1. House Health Care “Reform” Bill Passed late Saturday night – 220-215 Proposes to cover 36 million Americans currently without health insurance Major expansion of Medicaid – Up to 150% of federal poverty level Includes government health care option – Hospitals/providers negotiate rates with government insurer Fine for individuals who do not purchase health insurance Cost - $1 Trillion…1990 pages

2. House Health Care Reform Bill Private insurers cannot deny/drop coverage Increased income tax on those making more than $500,000 Medicare expenditures cut by 1.3% – $15 billion falls on prescription drug industry 2.5% tax on medical device manufacturers “Medicine Cabinet Tax” on HSAs Stupak Amendment – Prevents federal funding for plans that cover abortion

3. Concerns Medicaid broken! – Why expand a program all agree is broken? States pick up almost half the tab and it is required – This will force other programs to take a hit OR – Tax increases to fund the status quo This has not worked in TN, MA…why do it?

4. Concerns More people will move to government health care and thus COST-SHIFT HSAs are weakened by this legislation Medicare benefits are cut/Medicare Advantage undercut Still leaves almost half of the uninsured untouched Fines for those who do not insure

5. Concerns Can we afford this 1,000,000,000,000.00? Will mandates grow jobs? When will these new programs be passed along to the states? How many new government jobs are required to carry out this mandate? How much will be spent before the first person is helped? Tort Reform?

6. Other Ideas 1996 Welfare Reform – Let states use existing dollars to come up with own plan – Give national government true cost control – Flexible on many fronts – Proven model – Allow states to be empowered – Removes mandates

7. Other Ideas Help move people on margins from Medicaid to private – Instead of being on government program they move to their companies HMO/PPO Allow people to purchase health insurance across state lines Give tax credits to the individual instead of the company

8. Other Ideas HSAs better than no insurance especially for the “invinceables” Put cost of medical services on the wall Barebones coverage instead of required mandates More aggressive anti-fraud measures

9. Interest Groups Insurance Companies Hospitals Doctors Patients Small Business Owners

10. Interest Groups Insurance – Lose patients when they go to Medicare – Baby Boomers Like – Required coverage means more patients to insure Dislike – Public plans lure away customers – Regulation means higher prices – Tax “Cadillac” plans…

11. Interest Groups Hospitals – Hurt by low Medicaid reimbursement – Lack of EMR Like – EMR – Coverage for uninsured helps cut “charity care” – Stop doctors from ownership of hospitals Dislike – Lower reimbursements for Medicare

12. Interest Groups Doctors – Face high malpractice rates “defensive medicine” – Low reimbursement rates and lack of primary care Likes – Loan forgiveness for primary care – Medical home compensation Dislikes – Lower reimbursements – Less acute care means less business

13. Interest Groups Small Business – More are dropping coverage due to increased cost Likes – Buy into larger risk pool – Could be exempt from new plan if small enough (10-25 employees) Dislikes – Forced health benefits in weak economy – Higher prices or let employees go due to costs