When I heard the final Senate version of the healthcare reform bill, I had a complete meltdown (please see An Open Letter to President Obama). I had been sucker-punched by people who I thought I could believe in and it was clear that the democratic process had been replaced by corporate agendas.

 Louisiana Senator Mary Landrieu received an additional 100 to 300 million dollars for Medicaid, Nebraska Senator Ben Nelson cut a deal that guaranteed federal Medicaid payment for life (although this is now being challenged by several State Attorney Generals) and Connecticut Senator Joe Lieberman killed a public option because of his wife’s affiliation as a consultant and lobbyist to pharmaceutical and insurance companies.  Hadassah Lieberman was a consultant for Pfizer, who is one of the largest U.S. pharmaceutical companies and recently ordered by the U.S. Department of Justice to pay a $2.3 billion dollar lawsuit for healthcare fraud. Government lawyers settle $2.3 billion dollar Pfizer fraud lawsuit.

On Christmas Eve, the US Senate’s version of HR 3200, aka America’s Affordable Health Choices Act of 2009 passed. The House of Representative and Senate bills must now converge into one bill. The dynamics of that process will be interesting and we will need to watch our backs.

I challenged Doctors for America, an organization of approximately 16,000 physicians to answer the following questions regarding HR3200:

  1.  Will the premiums for people with pre-existing conditions be higher and by how much?
  2. Will there be some outside regulatory agency to govern the insurance companies in the event of misdeeds?
  3. Will there by co-pays and deductibles and by how much?
  4. Will there be a limit of services provided by these so-called state regulated insurance plans, i.e., will the poor receive less services based on the type of insurance they have?
  5. How much assistance will poor people receive regarding insurance premium payments? 10%, 20%, or 30%?
  6. Is there a cap on how much an insurance CEO can earn?
  7. Will there be reductions in payments of Medicare and Medicaid to physicians?
  8. Will these plans be taxed to people who earn above a predetermined income?

To the organization’s credit, they provided the following answers:

         1.   Older people will have to pay higher premiums at a ratio of 2:1 in the House bill and 3:1 in the     Senate bill. This means that as an “older” person, my premiums will either double or triple           based on the new “reform”. If you are a smoker, be prepared to pay higher premiums as well     and no, you can’t conceal your habits because they can do urine and blood tests in search of        nicotine.

          2.  Insurance companies will be required to report to the government on their performance, profits,  etc. A health insurance’s ability to participate in the Exchanges will depend on its performance.   If an insurance company increases its premiums prior to the Bill’s final approval, they will be  excluded as a candidate for the exchange.

        3.    Yes, there WILL be co-pays but there will allegedly be no more lifetime or annual limits on how  much an insurance company can pay on your behalf.                                       

         4.   Allegedly, there’s a minimum benefits plan on the Exchanges, and then several levels of plans above that. The minimum benefits plan provides “significantly” more benefits than the average individual plan today.

         5.   People earning 400% below the poverty line will have their insurance premiums subsidized.       Who are these people? Any individual who earns $43,000 or less and families of four who earn  less than $88,000. The table listed below illustrates provides an example of a subsidy.                                

         6.   At present there is no cap on the earnings of insurance CEOs but allegedly companies must spend between 80 to 85% of their revenues on medical care. They are also required to report profits annually and pay dividends to their customers if their profits exceed the cap.

         7.   Allegedly, there will be no cuts to either Medicare or Medicaid physician payments.

          8.  There is allegedly going to be an “excise” tax on “Cadillac” plans described as plans that cost  individuals more than $8500 per year or families more than $23,000 per year. Individuals  earning more than $200,000 and families earning more than $250,000 per year will pay 2.35%  more in Medicare payroll tax.    

                What does HR 3200 offer small business owners? Small business, with payrolls less than $250,000 per year will be exempt from the employer responsibility requirement. Allegedly, new small business tax credit will be available for companies who want, but can’t afford to provide their employees with healthcare insurance.

 As a physician, my main concern is patient care and safety both which have declined under an insurance-driven market. Have no doubt about it folks, the insurance companies are running the show and “old-school” physicians like me are growing weary of fighting near-impossible battles.  With the demise of the public option, who’s going to ensure that insurance companies play by the rules? Proposing that states assume that responsibility as suggested by the Senate Bill is unrealistic. The federal government had to enforce the Civil Rights Act back in 1964 and the same principle applies now. Without federal intervention, state governments will do nothing and insurance companies will conduct business as usual.

President Obama admitted that members of the US Senate and Congress have the best health insurance plans in our country. Why should WE settle for anything less?