mandatory funds to the Secretary to be obligated for administrative costs of servicing contracts with eligible non-profit servicers.  This section also requires the Secretary to provide technical assistance to institutions of higher education participating or seeking to participate in the Direct Lending program.  This section appropriates $50 million for fiscal year 2010 to pay for this technical assistance. Additionally, this section authorizes the Secretary to provide payments to loan servicers for retaining jobs at location in the United States where such servicers were operating on January 1, 2010.  This section appropriates $25,000,000 for each of fiscal years 2010 and 2011 for such purpose.

Section 2213.  Agreements with State-Owned Banks.   This section amends Part D of Title IV to direct the Secretary to enter into an agreement with an eligible lender for the purpose of providing Federal loan insurance on student loans made by state-owned banks.

Section 2214.  Income-Based Repayment.  The section amends the Income-Based Repayment program to cap student loan payments for new borrowers after July 1, 2014 to 10% of adjusted income, from 15% percent, and to forgive remaining balances after 20 years of repayment, from 25 years.

Subtitle B – Health

Sec. 2301.  Insurance Reforms.  Extends the prohibition of lifetime limits, prohibition on rescissions, limitations on excessive waiting periods, and a requirement to provide coverage for non-dependent children up to age 26 to all existing health insurance plans starting six months after enactment.   For group health plans, prohibits pre-existing condition exclusions in 2014, restricts annual limits beginning six months after enactment, and prohibits them starting in 2014. For coverage of non-dependent children prior to 2014, the requirement on group health plans is limited to those adult children without an employer offer of coverage.

Sec. 2302.  Drugs Purchased by Covered Entities.  Repeals the underlying 340B expansion to inpatient drugs and exemptions to GPO exclusion.  Exempts orphan drugs from required discounts for new 340B entities. 

Sec. 2303.  Community Health Centers.  Increases mandatory funding for community health centers to $11 billion over five years (FY 2011 – FY 2015).


Prepared by Committees on Ways & Means, Energy & Commerce, and Education & Labor, March 18, 2010

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Displaying 1-30 of 32 total comments.

  • brud 03/18/2010 12:41pm

    Clearly the democratic party has become the Democrat Socialist Party of 2010. Their attempt to bankrupt the country is nearing a real beginning. It would seem that common sense in America is to be a thing of the past. Obama, Pelozi, & Reid lead the nation down the rosy pathway of socialism and lie through their teeth to get it done. Hopefully the voters will cause them to answer in November for their arrogance in foisting such laws as the Health Care Reform Act.

  • Comm_reply
    BobPaul 03/19/2010 8:49am

    Yes, clearly. Because requiring people buy private insurance is SOCIALISM. I’m sorry Brud, but your argument smells of 1960s McCarthyism. Is it socialist when a state requires you car insurance?

    Regardless, America has been a socialist country for many many years. We just prefer socialism for the wealthy. If a business fails, we bail them out and call it necessary. When people are foreclosing on their homes because they can’t afford the medical bills resulting from an accident, birth, or chronic illness, we say, “Tough luck.”

    This is no more socialist than the Bush’s Wall Street bailout. In fact, this is less so. There isn’t even a public option!

  • Comm_reply
    USAF92 03/19/2010 10:26am

    I’m sorry BobPaul but it is not socialist for a state to require you to have car insurance. If you have a loan from a bank to purchase a car, the bank requires you to have insurance. States only require you to have insurance if you wish to register the car to drive it on public roadways. States do not require you to have insurance if you dont have a car so it is not socialist, also the insurance you pay for driving a car is to protect you the driver, because when you get in a wreck and it is your fault you will have to pay the person you hit, so again it is to protect you. There is no argument that car insurance and this crap the democrats are pushing down our throats are the same.

  • Comm_reply
    BobPaul 03/19/2010 11:07am

    Why even mention the bank? I asked about when states require it. Bank loans are a private matter.

    You seem pretty impressed by the fact that requiring drivers purchase auto insurance protects the driver. Hello? All insurance is to protect the you. When you have a child it’s your fault and you have to pay the hospital the cost of giving birth, pre-, and post-natal care. If you fall off a ladder or are struck by lightning, it’s your fault and you pay the ER costs. If you develop a chronic illness such as diabetes, it’s your fault and you’re responsible or suffer. “It’s for your protection” isn’t a reason why requiring car insurance isn’t socialism.

    With regards to cars, the total cost for society is less if every driver has insurance. Otherwise there would be many bankruptcies due to at-fault drivers who were can’t pay. Medical expenses are one of the leading causes of bankruptcy. Requiring everyone carry insurance will result in a lower cost to society, just like auto insurance has.

  • Comm_reply
    sjohns2 03/19/2010 3:22pm

    BobPaul Your right, medical coverage is awesome. We’ve experimented with social spending for 50 years and the Fed Debt is now 12.4 trillion and climbing. Every state in the union is struggling with budget deficits, let just pile on. I don’t have a clue how medicaid can support this addition. When does the Repo man show up. The CBO numbers are a joke. Why pay for anything when you can just charge it. You know the next thing is to legalize individuals so they will be added onto the plan. We all want reform that will work, this is not it.

  • Comm_reply
    BobPaul 03/19/2010 4:30pm

    ND has a surplus. Most of the debt was Reagan, Bush, Bush. ( And what’s wrong with the CBO numbers? You can’t discredit them simply because they don’t fit your politics. Is something wrong with the calculations? I’m sure the CBO would like to know about that.

  • Comm_reply
    aero405 03/21/2010 8:28am

    It has nothing to do with political views, really. Like Holtz-Eakin says, the CBO must base it’s analysis on what it’s told; if it’s given wild financial fantasies produced by gimmicks that make the entitlement look cheaper than it really is, then their cost estimate will also be a wild fantasy.

  • Comm_reply
    spartan0006 03/30/2010 1:49am

    guess that the prior eight years of raiding the trust funds and not budgeting wars, and tax cuts was okay with you. Bring on November!

  • stitcher927 03/18/2010 1:02pm

    Dear Senators and Congressman,
    There are four issues that you have neglected to address in your tax & spend document entitled “Health Care Reconciliation Bill”. 1) Every section punishes employers and employed. Where is the work requirement for the intentionally unemployed? 2) Where is the provision requiring U.S. territories Puerto Rico, the Virgin Islands, Guam, American Samoa, Northern Marianas Islands to pay income tax & penalties on investment income? 2) Where do you propose we’ll house the illegal immigrants flocking to this country for “free” healthcare, paid for by gainfully employed, hardworking, legal U.S. Citizens? 4) Where are the malpractice reforms? You have forgotten that you work for us. You somehow believe we work for you. You are wrong. You dishonor us with your arrogance, pompousness, and ignorance of the principles on which this great country was founded. Patricia C. Woodruff, Lincoln, Nebraska.

  • anomalous 03/18/2010 3:12pm

    How did the government takeover of private college financing get into the health care reform bill (section 2200+)? Insult to injury, 1/6th of the economy isn’t enough? This is a transition to the end-game which is government run college funding.

    Pushing the Cadillac tax back a few years and discounts to name-brand drugs are certainly gifts to the “friends of Obama” effort. The fact that the Louisiana purchase and Gatorade are still in there is even more evidence of the corrupted approach to policy-making that the Democrats are more than comfortable with.

    This thing is a nightmare.. wait, no, it’s a nightmare that amends a nightmare.

  • Comm_reply
    Christina1969 03/19/2010 7:47pm

    I run a Political Debate group and we’ve all been following this Healthcare bill as close as we could and were ALL surprised when it suddenly included educational affordability… and Sec. 1408. " Elimination of unintended application of cellulosic biofuel producer credit."

    Why were Obama and Pelosi so quiet on the education portion if it’s a thing to be proud of? We’re all for making education affordable, right?

    It’s hard not to be paranoid and believe the Dems are hiding things when they are… hiding things.

  • hootsbuddy 03/18/2010 3:26pm

    I see the opposition is after this bill hot and heavy. Steam and smoke rise from these first three comments.

    Prior to the Sixties all hospitals in the country were non-profit by law and it was practically a civic duty that everyone enroll in one of the Blues (both of which were opposed by the American Medical Association, incidentally.) Both Blue Cross and Blue Shield were also non-profit as well in the beginning.

  • btrask3 03/18/2010 3:38pm

    Government has never been the solution to ANY problem.

    e.g. Corruption, Inefficiency and Cost overruns: Medicare, SEC, Military Spending, IRS, Social Security, HUD, Educational Spending, EPA, Oversight of Indian Affairs, DOT, Department of Energy, TSA, the Federal Reserve Banks, etc. etc.

    Folks, just think about it… how many TAX DOLLARS will the MASSIVE BUREAUCRACY that will be required to oversee 1/6th of our economy. It doesn’t take a PHD to understand the Government only CONSUMES Tax Dollars, it does not produce anything!

    DON’T BELIEVE THE CBO Score… Government has never come-in with ANY project under budget. Which means our DEBT will skyrocket. Our DOLLAR will INFLATE and we will be left with the POOR, and the very very rich… Let me call them the PROGRESSIVE GLOBAL RULING ELITE.

    NO Congress person or Senator should vote for this ill-conceived Bill.

  • craines 03/18/2010 3:43pm
    Link Reply
    + -3

    Glad to see it pass, cant wait until Financial reform and Immigration. We will need another Stimulus program if not only for the school systems in all the states.

    I guess the first did work, it kept a lot of people from being laid off and teachers teaching where they are supposed to be. This Recession is far from over.

    Let’s fix the mesh the last eight years created.

  • Comm_reply
    sjohns2 03/19/2010 3:28pm

    Do you understand the simple concept of working and living within your means?

  • Comm_reply
    psellnow 03/20/2010 4:45pm

    sjohns, do you understand the simple concept of living within your means includes not giving away the store with tax cuts for the rich and senseless wars in the middle east?

  • Comm_reply
    lolyhill 03/23/2010 2:58pm

    The Stimulus program worked? I’m not feeling it. Unemployment rates are ridiculously high and, we aren’t even counting many of our unemployed, let alone considering the underemployed people who’ve taken serious paycuts just to keep working.

  • Comm_reply
    lolyhill 03/23/2010 2:58pm

    … and keeping teachers from being laid off? Please! If we don’t limit class size, solve disciplinary challenges, and cut beauracratic red tape, our teachers will soon be begging for a lay off. Speaking as a former administrator in higher education, the problem with the school system is a cumbersome budgeting process coupled with serious waste. The funds don’t end up where tax payers intend them to be. Why do you think teachers keep threatening to strike?

  • Comm_reply
    lolyhill 03/23/2010 2:59pm

    As for the suggestion of immigration reform, we have to first, as a nation decide what our true position is on immigration. Our talk and our walk don’t jive. It seems that we really want the freedom to hire undocumented workers, as well as the freedom to punish them for the crime of seeking gainful employment.

  • fenrir121 03/18/2010 6:44pm

    It is amazing that people believe that government spending can fix any problem just because short-term gains we have seen through stimulus in the last year. One person below is actually saying that we need another stimulus. Do you know what the stimuls is? It is money that we do not have. Every dollar they dump into the economy, and which is not hoarded by the banks, weakens all the dollars you already have. Get that through your head: they are selling us out in the most literal sense. They are spending our work, because that is what money measures, and they are spending it on people who do not work. Economies are zero sum and we owe more than we can repay. That is a much bigger problem than anything else. You need to distinguish your utopian ideals for the long-term from what is actually going on here and what is possible now and what will enable us to get to the long-term: they are spending what they don’t have and they cannot possibly ensure prosperity by funding it with debt.

  • Godizincontrol 03/18/2010 7:58pm

    How can anyone in their right mind and call themselves an American support this health care bill? This bill does more damage, and Obama knows this, than any single piece of legislation that has been devised since FDR. God help our country from this abuse!

  • Godizincontrol 03/18/2010 8:06pm

    The United States is “government by the people for the people.” What are we to do when our President and Congress would rather buy votes and have representatives sell out their states and communities instead of listening to the people that elect them? So far, Nebraska, Louisiana, Ohio, California, Michigan, and more have sold out to Obama’s bribery and stopped listening to the people who voted them into office. These will be held responsible some day.

  • Comm_reply
    USAF92 03/19/2010 10:49am

    We were “government by the people for the people.” The career politician ended it.

  • Mazter1224 03/19/2010 8:48am

    I just checked the poverty level, and found out that I am not poor. I make just enough to have my taxes raised, so that the government can pay for the people who choose to not work, not get educated, and have babies that they cant afford. Who knew that working as a cook would put me in a higher tax bracket? I guess I will have to quit working so much so I can drop back down and get some government support.

  • Comm_reply
    psellnow 03/20/2010 4:55pm

    Mazter1224, you work as a cook and make more than $250,000 per year (the threshold for Obama’s tax increases)? I’m impressed! And what percentage of the currently unemployed do you really think choose not to work? In case you haven’t checked lately, unemployment benefits are a small fraction of an unemployed person’s former salary. Let’s see: keep working and stay in my house and keep my kids in college, or choose to be unemployed and homeless — but collecting unemployment. Yeah, lots of people must be making that choice.

  • aero405 03/21/2010 8:14am

    “Section 2104. Investment in Historically Black Colleges and Universities and Minority Serving Institutions.”

    What’s affirmative action doing in a health care reform bill?

  • JenniferK 03/21/2010 10:56am

    How desprate are they to pass this bill that they tack on student loans. What in the world to student loans have to do with health care?

  • waitingforthisday 03/21/2010 9:21pm

    Thank you, thank you to the fine law makers who finally had the guts to stand up for the people of this country rather than the special interests and corporations. This is what government should be about. For all the talk of “no private citizens” wanting this bill passed, there sure are a lot of happy people on facebook, twitter, and other social networks. What’s that? Do I hear celebrating in the streets?!! I do!!! Going to go join them . . .

  • Dahmooser 03/22/2010 1:36pm

    I’d like to share my thoughts with some questions, because, I am no authority on any of these things…
    It’s my impression that when Clinton left office we had a budget surplus, is this true? Along those lines, I understand that Bush Jr. gave that back to a lot of American’s as a $350 check, is this true?
    Is it true that our spending on our “world war on terror” has driven us into deficit spending?
    Defense, Social Security, and DEBT are the biggest part of our budget woes, right? why is it that Bush signed into a law a resolution disallowing medicare to negotiate prices with drug companies? This seems odd to me, like it would increase our health care costs, right?
    I don’t want free handouts to people reduce their incentive to work, yet, what can we do to ensure children, who have no voice, are taken care of, when the parents can’t? I don’t have an answer.
    I also don’t feel it’s noble to save big wall street firms and let small homeowners lose their homes. How is this right?

  • javritt 03/22/2010 8:10pm

    look at how many people work full-time for minimal wage and can’t afford Health care.So let me get this strait,republicans would prefer to have the backbone of America just go on strike than to just give them health care.What’s the point,I promise if the Republicans drive this bill into the grown the working class (from both sides of the isle ) will just stop going to work,Why keep braking our backs to make everyone’s life easier when we keep getting stepped on and kicked to the side.No one seems to be able to get the point.It’s simple the working class uninsured stop working the upper class falls. Lets see you make money when you have to do everything yourselves.Wait you won’t be able too .You can’t get gas or food.You’ll have to watch your own kids so how are you going to go to work.Oh no, no more homes being built.who’s going to come to your home and fix anything that one that’s who.

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