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See also: "Provisions of the Patient Protection and Affordable Care Act
The Health Care and Education Reconciliation Act is divided into two titles, one addressing health care reform and the other addressing student loan reform.
Amending the Senate's Healthcare Bill
The Reconciliation bill made several changes to the "Patient Protection and Affordable Care Act that was signed into law 7 days earlier on March 23, 2010. These changes include the following,
- Increasing tax credits to buy insurance
- Eliminating several of the special deals given to senators, such as "Ben Nelson's ""Cornhusker Kickback"
- Lowering the penalty for not buying insurance from $750 to $695
- Closing the "Medicare Part D ""donut hole" by 2020 and gives seniors a rebate of $250.
- Delaying the implementation on taxing "Cadillac health-care plans" until 2018
- Requiring doctors who treat Medicare patients be reimbursed at the full rate
- Setting up a Medicare tax on the unearned incomes of families that earn more than $250,000 annually.
- Offering more generous subsidies to lower income groups. Households below 150% of the "federal poverty level would pay 2% to 4% of their income on premiums. Health plans would cover 94% of the cost of benefits. Households with incomes from 150% to 400% of the federal poverty level ($88,200 for a family of four) would pay on a sliding scale from 4% to 9.8% of their income on premiums, rest will be covered by government advanceable, "refundable tax credit. Health plans would cover 70% of the cost of the benefits.
- Setting a penalty for a company with more than 50 workers not offering health care coverage after 2014, of $2,000 for each full-time worker above 30 employees. For example, an employer with 53 workers will pay the penalty for 23 workers, or $46,000.
- Increasing Medicaid payment rates to primary care doctors to match Medicare payment rates, which are higher, in 2013 and 2014.
- Having the federal government pay all costs of expanding Medicaid under the reform until 2016, 95% in 2017, 94% in 2018, 93% in 2019, and 90% thereafter. Some states that already insure childless adults under Medicaid would receive more federal money for covering that group through 2018.
- Providing a 50% discount on brand-name drugs for Medicare patients beginning in 2011. By 2020, the government would pay to provide up to 75% discount on brand-name and generic drugs, eventually closing the coverage gap.
- Extending the ban on lifetime limits and rescission of coverage to all existing health plans within six months after signing into Law.
Student loan reform
Title II of the reconciliation bill deals with student loan reform. The language is very similar to the "Student Aid and Fiscal Responsibility Act that passed the House in 2009; but with some slight variation. The reform package included,
- Ending the process of the federal government giving subsidies to private banks to give out federally insured loans. Instead loans will be administered directly by the Department of Education.
- Increasing the "Pell Grant scholarship award.
- For new borrowers of loans starting in 2014, those who qualify would be able to cap the amount they must spend on loan repayment each month to 10% of their "discretionary income, down from 15%.
- For new borrowers after 2014, loans would be eligible to be forgiven to those who make timely payments after 20 years, down from 25 years previously.
- making it easier for parents to take out federal loans for students.
- using several billion dollars to fund schools that predominantly serve poor and minority students, as well as increasing community college funding.
The law codified the "economic substance" rule of "Gregory v. Helvering from 1935, which allows the IRS to invalidate "tax avoidance transactions in certain situations.
The "Congressional Budget Office's last estimate predicted that if both bills were passed into law in 2010, the net reduction in "federal deficits would be $143 billion over the 2010–2019 period as a result of the proposed changes in direct spending and revenues. That figure comprises $124 billion in net reductions deriving from the health care and revenue provisions and $19 billion in net reductions deriving from the education provisions. The health care and revenue provisions consist in part of several new taxes, fees on health-related industries, and cuts in government spending on healthcare programs like "Medicare Advantage.
- ^ Pub.L. 111–152, 124 "Stat. 1029, codified as amended at scattered sections of the Internal Revenue Code and in 42 U.S.C., 19 U.S.C., and 20 U.S.C.
- ^ Obama signs higher-education measure into law William Branigin The Washington Post March 30, 2010.
- ^ "Obama To Sign Health Care Reconciliation Bill". tpmlivewire.talkingpointsmemo.com. March 2010.
- ^ Gay, Sheryl (March 17, 2010). "Health Vote Caps a Journey Back From the Brink". The New York Times. NYTimes.com. Retrieved March 21, 2010.
- ^ "Concurrent Resolution on the Budget for Fiscal Year 2010 - S.CON.RES.13".
- ^ a b Klein, Philip (2010-03-15). "The Health Care "Shell" Game Begins". The American Spectator. Retrieved 7 April 2010.
- ^ HR443P1.PS
- ^ HR443P2.PS
- ^ http://www.rules.house.gov/111/RuleRpt/111_hr4872_rpt.pdf
- ^ a b Brown, Carrie Budoff. "Loan bill could give Obama twin win". Fredericksburg.com. Retrieved 21 January 2011.
- ^ "COMMITTEE ON RULES - Senate Amendments to H.R. 3590 Patient Protection and Affordable Care Act H.R. 4872 Reconciliation Act of 2010". Rules.house.gov. Retrieved March 21, 2010.
- ^ Roll call vote 167, via Clerk.House.gov
- ^ Health Care Fix-It Bill Headed for Revote 25 March 2010
- ^ http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h4872eas.txt.pdf
- ^ http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h4872pcs.txt.pdf
- ^ Roll call vote 105, via Senate.gov
- ^ Roll call vote 194, via Clerk.House.gov
- ^ Reconciliation bill posted. Live Pulse. POLITICO.com March 2010
- ^ a b c d e f Hossain, Farhana (March 19, 2010). "Proposed Changes in the Final Health Care Bill". The New York Times.
- ^ "Policies to Improve Affordability and Accountability". The White House. February 22, 2010.
- ^ Text of H.R.4872 as Reported in House: Health Care and Education Affordability Reconciliation Act of 2010 - U.S OpenCongress
- ^ a b c http://edlabor.house.gov/blog/2010/03/student-loan-reform-whats-in-i.shtml#more
- ^ a b "What would change if student lending legislation passes". The Washington Post. March 26, 2010.
- ^ Big Changes Coming to Student Loans - US News and World Report 24 March 2010
- ^ Rose CA. Tax Lawyer’s Dilemma: Recent Developments Heighten Tax Lawyer Responsibilities and Liabilities. Columbia Business Law Review. Volume 2011, Issue 1.
- ^ "Cost Estimate for Pending Health Care Legislation". CBO Director's Blog. n.d. Retrieved March 21, 2010.
- ^ "Health care reform bill 101: Who will pay for reform?". Christian Science Monitor. 22 March 2010. Retrieved 22 March 2010.