People Who Choose Not To Have Health Insurance

By Christopher Weaver, KHN Staff Writer

Not all of America’s 46 million uninsured people can be considered victims of a system that excludes them financially or because of pre-existing conditions. According to an unpublished Kaiser Family Foundation analysis of the CDC’s 2008 National Health Interview Survey, 2 percent of uninsured people said they simply didn’t want health insurance. Some experts say others who could - and should - buy insurance choose not to because they perceive the costs as too high.

What makes someone “voluntarily” uninsured ?

Some scholars say the number of people who cannot afford insurance is overestimated. An Employment Policies Institute study found that 43 percent of the uninsured – about 20 million people - earn more than 2.5 times the federal poverty level, or $55,125 for a family of four. The authors – who include June O’Neill, the GOP-appointed head of the Congressional Budget Office from 1995 to 1999 - write “because most people at that income level are able to get insurance, (they) thus may be classified as ‘voluntarily’ uninsured.”

Though some uninsured people may appear well-to-do on paper, other factors could still push insurance costs out of reach. Around 7.5 million uninsured Americans have family incomes higher than $75,000 but premiums may be high because of health status, age, cost of living and geography. While the federal poverty level is the same across the country–$10,830 for an individual and $22,050 for a family of four - premiums on the individual insurance market vary widely by state, according to research by America’s Health Insurance Plans. In Massachusetts, the average annual premium for family coverage was $16,897 in 2007. In Wisconsin, it was $3,087.

It may be difficult to draw a line between the voluntarily uninsured and those with little access to coverage, but it is clear that some who could buy insurance choose not to do so.

What about the “young invincibles”?

A subset of voluntarily uninsured people are young and healthy, who may believe they don’t need health coverage or that it’s a bad deal because of the low probability that they’ll use it. The U.S. Department of Health and Human Services estimates that 44 percent of the uninsured are between 18 and 34 years old.

Though not all young invincibles are playing the odds by choice, about 9 percent of uninsured people between the ages 18 and 24 have received affordable offers of insurance through their employers, said Lisa Dubay, a Johns Hopkins University professor. Another 14 percent could afford to buy coverage on the private market. Dubay, also an Urban Institute scholar, expects to publish a report on the topic soon. Her analysis is based on Census Bureau’s health insurance data for 2008 and the percentage of person’s income needed to obtain coverage. She estimates people earning two to four times the poverty line, for instance, could only afford to spend 10 percent of their income on insurance. “The young people are disproportionately uninsured, but they also have low incomes,” she says.

How will the reform proposals affect the voluntarily uninsured?

The Democratic reform proposals would require most individuals to have coverage or pay a penalty. The House bill calls for a penalty of a 2.5 percent additional tax on their income. The Senate Finance Committee bill would fine families up to $1,900 a year, depending on income.

The Senate Health, Education, Labor and Pensions Committee and House bills also would impose a mandate for employers to provide insurance to workers, which could encourage some uninsured people to join group plans.

All of the Democratic proposals would establish insurance “exchanges” to enable individuals or businesses to compare and buy plans. The Internet-based exchanges are intended to make getting coverage on the individual market easier. One plan type available on the exchange proposed in the Senate Finance Committee would specifically target young people. It would cover only catastrophic and preventive care, and be more affordable. In addition, the health committee would allow people up to age 26 to receive coverage through their parents’ insurance plans.

Many Democrats have pushed to expand subsidies to help middle-income people buy health insurance. All the bills would offer some level of assistance to people earning up to four times the poverty level, or $88,200 for a family of four. For some who could afford insurance, but would rather spend the money elsewhere, the extra help combined with the possible penalties could make insurance a more attractive investment.

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Still Confused? A Refresher on the Basics of the Health Debate

First: The Insurance

To make sure insurance is obtainable, there would be new rules, such as barring insurers from denying coverage based on pre-existing medical conditions.

With a few exceptions, the majority of Americans who already have insurance through an employer — about 160 million people — would have to stay with that coverage.

And starting in 2013, nearly everybody would be required to obtain health coverage, or pay a penalty for not doing so. The logic is the same as in requiring auto insurance: anyone without coverage poses a risk of high costs for everyone else. But the proposed “mandate” is also a political flashpoint: Americans tend not to like being told what to do by their government, and Republicans are attacking the penalty as a “tax.”

In any event, without government action, the Congressional Budget Office estimates that the number of uninsured people would rise to 54 million by 2019.

Under the Senate Finance Committee bill, the number of uninsured would be cut by 29 million. About 11 million people would be covered by Medicaid, and the other 18 million would buy policies through new government-regulated marketplaces, or exchanges.

At that point, according to the nonpartisan Congressional Budget Office, 94 percent of Americans would have health insurance, up from about 83 percent today.

But there would still be 25 million people without coverage. About 8.3 million of them would be illegal immigrants.

There has been much debate over the idea of a government-run insurance plan, or public option, to compete with private insurers. The Senate Finance Committee on Tuesday voted down two such proposals, but the other four Congressional committees working on health care legislation have included a public option in their bills.

While there are differences between those plans, there are some basic common points. The public plan, if created, would only be offered to people buying policies in the new exchanges. It might be cheaper than private plans, but it would not be free.

The majority of people already on Medicaid or who have employer-sponsored insurance could not drop it in favor of a new public plan. So, for all the uproar, the public plan would not be available to most people, at least initially.

The fight is really about what it might mean in the future. Because it would not have to earn profits or pay private-sector salaries, Republicans say the public plan would have an unfair advantage and ultimately drive private insurers out of business.

Democrats say the competition would make private insurers more efficient and pressure them to offer better coverage at lower prices.

Second: Paying for It

Central to understanding the debate — and deciding whether you are for or against whatever plan emerges from Congress — is the question of whether it will be affordable. And that means affordable on two levels:

Pay For Health Reform With an Alcohol Tax

 By Lloyd I. Sederer and Eric Goplerud - Washington Post

Americans like their beer, wine and spirits. Sales are good, even in bad times. And, for most people, modest consumption of alcohol can be beneficial to their health.

But there is the other side of the equation. Twenty percent of spirits consumed in America are by underage youth, which is illegal and associated with accidents, suicide and poor school performance. A third of motor vehicle accident deaths are attributed to alcohol. Fetal alcohol syndrome and many developmental disabilities are a consequence of maternal alcohol abuse. Injuries, accidents and fires add to the damage. Domestic violence, crime and sexually transmitted diseases are driven by alcohol, the universal solvent of inhibitions. Alcoholism abuse causes liver and brain damage, pancreatitis, and a host of other conditions, which build with each year of abusive drinking.

One way to reduce the harmful effects of heavy drinking is to make drinking more expensive: the more a drink costs, the less people drink. This is true of young people, pregnant women and even heavy drinkers. Research indicates that a 10 percent increase in current alcohol excise taxes — that is a penny for a beer — would result in less drinking, especially among underage drinkers, reducing rape, robbery, domestic violence and liver disease. A tax increase of 3 cents per beer would cut youth gonorrhea by 9 percent.

It has been 18 years since federal taxes on alcohol have changed. If we simply raise spirit taxes to reflect inflation over that period of time, federal taxes on a shot of spirits would increase by 10 cents, a beer by 21 cents, and a glass of wine 24 cents. This would raise $101 billion over 10 years, without state tax increases. Equalizing the tax among beer, wine and spirits, without inflation, would raise $60 billion over 10 years.

Taxes could pay for health care for the uninsured and budget-busting state Medicaid expenditures; some portion of the tax could be directed to alcohol prevention and treatment programs. We don’t know any politician who likes to champion taxes. Yet, a recent Kaiser Family Foundation poll found that two thirds of Americans favor increasing beer and wine taxes to support health-care reform, and opponents changed their mind when told that taxes could pay for health care and encourage healthier habits.

Reducing the rate of growth of health-care costs will not suffice to cover health reform. More money is needed, and selected taxes work in reducing problem behaviors such as drinking. After 18 years shouldn’t we be considering an alcohol tax? Can we afford not to?

Dr. Lloyd I. Sederer is medical director for the New York State Office of Mental Health and adjunct professor at the Columbia Mailman School of Public Health. Eric Goplerud is director of the Center for Integrated Behavioral Health Policy at George Washington University Medical Center.

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Health care: Five faces of the uninsured

Should those without health insurance be required to buy it, and should they get government subsidies to help with the cost? Where will they get the coverage — from private insurance companies or a new government program? How much should they have to pay? Can they be denied for smoking, for having a chronic disease, or for a past heart attack?

 While the nation waits for Congress and the White House to come up with answers, those who live without insurance say they are waiting scared.

Patrick Bruce, 61, of Isle of Palms, S.C., says the fact that he’s been uninsured since his 2002 heart attack and triple bypass is “always in the back of my mind.”

He says he eats right, doesn’t smoke and exercises — efforts he hopes will keep him healthy until he qualifies for Medicare in four years. “I hope this health kick that I’m on works,” he says.

Others worry about missing cancer screenings that could save their lives or fear that one accident or serious illness will leave them with a lifetime of debt. Some wrestle with whether it makes more sense to save for retirement or pay for health insurance.

“We are the only democracy … the only wealthy nation that allows such hardship for millions of its people,” PresidentObama told a joint session of Congress on Sept. 9, in an effort to jump-start his revamp of the health-care system.

Obama has conceded that his plan would not cover all of the uninsured. It also would not provide insurance to illegal immigrants.

Republicans such as House Minority Leader John Boehner of Ohio argue that the government can’t afford to spend up to $1 trillion on health care changes. But Obama has pushed for a government-run “public option,” saying such a program would help bring costs down for everyone by giving insurance companies some competition.

“Every day, 14,000 Americans lose their coverage,” Obama said. “It can happen to anyone.”

Numbers from the U.S. Census Bureau for 2008 illustrate the point. About 27% of adults age 18-34 are uninsured. About 13% of those 35 or older are also uninsured. More than half of the uninsured are minorities. Being uninsured isn?t just about being out of work: About 27.8 million people ?without coverage are working, either part or full time.

The uninsured come from different backgrounds, but as a group, they are vulnerable, they are frightened and some of them are angry. These are their stories.

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Getting Well: It’s About Time

What cures colds, flu, sore throats, sore muscles, headaches, stomach aches, diarrhea, menstrual cramps, hangovers, back pain, jaw pain, tennis elbow, blisters, acne and colic, costs nothing, has no weird side effects and doesn’t require a prescription?

Plain old-fashioned time. But it’s often the hardest medicine for patients to take.

“Most people’s bodies and immune systems are wonderful in terms of handling things—if people can be patient,” says Ted Epperly, a family physician in Boise, Idaho, and president of the American Academy of Family Physicians.

“I have a mantra: You can do more for yourself than I can do for you,” says Raymond Scalettar, a Washington, D.C., rheumatologist and former chairman of the American Medical Association. But, he says, “some patients are very medicine-oriented, and when you tell them they aren’t good candidates for a drug they’ve heard about on TV, they don’t come back.”

An estimated one-third to one-half of the $2.2 trillion Americans spend annually on health care in the U.S. is spent on unnecessary tests, treatments and doctor visits. Much of that merely buys time for the body to heal itself.

And while temporary relief from symptoms is nothing to sneeze at, it adds up to a considerable amount of spending: $5.4 billion annually on cough and cold remedies, $2.7 billion on headache remedies and $411 million on chest rubs and other analgesics, according to Nielsen Co. Americans also spend an estimated $1 billion on unnecessary antibiotics that don’t even relieve the symptoms of viral infections, and contribute to antibiotic resistance. But some patients are so insistent on getting antibiotics that doctors give in.

“I have colleagues who say, ‘You can take this pill and get better in two days, or do nothing and get over it in 48 hours,’ ” says Dr. Scalettar.

Even H1N1, or swine flu, for all the uproar, almost always resolves in a few days with no treatment. The Centers for Disease Control and Prevention is urging physicians to use Tamiflu, an antiviral medication, sparingly to prevent shortages and avoid antiviral resistance. Only people who are hospitalized or at high risk for complications should get Tamiflu, according to the CDC.

The list of “self limiting” maladies—those that require no outside treatment—range from minor annoyances to what might appear to be more serious musculoskeletal problems. “Muscle aches and pain, minor traumas, sprains and strains typically do not need to be seen by a doctor,” says Dr. Epperly, who recommends his organization’s Web site, www.FamilyDoctor.org, as a resource to look up symptoms and health concerns. “Nausea, vomiting and diarrhea are typically time-limited. People will start to see improvement in two or three days—just watch that you’re not throwing up blood,” he says. If so, call your doctor.

Almost all viral infections resolve on their own, unless you have a compromised immune system. As a rule of thumb, Dr. Epperly says, infections in the nose, throat, stomach and upper respiratory tract tend to be viral. Infections elsewhere in the body are likely to be caused by bacteria, and those can get worse without antibiotics. About 80% of urinary-tract infections resolve on their own, for example, but about 20% develop into more serious kidney or blood infections. And even if they don’t, the symptoms can be very uncomfortable.

Parents are often extremely eager to “do something” for children who complain of sniffles, stomach aches, scrapes and fevers. Yet kids are generally very resilient, writes Lara Zibners, an emergency pediatrician, in her book, “If Your Kid Eats This Book, Everything Will Still Be Okay.” (For a fever, she advises calling the doctor if the patient is a baby younger than three months and has a fever over 100.4 degrees. For kids older than that, other symptoms are more important than the thermometer—especially if a child is listless, irritable, unusually sleepy, refusing to eat or drink, or having trouble breathing.)

Some chronic maladies follow predictable courses, according to many medical experts ,whether or not they are treated.

Colic is almost always gone in four months. Some 70% of acne is gone three to four years after it first appears. “Frozen shoulder”—a painful restriction of the shoulder joint—is typically painful for three to six months and stiff for the next four to six months, and resolves completely after one to three more months. Temporomandibular joint (TMJ) pain tends to go away by itself in 18 months. Sciatica resolves on its own in three weeks in 75% of cases.

For all the misery it causes, 80% to 90% of back pain resolves with only “conservative measures” (which include anti-inflammatory drugs, rest, heat, physical therapy and chiropractic treatments). “Sometimes it take days to weeks, sometimes it takes weeks to months, but pain lasts more than three months in only about 10% of cases,” says Michael J. Yaszemski, chief of orthopedic spine surgery at the Mayo Clinic in Rochester, Minn.

Whether to operate even in those remaining cases is controversial, he says. With acute lumbar disc herniation, studies have found that two and five years later, there’s little difference between patients who had surgery and those who did not. But surgery can sometimes provide relief faster.

“There are those patients who feel they just can’t wait—like Joe Montana,” says Dr. Yaszemski of the former San Francisco 49ers quarterback, who made headlines when he returned to playing football just eight weeks after spinal surgery in 1986.

Many patients are relieved to hear that they don’t need to take medicine, have a blood test or undergo surgery for what ails them. But some feel embarrassed to have taken the doctor’s time or frustrated because they think the doctor isn’t taking their situation seriously. (”Much depends on the way you tell them,” says Dr. Scalettar. “There are some arrogant doctors.”)

And some patients resent paying for a visit when all the doctor provides is reassurance that they’ll get better with time. “If a patient says, ‘You mean, I’m paying $100 for you to tell me there’s nothing wrong?’ I say, ‘There is something wrong—a virus,’ ” says Dr. Epperly. ” ‘But more importantly, I can tell you what’s not wrong: it’s not meningitis or cancer or a brain tumor or some other life-threatening illness. And if the pain doesn’t go away in a few days, please, please tell me, and we’ll investigate further.’ ”

“The longer you’ve known someone, the easier that conversation is,” Dr. Epperly adds.

Indeed, applying what some call “a tincture of time” requires time on the doctor’s part as well. Explaining why a medication or CT scan or MRI isn’t necessary, or what signs to look for if an ailment isn’t getting better, often takes more time than writing a quick prescription.

Of course, there are symptoms that people should never ignore, since they could signal a serious illness or a condition that could get worse, not better, with time. Contact your doctor immediately if you experience any of the following:

• Crushing chest pains—the classic signs of a possible heart attack.
• Sudden numbness or weakness on one side of the body, confusion, trouble speaking or severe headache—which could indicate a stroke.
• Sudden, severe headaches.
• Any major injury, especially involving loss of consciousness.
• Coughing up, throwing up or excreting blood.
• Suicidal or homicidal urges.
• Flashing lights in your vision—which could be a detached retina.
• Inability to breath—which could be a severe allergic reaction.
• Recurrent tooth pain. “You can typically give a tooth ache 24 hours,” says Dr. Epperly. “If it’s an abscess that would require a root canal, it won’t get better by itself.”

The bottom line: Don’t hesitate to call your doctor if you have persistent pain or a loss of function or anything unusual for you. It’s worthwhile to rule out something serious that does need medical attention. But if the doctor says you will get better on your own, that’s a powerful prescription itself.

—Email: healthjournal@wsj.com

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Check Point: Examining Obama’s Assertions
By DAVID M. HERSZENHORN - The New York Times

WASHINGTON — In what may become the most talked-about moment of President Obama’s speech to Congress on health care, Representative Joe Wilson, Republican of South Carolina, pointed his finger and shouted, “You lie!”

It was an angry retort to Mr. Obama’s statement that illegal immigrants would not benefit from proposed health care legislation. And while other points in Mr. Obama’s speech were debatable, this one was not.

The legislation approved by three House committees clearly states that only lawful residents will qualify for new health insurance subsidies. “Nothing in this subtitle,” it says, “shall allow federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.”

But Mr. Obama did repeat some assertions he had made about the proposed health care overhaul that are not so easily defended.

For instance, the president said that “if you are among the hundreds of millions of Americans who already have health insurance” through an employer or the government “nothing in our plan requires you to change what you have.”

That is technically true. But there is a real possibility that existing policies could change as a result of the legislation. The government, for instance, would set new standards, and employers that already offer insurance would have to bring their plans into compliance.

Some existing policies might not be sustainable given the new requirements. Doctors, for example, could end up refusing to accept insurance plans patients now use.

The Congressional Budget Office predicts that far more people will obtain health insurance as a result of the legislation, but whether existing benefits will remain the same for everyone who is now covered is far from certain.

Mr. Obama also seemed to stretch things a bit when he declared: “Not a dollar of the Medicare trust fund will be used to pay for this plan. The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud as well as unwarranted subsidies in Medicare that go to insurance companies.”

Critics of the president’s plan have said Americans ages 65 and over could find their Medicare benefits reduced as a result of the health care overhaul. Congressional Democrats certainly do not intend to cut benefits, but they are proposing big cuts in government spending on Medicare and not all of it would come from eliminating waste.

The legislation seeks to trim Medicare payments for most services, as an incentive for hospitals and other health care providers to become more efficient. Other cuts would come from reduced payments to drug makers. Such cutbacks could inadvertently reduce access to some types of care.

The changes could also create new co-payments for services, including some laboratory tests that are now provided without charge.

Mr. Obama, in his speech, forcefully rejected contentions that the legislation would limit end-of-life care or even encourage euthanasia. Both of those claims are indeed false.

But his assertion that “no federal dollars will be used to fund abortions” is not so clear-cut.

Abortion opponents say tax dollars could be used to subsidize insurance that could pay for abortion. The legislation approved in the House committees seeks to avoid this by requiring that only money from premiums paid by beneficiaries be used to cover abortion.

Existing restrictions on the use of federal money for abortion would remain in place, as Mr. Obama stated. But in practice, the public and private money would all go into the same pot, and the source of money for any single procedure is largely a technicality.

At one point, Mr. Obama made future health benefits seem more generous than they may actually turn out to be. “Insurance companies,” he declared, “will be required to cover, with no extra charge, routine checkups and preventive care like mammograms and colonoscopies.”

The president’s plan would establish a minimum package of benefits that all private insurers would have to provide as a condition for participating in new government-regulated insurance markets or “exchanges” where consumers could shop for plans.

Insurers would have to include the cost of minimum benefits, including preventive care in their basic premiums. So while there might not be an “extra” charge, the services would not be free.

On some major points, Mr. Obama’s speech recounted irrefutable truths.

He stated, for instance, that for nearly a century presidents and the Congress have tried and failed to address major gaps in the health care system. And he accurately stated that the United States is the only developed democracy with millions of uninsured citizens with little or no access to anything but emergency care.

He truthfully stated that nearly all Americans with insurance are at risk of losing it if they lose or change their jobs or run afoul of obscure technical rules. Mr. Obama also accurately stated that Americans spend more per person on health care than residents of any other country but often get worse results and that health care costs are spiraling out of control.

Of course, it is far from certain that Mr. Obama will succeed in overcoming partisanship and achieve a sweeping health care overhaul as he predicted in the speech.

But there is little disagreement that without government action, things stand to get worse.

“Everyone in this room knows what will happen if we do nothing,” Mr. Obama said. “Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result. We know these things to be true.”

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Baucus presents healthcare overhaul plan
By Noam N. Levey and Janet Hook - Los Angeles Times

The Montana Democrat who heads a key Senate panel unveils his proposal. It would tax high-end insurance plans and create nonprofit insurance cooperatives as an alternative to a government-run option

Reporting from Washington - Senate Finance Committee Chairman Max Baucus (D-Mont.) on Tuesday unveiled his long-awaited compromise blueprint for healthcare reform, proposing new taxes on high-end insurance plans and offering nonprofit insurance cooperatives as an alternative to a controversial government-run option.

The unveiling marked an end to his marathon effort to win over substantial Republican support for a healthcare reform plan. Baucus’ plan lays down a vision designed to appeal to moderate and conservative Democrats, who will be key to any overhaul.

Liberals in the House and Senate have already spelled out their vision. With Baucus’ proposal, the range of potential reform options has solidified, since no final bill is likely to be substantially more liberal than the House version or more conservative than Baucus’.

President Obama’s speech to a joint session of Congress tonight is likely to further clarify the boundaries of a final compromise.

After a meeting with Baucus on Tuesday, none of the three Finance Committee Republicans who have been negotiating with him for most of the year would commit to backing the plan, according to a GOP aide briefed on the meeting. Baucus said he had to move forward in the committee with or without them.

“The rubber’s starting to hit the road,” Baucus said Tuesday. “We’re not going to dawdle.”

To draw moderates who object to the government-run insurance option, Baucus would provide federal funds to help set up nonprofit, state-level cooperatives in which consumers could band together to purchase health insurance.

Advocates of this approach, including Sen. Kent Conrad (D-N.D.), argue that these cooperatives could pressure private insurers to provide affordable, quality coverage in the same way that a government plan could. In many regions, a small number of companies often dominate the medical insurance market.

On Tuesday, several lawmakers praised Baucus’ efforts, including Sen. Olympia J. Snowe of Maine, a moderate Republican who has been working with Baucus and whom Democrats see as a crucial vote.

“There are a lot of promising elements. It’s a work in progress,” Snowe said, adding that she wanted to see a trigger mechanism setting up a government plan in case the cooperatives don’t work.

Sen. Debbie Stabenow (D-Mich.) said she was not troubled by the absence of a public option because the legislation will be “refined.” She said Baucus’ proposal was a “very, very good starting point.”

Baucus, who began sharing his plan with a bipartisan group of lawmakers over the weekend, proposes to help pay for his bill with a series of new fees on the health insurance industry as well as taxes on some employer-provided healthcare plans.

Like the other major Democratic proposals, Baucus’ plan would prohibit insurers from denying coverage to people with preexisting medical conditions, a cornerstone of the changes being pushed by the president and his congressional allies.

It would also require nearly all Americans to get insurance — a provision that would create millions of new customers, which private insurers say they must have to offset the cost of dropping the restrictive rules that deny and limit coverage.

The Baucus plan would set up regulated insurance marketplaces operated by states, in which people who do not get their insurance through work could shop among plans offered by private carriers.

The proposal also would dramatically increase federal aid to Americans seeking insurance, expanding the Medicaid program for the country’s poorest residents and offering tax credits to other low-income people to help them pay their insurance premiums.

Democratic leaders have all but abandoned hope that more than one or two Republicans in Congress will back their effort to reshape the nation’s healthcare system.

They are instead laboring to bridge the divide between liberal Democrats, who demand a new government insurance plan, and more conservative members of the party, who have said they will never vote for such a plan.

That tension was underscored Tuesday as House Speaker Nancy Pelosi (D-San Francisco) insisted that a government plan must be part of healthcare legislation just hours after her senior deputy, Majority Leader Steny Hoyer (D-Md.), told reporters it was not essential.

Baucus’ plan does not include a mandate requiring employers to provide health insurance, as other proposals do. Instead, large employers that do not provide insurance would have to pay a fee for each of their employees that received federal subsidies to purchase insurance.

Individuals, meanwhile, could face fines if they elect not to get insurance. Under Baucus’ plan, families making more than three times the federal poverty level — or $66,150 for a family of four — could pay as much as $3,800 in fines.

To pay for a bill that Baucus estimated would cost $900 billion over the next decade, the senator is proposing new taxes on insurance plans worth more than $8,000 for individuals and $21,000 for families, and new fees for insurers, drug makers, device makers and clinical labs.

That drew sharp criticism from the insurance industry Tuesday. “New taxes on healthcare coverage will only make coverage less affordable,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, the industry’s Washington-based lobbying arm.

“That is the opposite of what healthcare reform is supposed to accomplish,” he said.

On the other end of the political spectrum, a leading consumer group also took aim at the Baucus proposal, criticizing a provision that could allow insurers more flexibility to sell plans across state lines.

“This is a huge loophole that the insurance industry has been seeking for decades,” said Jerry Flanagan, healthcare policy director of Santa Monica-based Consumer Watchdog.

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