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Health Care Reform Makes Historic Changes, But Without Gay Provisions

By Russ Klettke

The U.S. Congress passed the most sweeping healthcare policy changes in history last week with a narrow, Democrats-only majority. While benefits of the plan positively affect all people who lack large-company benefits plans, gay Americans were denied specific benefits in the legislation.  

Excluded were provisions championed by the Human Rights Campaign (HRC), The Center for American Progress and other progressive groups. These were: 

  1. The Tax Equity for Health Plan Beneficiaries Act, which would end the unfair taxation of employer-provided domestic partner health benefits (on average, a $1,069 annual cost to gay partners that heterosexual spouses don’t have to pay).
  2. Early Treatment for HIV Act, permitting states to offer HIV treatment under Medicaid to low-income individuals before their disease is full-blown AIDS (earlier treatment prevents disease progression and ultimately save taxpayers from covering more expensive, later-stage medical treatments and care).
  3. Funding to collect critical health data on LGBT people.
  4. End discrimination in health care, such as when gay partners are prevented from hospital visitation by a “family only” policy.
  Recognizing that no bill is perfect and that Sunday’s vote establishes a foundation for further revision, HRC promises to continue to fight for those benefits in the future. The HRC website also notes “on a mixed note” that the bill provides $50 million for abstinence-only sex education programs and $75 million for comprehensive programs that address prevention of sexually transmitted diseases. 

A good illustration of how healthcare reform can affect anyone is a story that surfaced in national media just days before the vote. 

The Reuters news agency reported on Jerome Mitchell, a rural South Carolina college freshman who had purchased his own health insurance policy in 2002 when he was 17. He learned he was HIV-infected after buying the policy, and subsequently his policy was revoked by his insurer (Fortis, now Assurant Health), based on erroneous information. Mitchell has since successfully sued the company, with the South Carolina Supreme Court upholding a lower court’s decision, that the company was wrong to revoke the policy. 

Targeting high-risk groups is a business practice frequently found in the current for-profit health insurance system. Sick people are a cost, and costs eat into profit. Fortis employed a computer program algorithm that automatically put every HIV-diagnosed customer under fraud investigation, and records that surfaced in Mitchell’s lawsuit reveal other policies were cancelled based on flimsy and erroneous information. 

The healthcare reform act prevents the rejection of patients on the basis of pre-existing conditions. The bill also limits premiums and out-of-pocket deductibles on a sliding scale, with assistance for those with lower income. 

I ran into friends, a couple, on the night before the vote. Their story provides a stark illustration of the good and bad of the old and new systems. One partner is HIV positive and an accomplished, independently employed individual. Ten years ago, when single, he personally paid $5000 per month in healthcare premiums and out-of-pocket medical expenses. He now is fortunate to be partnered with a public school teacher whose district provides partner benefits, such that his expenses are reduced to a fraction of that. They still have to pay a tax on those benefits, unlike heterosexual couples where the spouse pays no tax on the family policy. Under the new plan, a single individual with a pre-existing condition would find more affordable rates and deductibles.  

What about proactive health?
Largely absent from much of the year-long debate that preceded the vote was substantive discussion on preventive health, such rewards for people who pursue fitness and nutrition (given how three-quarters of healthcare costs are tied to “preventable chronic diseases,” according to the Centers for Disease Control). Note that “preventive” is often defined as early diagnoses of disease, less about healthy lifestyles. Nonetheless, some such provisions were included in the bill: 
  1. Includes $15.4 billion to support prevention and wellness activities, including research and delivery of preventive services via state and local public health infrastructure and by providing grants to implement recommended services.

  3. Requires chain restaurants (20 or more units) to post calorie counts on menus and make other nutrition information available.
  5. Requires insurance companies to spend 75 to 80 percent of revenues on clinical or preventive services (limits on salaries and stock dividends).
  7. Some grants will be provided to smaller companies to develop workplace programs for employees “at risk,” which usually means those who are overweight or smoke.
  So it’s not likely you’ll get a tax deduction for your gym membership, for hiring a trainer or for grocery trips to GNC. But perhaps a culture of wellness will mean fewer 2000-calorie menu items at major restaurant chains and maybe more public fitness facilities at your local city park. 

Who pays for it?
According to the CBO report, a net savings to taxpayers will be accrued over time, saving the federal treasury more than a trillion dollars over the next 20 years. But certain groups will experience some costs in the short run: 
  1. Starting in 2014, everyone must purchase health insurance or face a $695 annual fine. If you earn less than four times the poverty level (currently $10,830, or $43,320), you qualify for a government subsidy.
  3. Individuals earning more than $200,000 per year ($250,000 for families) will pay a 3.8 percent tax on investment income.
  5. If you use indoor tanning services, expect to pay a 10 percent excise tax.
  The fact that insurance is now mandatory is part of how it is expected to succeed. Many of the currently-uninsured are younger people in entry-level jobs with smaller companies. By increasing the size and healthiness of the risk pool—collecting premiums from more people who tend to be healthy—the system has more money to cover sick people. 

The fight was ugly
Opposition to the bill reached a fever pitch over the last several weeks, with openly gay Congressman (D-MA) Barney Frank having anti-gay epithets hurled in his direction on Sunday. "It's like the Salem witch trials, and health care is the witches," Frank said, who noted the noisy rancor was egged on by Republican legislators. "There is mass hysteria." In response to the slur, a supportive group of Catholics sang, "We love you Barney, oh yes we do."

The vote shows the narrow majority of support for a progressive approach to a hugely contentious and complex part of life: health. The bill defines the need for financial security in the face of adverse health events, and as such says that the country accepts this shared responsibility for taking care of each other. It also acknowledges the macroeconomic benefits of preventive care—even if specific provisions for fitness and nutrition are not yet part of public policy. 

Two late-in-the-game factors prompted the “yes” vote majority in the House. Just three days before the vote the Congressional Budget Office, whose role is to provide non-partisan, objective financial analyses of proposed bills before the Congress, projected a net reduction in the federal budget deficit over time if the healthcare overhaul is implemented as written into the current bill. On Sunday, seven anti-abortion Democrats were swayed to support the bill by assurances from the President that no new abortion funding would be provided by the legislation. 

About Russ Klettke: Russ Klettke is a business writer, an ACE (American Council on Exercise) certified fitness trainer and also the author of “A Guy’s Gotta Eat, the regular guy’s guide to eating smart” (Marlowe & Co., 2004, with Deanna Conte, MS RD LD), available where books are sold and in more than 70 public library systems in the U.S., Canada and Europe. For more information, see