3/30/2010: FINAL PASSED REFORM BILLS SIGNED BY PRESIDENT--TEXT:

NOTE: HR3590 is the Main bill, HR4872 is the Reconciliation bill, which modified HR3590, and added student loan provisions).

The full text of the two bills, in a nice form (with hyperlinked Table of Contents, and modifications to HR3590 from HR4872 shown in HR3590), is available here.

For certain purposes, such as searching for text, a .pdf is preferred. Here is HR3590 .pdf (click here), and Here is HR4872 .pdf (click here),

The bills have some details in references to external laws. If you have sufficient interest in those details, you can find some of them here at the full codified US law. (In other cases, you may need a Google search to find the law. What I have found helpful when doing this is to take any Wikipedia page that comes up at Google, where a footnote on that Wikipedia page will usually link you to the text.)

7/11/09:WONDERFUL Bill Moyers (watch, read transcripts, and informative links here), showing cases of insurance companies not paying claims to policyholders, after people get sick based on searching for pre-existing conditions in their old records (this is in the first 10 minutes). The rest of the show has an ex industry insider from the Health Insurance Industry (PR Executive) discuss the current manipulation of the public by the industry (which is working really well for them).

For the Following Graphs, NOTE Our Relative Costs per Person are Even Higher Because We Deny Coverage to 1/6 of our Population All the Other Countries Cover Everyone Per-Capita Health Costs Around the World (2003) Life Expectancy and Per-Capita Health Costs Around the World (2000) Plot below is based on Congressional Budget Office data, taken from this page. U.S. Medicare, Medicaid, and Social Security Projected Spending (% of GDP) Universal Healthcare Country Polling Results: here, Universal Health Care dates enacted--all developed countries except ours here. --Posted by Norm Spier . (I am actually a statistician who has made a successful career by working for the Pharmaceutical Industry. A Universal Healthcare plan threatens that industry, but I accept that. We all have to give a little and not be pigs if this country is going to work.) BOOK TV--It's Really Good. Archived free BookTV program video feeds Watch live (weekends) (C-SPAN 2) SOME CAMPAIGN DECEPTIONS (happen to be by McCain Campaign) which I am keeping around now, well after the election, as examples for us to study of how the government is getting taken away from the people by the special interests (and making us sick, broke, and otherwise miserable). Deception 1: McCain posted on his Website; archived here post-election. This text is near the bottom of McCain's page: "MYTH: Some Claim That Under John McCain's Plan, Those With Pre-Existing Conditions Would Be Denied Insurance." To anyone not armed to expect a deceptively worded statement, it sounds like under McCain's proposal, an insurer would not be able to turn you down for a pre-existing condition. But the McCain proposal kept the precise pre-existing-condition-screened system in place. Currently, in many states, a "high-risk-pool" is set up to cover some of the people who can't pass pre-existing condition screens. These plans can run up to $23,000. or more a year per person (as in CT), they often have ridiculous exclusions (e.g., paying at most $75,000 a year in your medical bills and with a waiting list in California, paying only half of out-of-state emergency treatment in MO), and they keep many people with pre-existing conditions ineligible. McCain keeps this precise system. (On his site, he renamed "high-risk-pools" as "guaranteed acceptance plans" to make it sound like something would change.) If McCain himself didn't intend to fool you, then it is clear he is working with deceptive marketing-types from the insurance industry who intentionlally came up with language that would fool most people. Under McCain, you still would have paid much more for insurance, and could fall through the gap entirely, if you had or got a pre-existing condition. McCain's so called MYTH statement would only be a myth if stretched to "those With Pre-Existing Conditions Would Be Denied the ability to get any Insurance at all". And, this would be very expensive high-risk-pool insurance (up to $23,000 a year per person), that you might not be able to afford. And further, with the current set of high risk pools, 35 states of 50+D.C. have some sort of big gap that misses some or all people. Those would have had to be ironed out in each and every state. (And further, massive funding for filling those gaps for people with pre-existing conditions would have to come from somewhere. And McCain actually melted down the limited current funding, with his "across state lines" provision.) Deception 2: In the first presidential debate, and then the first vice-presidential debate, we have a big misportrayal of the Obama plan as a government takeover. For example, in the VP debate, Palin said that Obama’s plan would be "universal government run" health care and that health care would be "taken over by the feds." However, as factcheck.org indicates, that's not the case at all. Obama’s plan would not replace or remove private insurance, or require people to enroll in a public plan. My favorite goofy little deception by McCain (nothing to do with insurance-- but it's cute) -- the "3 million dollar overhead projector for a planetarium" Obama earmark: As I guessed during the debate, and other science people may have guessed, that turns out to be a replacement of a 40-year old projector of the night sky at the major Chicago planetarium, the Adler. (factcheck.org on Adler Planetarium projector). In my book, over the next 40 years, about two million kids, young adults, and some adults would have learned a lot of science from it, had the earmark been approved. (I learned a lot, from the one at the Hayden in NYC. And I now have a Ph.D. in science!) Factcheck.org on both candidates on Presidential debate # 3. [Note: factcheck.org isn't perfect, but it's stilll pretty good. Notably, I find they are good with exact facts, but sometimes miss conspicous aspects when economic or other analysis is involved.] Silly People Looking for a Too-Good-To-Be-True Bargain Get Just What They Deserve Ah, the silly citizens. When they need non-group health insurance, and have been completely healthy, they buy this cheap health insurance that is cheap based on keeping all the unhealthy people away. It's really cheap, maybe $900. a year. It's a wasteful product, being that it only pays out 55%-75% in claims of the premiums paid in. But they've got really cheap rates. They see "Harry and Louise" (ad 2), and they feel really good about their really cheap insurance. [More recently (11/16/08), in this Marketwatch article, note paragraphs 7-10, where low average rates on individual insurance, achieved by basically keeping the chronically very sick without policies, are touted by a very interested party from a corporation that sells individual policies. Note also, in earlier paragraphs in the same article, a health insurance industry spokesperson posturing to bring "change"--some form of limited change--an illusion of "change" if they can get away with it this time. He indeed knows you can fool most of the people most of the time.] But then, when those silly people do get sick (which is what they had insurance for), they wind up with much higher rates, or no insurance at all So, collectively, we are morons looking for a bargain by getting insurance that keeps away unhealthy people. And when we get sick, that insurance, that keeps away sick people, says "good luck, buddy", and we get what we deserve. Curious, isn't it, that individual insurers never advertise their "payout rates". (This is the percentage paid out in claims for every premium dollar paid in.) Not only don't they advertise, but they won't even tell me when I ask lately, and often pretend never to have heard of such a term. You would think that it is a fundamental number that the consumer needs to know, like pixels in a digital camera, or fuel-burning efficiency in a furnace, both of which are always prominent when you look to buy it. But with health insurers, the product is so complicated that the company selling you insurance has an information advantage that the consumer isn't knowledgeable enough to break. And if they did give you a number, which would usually be in the 65% to 75% zone, and you compared to employer plan numbers, around 90%, or government Medicare efficiency (98%), you'd really know you were buying a wasteful, inefficient product. 10/24/08: Plans for government aid to Insurance Companies (besides AIG) in the works Due to Financial Crisis!(According to several guests on PBS Lehrer NewsHour). Aid to more Insurance Companies??? The very same entities that won't insure people with pre-existing conditions in the U.S., and lobby for keeping able to keep not insuring them, when no other industrialized country allows the non-insurance of people due to pre-existing conditions? The Insurance Companies NOW HAVE A PRE-EXISTING CONDITION (near bankruptcy), AND WANT US TO INSURE THEM? The Insurance Companies want help from us??? IF THERE IS TO BE ANY JUSTIICE AT ALL, IN LIGHT OF THIS, UNIVERSAL-COVERAGE-TYPE PRE-EXISTING CONDITION REFORM MUST BE PASSED WITHIN 90 DAYS OF A NEW PRESIDENT AND CONGRESS! WHAT IS OUR CURRENT SYSTEM, BY THE WAY? People under 65: Currently, people with very low incomes and assets (often assets < $2000 though sometimes a car or something else may be allowed) get free medical care (Medicaid). (NOTE: In a few states, even these very poor people will not be eligible for Medicaid if they do not have dependent children.) The quality varies based on the state--in many states, they really try to not stigmatize the people getting Medicaid, and feel like they just have a decent HMO. The trick for these people is that they're really in what economists call a poverty trap. If they work hard, they'll lose their free health insurance, and be much worse off and possibly dead. In the statistics, by the way, these people all count as insured -- they are not among the 46 million (almost 1/6 of the country) counted as uninsured. People above the very low Medicaid limits, but without enough money to pay for whatever insurance is available, when their job doesn't provide insurance, or when they are between jobs, are most of the uninsured. These people can be classified as "working poor" or "working class income" if they have lower incomes, and can't afford health insurance, and don't get it from their job. Besides working-class-level salaries, there are actually many higher-income/asset middle class people in this group. This is because, in most U.S. states, insurance can be denied due to pre-existing conditions. Further, in many states, a special "high-risk-pool" is set up by the state to cover them, but rates can hit $24,000 a year per person, and there are gaps. Also, many states have no high risk pool, and no alternate mechanism, or a humongous-gap alternate mechanism. (I took it upon to study the pre-existing condition wipeout risk to the hard-saving relatively-high-income middle class people here in my by-state dangers table. There is a wipeout risk in 23 states if you never move between states, and 36 if you do try to move. Few people know this.) Most insurance currently is employer-based insurance. Typically, smaller employers buy group insurance from an insurance company. The rates they pay depend on the state. In most states, nowadays for employers buying the insurance have some form of community rating or modified community rating, where they don't pay too much more for sicker employees. (This is in contrast to what happens to people in those same states when they are sick--individual policies in most of these same states that are community-rated for the employer are not community rated for the individual. This is one reason many experts are concerned about moving away from employer-based insurance without fixing the individual insurance regulations first.) At any rate, there can still be pre-existing-conditions coverage problems for employees of employers who have purchased group insurance. I am not an expert in this area, but you need to check the state specifics if this affects you. For employer-based insurance for large employers, the employer is usually self-insured, which means that they set up an insurance plan and just pay the cost of the medical bills that roll in themselves. (They often have an insurance company administer it, but they pay them a fee and the medical bills. The insurance company doesn't assume the medical risk.) Note that these large employer plans are usually exempt from state regulations by a Federal ERISA law. I am not an expert in this area, but I have been told there are few or no regulations of the Health insurance under ERISA. One thing I would like to point out about employer based plans is that, though Obama and the Democrats want to keep that system now, and that's OK, in the further future we might want to get rid of it. The reason is that there is a kind of manipulation or hanky-panky with freeloading on society, where employers can higher just young or healthy people, and reduce there medical costs. This keeps older and less healthy people both uninsured and unemployed. (Want an example of where this was at least contemplated--See The Walmart Memo. And I'm really not blaming Walmart -- there's a real economic force to be dealt with, and we have to engineer our system well.) Ironically, the McCain plan would have acted to de-employerize health insurance, which in itself is good, but because the plan messed up all protections for pre-existing conditions, and put people into the inefficient (65%-75% payout rate) individual system, it would have actually made things much, much, worse, as I posted here about a month before the election when I found out the exact details of his plan. [Incidentally (11/18/08), with the three American auto makers asking for a government bailout to stave off bankruptcy, many are pointing out that Toyota and other Japanese carmakers when manufacturing in the U.S. have lower costs than U.S. automakers manufacturing in the U.S. Though there probably are other factors, such as too many car models and dealerships for the US companies, I'll bet some of Toyota's reduced cost is that being newer in manufacturing in the U.S., they have younger employees. Think about this, and see what a mess self-insured employerized insurance can make of the economy!] Also, though I think Obama will keep the tax-favorable treatment of employer-based insurance, as we make things more optimal in the future, we may want to give equal deductions whether insurance is individual or employer. That is, we want to break the tie of health insurance (and in fact pension, etc.) to employers, since when we don't have continuous long term employment with one employer, all those things get messed up. (We have such a stupid way of doing things! It's stupider now that young people are expected to go between 10 jobs, not 1 job, per lifetime.) Now, there would be problems dis-employer-connecting in a non-mandated system (particularly, freeloading by individual people not replacing lost employer-provided insurance). But somes of the issues of de-employerization are false: the economics-versed will realize that "employer-pays" vs. "I pay" vs. "we split the cost" is a false belief (under everyone rational, no psychological effects, and no-sticky-entanglement agent assumptions at least.) Oh, yes. For completeness let me add that people with over $10,000,000 in assets often don't have or need insurance. They just pay cash. And at the risk of sounding facetious, people in prison get free medical treatment, whether they have a pre-existing condition or not. Current System, for People 65 and Up: Medicare, a program which has been in place since the mid 1960s, insures people for a modest fee. (Funding from a payroll tax.) There is no pre-existing conditions exclusion. The standard version of the program has a notoriously high efficiency measured by "payout ratio" of around 98%. There are also certain controversial private alternatives, which cost the Federal government something like $1200. more a year per person, due to the administrative inefficiency and cost of marketing the private alternatives. (Republicans generally support these alternative plans, indicating that they believe that though not the case now, ultimately the private plans will manage to squeeze costs down. At the moment, in my area of upstate New York, it looks like much of that $1200. is going into the ads I see on TV for the various private Medicare plans, and the sales people. Several different companies offer on TV to send a sales person (the ads say "health insurance advisor") out to the older people.) Do note that Medicare falls short in some areas, so people with assets to lose often purchase supplemental plans. I do not myself know about the problems people with pre-existing conditions have with supplemental plans. I do believe that at least in certain states, if you purchase a supplemental plan when you first hit 65 and start Medicare, you are O.K. Since so much of the medical system is Medicare (older people use a lot of care), you would think no one would sensibly object to the Obama plan, which has less of a government roll than Medicare. But, the explanation is that the current system for under 65 year old people is where the profit lies for many, many insurance companies. That is, those 65% to 75% payout ratios on individual policies mean there is 25% to 35% of premium left to be spread around to insurance agents, insurance company employees, and profit. Current Sytstem and Hidden Cost Shifting--Hidden Cost Shifting Now Worsening Due to Economic Meltdown The current system shifts the cost of medical care of those without insurance, and with lesser insurance, to the rest of us in a dishonest, hidden way. (An honest way would be to pay in an explicit way where the costs are calculated and announced-- e.g., the government budget with taxes. A dishonest way is just to have it all added to our medical and insurance bills, with nobody knowing what the amount really is. Hospitals and doctors rarely dare calculate the number, because if they have to tell you a third of your bill is really for other people, you might not pay.) The cost shifting is from the uninsured, who are required to be stabilized by law in a hospital whether or not they will be able to pay. Also, it occurs for hospital and doctor "charity" care. It occurs commonly for Medicaid -- when the state governments set doctor and hospital reimbursement rates too low. (And for example, in New York State, they've had a budget emergency due to the meltdown, and announced (11/12/08) a plan to cut the Medicaid payment amounts. So the cost will get shifted to all not-on-Medicaid state residents.) There is also cost-shifting in the patchwork of state government programs designed to help some of the uninsured, with a little too much income for Medicaid, get medical care. Those usually involve some government money, and also often involve an unrealistically low payment rate to doctors and hospitals (often with a law requiring that the doctors and hospitals accept that unrealistically low payment). This is yet more cost shifting, and of course this should get worse as state governments go into budget troubles. YOUNGER PEOPLE NOTE: You may be too young to know that in the early Bill Clinton Presidency years, around 1993, we were on the verge of getting universal healthcare in place when the special interests came in, ran these "Harry and Louise" ads to scare the people away from it. And it worked. (Thus, unlike the current financial meltdown, you can't really blame the government leaders--some of them were alert --you can blame the special interests, and the ability of some of the people to be mislead.) Since you, young people, can expect to have not one steady job, but rather 10 shorter-term jobs, over your lifetime, lets hope your parents and grandparents will let you have reliable and steady health care. Video: Economic Journalist Peter Gosselin and others discuss his book High Wire, about the increased risk of sudden financial catastrophes to families in America due to health insurance and other reasons. Frontline with Full Video on 5 Country's Systems Documentary Showing how well the current system is working for the working poor . The people followed in this documentary are all in the lower-middle and working-poor class. I find it a flaw that they missed the more well to do middle class, which is also at high risk. Though the better-off portion of the middle class has a lower likelihood of having no care or far inferior care most of the time than the working poor, the system still leaves no care and inferior care all too likely. And further, it gets combined with the likelihood of losing say $600,000 worth of savings all at once. (The working poor simply don't have that much in assets to lose.) American Prospect Special Report on Universal Health Care--May, 2008 . The following articles strike me as particularly lucid: Ezra Klein on two of the major proposals and their variants, Marcia Angell on the Massachusetts reform, and Anthony Wright on the California attempt. Cross-Insurer Database of Pre-Existing Conditions: Some people are not aware of it, and think they might give a try at just not putting down a pre-existing conditions. The health insurance industry maintains a large cross-insurer database of pre-existing conditions. Note below, my own policy's privacy statement indicates they can do that, as below, circled. ("Medical underwriting" is precisely pre-existing-condition-screening. The industry prefers that term, because it sounds more innocent, and most people don't know what it is.) WHY IS HEALTH INSURANCE DIFFERENT FROM OTHER INSURANCE LIKE FIRE AND AUTO?, (that don't need pre-existing condition regulation or subsidies). This is a perceptive question with a compelling answer. A)Pre-Existing Condition Regulations are Needed because the larger part of the cost of a medical event (heart attack, coming down with cancer, etc.) is not the immediate cost of treatment, but rather the future cost of treatment due to conditions which will pre-existing after the event. (Compare: If your house burns, it gets rebuilt and the insurer pays for that, but you can still get insurance on the new house because it is not more likely to burn again. Auto is actually similar -- yes, there is a detail that after an accident the insurer may presume you are a less good driver and raise your rate even 50% for a few years, but this is nothing like the event of a heart attack or cancer, where if you lose your current insurance, or you need to change insurers because your insurance pool gets cherry picked (see box below), your unregulated insurance premium (i.e. expected medical cost) may rise to 10 or 30 times what is was. Another way of looking at the paragraph above is that any truly rational consumer (with assets to lose) will only buy health insurance that covers, for a medical event, not only the cost of treatment now, but the elevated expected cost of future treatment which becomes apparent due to the current medical event. Of course, one reason no individual or job insurance offers this is that only about 2% of people are economics-quantitative analytical enough to see this even when pointed out, and the other 98% are oblivious to this. (Thus, for the health insurance product, consumers are not informed consumers -- rather they are terribly, terribly ignorant consumers for this product.) Another reason the rational-consumer insurance is unavailable is that such truly sound insurance is impossible to offer, based on the unpredictability of future medical advances and costs. Thus, the only available solution for a rational consumer would be to join a non-revocable agreement to pool medical costs with a large number of other individuals. Well, if you make that large group of individuals everyone, this is one form of universal care. B)Subsidies are Needed (even after regulation for pre-existing conditions) because many people simply can't earn enough to pay for the average cost of treating disease. This has much to do with the free-market spirit of U.S. regulations, where those with limited labor market power to garner a high wage (which arises largely because there is not a shortage of people doing the particular work that they do in the absence of unions of much higher minimum wages). C)Regulation Reducing Redundancy and Increasing Administrative Efficiency are not essential, but desirable, because of the extreme waste, partly in the insurance-marketing area. For example, because of so many insurers existing with all kinds of different rules, perhaps 20%-25% of doctor and hospital costs are due to assistants dealing with all the forms and different pre-approval rules for the different insurers. Further, on non-employer insurance, beyond that administrative loss on all health insurance, the insurance company only typically pays out 60%-72% in bills of the premium dollars it takes in. (I actually saw 55% for one individual insurance policy one time.) Thus, we spend 16% of GNP on medical care whereas the other industrialized countries spend 6%-11% or GNP, and many have longer life expectancies than us. TWO GENERAL SOURCES OF SOME BY-STATE AND CROSS-STATE INFORMATION: is the Georgetown University All-States Health Insurance Site. There is, for individual insurance, a by-state comparison table on the site: Georgetown By-State Table) THERE IS EVEN BETTER STATE-COMPARISION INFORMATION (ABOUT INDIVIDUAL AND STATE SMALL GROUP RULES) AT: kaiser statehealthfacts.org "Managed Care and Health Insurance" subpage., Who am I? I am Norm Spier, a mathematical statistician who has spent most of his life in Metro NYC, Upstate New York, and Connecticut. Recently (3/2010), I moved from Vestal, in Upstate New York, to the Five Colleges area of Massachusetts. If you have any comments, or want to point out an error or oversight, please email me at norm@nastechservices.com Ads This Site and Elsewhere: Buyer Beware! -- even Well-Meaning Sellers May Only Be Able to Provide Terrible Products Given Current Laws --And Many of Them Just Want Your Money! MISCELLANEOUS OTHER SITES OF MINE REFLECTING OTHER INTERESTS Social Science Books for Science People Musical Software 1 Musical Software 2 Musical Spectrograms Sites not mine of Interest: Jewish Voice for Peace (Jewish Organization offering contrasting view to the "Israel Lobby", opposes West Bank Settlements, members include myself.) Comment by Charles Freeman, Obama Intelligence appointee, on his withdrawal due to Israel Lobby pressure. This site is partly supported by donations (with very modest supplementation by advertising revenue). If you wish to donate viaPaypal, you may use this link: Important Legal Disclaimer: I am trying to put useful, helpful information on this page. However, I can not be responsible for any errors above. Therefore, please check with the appropriate state insurance departments, and/or seek legal advice, as appropriate, before relying on the information above. Also, please note the above information is copyright 2000-2012 by Norman A. Spier. This page contains (above) information on: Obama pre-existing conditions Obama Health Plan Baucus Health Plan pre-existing conditions obama Fixing pre-existing conditions Pre-existing conditions and health insurance