The Anti-climactic Climax

Note from Lionel: Below is a post from Dr. Kevin Fickenscher. He joins the Dell team from the Perot Systems family where he has been actively engaged on a variety of healthcare-related topics. He will become a regular contributor to Direct2Dell and beyond. To see more from him, you can take a look at The Washington Reports. For more about him, take a look at his bio here. Here is his first post:

While the healthcare reform debate may be over, the long and winding road toward implementing the changes proposed in the legislation has only just begun.

After nearly a year of constant drama more akin to a daytime soap opera than an act of Congress, the healthcare reform debate is over. Following last Sunday's passage in the House , the Senate passed their reconciliation bill 56-43 on Thursday afternoon with hardly anyone in attendance and the galleries mostly empty except for the occasional reporter. While there was a slight hiccup in the process with regard to the language surrounding Pell Grants – the federal grants to fund a college education that was included in the reconciliation bill – Congress' comprehensive health overhaul is now complete.

As the Grateful Dead once said, "What a long, strange trip it's been."  It's an apropos description for the healthcare reform journey during the past fifteen months of the Obama Administration. With countless peaks and valleys, no one could have predicted – especially with the Democratic dominance in House and Senate as well as control of the White House – that Congress' efforts to reform the nation's medical system would have taken this road … or, this long. While it may seem that healthcare reform has crossed the finish line, as I've said many times before, we have only just begun. With nearly ten more years until all of the changes included in the bill take effect, I predict healthcare reform discussions will be with us for at least the coming decade and, more likely, two decades.  But, that's fine if you believe we need fundamental reform.  This legislation is a cornerstone, not the solution.

Let's take a look at what we can expect in the years moving forward…


  • All insurance plans must cover dependent children until they turn 26 while insurers are prohibited from denying coverage to children due to a pre-existing condition
  • Tax credits will be given to small businesses who employee up to 25 employees to support them in helping employees obtain coverage
  • A $250 rebate will be given to eligible seniors caught in the Medicare "doughnut hole" (Mom will be pleased)
  • A 10% sales tax on indoor tanning will be implemented (My daughter will be disappointed)


  • A $2.3 billion annual fee on drug makers will begin.
  • Employers will be required to report the value of their health plan on their W-2 tax forms
  • A 10 percent Medicare bonus will be given to primary care doctors and surgeons practicing in underserved areas
  • Establishment of a new voluntary long-term care insurance program for disabled people
  • 50 percent discount for brand-name drugs for Medicare recipients


Establishment of non-profit insurance co-ops to compete with commercial plans

Establishment of a new penalty on hospitals with high rates of preventable readmissions by cutting Medicare payments

Begins Medicare payment reforms by organizing pilot programs of "accountable care organizations" to test models of paying hospitals, physicians, and providers who care for Medicare patients


  • Start of new standardization of insurance company paperwork
  • Establishment of  a new 2.3 percent sales tax on medical devices
  • Raises the Medicare payroll tax to 2.35 percent on couples earning more than $250,000 and individuals making more than $200,000 while adding a new 3.8 percent tax on investments


  • New rules kick in that prohibit insurers from denying coverage to people with medical problems
  • Health plans are prohibited from limiting coverage based on pre-existing conditions
  • Premiums can now only vary by age, residence, family size, and tobacco use
  • New health insurance exchanges will launch to allow people to purchase coverage
  • Income-based tax credits will begin for those who access insurance through the exchange
  • All citizens will be required to have health insurance or pay a penalty
  • New penalties for employers with 50 or more workers who do not offer affordable insurance coverage will be implemented


  • A new "Cadillac" tax on employer-sponsored insurance worth more than $10,200 for an individual or $27,500 for a family will begin


  • The Medicare "doughnut hole" will officially be closed. Seniors will pay 25 percent of their drug costs until they reach the threshold for catastrophic coverage. When that happens, their payments will drop to 5 percent

So, there you have it. While it may seem that healthcare reform finally ended this week, we really have another 10 years to wait until all of the provisions take effect. With many provisions in the health bill not kicking in for a few years, it seems that Congress' reforms will not be fading into the sunset anytime soon…

About the Author: Kevin Fickenscher