A Compromise on Obamacare

Published in Xinhua Net
(China) on 24 February 2010
by Du Jing (link to originallink to original)
Translated from by Jake Curtis. Edited by .

Edited by Alex Brewer

American President Obama announced a new health care reform bill on Feb. 22. The proposed bill goes against the Republicans' call for “ripping it up and starting over,” instead focusing on bridging the current divide between the Senate and House bills, while adopting part of the Republican position.

The American public sees the new health care reform bill and the upcoming bipartisan health care summit as Obama’s last-ditch effort to save health reform. The new bill faces heavy criticism from Republicans, yet Obama’s health care reform faces an even rockier road ahead.


How the Shape of Health care Reform Could Change

Obama set Feb. 25 as the date for the bipartisan health care summit to discuss details of health insurance reform. He hoped that Republicans would propose their own health reform bill prior to the start of the summit. Thus, the parties could use the meeting for discussion to create a compromise.

The Democrats previously had hoped to disregard Republicans, and through internal compromise, create their own version of a health care reform bill. However, at the beginning of the year, this hope evaporated with the election defeat in Massachusetts. In January, Democrats lost a Massachusetts senator in a special election, thus losing the advantage of an absolute majority in the Senate. Under these conditions, finding a way to win over a Republican to vote in their favor has become Obama’s toughest challenge in his push for health care reform; in all previous sessions on health care reform in both the House and Senate, Republicans have unilaterally casted an opposing vote.

To this end, Obama has made it clear that he wishes to cooperate with Republicans over the new bill. The White House Web site states that the new bill will draw from the Democrats’ desire to root out the waste, fraud and abuse in health insurance. However, the American media says that the new bill will be difficult to satisfy the Republicans, as the two parties are seriously divided on a few key issues.


Obama Strives for Compromise

Whether looking at the previous legislation that passed through the House and Senate or Obama’s recent proposal, both have a far-reaching scope across health insurance. Cutting spending on health care and lessening the government financial burden is a central consideration. Currently, approximately 46 million Americans are without health care; Obama’s bill would grant coverage to more than 31 million of those uninsured. Moreover, if the legislation is enacted, supporters hope that it would reduce the budget deficit by $100 billion over the first ten years and $1 trillion over the following decade.

The new bill to some extent represents a compromise on health care reform bills between the House and Senate. First of all, if the House bill came into effect, it would cost an estimated $9.5 trillion over the first ten years while the Senate bill in the same period would cost about $8.7 trillion — almost $1 trillion more. Secondly, the House and Senate’s biggest disagreement is over how to tax the wealthiest Americans to finance some of the health care reforms. On this issue, the new bill supports the Senate’s proposed tax on “Cadillac plans” but delays its implementation and raises the income threshold.

The Senate bill proposes a 40 percent tax on insurance at or above $23,000 annually for families or at or above $8,500 for individuals. And in the House version, there was a proposed additional tax for families earning greater than $1 million annually or $500,000 for individuals.

In Obama’s plan, the government will also tax the so-called “Cadillac plans,” but the initial implementation date of 2013 proposed by the Senate has been postponed to 2018. Additionally, the tax threshold has been raised to $275,000 dollars annually for families or $120,000 dollars for individuals.

As for the so-called “public option,” whether to establish a state-run health care system, Obama’s bill tacitly agrees with the Senate bill. The House bill includes content on creating a state-run health care system, with the goal of having state-run insurance openly competing with private insurance companies, providing policyholders with a cheaper option. However, this point has met strong opposition in the Senate.

Additionally, the new bill for the first time proposes establishing a “Health Insurance Rate Authority,” responsible for overseeing health insurance companies’ rate policies. The proposed authority would carry out adjustments, supervise and evaluate health insurance company rates and have the authority to reject unreasonable premium increases.


The Republicans’ Criticism

Despite Senate Minority leader Mitch McConnell saying they would attend the bipartisan health care summit, it would be unlikely that the Republican Party would propose their own version of health care reform bill prior to the meeting.

Compared with the Democrats, Republicans tend to prefer a relatively modest program of reform and make only “small adjustments” to the overall health care system. Prior to the announcement of Obama’s health care reform proposal, Republicans had remarked that they endorse the following four points of the Democrat’s plans for health care reform: 1) All Americans have the right to receive health care coverage, 2) insurance companies cannot refuse coverage or increase premiums based on prior medical history, 3) the government should provide access to medical care for the disadvantaged and 4) insurance companies must provide coverage for preventative medical care.

After Obama’s announcement on the new health care reform proposal, the Republicans continued to express their dissatisfaction. House Minority Leader John Boehner remarked that the new proposal was essentially still a government takeover of health care, weakening the credibility of the bipartisan health care summit.

McConnell called the new proposal “disappointing” and blamed the Democrats for “completely ignoring what Americans across the country have been saying.”

Analysts have said that, in the end, whether or not the Democrats and Republicans can come to a consensus on Obama’s new health care reform bill would depend on the outcome of negotiations, with particular focus on how it would benefit congressmen in the upcoming midterm elections.


奥巴马医改 妥协进行时
来源:新华网 作者:杜静 2010年02月24日08:10

  美国总统奥巴马22日公布新的医疗改革方案。新方案否定了国会共和党人将医改“推倒重来”的要求,着眼于在参众两院现有医改法案基础上弥合分歧,并采纳了共和党人的部分主张。
  美国舆论认为,新医改方案的提出和即将召开的国会两党医改会议,将是奥巴马为挽救医改所作的最后努力。然而,由于共和党人对新方案予以消极评价,奥巴马医改难关重重。


医改形势因何变

  奥巴马定于本月25日召集民主、共和两党人士开会讨论医保改革事宜,并希望共和党人在两党会议召开前提出自己的医改方案,从而在会上进行磋商,弥合分歧。
  如果说过去民主党人还有希望抛开共和党人,通过内部妥协来达成最终医改法案,那么今年年初民主党在马萨诸塞州的选举失利让这一希望彻底破灭。1月份,民主党人输掉马萨诸塞州国会参议员特别选举,从而在参议院失去“绝对多数”地位。在这种情况下,如何争取到共和党人的赞成票成为奥巴马在推进医改过程中面临的棘手问题,因为在此前参众两院通过各自医改法案过程中,共和党人无一例外地投了反对票。
  为此,奥巴马在新方案中显示了与共和党人合作的愿望。白宫网站说,新方案吸收了共和党人有关医改的一些设想,如打击医疗保险的浪费、滥用和欺诈等。但美国媒体认为,新方案很难让共和党人满意,两党在一些核心问题上仍存在严重分歧。


奥巴马力求折中

  无论是参众两院先前通过的医改法案,还是奥巴马刚刚提出的新主张,都将扩大医保覆盖范围、削减医疗开支、减轻政府财政负担作为重要政策考量。目前,约4600万美国人没有医疗保险,奥巴马新方案计划使这一群体中超过3100万人获保。同时,新措施实施后第一个10年内有望使美国政府预算赤字减少1000亿美元,在第二个10年内减少约1万亿美元。
  新方案在一定程度上代表着参众两院医改方案的妥协与折中。首先,在生效后的第一个10年内,新方案预计将耗资9500亿美元,而参众两院法案同期预计分别耗资8700亿美元和超过1万亿美元。
  其次,美国参众两院争执的焦点之一是如何增加对富裕阶层征税来为医改融资。在这个问题上,新方案支持参议院提出的征收“豪华保单”税,但延期执行并提高起征点。
  参议院法案提出对家庭年保费在2.3万美元或者个人年保费在8500美元以上的保单征收税率为40%的消费税。而众议院法案则主张对年收入100万美元以上的家庭或年收入50万美元以上的个人额外征收所得税。
  在奥巴马新方案中,政府将对“豪华保单”征税,但起始实施时间由参议院提出的2013年延后至2018年,起征点则提高到家庭年保费2.75万美元或者个人年保费10200美元以上。
  而在所谓“公共选择”,即是否建立国营医保机构问题上,新方案默认了参议院的主张。众议院法案包括建立国营医保机构的内容,目的是让国营保险机构与私营保险公司展开竞争,向投保人群提供廉价保险产品。但该条款遭到参议院的强烈反对。
  另外,新方案首次提出建立“医疗保险费率管理局”,负责监管保险公司的保费政策。该机构将对各保险公司的保险费率调整进行监督和评估,有权否决不合理的保费上调计划。


共和党评价消极

  尽管参议院共和党领袖米奇·麦康奈尔表示将携共和党人士出席两党医改会议,但舆论普遍认为,共和党在会前提出自身医改方案的可能性不大。
  与民主党相比,共和党人更倾向于相对温和的改革方案,对医疗体系进行“微调”。在奥巴马新医改方案公布前,共和党人表示在以下4个方面赞同民主党的医改主张:所有美国人有权获得医保,保险公司不得以过往病史为由拒保或上调保费;个人及小企业拥有联合议价权,可像大公司或工会组织那样以较低价格获保;政府可以向困难群体提供就医援助;保险公司必须为投保人的预防性医疗检查提供保险。
  奥巴马的新医改方案公布后,共和党人纷纷表示不满。众议院共和党领袖约翰·博纳说,新方案实质上仍是“政府接管医保”,它削弱了本周两党医改会议的可信度。
  麦康奈尔称新方案“令人失望”,并指责民主党人“忽视全美国人民的声音”。
  分析人士认为,民主党和共和党最终能否就奥巴马医改新方案达成共识,一方面取决于双方对医改内容的磋商结果,另一方面也与两党针对各自中期选举的利益考量息息相关。
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