CLASS Act, individual mandate draw new attention to health bills

Some provisions in the health bills are attracting a new wave of analyses and some criticism of the health reform bills.

The "individual mandate" issue has taken on new life because of conservatives' "assertion that under the Democrats' plan, people who refuse to buy health insurance could spend five years in prison," The Wall Street Journal reports. Reform supporters have compared their reasoning to the "scare tactic" of warning about government "death panels" over the summer. "The notion of imprisonment has its origins in the bill's requirement that most Americans must get health insurance, with the help of government subsidies if necessary, or pay a special income tax of up to 2.5%. If someone refuses to get insurance and refuses to pay the tax, that person would be guilty of tax evasion. Criminal penalties for willful tax evasion, which are pursued in rare cases, include a fine of as much as $250,000 and up to five years in prison for the most egregious cases" (Bendavid, 11/18).

Meanwhile, The Associated Press reports on another provision in the bill: "Senate health care legislation expected this week is likely to include a new long-term care insurance program to help the elderly and the disabled avoid going into nursing homes, Democratic officials say."  The House included the Community Living Assistance Services and Supports Act, or CLASS Act program in its health care legislation, with the approval of the Obama administration. The act was a "top priority" for the late Sen. Edward Kennedy.

But CLASS Act opponents "have questioned whether the program would be financially sustainable over the long run, and insurance companies are lobbying to strip it from the health care bill." The proposal would create a new insurance program that collects "modest premiums" from workers. If they become disabled, it would give them at least $50 a day "to pay a home care attendant, buy supplies and equipment, make home improvements such as adding bathroom railings, or defray the costs of nursing home care. ... Critics' concerns got validation recently from a report by Medicare economists who are expert in long-range cost estimates. In a report issued last weekend, they said a voluntary insurance program is likely to attract people who expect they'll need the coverage. Without taxpayer subsidies, premiums would keep going up, discouraging healthy people from signing up" (Alonso-Zaldivar, 11/17).

And The Mercury News examined how the creation of a public option might affect California. "With a huge number of residents who buy health care on their own and relatively few companies selling them coverage, California is just the kind of market in need of a new government-run insurance plan, supporters of the controversial proposal dominating much of the health reform debate say. But some health care experts in California say it's far from certain that the public option, if it's even adopted, would become the low-cost, benefit-rich alternative to the private market that its proponents have touted. Nor, analysts say, is it likely the mortal threat to the insurance industry that opponents claim" (Zapler, 11/17).