House Republicans decided Thursday night to tie the passage of the doc fix to a 10-year delay of the individual mandate. If that sentence means nothing to you then you're in the right place. The short version is that the doc fix would add some long overdue stability to the way the government pays doctors for Medicare, while delaying the individual mandate a decade would likely reduce enrollment. The long version involves digging a little deeper into the terms, which we've done below. Here's your primer on all the politically charged terms floating around in the Obamacare debate.
See: risk corridor
Currently, the rate at which the government pays doctors for Medicare is set by the sustainable growth rate, which was established in the 1990s. As The Washington Post explained, the SGR is way too low, so every year or few months Congress allocates additional funds to keep doctor payments up. The reason it hasn't been fixed yet is that the Congressional Budget Office predicted it would cost $276 billion to fix the rate of Medicare payments in the budget for the next decade, and Congress would have to take that money from somewhere else in the budget — it's been cheaper and easier to fund it for short periods of time.
Recently, however, three things happened. The rise of healthcare costs slowed down, the CBO said it would only cost $139 billion for a permanent doc fix, and Congress drafted a bi-partisan bill for a permanent fix.
"Doc Fix" Ransom
And just when we thought Congress would pass a bipartisan bill to end years of inefficiency, House Republicans said they were planning on tying the doc fix to a 10-year delay of the individual mandate.
Basically, you need to have health insurance or you will be fined. The fine is $95 or one percent of your taxable income, whichever is greater. Recent studies show it'll probably be greater for most people.
Individual Mandate Delay
Something that is unlikely to ever happen, no matter how many times the House votes for it. The CBO has found, unsurprisingly, that delaying the individual mandate would lead to fewer people getting insurance, which would undermine the law. If it were to happen, it wouldn't be for a decade.
President Obama has referred to skimpy plans that lacked some of the 10 essential benefits mandated by the healthcare law as 'junk' plans sold by bad apple insurers. Some have argued that their plan wasn't junk — they liked it but they couldn't keep it — but some of the cancelled plans were actually garbage.
A government insurance program for low-income families.
Some states have not expanded Medicaid. Meanwhile, the Affordable Care Act doesn't offer subsidies to people whose income is below a certain point, since the assumption was that those people would qualify for Medicaid. The gap in the income bracket where you're too "well off" for Medicaid but too broke to qualify for subsidized healthcare. (Related: private option.)
The federal health insurance program for people 65 or older, some children with disabilities, and permanent kidney failure.
Medicare's private insurance option. Members sometimes get cool perks like free gym memberships. Both parties think the government pays doctors too much for the program (more than regular Medicare) but Republicans are now portraying cuts to Advantage as an attack on old people.
Arkansas worked with the federal government to create a version of Medicaid that utilizes the private sector and requires individuals to pay in. It was seen as an example of how Republican-led states could expand Medicaid without feeling like they were giving handouts. But then Arkansas' legislators got cold feet and almost failed to fund the program for 2015.
Basically, this is an insurance policy for insurers. Companies that end up with a healthier spread of individuals than they expected pay into the system, and that money goes to companies with sicker patients. The White House has said they expect the program to be budget-neutral and the CBO predicted it would net $8 billion over the next decade. Some Republicans have called it a bailout. It is not a bailout.
This article is from the archive of our partner The Wire.
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