President Obama, who has been personally lobbying fence-sitters, postponed his trip to Australia and Indonesia for a down-to-the wire vote, set for Sunday, on sweeping legislation that has been more than a year in the making and has drained his political capital.

Despite the complicated parliamentary maneuvering that will be required to get the Senate to accept the “fixes” the House wants on the underlying Senate bill, House passage of that bill will make it the law of the land with Obama’s signature.

The budget office found that the House changes to the Senate legislation will shave $138 billion from the federal deficit over the next decade and save as much $1.2 trillion over the following decade after the more than $900 billion is spent on expanding coverage and other benefits.

Conservative critics called those figures implausible, and Republicans said Pelosi got them by raising taxes and cutting Medicare. But the budget office’s word is gold on Capitol Hill, where the agency is considered by both parties to be a neutral, professional arbiter.

Its bottom line meets Obama’s key objective that health care reform curbs deficits.
House changes

The House unveiled its changes, which would expand the Senate bill’s benefits and reduce a “Cadillac tax” on high-cost insurance plans. To make up the revenue, it would impose a 3.8 percent Medicare tax on unearned income for people who earn more than $200,000 a year and further reduce payments to GOP-backed Medicare Advantage plans, which offer a wider array of benefits than standard Medicare.

Dropped from the changes was a provision by Sen. Dianne Feinstein, D-Calif., crafted in response to Anthem Blue Cross’ planned rate increases as high as 39 percent in California, that would have created an insurance regulator. The provision, backed by Obama, was ruled out of order under the special rules required to get the package of House changes through the Senate.

Several members of the Hispanic caucus swung behind the bill, abandoning objections to Senate provisions to ban illegal immigrants from buying health insurance, for what they called the larger effort to broaden health care coverage.

Anti-abortion Democratic Rep. Bart Gordon of Tennessee also moved into the “yes” column. Wednesday’s endorsement of the bill by groups representing 59,000 Catholic nuns gave political cover for abortion foes who have been a major block to reaching the 216 votes required for House passage.

The nuns, who broke with Catholic bishops who contend the Senate bill does not go far enough to ban taxpayer funding of abortion, told lawmakers that the health care overhaul is “the real pro-life stance” because it will help provide health care for pregnant women.

The AFL-CIO also endorsed the legislation, despite the nation’s largest labor federation’s opposition to the Cadillac tax. The House changes would greatly reduce the tax over the next decade, but after 2018 it would be tied to the general inflation rate, which is much lower than the rise in health care costs.

The tax would help reduce the enormous federal tax subsidy to health insurance. Many liberal House members opposed the tax but the White House considered it key to controlling health care cost inflation.
Pelosi led the effort

More than any other leader in Washington, Pelosi is responsible for bringing Democrats to the brink of a victory that eluded her predecessors in 1994, when congressional Democrats abandoned an equally controversial reform effort by President Bill Clinton.

She remained relentless even when members of her own party declared the bill dead after Democrats lost a Massachusetts Senate seat in January.

“I’ve never seen anything like her,” said Rep. Lynn Woolsey, D-Petaluma, who led the liberal fight for a government-run insurance option, which was defeated by the Senate. “I’ve never seen anybody work harder, know more about every single word that’s in this legislation as it changes, and where every single one of her members is standing at the moment, and why, and what they’re going to do. She’s an amazing speaker.”

Senate Democratic leaders have promised to quickly take up the House changes under “reconciliation” rules that skirt a Republican filibuster and allow the bill to pass on a simple majority of 51 votes.

Democrats have 59 votes in the Senate. Republicans promised to raise parliamentary objections.

Sen. Judd Gregg, R-N.H., said a Senate reconciliation rule could bring down the House fixes if they are found to affect Social Security, even indirectly. Under the legislation, employers are expected to pay out more wages as cash rather than health care benefits, which would increase revenue from the Social Security payroll tax.

In many countries, diabetics are lucky to have their regular care covered by a national health plan. In the U.S. however, finding insurance after diabetes has been diagnosed may be difficult, because of many common limitations on coverage of “pre-existing conditions” placed by most insurance companies.

However, even if you have a good basic insurance plan that covers the cost of your basic medication and office visits, check and find out what kind of coverage you do or do not have for important ‘accessories’ for diabetics, such as special diabetic shoes and socks, and custom shoe insoles. Proper pedorthic insoles and diabetic footwear can be expensive, and finding ’supplemental insurance’ to cover it (if your regular insurance does not) can be a great financial help in managing your diabetes.Finding insurance that will also cover the cost of special diabetic personal care items may be quite difficult, but prescription skin lotions to help prevent dry, cracked skin and encourage healing of scratches, ulcers and fungal infections can be an important part of diabetes care. If your insurance will cover such items, you may also want to ask if you are covered for other ‘accessory’ items such as self- massage and exercise equipment, to help combat the effects of poor circulation and muscle wasting.

If you cannot obtain coverage for such ‘extra’ items with your primary insurer, you may be able to find supplemental insurance with less restrictive coverages, or even a specialty insurance policy designed for diabetics.

Research your options, if you’re having any financial difficulty with proper management of your diabetes, because the potential costs of improper or inadequate care are much higher than most insurance premiums ever could be.

These new marketplaces should provide up to 30 million Americans with an easy-to-use way to shop for coverage by offering a menu of plans, presented in a Web-based standardized format. By creating a large pool of customers, the exchanges should be able to get better insurance at a lower cost than individuals or small businesses could get on their own.

There is more that we don’t know than we do know” as to how the exchanges will work, said Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, the exchange created by health insurance reform in Massachusetts. “Implementation is 90 percent of the game.

Creating a national health insurance exchange — or a system of state or regional exchanges — “has incredible potential if it’s done right.

People have just not focused on the mechanics of the exchange enough.

All seniors have access to the federally-subsidized Medicare program. In addition, they have the option of purchasing a Medicare supplement, also known as medigap insurance (note: not connected with or endorsed by the U.S. government or the federal Medicare program.). For low income seniors or those living on a fixed income, there are some special programs like Medicaid that can help provide essential health insurance coverage. Finally, there are many types of coverage, such as long term care, that go beyond traditional health insurance and can help guarantee freedom and financial stability for seniors as they get older.

When applying for family health insurance coverage, all members of the family will likely be evaluated by the health insurance company. If there are smokers in the family or members with pre-existing health conditions, your family health insurance premiums may be higher, or it may be more difficult to find family health coverage at all. Even if you can obtain coverage those pre-existing conditions may not be covered for some period of time (which varies according to state laws). The price of family health insurance may even be affected by the area where you live and the ages of your family members. Make sure you ask lots of questions when purchasing a family health insurance policy in order to avoid any surprises when it comes time to receive medical care.

The health insurance company will evaluate each of your family members using a series of questions and possibly even a physical exam and each member’s medical history will be documented thoroughly during this process. Since most health insurance companies verify your family’s health information with the Medical Information Bureau (MIB), it is in your family’s best interest to honestly disclose any medical conditions.