Ezra Klein has been incredibly busy today.
What does the health-care bill do in its first year?
As most of you know, the bulk of the bill kicks into effect in 2014. But it's become a common GOP talking point to say that there are 10 years of taxes for six years of spending. The graph above compares what the bill spends with what it raises for each year between 2010 and 2019. What you'll see is that there are two years -- 2013 and 2014 -- when the bill is raising a lot more than it spends. The GOP has painted this as some sort of rank deception. Apparently, saving up before you purchase something is no longer fiscally responsible.
But though the bill won't be spending much in its early years, it won't be entirely absent. For a full list of benefits scheduled to activate in the first year, download this document (pdf). For a full timeline of the bill's implementation, grab this one (also pdf).
I'm not going to list every quick-acting provision here, because it would be redundant. The most genuinely useful of them will be the ability to keep kids on their parents' insurance until they're 26 (that begins six months after the bill passes), the $250 rebate for Medicare enrollees who fall into the prescription drug benefit's "doughnut hole" (the bill eventually closes the hole altogether), and an end to rescission of coverage or annual limits. At the beginning of 2011, employers in the individual and small-group markets have to spend 80 percent of each premium dollar on actual medical care, or they have to rebate the difference. Oh, and the tanning-salon tax triggers in July. Sorry, Mr. Boehner.
As the bill prepares for full implementation, there are some other policies worth pointing out. Many have been concerned that there will be a shortage of primary care doctors to deal with the influx of new patients. Starting in 2010, a variety of new loan repayment and scholarship programs kick into effect. But more importantly, in 2011, the government directly expands primary-care training programs and sends a 10 percent increase in payments to primary care doctors in the Medicare program (which makes being a primary care doctor relatively more lucrative).
You can pick through the policies yourself, and it's anyone's guess whether they'll be enough. But the architects of the bill are thinking about how to build a medical workforce that works with this legislation. That's why the American Medical Association, the American Nurses Association and the American Hospital Association all endorsed the legislation.
By Ezra Klein | March 22, 2010; 11:02 AM ET
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