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Health care -- one year later


President Barack Obama signs the health care bill in the East Room of the White House in Washington, Tuesday, March 23, 2010. (AP Photo/J. Scott Applewhite)

Health care -- one year later ... A nation still divided … and confused … Who’s left in Congress who voted for and against it … Where it stands in the courts … What’s ACTUALLY in effect … What will be and when … Bet you didn’t know … By the numbers

From NBC's Chuck Todd, Domenico Montanaro, Ali Weinberg, Carrie Dann, and Kevin Hurd
*** Health care -- one year later: Today marks the one-year anniversary of President Obama signing the health-care overhaul into law. That debate, the town halls, the process, and the late-night votes consumed every bit of the political oxygen for a year and were the subject of heated political rhetoric and spin (see: “Death panels,” pulling the plug on grandma, “government takeover,” socialism, and the public option). But look at what’s happened since (in order): the BP oil spill, the Greece riots, Elena Kagan to the Supreme Court, floods in Pakistan, Democrats’ “shellacking” in the midterms, Republicans take control of the House, Rahm Emanuel becomes Chicago mayor, Bill Daley replaces him at the White House, a new press secretary, no more Michael Steele, Tucson, Tunisia, Egypt, Japan, and Libya.

*** A nation still divided…: Back to the health-care anniversary … the needle hasn’t moved all that much on the health-care bill’s popularity. In the most recent monthly tracking poll conducted by the Kaiser Family Foundation, 42% of respondents said they had a favorable opinion of the bill compared to 46% who saw it unfavorably. In April 2010, just after the bill was signed, the numbers were a similar -- but more favorable -- 46%-40%. In November 2010, when the midterm elections put the politics of health care front and center, those numbers were 42%-40%. The 2010 exit polls, which reflected an electorate that voted to sweep Democrats out of power in the House, showed an equally split country -- with 47% saying it should either be expanded or left as is and 48% saying it should be repealed. Kaiser’s numbers are similar to the ones shown by our NBC/WSJ poll. In March 2010, right before the legislation passed, 46% said they supported passage, 45% opposed. That’s exactly the same breakdown as NBC/WSJ found 10 months later in January 2011 on a DIFFERENT question -- on whether they supported or opposed its repeal.


*** …And still equally confused: Polling indicates Americans continue to be confused about how the bill will impact them, what’s actually in it, what’s been implemented, and whether it’s been repealed. Kaiser shows that, as of March, 53% say they are “confused” about their feelings on the law. In April 2010, 55% said they were confused. That dipped to 42% by June, but then spiked back up to 53% by September, dipped again to 43% by December and ticked back up at the beginning of this year; 52% say that they don’t know enough about the legislation to understand how it will affect their lives. That’s about the same as April 2010, when 56% said so. Incredibly, almost half in February of this year said INCORRECTLY either the bill had been repealed (22%) or weren’t sure (26%).

*** Congress -- who’s left: Of the 219 House Democrats who voted for the health care bill, 171 remain. The four House Democrats who voted for the health-care bill and ran for Senate all lost. Of the 34 House Democrats who voted no, 14 remain. One, Charlie Melancon (LA-3) ran for the Senate and lost. Of the 56 Senate Democrats who voted for it, 46 remain, 11 of whom won re-election in 2010. Of the three Senate Democrats who voted against it, two remain. Only one -- Blanche Lincoln (AR) -- was up for re-election last year. And she lost. (Republicans point out that NO Senate Democrats voted against the bill the first time around on the Christmas Eve vote.) *** UPDATE *** Republicans also point out that "six of the last eight Senate Dems to decide whether to support the health care bill will either not run for reelection or have been beaten. The seventh will be in a dogfight this year and the eighth will likely be reelected barring something dramatic in Vermont: Lincoln – lost; Ben Nelson – will likely lose; Lieberman – retire; Bayh – retire; Webb – retire; Conrad – retire; Feingold (because it wasn’t liberal enough) – lost; Brown (D - OH) (because it wasn’t liberal enough) – ??; Sanders (because it wasn’t liberal enough) – ??"

*** Where it stands in the courts: Nearly two dozen legal challenges have been filed in federal court over the law, NBC’s Pete Williams reports. And while most have been dismissed on technical grounds, five resulted in decisions on the central issue -- whether the law’s requirement that nearly all Americans buy health insurance is unconstitutional. The five cases are pending before federal appeals courts, and one may reach the U.S. Supreme court during its next term. In three of those cases, filed in Virginia, Michigan, and Washington, D.C., judges said the law is constitutional. In the other two, brought by the states of Virginia and Florida, judges said Congress exceeded its powers in passing the law. The lawsuit filed by Florida was backed by 25 other states. Adding Virginia, that brings to 27 the number of states challenging the law’s constitutionality. Six more cases are pending in the lower courts.

*** How is the law affecting you RIGHT NOW? There were cries of, “Have you read the bill?” and “What’s in the bill?” which led to a lot of the confusion. Well, here’s some of what’s ACTUALLY in the bill that’s taken effect already or will this year, per NBC’s Betsy Cline and others:

- Children allowed to stay on their parents’ health insurance plans until their 26th birthday.
- A 10% tax on indoor tanning services. (Sorry, Snooki.)
- Seniors receive a $250 rebate to help cover the so-called “donut hole” in Medicare drug coverage
- Free preventative care covered by Medicare and private plans. (So, when your company says, “Good news, you now get free health-care screenings, child well visits, physicals and other preventative care,” that comes from the health-care bill.)
- Nursing mothers to be allowed lactation breaks
- Insurance companies no longer allowed to discriminate against children with pre-existing conditions
- Government-run insurance plan set up for adults with preexisting conditions who are denied coverage
- Government-run long-term care program set up. For those who participate, people pay premiums for five years and then will receive benefits if they need them -- “whether they are 20-somethings in snowboard accidents or 80-somethings with Parkinson’s disease,” the New York Times wrote.
- Insurance companies barred from placing lifetime caps on benefits
- Insurance companies barred from dropping patients’ coverage when they get sick
- Insurance companies must prove they spend 80% to 85% of premium revenue on medical services.
- Insurance companies required to disclose rate increases (and the reason) of 10% or more
- Small businesses (with fewer than 50 employees) begin receiving tax credits covering 35% of premiums to help them buy coverage. (This credit jumps to 50% in 2014.)
- States receive billions in funding for community health centers
- Drug companies face $2.5 billion in fees (rises in later years)
- Creation of a government research institute created to examine the effectiveness of medical treatments
- Establishment of a Medicare Independent Advisory Board, which will be tasked with trying to keep Medicare spending down and submitting legislative proposals to do so. It will first submit recommendations in 2016.

*** How will it affect you IN THE NEXT FEW YEARS? If most of that sounds good (that is, unless you’re Snooki), Republicans will rightly argue the law was front-loaded with many of the positive parts. In 2013, new taxes and fees go into effect for individuals making more than $200,000 a year (and families making more than $250,000 a year), on dividends and interest, and on sales of medical devices. By 2014, the individual mandate goes into effect -- if you don’t have insurance, you have to buy it or face a fee. By 2016, that fee will be 2.5% of your income or $695 a year, whichever is more. (Kaiser has a helpful interactive timeline here.)

*** Bet you didn’t know…: Senate Minority Leader Mitch McConnell’s office yesterday passed around a quote from Starbucks’ CEO, who said, “I think as the bill is currently written and if it was going to land in 2014 under the current guidelines, the pressure on small businesses, because of the mandate, is too great.” It’s true that by 2014, businesses with more than 100 employees will have to contribute to buying health insurance for their employees or face hefty fines (if at least one of their employees qualifies for tax credits, but not Medicaid). But, we bet you didn’t know that businesses with fewer than 50 employees NEVER have to buy health insurance for their employees, per the White House.

*** By the numbers: For all your quick facts needs, here’s a health care, by numbers (gathered from published reports, the Kaiser Family Foundation, government health-care Web sites, the Department of Health and Human Services, and White House “fact sheets”):

- $2.8 billion: Dollars distributed so far to states to implement the law.
- $241 million: Dollars given so far to six states and a “coalition of states” in “Early Innovator” grants
- $50 million: Dollars to go out this year for five-year medical malpractice grants to go out this year to states to “develop, implement, and evaluate alternatives to current tort litigations”
- $50 million: Dollars in grants sent to states to establish exchanges
- $46 million:
Dollars in grants so far to states to address insurance rate increases
- 4 million:
People received $250 because they hit the Medicare “donut hole” since the law passed
- 12,000:
People who were denied coverage because of pre-existing conditions since the law was passed and were added to the government-run Pre-Existing Condition Insurance Plan
- 1,040:
Waivers granted that allow companies to cap annual payouts at lower levels than the original law orders
- 219:
House Democrats voted for the health-care bill
- 171: House Democrats remain in Congress
- 63: House seats Democrats lost in the 2010 midterms
- 56: Senate Democrats voted for the bill
- 53:
Percent who say they’re still confused by the law
- 48: Percent who say they think the law has either been repealed (22%) or aren’t sure (26%)
- 46: Democrats who voted for the bill remain in the Senate
- 38:
States whose legislatures have proposed measures opposing elements of health reform
- 27: States have challenged the constitutionality of the law
- 26: Percent who say they’re not sure if the health-care law has been repealed
- 22: Percent who say incorrectly that the health-care law has been repealed
- 6: States -- Nevada, Kentucky, Florida, Georgia, North Dakota, and Iowa -- all have applied for waivers and are being reviewed
- 6: Cases pending in lower courts challenging the health-care law
- 5: Health-care lawsuits taken up by the courts out of the dozens of cases that were filed -- most centered on the individual mandate, which requires all Americans to buy health insurance
- 3: Steps the Small Business Administration created for small businesses to apply for or see if they qualify for government subsidies. The SBA claims, “Four million of the nation’s six million small businesses that employ workers could be eligible for these credits.”
- 3: Court decisions in court in favor of the administration
- 2: Court decisions against the administration.
- 1: State -- Maine has undergone the full process to get approval for a waiver on the 80%-85% provision of the health-care law. It got the provision adjusted to 65% through 2012. The reason for approval, per HHS: “The main insurance company that provides coverage for about” one-third of the 37,000 people on the individual market “said they may leave the market if they are required to meet the higher standard.”
- 1: Other state -- New Hampshire -- is farthest along in its waiver process and has a hearing set for Thursday.