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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 11:55 AM
Original message
When Social Security passed in 1935, it wasn't perfect
1939 Amendments

The original Social Security Act provided only retirement benefits, and only to the worker. The 1939 Amendments made a fundamental change in the Social Security program. The Amendments added two new categories of benefits: payments to the spouse and minor children of a retired worker (so-called dependents benefits) and survivors benefits paid to the family in the event of the premature death of a covered worker. This change transformed Social Security from a retirement program for workers into a family-based economic security program. (The 1939 Amendments also increased benefit amounts and accelerated the start of monthly benefit payments to 1940.) The 1939 Amendments thus became a pivotal turning-point. Indeed, the 1939 law is probably second in importance only to the original Act itself in shaping Social Security in America.

link


Could you imagine the mentality that would have voted against a bill that took four years to amend?

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jobycom Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 11:57 AM
Response to Original message
1. Dang.
Excellent post.
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Tommy_Carcetti Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 11:58 AM
Response to Original message
2. Beautiful.
:thumbsup:

Simple and to the point. Exactly what we need to know. Progress takes progress.
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emulatorloo Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 11:59 AM
Response to Original message
3. Good history lesson. Huge shifts/Immediate Breaks don't often happen in US. "Checks and Balances"
seems to prohibit that.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:23 PM
Response to Reply #3
11. Bury the facts. n/t
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leeroysphitz Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:00 PM
Response to Original message
4. It still is not perfect. Hell it is barely solvent at this point.
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optimator Donating Member (606 posts) Send PM | Profile | Ignore Thu Nov-12-09 12:01 PM
Original message
no comparison
SS isn't a private corporation and nobody is demanding "perfection"
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:03 PM
Response to Original message
7. "SS isn't a private corporation" Neither is SCHIP
Also what the hell does being private have to do with something representing progress?



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Hannah Bell Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 05:20 PM
Response to Original message
43. SS didn't mandate payments to private corporations. & it was transparently straightforward.
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T Wolf Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:01 PM
Response to Original message
5. But it originally did NOT require people to invest their money with private, predatory corporations
that had been cheating them for decades. Or guarantee those corporate profits continue forever.

Or ignore the wishes of the American people for true retirement security instead an insurance racket.

Not comparable in the least.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:05 PM
Response to Reply #5
10. So the insurance companies that people have to pay right now to get coverage are not private?
Again with the all or nothing BS.

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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:34 PM
Response to Reply #10
17. You are willing to accept the "next to nothing" just for a "win"
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emulatorloo Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 03:05 PM
Response to Reply #17
27. There is a lot more in the bill that is good than some DU'ers want to admit.
Edited on Thu Nov-12-09 03:05 PM by emulatorloo
Every day the industry spends more and more on trying to kill it. That's the endgame for them. Happily they have willing agents like Liebermann to do their bidding.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 05:16 PM
Response to Reply #27
42. Will you support this bill with the Stupak language intact?
If so, why? Are there other rights you are willing to relinquish to pass this bill? What rights would those be?:shrug: :shrug: :shrug: :shrug:
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MilesColtrane Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Nov-13-09 12:54 AM
Response to Reply #42
54. Stupak won't be in any bill sent to the Oval Office.
If it's in after reconciliation, it will be killed.

Politicians are greedy fuckers, but most aren't stupid.
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liberal_at_heart Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:02 PM
Response to Original message
6. That was before the corporations owned the country
The insurance companies are today what the tobacco industry was a couple of decades ago. They are all powerful. They have too much money, too much power and until they are taken down a notch like the tobacco indurstry was they will never allow real healthcare reform.
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Winterblues Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:05 PM
Response to Original message
8. Social Security is a bill that only helps the people..no corporations
Never from the very beginning was there any benefit for private industry. It was only to benefit American workers.. Now if we compare it to what is being promoted as a Health Care Reform bill...welllll.
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Toucano Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:05 PM
Response to Original message
9. Did it mandate that we purchase our retirement benefits from a privately owned cartel?
Your point is well taken, but there are some key differences.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:26 PM
Response to Original message
12. But it did not set back womens' rights 50 years, now did it?
Edited on Thu Nov-12-09 12:27 PM by MNDemNY
This House HCR bill does just that with the Stupak amendment. And you support the House HCR bill with the Stupak amendment, don't you??? Why is that? are you willing to just toss away reproductive rights for poor and middle class women??Why?
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PVnRT Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:28 PM
Response to Original message
13. Does it upset you that much that people are disappointed with the bill?
Poor thing.
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:32 PM
Response to Reply #13
16. She and her co-horts are only interested in a "win" for the administration.
All they want is the Rose Garden signing ceremony. Damn the consequences. They are actually OK with the Stupak amendment.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:35 PM
Response to Reply #13
18. Not at all. I'm really happy it passed.
Save your pity for those who are constantly criticizing anyone but Kucinich.

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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:43 PM
Response to Reply #18
22. so happy are you willing to let the Stupak amendment become law???
Will you drop your support if the Stupak language remains in the final bill??? YES or NO ???
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MNDemNY Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:31 PM
Response to Original message
14. It is not that this bill is not "perfect".
This bill is little more than assurance for the insurance industry profits. AND with the Stupak amendment , which you are OK with, it sets asunder 50 years of Democratic effort to insure reproductive rights for all american women. But you would toss that out just for a Rose Garden signing ceremony, now wouldn't you??
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OHdem10 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:32 PM
Response to Original message
15. What was different--you had real Democrats with spines who
Would Work to perfect it.

Because of the type Democrats we now have, we can expect
more and more Republicans back in office. I hate to even
think of how they will fix it.

The Republicans have a chance for one reason only--People
are angry. When Angry , we are irrational. The people
will go to vote full of anger. They will be voting AGAINST.
NOT VOTING FOR. Therefore, they will pull the lever AGAINST
the people in office. Human Nature is Human Nature.

Thinking they will be happy just because Democrats pass any bill.
If it is perceived as a bad bill, they will go that much more
ballistic. This pass anything strategy is a loser.



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Political Heretic Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:37 PM
Response to Original message
19. No, but when it was passed it had sufficient benefits and no critical defects
When is a bill "good enough?"

1. When it has sufficient benefits for the poor and working class
2. When it has no critical defects for the poor and working class
3. When the benefits sufficiently outweigh the remaining defects
4. And when, all things being equal, further effort to make a better bill would be more harmful than helpful.

In my opinion, the case of this Health Care "reform" bill, THOSE CRITERIA ARE NOT MET.
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Shagbark Hickory Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:39 PM
Response to Original message
20. Quit making exuses.
If nothing is done to take the profit motive out of health insurance then it's not reform.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:43 PM
Response to Reply #20
23. Pure nonsensical spin
A public option based on Medicare rates would have had more of an impact, but claiming this will have none is nonsense.

A robust public option changes the rate structure of the existing public option, but doesn't fundamentally change the bill.

Claiming that the choice is between a robust public option or no bill is silly. The progressive caucus fought for a stronger bill, and then voted for a good bill.






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Xithras Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:39 PM
Response to Original message
21. That summary badly glosses over what really happened.
The original 1935 bill was so poorly written that in only four years the program was on the brink of financial collapse, and the vast majority of Americans were still not covered. The Democratic Party reopened the discussion in 1939 with literally DOZENS of expansions planned, to build something more like what we see today (actually, what they had planned in 1939 would have offered even more coverage than we have today in 2009, and was a true social support program). What erupted was a partisan war that very nearly destroyed Social Security after only four years. The resulting 1939 bill was a compromise package that offered a more stable funding mechanism, and a modest expansion of coverage.

The fight was so fierce that the program became a political hot potato and wasn't touched again until the 1950's. It took more than a decade of arguing to get something as basic as part time worker coverage added to Social Security, and benefits for divorced women weren't included until the 1960's after another major political fight.

The SS we have today, with COLA's, equal benefits for all parties in a marriage, etc, wasn't finalized until the 1972 amendments. It took 38 years, following the original passage of the bill, to develop a sustainable SSDI program that people could actually live and retire on.

So yes, you can use Social Security as a model if you want, but I don't think doing so really supports your point. I'd rather not wait until 2047 for comprehensive healthcare coverage.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:44 PM
Response to Reply #21
24. "The original 1935 bill was so poorly written...."
You just made my point.

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Xithras Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:54 PM
Response to Reply #24
25. And you're ignoring mine.
CAN a poorly written health care bill eventually develop into something more comprehensive and socially acceptable? Of course it can. But how many decades will it take? How many millions of Americans will die between now and then because they're still caught in the "compromise" bureaucracy and can't get the treatments they need TODAY. How many years will it take to turn this canard into a real health care plan? 20? 30? 40? How long are you willing to wait.

The REAL problem here is that many on the left are stuck with a "lets just get a bill in place now" mentality and offer little thought as to what the coming years are going to bring us. I would MUCH rather see Congress spend more time building a REAL bill to offer REAL coverage, than to offer a halfassed one like they're doing now. Even if it takes 5 years of fighting to get it done, we'd still end up with comprehensive coverage far sooner than the compromise method that many here are supporting.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 12:59 PM
Response to Reply #25
26. You're contradicting yourself
From your previous comment:

The original 1935 bill was so poorly written that in only four years the program was on the brink of financial collapse, and the vast majority of Americans were still not covered.


Your current statment:

CAN a poorly written health care bill eventually develop into something more comprehensive and socially acceptable? Of course it can. But how many decades will it take?


You are proving my point: "Of course it can." One thing we do know is that when a bill fails after this much effort, the suffering continues for a decade or more until it's address again (see the Clinton health plan).

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Xithras Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 03:22 PM
Response to Reply #26
28. There is no contradiction in my statement.
Edited on Thu Nov-12-09 03:25 PM by Xithras
You, and many others, seem to be suffering from a horrible case of tunnelvision. If todays bill fails, introduce a new one tomorrow. Or amend the current one and reintroduce it. The idea that we will get NOTHING if the current bill fails is stupid and doesn't reflect reality. We can keep healthcare front and center in Washington for YEARS if we have to, if it will get us the program we want.

If our party walks away after this bill fails (and I hope it does fail, because it's a farce), that action would say more about the leadership of OUR party than anything else.

As for the Clinton failure, I have to point out that we lost Congress the following year, and didn't regain control of Washington again until this past January. There wasn't an opportunity to do readdress it. I also have to point out that MANY pundits have pointed to the Democratic parties abandonment of healthcare reform, and the subsequent anger it caused among those on the left, as one of the reasons behind the 1994 ascendance of the Republican party. We would be stupid to repeat that mistake. If the party angers the left again on this topic, it will simply show that they learned nothing from the last time we went through this.

I want real healthCARE reform, not health INSURANCE reform. They are not the same thing. Don't take my vote for granted. I don't vote for Republicans, even the ones who claim to be Democrats. If it walks like a duck, and gives money to giant corporations like a duck....
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 03:57 PM
Response to Reply #28
30. "If todays bill fails, introduce a new one tomorrow." What?
Edited on Thu Nov-12-09 03:57 PM by ProSense
That is a completely unrealistic statement.



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Xithras Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 04:17 PM
Response to Reply #30
31. As I said, a failure of leadership.
The only thing unrealistic about it is the lack of a spine that exists within the leadership of our party to do such a thing, and the lack of will among the party base to demand it.

If healthcare reform really matters to those in Washington, they won't let it die.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 04:21 PM
Response to Reply #31
32. " a failure of leadership"
The President is getting what he wants. Some people being unhappy about that isn't a reflection on his leadership. Most people are extremely happy the bill passed.

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Xithras Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 04:31 PM
Response to Reply #32
35. Most people? Hardly.
Polls here on DU and elsewhere all say the same thing. Only a tiny percentage of people actually LIKE this bill, a very large percentage (including me) actively despise it, and a somewhat larger percentage dislike it but are willing to take it as a "better than nothing" option.

Don't confuse the "lack of organized majority opposition" with "support". Aside from a few yappers on messageboards like this one, I have yet to meet an actual "Democrat on the street" who is really happy with this bill. Among voters, it certainly isn't a political win for the party. It sure as hell isn't going to translate into votes in the next election.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 04:33 PM
Response to Reply #35
37. "Polls here on DU "
:rofl:


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backscatter712 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 04:26 PM
Response to Reply #21
34. That's why the health care bill in Congress, if it passes, will work.
Edited on Thu Nov-12-09 04:29 PM by backscatter712
Everybody says "HR 676!!!!!111one", but nobody can show me the 218 House and 60 Senate votes required to get it into law.

We've got to be pragamtic.

So for all of you arguing that the current health care bill is a piece of shit, yes, you're right...

But it WILL be fixed.

Once in law, it will be next to impossible to take health care coverage away from the voters without politicians getting tarred and feathered, but the bad parts of the bill will end up getting patched.

But first, we've got to get version 1.0 of health care reform into law. Then we can work on fixing the broken stuff.

That's how this sausage-making machine works.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 03:23 PM
Response to Original message
29. "Administration should have engaged in a far more comprehensive...aid to the poor and unemployed"
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SIMPLYB1980 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 04:23 PM
Response to Original message
33. K&R
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 04:32 PM
Response to Original message
36. A few differences
1) As already mentioned, SS never involved forcing people to do business with an evil, profit at any cost industry.

2) In today's political climate, if the HCR is not a success pretty early after implementation it is unlikely to get 'fixed.'
Likely it will just get killed and not attempted again for another hundred years.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 04:47 PM
Response to Reply #36
39. "if the HCR is not a success pretty early after implementation it is unlikely to get 'fixed.'"
That's a pretty big if, especially since it will significantly reduce the number of uninsured.

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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 07:20 PM
Response to Reply #39
45. I suppose it may be a rousing success right out the barn door
but I don't see it doing much for the 50-64 crowd with the exception of the ones who can pay a high premium and are just left out now as the result of preexisting conditions. What I can see, as it stands now, is a couple in my age group who don't have employer based insurance and make over 58,280 per year will still find premiums outrageous and out of reach. The premium for my COBRA from my last job was $1200 per month. That would be 25% of our income if we were still working. I don't predict a lot of celebration from people in our age/class over this bill.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 07:40 PM
Response to Reply #45
46. Actually, this isn't quite accurate
What I can see, as it stands now, is a couple in my age group who don't have employer based insurance and make over 58,280 per year will still find premiums outrageous and out of reach. The premium for my COBRA from my last job was $1200 per month.


You would eligible to participate in the public option and your premiums would likely be capped based on your income.

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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 07:50 PM
Response to Reply #46
47. The way I read the bill people at over 400% of the poverty level do not qualify for subsidies
Edited on Thu Nov-12-09 07:51 PM by laughingliberal
Hoping this will change but that is the limit of income eligibility for help in the Senate version. The most generous subsidy was in one of the House bills and helped people at up to 500% of federal poverty guidelines. I used the 400% figures in my post as I believe it is the one most likely to make it in. Baucus' bill only allowed help for those at up to 300% of federal poverty guidelines.

The public option may help some but, as it stands now, so few will be eligible to enroll the risk will not spread wide enough to bring premiums down by much.

I'm as hopeful as anyone that we can get some benefit out of this. But, for the most part, I've resigned myself to my husband and myself trying to hang on til we are eligible for Medicare. He could make it. He's 62. Me? 54. Not eligible til 66 years and 2 mos old. A long way to go.

edited for typo
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 07:55 PM
Response to Reply #47
48. It has nothing to do with subsidies.
Premiums are capped.

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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 08:06 PM
Response to Reply #48
49. I don't see where the insurer has any obligation to cap my premium.
The language I have heard regarding caps is about subsidies-that people of modest means will get subsidies to keep the amount they pay at 12% or so of their income. People over the defined percentage of the poverty level have no such protection from high premiums. I see, in the House bill, insurers will not be allowed to charge people for age at more than a 2:1 ratio. Baucus' bill allowed 4:1. No telling what will come out. There are some provisions about medical loss ratio which will require the insurers to pay out a defined percentage of the premiums they take in for claims but I don't see that as capping a rate for an individual.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 08:08 PM
Response to Reply #49
50. It's in the bill.
Not only is there a cap, but also a tax on the more costly plans.

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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 11:24 PM
Response to Reply #50
51. I would love to think it is in the bill
Edited on Thu Nov-12-09 11:56 PM by laughingliberal
Here is what I find in the bill related to limiting premiums to a percentage of income. It is for individuals at up to 400% of federal poverty levels. It is done by providing affordability credits. There is nothing which prevents the insurer from charging more. The government will provide a subsidy to make up the difference. If you can find anything requiring the insurance cartels to base our premium on our income, I'd be happy to read it but I've read the bill and the only restriction on their pricing is the limitation of the 2:1 ratio for age and the medical loss ratios. Here is the relevant section of the bill:

http://thomas.loc.gov/cgi-bin/query/D?c111:2:./temp/~c111c3f0CF::

SEC. 343. AFFORDABILITY PREMIUM CREDIT.

(a) In General- The affordability premium credit under this section for an affordable credit eligible individual enrolled in an Exchange-participating health benefits plan is in an amount equal to the amount (if any) by which the reference premium amount specified in subsection (c), exceeds the affordable premium amount specified in subsection (b) for the individual, except that in no case shall the affordable premium credit exceed the premium for the plan.
(b) Affordable Premium Amount-
(1) IN GENERAL- The affordable premium amount specified in this subsection for an individual for the annual premium in a plan year shall be equal to the product of--
(A) the premium percentage limit specified in paragraph (2) for the individual based upon the individual's modified adjusted gross income for the plan year; and
(B) the individual's modified adjusted gross income for such plan year.
(2) PREMIUM PERCENTAGE LIMITS BASED ON TABLE- The Commissioner shall establish premium percentage limits so that for individuals whose modified adjusted gross income is within an income tier specified in the table in subsection (d) such percentage limits shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier.
(c) Reference Premium Amount- The reference premium amount specified in this subsection for a plan year for an individual in a premium rating area is equal to the average premium for the 3 basic plans in the area for the plan year with the lowest premium levels. In computing such amount the Commissioner may exclude plans with extremely limited enrollments.
(d) Table of Premium Percentage Limits, Actuarial Value Percentages, and Out-of-pocket Limits for Y1 Based on Income Tier-
(1) IN GENERAL- For purposes of this subtitle, subject to paragraph (3) and section 346, the table specified in this subsection is as follows:
----------------------------------------------------------------------------------------------------------------------------------------------------------------
The initial premium percentage is-- The final premium percentage is-- The actuarial value percentage is-- The out-of-pocket limit for Y1 is--
----------------------------------------------------------------------------------------------------------------------------------------------------------------
133% through 150% 1.5% 3.0% 97% $500
150% through 200% 3.0% 5.5% 93% $1,000
200% through 250% 5.5% 8.0% 85% $2,000
250% through 300% 8.0% 10.0% 78% $4,000
300% through 350% 10.0% 11.0% 72% $4,500
350% through 400% 11.0% 12.0% 70% $5,000
----------------------------------------------------------------------------------------------------------------------------------------------------------------
(2) SPECIAL RULES- For purposes of applying the table under paragraph (1):
(A) FOR LOWEST LEVEL OF INCOME- In the case of an individual with income that does not exceed 133 percent of FPL, the individual shall be considered to have income that is 133 percent of FPL.
(B) APPLICATION OF HIGHER ACTUARIAL VALUE PERCENTAGE AT TIER TRANSITION POINTS- If two actuarial value percentages may be determined with respect to an individual, the actuarial value percentage shall be the higher of such percentages.
(3) INDEXING- For years after Y1, the Commissioner shall adjust the initial and final premium percentages to maintain the ratio of governmental to enrollee shares of premiums over time, for each income tier identified in the table in paragraph (1).
SEC. 344. AFFORDABILITY COST-SHARING CREDIT.

(a) In General- The affordability cost-sharing credit under this section for an affordable credit eligible individual enrolled in an Exchange-participating health benefits plan is in the form of the cost-sharing reduction described in subsection (b) provided under this section for the income tier in which the individual is classified based on the individual's modified adjusted gross income.
(b) Cost-sharing Reductions- The Commissioner shall specify a reduction in cost-sharing amounts and the annual limitation on cost-sharing specified in section 222(c)(2)(B) under a basic plan for each income tier specified in the table under section 343(d), with respect to a year, in a manner so that, as estimated by the Commissioner--
(1) the actuarial value of the coverage with such reduced cost-sharing amounts (and the reduced annual cost-sharing limit) is equal to the actuarial value percentage (specified in the table under section 343(d) for the income tier involved) of the full actuarial value if there were no cost-sharing imposed under the plan; and
(2) the annual limitation on cost-sharing specified in section 222(c)(2)(B) is reduced to a level that does not exceed the maximum out-of-pocket limit specified in subsection (c).
(c) Maximum Out-of-pocket Limit-
(1) IN GENERAL- Subject to paragraph (2), the maximum out-of-pocket limit specified in this subsection for an individual within an income tier--
(A) for individual coverage--
(i) for Y1 is the out-of-pocket limit for Y1 specified in subsection (c) in the table under section 343(d) for the income tier involved; or
(ii) for a subsequent year is such out-of-pocket limit for the previous year under this subparagraph increased (rounded to the nearest $10) for each subsequent year by the percentage increase in the enrollment-weighted average of premium increases for basic plans applicable to such year; or
(B) for family coverage is twice the maximum out-of-pocket limit under subparagraph (A) for the year involved.
(2) ADJUSTMENT- The Commissioner shall adjust the maximum out-of-pocket limits under paragraph (1) to ensure that such limits meet the actuarial value percentage specified in the table under section 343(d) for the income tier involved.
(d) Determination and Payment of Cost-sharing Affordability Credit- In the case of an affordable credit eligible individual in a tier enrolled in an Exchange-participating health benefits plan offered by a QHBP offering entity, the Commissioner shall provide for payment to the offering entity of an amount equivalent to the increased actuarial value of the benefits under the plan provided under section 303(c)(2)(B) resulting from the reduction in cost-sharing described in subsections (b) and (c).
SEC. 345. INCOME DETERMINATIONS.

(a) In General- In applying this subtitle for an affordability credit for an individual for a plan year, the individual's income shall be the income (as defined in section 342(c)) for the individual for the most recent taxable year (as determined in accordance with rules of the Commissioner). The Federal poverty level applied shall be such level in effect as of the date of the application.
(b) Program Integrity; Income Verification Procedures-
(1) PROGRAM INTEGRITY- The Commissioner shall take such steps as may be appropriate to ensure the accuracy of determinations and redeterminations under this subtitle.
(2) INCOME VERIFICATION-
(A) IN GENERAL- Upon an initial application of an individual for an affordability credit under this subtitle (or in applying section 342(b)) or upon an application for a change in the affordability credit based upon a significant change in modified adjusted gross income described in subsection (c)(1)--
(i) the Commissioner shall request from the Secretary of the Treasury the disclosure to the Commissioner of such information as may be permitted to verify the information contained in such application; and
(ii) the Commissioner shall use the information so disclosed to verify such information.
(B) ALTERNATIVE PROCEDURES- The Commissioner shall establish procedures for the verification of income for purposes of this subtitle if no income tax return is available for the most recent completed tax year.
(c) Special Rules-
(1) CHANGES IN INCOME AS A PERCENT OF FPL- In the case that an individual's income (expressed as a percentage of the Federal poverty level for a family of the size involved) for a plan year is expected (in a manner specified by the Commissioner) to be significantly different from the income (as so expressed) used under subsection (a), the Commissioner shall establish rules requiring an individual to report, consistent with the mechanism established under paragraph (2), significant changes in such income (including a significant change in family composition) to the Commissioner and requiring the substitution of such income for the income otherwise applicable.
(2) REPORTING OF SIGNIFICANT CHANGES IN INCOME- The Commissioner shall establish rules under which an individual determined to be an affordable credit eligible individual would be required to inform the Commissioner when there is a significant change in the modified adjusted gross income of the individual (expressed as a percentage of the FPL for a family of the size involved) and of the information regarding such change. Such mechanism shall provide for guidelines that specify the circumstances that qualify as a significant change, the verifiable information required to document such a change, and the process for submission of such information. If the Commissioner receives new information from an individual regarding the modified adjusted gross income of the individual, the Commissioner shall provide for a redetermination of the individual's eligibility to be an affordable credit eligible individual.
(3) TRANSITION FOR CHIP- In the case of a child described in section 302(d)(4), the Commissioner shall establish rules under which the modified adjusted gross income of the child is deemed to be no greater than the family income of the child as most recently determined before Y1 by the State under title XXI of the Social Security Act.
(4) STUDY OF GEOGRAPHIC VARIATION IN APPLICATION OF FPL-
(A) IN GENERAL- The Secretary of Health and Human Services shall conduct a study to examine the feasibility and implication of adjusting the application of the Federal poverty level under this subtitle for different geographic areas so as to reflect the variations in cost-of-living among different areas within the United States. If the Secretary determines that an adjustment is feasible, the study should include a methodology to make such an adjustment. Not later than the first day of Y1, the Secretary shall submit to Congress a report on such study and shall include such recommendations as the Secretary determines appropriate.
(B) INCLUSION OF TERRITORIES-
(i) IN GENERAL- The Secretary shall ensure that the study under subparagraph (A) covers the territories of the United States and that special attention is paid to the disparity that exists among poverty levels and the cost of living in such territories and to the impact of such disparity on efforts to expand health coverage and ensure health care.
(ii) TERRITORIES DEFINED- In this subparagraph, the term `territories of the United States' includes the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, the Northern Mariana Islands, and any other territory or possession of the United States.
(d) Penalties for Misrepresentation- In the case of an individual who intentionally misrepresents modified adjusted gross income or the individual fails (without regard to intent) to disclose to the Commissioner a significant change in modified adjusted gross income under subsection (c) in a manner that results in the individual becoming an affordable credit eligible individual when the individual is not or in the amount of the affordability credit exceeding the correct amount--
(1) the individual is liable for repayment of the amount of the improper affordability credit; and
(2) in the case of such an intentional misrepresentation or other egregious circumstances specified by the Commissioner, the Commissioner may impose an additional penalty.

edited to add link
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 11:27 PM
Response to Reply #51
52. The credits don't have anything to do with the cap. They are separate issues. n/t
Edited on Thu Nov-12-09 11:27 PM by ProSense
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laughingliberal Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 11:38 PM
Response to Reply #52
53. Then find me the section that states the insurance company has to limit my premium to a percentage
Edited on Thu Nov-12-09 11:57 PM by laughingliberal
of my income. I'd be glad to see that. Ed Shultz has addressed this on his program that people over 400% of poverty level have no protection against the outrageous premiums. I have read the bill (riveting, I assure you) and I don't see it. The caps of which you speak are about the credits which make up the difference between 11% of the person's income and the premium the insurance company is charging. If I'm wrong, point me to the language in the bill which requires the insurer to consider my income when determining my premium.

http://thomas.loc.gov/cgi-bin/query/D?c111:2:./temp/~c111c3f0CF::

edited to add link
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dugaresa Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 04:42 PM
Response to Original message
38. Not a fair comparison, Social Security was a new program
it was at first a simple design that was later added to based on the needs of the citizens.

I support building a new system and discarding the old system of health care in this country.

However in the case of the current legislation I can't help but view it as putting layers of legislative gauze over a puss filled industry.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 04:48 PM
Response to Reply #38
40. The public option is a new system. n/t
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dugaresa Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 05:02 PM
Response to Reply #40
41. however i am currently covered under a bad employer based option
I only hope they let large corporations opt to join the public option.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Nov-12-09 06:37 PM
Response to Reply #41
44. Larger employers will be given access.
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