Health Care and Education Reconciliation Act

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US President Obama signs the PPACA

The Health Care and Education Reconciliation Act (HCERA) , together with the Patient Protection and Affordable Care Act (PPACA), also called Obamacare, was passed by the House of Representatives on March 21, 2010 and by the Senate on March 25, 2010 . The law includes changes to the PPACA called for by Congress and the Student Aid and Fiscal Responsibility Act (SAFRA), which replaces the Higher Education Act (HEA) of 1965. HCERA is seen as a concession for the Republican majority in the Senate to avoid the possibility for MPs to delay the legislative process through filibusters .

In principle, most Republicans are seen as opponents of the PPACA because they see the step from the private purchase of health insurance to a universal social insurance model as interference by the state in the private doctor-patient relationship and thus the personal freedom of every American would be restricted .

The law was officially signed by President Barack Obama at Northern Virginia Community College on March 30, 2010 and came into effect seven days after the PPACA, which became lawful on March 23, 2010 with Obama's signature. Among other things, the law increases the compulsory contributions to the Pell Grant program, a state training subsidy program of the Ministry of Education , which is intended to enable students who are financially needy to study, and includes changes to the Obamacare health care reform.

history

After the US Senate had approved the PPACA bill introduced by Obama on December 24, 2009 with a majority of 60 to 39 votes, the next step was for the Senate and the House of Representatives to vote on a uniform bill. Since the Democrats in the Senate lost their two-thirds majority shortly after the majority vote for the Obama bill due to a by-election, there was an opportunity for the Senate-seated Republicans to delay the legislative process by filibuster. The tactic of making the legislative process more difficult or prolonging the legislative process through "fatiguing speeches" in the Senate would have dragged out the decision of the PPACA and made an agreement in the Senate more difficult in the long term. Because of the democratic minority in the Senate, it was therefore necessary to make concessions for the Republican majority, which are reflected in the HCERA. The use of a reconciliation procedure with limited speaking time for all involved and joint work by the Senate and the House of Representatives was also decisive .

In order to bypass a filibuster blockade by the Republicans in the Senate, the House of Representatives voted in a first step on March 21, 2010 with 219 votes to 212 for the Patient Protection and Affordable Care Act of the Senate. In a second step, requests for changes from the House of Representatives were made effective on the same day by passing the Health Care and Education Reconciliation Act of 2010. Based on these changes, the Senate met on March 25, 2010 in the reconciliation process via HCERA and decided by a majority that filibusters were no longer possible. The Health Care and Education Reconciliation Act of 2010 was then confirmed by a majority in the Senate, with 56 to 43 votes, and officially legal with the signature of Barack Obama on March 30, 2010.

Since only one law based on reconciliation procedures can be passed in one fiscal year, the Student Aid and Fiscal Responsibility Act was added to the HCERA to avoid the danger of filibusters in the Senate. At the same time, the combination of these two laws should shed good light on President Barack Obama in the overhaul of America's health and student loan system. The savings caused by the student loan system were ultimately the decisive factors for the success of the entire draft law, since the draft law was only qualified for a reconciliation process through the deficit reduction resulting from the student loan system.

Content of the law

Modification of the draft law by the Senate

Senate vote by state

The changes implemented by the House of Representatives through HCERA to Barack Obama's PPACA bill, which the Senate initially approved with a two-thirds majority, included numerous changes to planned health care and health insurance. The most important changes are summarized below:

  • Increase in tax credits to finance insurance.
  • Dissolution of numerous offers that were added to the bill specifically for some senators.
  • Penalty reduction for those who do not purchase insurance from $ 750 to $ 695.
  • Postponement of the introduction of taxes on the "Cadillac health care plans" until 2018.
  • Compulsory full reimbursement for doctors caring for Medicare patients.
  • Introduction of a Medicare tax on unearned income for families who collectively earn more than $ 250,000 a year
  • More generous subsidies for low income groups. According to this, households below 150% of the federal poverty line pay 2 to 4 percent of their income as a premium. The mentioned health plans would cover about 94 percent of the costs for health services. According to the law, households with an income between 150 and 400 percent of the federal poverty line must pay around 4 to 9.8 percent of their income independently as a premium, with the rest being repaid by the government with a refundable tax credit. The health plans mentioned cover around 70 percent of the costs.
  • Introduction of a penalty for companies with more than 50 employees who are not offered health insurance by the company (valid from 2014). The fine applies to all full-time employees over 30 employees and is $ 2,000.
  • Increase in Medicaid rates for general practitioners in order to bring prices into line with the level of the Meidcaid rates from 2013 and 2014.
  • The government will cover the following costs for the expansion of Medicaid reforms: 100% of the costs incurred by 2016, 95% in 2017, 94% in 2018, 93% in 2019 and a constant 90% in subsequent years. Those states that are already insuring childless adults under the Medicaid umbrella will receive more money in the course of 2018 to continue funding these people.
  • Introduction of 50% discount on branded drugs for Medicare patients from 2011. Until 2020, the government is also guaranteeing up to 75% discount on branded and generic drugs to close the coverage gap.
  • Extending the prohibition on lifetime limits and withdrawing the protection of all existing health plans within six months of the signing of the law.

Student loan reform

The reform of student loans, which was also implemented as part of the reconciliation process in the Health Care and Education Reconciliation Act, largely includes wording and content from the Studen Aid and Fiscal Responsibility Act passed in 2009. The content of this bill, passed by the House of Representatives on September 18, is to use the savings made by the cancellation of the US Department of Education's educational support program to fund a new Federal Direct Perkins loan program. Prior to the Obama administration's student loan reform, most student loans were privately owned and subsidized by government funds to private donors. In the course of the reforms, this system was replaced by Pell Grants and income-oriented debt repayments. The aim of these reforms was to make student loans repayable for all students, regardless of their income, as many students have problems earning enough money immediately after graduation to pay off their debts in the agreed time.

Donald Trump presidency

Further information under: Continuation of the political conflict

Change in health plans

Already during the election campaign for the 58th presidential election between Hilary Clinton and Donald Trump , the laws on health care reform and student loan reforms passed by President Barack Obama were part of the debates between the two candidates. With the election of Donald Trump as 45th President of the United States , an opponent of the Obamacare reforms came to power who had already promised his voters during his election campaign to repeal and replace all of Obama's health reforms, including the Health Care and Education Reconciliation Act .

As early as January 2017, a few weeks after Donald Trump was elected, the Republican majority in the House of Representatives passed a financial resolution, which, among other things, included funds for the formulation of new health legislation. In addition, the prerequisites for carrying out a reconciliation procedure were created. Despite the unanimous opinion of the Republicans in the House of Representatives that the health reforms launched by Obama must be repealed and replaced, differences of opinion still prevail as to which parts of the entire Obamacare package should be dissolved and which can be preserved.

Numerous attempts by Republican MPs to have bills approved by the majority of the House of Representatives have so far failed or are currently still being discussed.

Student loan reform under Trump

During and after the Trump-Clinton presidential campaign, many Republicans have argued that the student loan reforms Obama implemented were expensive and inefficient. Even after his election as President of the United States, Trump continued to pursue this view and promised his constituents, shortly after his election as President, to present alternative reforms to student loans.

The reforms proposed by Donald Trump in the 2018 budget primarily include a cut in state social benefits, both in terms of health insurance and student loans. In terms of content, Trump's reforms differ from those of Barack Obama's mainly with regard to the loan term and the proportion of repayments in individual income. While Trump's reform plans propose an extension of lending to master’s students up to 30 years, lending to bachelor’s students is to be reduced to 15 years. The reforms implemented by Obama, on the other hand, provide for lending to bachelor and master students over a period of 20 years.

In addition, according to Trump, subsidized Stafford loans for undergraduate students are to be completely abolished. With regard to the repayment of student loans, Trump's reform proposals include an increase in the percentage of repayments in relative income by 12.5% ​​per month instead of the 10% set by Obama.

Individual evidence

  1. ^ Tax Provisions in the Health Reconciliation Act. Journal of Accountancy, March 25, 2010, accessed April 28, 2018 .
  2. ↑ a b Jennifer Smith, jsmith@ocap.org: HCERA - Health Care and Education Reconciliation Act of 2010. Accessed May 2, 2018 .
  3. ↑ Why Republicans Hate "Obamacare" . In: news.ORF.at . March 19, 2017 ( orf.at [accessed May 14, 2018]).
  4. ^ Federal Pell Grants . In: Federal Student Aid . April 10, 2018 ( ed.gov [accessed May 2, 2018]).
  5. ↑ US Senate: Obama loses strategic majority in the Senate . In: ZEIT ONLINE . ( zeit.de [accessed on May 2, 2018]).
  6. ↑ Public Law 111-152 - Health Care and Education Reconciliation Act of 2010. Accessed May 2, 2018 .
  7. ↑ Final Vote Results for Roll Call 167. Retrieved April 27, 2018 .
  8. ↑ FOCUS Online: Obama's health care reform now through the House of Representatives . In: FOCUS Online . ( focus.de [accessed on May 2, 2018]).
  9. ↑ a b Fredericksburg.com - Web . In: archive.is . January 23, 2013 ( archive.is [accessed May 2, 2018]).
  10. ↑ a b ObamaCare Facts: An Independent Site For ACA Advice. Retrieved April 28, 2018 .
  11. ↑ NASFAA | Summary of the Student Aid and Fiscal Responsibility Act (HR 3221) as Passed by the Full House. Retrieved May 2, 2018 .
  12. ↑ For this industry, Trump is ironically a disaster + more and more US student loans failing - finanzmarktwelt.de. Retrieved on May 2, 2018 (German).
  13. ↑ Opinion | Don't Let the GOP Dismantle Obama's Student Loan Reforms . In: The New York Times . April 9, 2018, ISSN  0362-4331 ( nytimes.com [accessed May 2, 2018]).
  14. ↑ Tom Kludt, CNN: What Donald Trump, Hillary Clinton have promised to do to Obamacare . In: CNN . ( cnn.com [accessed May 2, 2018]).
  15. ↑ Abolition of "Obamacare": Trump announces health insurance "for everyone" . In: FAZ.NET . January 16, 2017, ISSN  0174-4909 ( faz.net [accessed May 2, 2018]).
  16. ↑ US Health Care System: Republicans Begin Obamacare Abolition . In: Spiegel Online . January 12, 2017 ( spiegel.de [accessed May 2, 2018]).
  17. ↑ Obamacare: Republicans fail again with the abolition of Obamacare . In: ZEIT ONLINE . ( zeit.de [accessed on May 2, 2018]).
  18. ↑ Opinion | Don't Let the GOP Dismantle Obama's Student Loan Reforms . In: The New York Times . April 9, 2018, ISSN  0362-4331 ( nytimes.com [accessed May 2, 2018]).
  19. ↑ Budget: Has Donald Trump planned two trillion dollars twice? In: FAZ.NET . May 25, 2017, ISSN  0174-4909 ( faz.net [accessed May 2, 2018]).
  20. ^ A b Jason Delisle and Alexander Holt: Winners and losers in President Trump's student loan plan . In: Brookings . August 3, 2017 ( brookings.edu [accessed May 2, 2018]).