2 Million Eager For Health Care On Parents' Plans

A 360 Degrees Perspective

Congress voted to overhaul the health care system on a Sunday. On Monday, Patti Lawson e-mailed her employer's human resources office to ask how soon she could get her 22-year-old daughter back on her health insurance.

In about six months, the new law will allow at least 2 million young adults to be covered under their parents' policies. These are the "millennials," those who came of age in the new century and now are struggling to get on their feet during the worst slump since the Depression.

Many can't find jobs, and many who are employed don't have health coverage from their employers.

The law will allow young adults to stay on or return to their parents' insurance until age 26. To qualify, young people must be "dependents" of their parents. They don't necessarily have to live under the same roof.

Lawson, a Gettysburg College administrator in Pennsylvania, said she is hoping to get her daughter back on her health plan because she is tired of playing "a roulette game." Her daughter has just a temporary job that doesn't provide insurance.

"You're banking on your child staying well," said Lawson, who has been a single parent since her husband died of cancer three years ago.

Regulations still have to be written, but here are some of the crucial specifics of the new law, based on a reading of the measure and interpretation by various experts:

• It applies to young adults up to their 26th birthday who don't have access to insurance through their employer.

• There is no dispute the measure applies to young people away at college. It is widely assumed the law also covers other young people living on their own.

• It will include married children but not their spouses or their kids.

• It is unclear whether parents must wait until their health plan's next open enrollment period to sign up their uninsured older children.

• Young adults who live in a different state from their parents should check to see if their parents' health plan covers medical services where they live.

This is the first time the federal government has forced insurance companies to let young adults stay on their parents' policies. More than half the states already have laws that extend the age of dependent coverage. New York and New Jersey push it all the way to age 30 and 31 and would be allowed to keep those provisions.

The new federal law "provides a minimum, not a maximum," said law professor Timothy Jost of Washington and Lee University. Also, while many state laws do not apply to coverage from self-insured employer plans, the federal law will, experts say.

Much will depend on regulations to be written by federal health officials.

Among other things, Health and Human Services will have to decide what constitutes "dependent," and the definition will not necessarily be the same one used by the Internal Revenue Service for tax purposes. Also, HHS will have to clear up the issue of whether young people who live far from home can stay on their parents' plans.

Young adults in their 20s are the most likely age group to be uninsured, and nearly 30 percent of them lacked insurance in 2008.

"Given the downturn in the economy and the unemployment rate among young adults, it's a really important provision in the bill," said Sara Collins of the nonpartisan Commonwealth Fund.

Since 2003, the group has written a report titled "Rite of Passage?" about uninsured young adults and how they often lose health coverage at age 19 or upon high school or college graduation.

"It's a problem that spans the income spectrum," Collins said.

Before the law takes effect, some young adults who are graduating from college or otherwise becoming ineligible to stay on their parents' plans may want to buy insurance through COBRA to bridge any gap in coverage. But that can be expensive; there are also short-term plans that can be found through Web sites like www.ehealthinsurance.com.

The law will help Portland, Oregon, mother Jessie Edwards sleep better at night. The nurse practitioner will be able to get both her young adult children covered as dependents on her insurance. Her 23-year-old son is losing his insurance this month, and her 25-year-old daughter has been uninsured for two years.

What frightens Edwards most is the possibility of one of them getting into an accident, she said. "What would we do? How would we cover that?"

Pat and John Curry of Augusta, Georgia, have two daughters, ages 23 and 21. Without the new law, the older daughter would lose coverage on the family health plan at her next birthday.

"It would be a tremendous relief to us if we could keep them on our insurance," Pat Curry said. "This is something that would give them just a little more time to get their feet under them with the economy the way it is."

Lawson bought her college graduate daughter, Katie Byrne, catastrophic coverage on the independent market, so she wouldn't be completely uninsured while she searches for a job with benefits. But the $100-a-month plan does not include doctor visits. Meanwhile, Lawson's 19-year-old son is still covered.

"My son can go to a doctor if he twists his knee playing soccer and it's a $15 copay," Lawson said. "Then I have a daughter who does not have the same benefits. It illustrates for me what a lot of Americans face."

Under Pennsylvania law, Lawson's employer could choose to offer coverage for dependents up to age 30, but her employer has decided not to do so.

In the meantime, Lawson plans to fill an Easter basket with dental floss, medications and other health items for her daughter.

She is encouraging her daughter to stay healthy while they wait to get her back on Lawson's plan.

On the Web:

FAQs on young dependent coverage

AP; Dept of Health and Human Services; The Wall Street Journal.

GOP Forces New House Vote On Health Overhaul

A 360 Degrees Perspective

Senate Republicans learned early Thursday that they will be able to kill language in a measure altering President Obama's newly enacted health care overhaul, meaning the bill will have to return to the House for final congressional approval.

It appeared initially that deleting the provisions, dealing with Pell grants for low-income students, should not cause major problems for Democrats hoping to rush the bill to Obama and avoid prolonging what has been a politically painful ordeal for the party. Democrats described the situation as a minor glitch, but did not rule out that Republicans might be able to remove additional sections of the bill.

The president, who signed the landmark legislation into law on Tuesday, was flying to Iowa later in the day for the first of many appearances he will make around the country before the fall congressional elections to sell his health care revamp.

Obama was appearing in Iowa City, where as a presidential candidate in 2007 he touted his ideas for health coverage for all. His trip comes with polls showing people are divided over the new health law, and Democratic lawmakers from competitive districts hoping he can convince more voters by November that it was the right move.

As an exhausted Senate labored past 2 a.m. on a stack of GOP amendments, Jim Manley, spokesman for Senate Majority Leader Harry Reid, told reporters that Republicans consulting with the chamber's parliamentarian had found "two minor provisions" that violate Congress' budget rules.

Republicans have been hunting for such violations in hopes of bringing down the legislation. Democrats had also been consulting with the parliamentarian, Alan Frumin, and hoped they had written a measure that would not be vulnerable to such problems.

The two provisions are expected to be formally removed from the bill on Thursday. Manley said he expected the Senate to approve the measure without them and send it to the House. He said Senate leaders, after conversations with top House Democrats, expect the House to approve the revised measure.

The Senate scheduled passage of the health bill for Thursday afternoon. Both chambers are hoping to begin a spring recess by this weekend.

Besides reshaping parts of the landmark health overhaul, the legislation transforms the federal student loan program -- in which private banks distribute the money -- into one in which the government issues the loans directly. That produces some federal savings, which the bill uses in part to increase Pell grants to needy students.

Democratic aides said the problematic provisions deal with protecting students from future cuts in their grants if Congress does not provide enough money for them. They violate budget rules because they do not produce savings, one aide said.

The development came as the Senate completed nine hours of uninterrupted voting on 29 GOP amendments to the legislation. Majority Democrats defeated every amendment.

The legislation would change the new health care law by making drug benefits for Medicare recipients more generous by gradually closing a gap in coverage, increasing tax subsidies to help low-income people afford health care, and boosting federal Medicaid payments to states.

It kills part of the new statute uniquely giving Nebraska extra Medicaid funds -- designed to lure support from that state's Sen. Ben Nelson -- that had become a glaring embarrassment to Democrats. It also eases a new tax on expensive health coverage bitterly opposed by unions and many House Democrats, while delaying and increasing a new levy on drug makers.

As they began pushing the bill to passage on Wednesday afternoon, Democrats ran into a mountain of GOP amendments. Outnumbered and all but assured of defeat, Republicans forced votes on amendments aimed at reshaping the measure -- or at least forcing Democrats to take votes that could be used against them in TV ads in the fall campaigns.

"There's no attempt to improve the bill. There's an attempt to destroy this bill," said an exasperated Reid, D-Nev.

"The majority leader may not think we're serious about changing the bill, but we'd like to change the bill, and with a little help from our friends on the other side we could improve the bill significantly," answered Senate Minority Leader Mitch McConnell, R-Ky.

Senators voted on 29 consecutive GOP amendments between 5:30 p.m. Wednesday and 2:30 a.m. Thursday, when they recessed.

By 57-42, Democrats rejected an amendment by Sen. Tom Coburn, R-Okla., barring federal purchases of Viagra and other erectile dysfunction drugs for sex offenders. Coburn said it would save millions, while Sen. Max Baucus, D-Mont., called it "a crass political stunt."

Democrats also deflected GOP amendments rolling back the health law's Medicare cuts; killing extra Medicaid funds for Tennessee and other state-specific spending; barring tax increases for families earning under $250,000; and requiring the president and other administration officials to purchase health care from exchanges the statute creates.

The landmark legislation that Obama signed Tuesday would provide health care to 32 million uninsured people, and make coverage more affordable to millions of others by expanding the reach of Medicaid and creating new subsidies. Insurance companies would be forbidden to refuse coverage to people with pre-existing illnesses, individuals could buy policies on newly created exchanges and parents could keep children on their family plans until their 26th birthdays.

The $938 billion, 10-year price tag would be financed largely by culling savings from Medicare and imposing new taxes on higher income people and the insurance, pharmaceutical and medical device industries.

AP; Reuters; US Senate; US House.

Tea Partiers: A Vow Revenge

A 360 Degrees Perspective

Tea party activists aren't just angry that Democrats passed a major health care overhaul, they are out for revenge.

The Tea Party doesn't see passage of the landmark reforms that usher in near-universal medical coverage as the end of the debate. Tea partiers instead vow to support attorneys general who plan a lawsuit seeking to declare the law unconstitutional. They are demanding the bill be repealed or not funded and want to kick out of office all supporters of the measure.

So far, the nascent movement has almost reveled in its rebellious and grass roots nature and has avoided becoming as much a part of the establishment as the Republican and Democratic parties. But some tea party organizers see the health care debate as a galvanizing force that could stir its followers to greater action and something to rally around with midterm elections this year.

In states across the country, tea party groups planned protests and vowed to target any congressional member who supported the measure passed Sunday night.

"There's going to be a whole, all-out effort for an Election Day onslaught," said Michael Caputo, a public relations consultant who works with tea party activists on the national level, as well as in Florida and New York. "The health care process has been an incendiary issue for the tea party organizations since Day 1. Losing that vote is going to inflame them more."

The number of tea party groups has been growing for a little more then a year. Many in the movement were previously not politically active and have a strong independent streak, making organization sometimes difficult.

Most share a common belief that government spending and influence should be limited and they're angry about policies President Obama and the Democratic-controlled Congress are implementing, including last year's $787 billion federal stimulus package and health care.

In a conference call with tea party activists Monday night, Eric Odom of the Patriot Caucus mapped ambitious plans to set up state chapters, organize voters online and raise money to oust incumbents who supported the health care overhaul.

He predicted the vote would increase support for the movement across the country.

The government "has declared war on our way of life," Odom from Nevada told listeners.

"It's now time to boot them from office," said Odom, who chairs the Liberty First PAC, a fundraising arm of the group. "We absolutely must have your help."

In Florida, about 85 tea party groups encompass about 100,000 people, according to Everett Wilkinson, a leader in the state's movement. A small rally is being planned in Boca Raton on Tuesday with more likely the rest of the week in response to the vote, he said.

There are similar reactions elsewhere.

"We will be more determined than ever to see that this country is governed the way the constitution intended," said Brenda Bowen, a tea party organizer in Greenville, Ala. "We are all getting our second wind. When we do, you'd better watch out."

Even though they didn't stop the bill, Tim Dake, organizer of the Milwaukee-area group GrandSons of Liberty, said he and others intend to push for a state constitutional amendment that would prohibit forcing people to buy health insurance. The amendment has been introduced by Republicans in the Democratic-controlled Wisconsin Legislature, but there are no plans to hold a hearing on it.

The Republican-controlled Legislature is pushing a similar measure in Florida. If lawmakers put it on the ballot, at least 60 percent of voters would have to approve it.

Christen Varley, head of the Greater Boston Tea Party Organizers, said the House health vote was both "heartbreaking" and a wake-up call.

"I think we all went to bed a little dejected last night, but from the communication I received this morning, people are energized," said Varley. Sarah Palin is scheduled to headline a tea party rally on historic Boston Common on April 14.

Massachusetts already has a form of universal health care, yet the state made passage of the bill more difficult when voters elected Republican Scott Brown to replace the late Sen. Ted Kennedy - who spent nearly his entire career pushing for health care for all. Brown's election took away Democrats' filibuster-proof majority in the Senate.

Willie Lawson, a Tampa-area conservative radio talk show host who speaks at tea party rallies, wondered what effect the vote will have on an April 15 event at a University of South Florida stadium.

"It's just a big punch in the gut. It really is to a lot of people," said Lawson, who wondered whether people new to the movement will be discouraged by the vote and not bother to come. Others, he's sure, will be more fired up.

"For some people it will just be more raw meat, more raw meat out the back door to get people to come," he said. "The hardcore people will be there. They'll be angrier than ever."

Whether or not tea partiers will be able to turn anger into organization may vary from state to state.

"People in the Tea Party movement are fiercely independent. They don't like being told what to do. It's like herding cats," said Chad Capps, strategy coordinator for a Huntsville, Ala., group.

While tea party activists have made themselves heard, University of North Florida political science professor Matthew Corrigan said the movement alone won't be enough to oust incumbents.

"Do they have energy? Yes. Have they been getting into the media? Yes, but they still haven't sold me on the fact that they can swing elections," Corrigan said. He added, however, that tea party activists could be more influential if they work with Republicans against Democrats.

And for Wilkinson, it doesn't just stop at voting out the lawmakers who supported the measure.

"When they leave office, we're going to make sure the private sector is aware of who they are and we'll make it virtually impossible for them to have a job even after they leave office," Wilkinson said. "Wherever they are, we will be there. We are not stopping. We're not going away. This is just the beginning."

The Tea Party; Liberty First PAC; GrandSons of Liberty; Reuters; AP; FOX News.

States Line Up To Challenge Health Overhaul

States are already lining up to sue the federal government over the constitutionality of President Obama's health care overhaul.

Officials in at least 10 states have agreed to file a lawsuit challenging the legislation.

Texas Attorney General Greg Abbott said he planned to file the complaint "the moment Obama signs the bill."

Abbott pledged to pursue the case "to protect all Texans' constitutional rights, preserve the constitutional framework intended by our nation's founders and defend our state from further infringement by the federal government."

Other states planning to challenge the bill were Alabama, Florida, South Carolina, Nebraska, North and South Dakota, Pennsylvania, Utah and Washington.

Nebraska Attorney General Jon Bruning said the measure "tramples on individual liberty and dumps on the states the burden of an unfunded mandate that taxpayers cannot afford."

Bruning, a Republican, is president of the National Association of Attorneys General. His statement did not explain why he believes the bill is unconstitutional. But other attorneys general have said it violates state sovereignty by mandating that all Americans have some form of health insurance.

The House voted 219-212 late Sunday to approve the overhaul, which would extend coverage to 32 million uninsured Americans and make a host of other changes. Obama could sign the bill as early as Tuesday.

AP; Reuters; FOX News; ABC News; Wall Street Journal.

Political Lift Of Health Bill Uncertain

A 360 Degrees Perspective

The initial blush of President Obama's health care triumph immediately gives way to a sober political reality - he must sell the landmark legislation to an angry and unpredictable electorate, still reeling from the recession.

Voters may not buy it.

And that could mean a disastrous midterm election year for Obama and his fellow Democrats.

"We proved that this government - a government of the people and by the people - still works for the people," the president said late Sunday, beginning his sales pitch from the White House one hour after Congress passed the sweeping measure.

"This isn't radical reform but it is major reform," he added. "This is what change looks like."

Obama and the Democrats are certain to look for a much-needed political lift from the legislation, a capstone for a young presidency and a party after decades of trying to remake the nation's health care system.

But there's no guarantee they'll get it.

For now at least, Obama is savoring victory; he looks strong, principled and effective for getting something huge done in a city many Americans detest.

Still, the near-term reward could easily be forgotten come November.

This campaign season already has been unforgiving for the White House and the Democratic Party, with a monumental loss in the Massachusetts Senate election and a spate of debilitating congressional retirements. And conditions seem ripe for the electorate to punish the party in power.

Voters are furious. They hate Washington. They also detest incumbents. They're concerned most about the economy. And unemployment that's hovering near 10 percent. They're also split over whether Obama's health plan is good for a nation with enormous budget deficits and climbing debt.

How those variables play out is anyone's guess.

Even so, Obama reassured rank-and-file Democrats before they cast what he rightly called a tough vote.

"It will end up being the smart thing to do politically because I believe that good policy is good politics," the president said Saturday at the Capitol.

Nearby, enraged tea party protesters filled the grounds and the steps of adjacent office buildings, railing against the measure and promising to fire lawmakers who backed it. Some cursed and yelled racial epithets at black lawmakers.

Protesters were back Sunday, the message the same: "Kill the Bill."

Ahead of the vote, a Gallup poll showed more Americans believe the measure will make things worse rather than better for the country as a whole and for them personally. And most polls show most people don't like the plan although some surveys showed Americans giving high marks to individual elements.

"It's very unusual that you have a major policy that doesn't have a majority of support in the public," said George Edwards, a Texas A&M University presidential historian. "When they enjoy the benefits of the bill, they may come around. But that may take some time."

Also unclear is how voters will treat Republicans. Some of the measure's elements go into effect immediately, such as coverage for children on their parents' policy until age 26 and prescription drug benefits for seniors. Republicans could be tagged obstructionists if the electorate likes these provisions and if the economy improves.

From now on, Obama and the Democrats will promote the measure's benefits while countering Republican nay-saying and griping about process. The president also will focus primarily on voters' most pressing concern -- jobs. And that may endear him to voters more than the passage of his signature domestic issue.

Obama's immediate concern is holding Democratic majorities in Congress. His own political re-election is a while off, but the White House is almost surely focused on it, too.

His job-performance rating is hovering near 50 percent and may not rise even after he put so much political capital on the line.

Past presidents have either seen their poll numbers stay the same or dip following passage of divisive, though history-making, measures.

That was true for Lyndon B. Johnson's Civil Rights Act and Great Society agenda in the 1960s, Ronald Reagan's economic measures in the 1980s, and George W. Bush's tax cuts in the early 2000s. The exception was Bill Clinton, who saw his support increase in the 1990s after signing a contentious budget measure and welfare reform legislation. But it eventually fell.

Obama's political boost may come later.

"There's a bump for the history books," said Fred Greenstein, a Princeton University presidential scholar. "When historians ask if this is a kind of squandered presidency, there will be health care to point to."

The immediate future is less certain.

Will voters give Obama credit for addressing the issue if many Americans won't feel most changes immediately? Or will voters punish Democrats for a year of partisan wrangling that has exacerbated Americans' anti-Washington feelings and diverted focus from the economy? Will health care even be on the minds of Americans struggling through recession?

Throughout the yearlong debate, the GOP derided the bill as "socialized medicine" and warned that it would be devastating. But Republicans may find themselves looking sheepish given that the status quo won't change for most people for years.

Democrats now have an accomplishment around which to unite. Also, critical constituencies like senior citizens and young voters will feel change soon. And independent voters may praise Obama for showing that a Democratic majority can make Washington work.

Still, Democrats face a public fed up with Washington and disappointed by a president elected to change it. A year of bitter haggling and legislative maneuvering may feed into the argument -- successfully stoked by Republicans -- that Democrats have failed to fix Washington.

That's the reason some Democrats now worry about losing control of Congress.

"The voters will have their say on the politics," says White House press secretary Robert Gibbs. Still, he adds: "The president was and the Congress were sent here to address the problems that people face in this country, and that's what voters want us to see."

AP; Wall Street Journal; Bloomberg; Reuters; BBC.

Health Bill's Passage: End Of Beginning Or Beginning Of The End?

A 360 Degrees Perspective

It took lawmakers a year to shape President Obama's health care bill. If it finally passes Congress, it'll take the better part of a decade to write the user manual for consumers and doctors, employers and insurance companies.

Some health insurance consumer protections would go into place immediately, significant but limited in scope. The big expansion in coverage comes about four years from now, allowing more than 30 million people to sign up for insurance, with financial help from the government for most. Ripple effects continue well after Obama has to leave office in 2017, assuming he's re-elected.

But even if the 2,700-plus-page bill passes, it's only the end of the beginning. The Obama blueprint will be carried out under less-than-ideal circumstances. Rising medical costs and an aging population will keep squeezing the federal budget. Lawmakers will have to revisit hard choices they sidestepped.

"This is going to play out over a generation," said Andrew Hyman, who oversees health insurance research for the nonpartisan Robert Wood Johnson Foundation. "The impact of the reform legislation will affect every facet of our health system. It will address how people get coverage, how health care is delivered, and how health care is paid for."

The House could vote on the final legislation as early as this week, with the Senate to follow. Here's a primer on some of the major effects for consumers and other key players:

IMMEDIATE CHANGES

Uninsured people with medical problems will have a workable alternative. The bill pumps $5 billion into high-risk insurance pools run by the states to provide coverage to those in frail health. Taxpayer-backed insurance won't be free, but premiums should be much lower than what's charged by private insurers willing to take those in poor health.

For people with private health insurance - about two-thirds of Americans - there would be some new safeguards. For example, insurers would be barred from placing lifetime dollar limits on coverage and from canceling policies except in cases of fraud. Children could stay on their parents' coverage until age 26.

THE SELF-EMPLOYED

Starting in 2014, self-employed people and those whose employers don't offer coverage would be able to pick a plan through a health insurance exchange, like a supermarket. It's modeled on the federal employee health program available to members of Congress, which offers a range of private insurance. Small businesses could also join the exchange.

More than 30 million people would buy their own coverage through state exchanges, and nearly 6 in 10 would be eligible for tax credits to help pay premiums. The aid would be generous for lower-income families, less so for those solidly in the middle class.

For example, a family of four making $44,000 would pay $2,763 in premiums, or about 6 percent of its income.

But a similar family making $66,000 would have to pay $6,257 in premiums, close to 10 percent of its income. That may be less than a mortgage, but it's more than a car payment.

Once the exchanges open, most Americans would be required to carry health insurance or pay a fine. Medicaid would be expanded to cover childless adults living near poverty.

People with employer-provided insurance would not see major changes. But if they lost their job, they'd be able to get coverage through the exchange.

SENIORS

Seniors have been understandably worried about the health care plan, since much of it is financed with Medicare cuts the government's own experts say could be unsustainable.

On the block are subsidies to private Medicare Advantage insurance plans, which now enroll about one-quarter of seniors. The government overpays the plans when compared to the cost of care under traditional Medicare. That largely translates to lower out-of-pocket costs for seniors in the plans, and the bill could trigger an exodus from Medicare Advantage as insurers are forced to raise their rates to stay in business.

But seniors stand to gain as well. Obama would gradually close the coverage gap in the middle of the Medicare prescription drug benefit. The so-called doughnut hole would start to shrink immediately, but it wouldn't be fully closed until 2020. In the meantime, seniors in the gap would get a 50 percent discount on brand name drugs.

The plan also improves preventive benefits for seniors in traditional Medicare.

DOCTORS

Primary care doctors and general surgeons practicing in underserved areas such as inner cities and rural communities would get a 10 percent bonus from Medicare. But the more significant changes for doctors would unfold slowly. The goal is to start rewarding doctors for keeping patients healthy, not just treating them when they get sick.

The plan would use Medicare as a testing ground for new ways of coordinating care for patients with multiple chronic illnesses such as high blood pressure, diabetes and heart problems, a common combination. Primary care doctors would become care managers for such patients, keeping close tabs on medications and basic health indicators.

Doctors and hospitals would be encouraged to band together in "accountable care organizations" modeled on the Mayo Clinic.

EMPLOYERS

Obama's plan wouldn't require employers to provide insurance to their workers, but it would hit them with a stiff fine if even one of their workers gets a federally subsidized coverage. Companies with 50 or fewer workers would be exempt, and those with 25 workers or fewer could get federal assistance.

But the fines could turn into a big headache for many employers, particularly since they may not be able to tell if their workers are getting benefits from the government. For example, a company with 100 employees that fails to provide coverage could face a fine of $140,000 under the plan Obama unveiled Feb. 22. Getting the bill from the IRS would become a dreaded moment for business owners.

INSURANCE COMPANIES

Health insurance companies would face unprecedented federal regulation and particularly close scrutiny of their bottom line. A fixed percentage of income from premiums would have to go to medical care, otherwise insurers would be forced to provide rebates to consumers. That share is 85 percent for large group plans, and 80 percent for plans in the small group and individual markets.

One of the central reforms of the bill won't start until 2014, when the exchanges open. From then on, insurers will not be able to turn away people with medical problems or charge them more.

On the Web:

White House Health Care Strategy

The Washington Post

US Conference of Catholic Bishops

The Rand Corporation

The White House; US House of Representatives; The Washington Post; USCCB; The Rand Corporation; Robert Wood Johnson Foundation; The Mayo Clinic.