The Finance Committee's Work in Progress
The Washington Post's Ezra Klein has gotten hold of an outline of the health care reform bill that the Senate Finance Committee is working on. It gives a clue to their direction, although it is certain to change--perhaps substantially--between now and the time the committee begins formally drafting the bill after the July Fourth recess. Here's what Ezra thinks of it:
You could write this story a couple of different ways. The first is to note is the Finance Committee has substantially retreated in the face of the $1.6 trillion price tag the Congressional Budget Office affixed to its original submission. This version of the plan is, comparatively, quite diminished.
The numbers tell the story. In that plan, subsidies [KT NOTE: for helping the uninsured purchase health coverage] reached [those earning up to] 400 percent of poverty. In this plan, they've been cut to 300 percent. In that plan, Medicaid eligibility was as high as 150 percent of the poverty line. In this plan, it's 133 percent for pregnant women and children, and 100 percent for childless adults. In that plan, the "gold" coverage was 93 percent of a person's estimated expenses, and "bronze" coverage was 68 percent. In this plan, those numbers are 90 percent and 65 percent, respectively. That means people with a low-cost plan might be covered for only 65 percent of what they're likely to need.
Another way of looking at the plan is that it remains a significant step forward. Subsidies to 400 percent of poverty would be nice, but subsidies to 300 percent of poverty are far beyond anything we offer now. Coverage that protects against 65 percent of anticipated costs is better than no coverage at all. The co-op idea isn't a public plan, but with federal seed money to start new co-ops, it's a good idea on its own merits. There's an individual mandate, state-based health insurance exchanges, and a substantial health and wellness initiative. Insurers are barred from discriminating based on health history and Medicaid is sharply expanded.
-
1
KT-Have many elements of this plan been offered before?
-
2
I am just so frustrated with this whole mess. Compromising with people who are paid to oppose health care reform is sausage making at the worst.
.
It would be nice if the American people could get a choice to have their say. Behind all the complications and details there is a philosophical divide. There are those who believe health care is a right, and those who believe it is a privilege that should be addressed by the free market.
.
This health care debate is going to end up with Broderian compromise which may end up being inadequate, and more expensive than a complete overhaul. I don't know who came up with the dumb idea that compromise on basic principles is a great thing. You can compromise on priorities, but health care really is about your basic belief system when it comes down to it.
.
Would anybody accept a compromise on abortion that if you were pregnant with twins, you could abort one, and the other is given state protection?
.
I am deathly afraid that this compromise is going to cost a ton of money, still leave many people in a gap, and because it's not going to be that effective, it will be used as an excuse later not to try fixing it again. Perhaps we can make the 2010 election a national referendum on the issue. Do you like it how it is, or do you want a change? Or maybe Joe Lieberman, Arlen Spector, and Olympia Snowe will come up with a Washingtonian compromise where if you make between $30,000-$40,000 a year, you qualify for your wound to be half sutured. Oye. -
3
gunny: the elements are all pretty much what they have been talking about. it's--for lack of a better word--the aggressiveness of those elements that is being scaled back. for instance, to save money, they are offering subsidies (presumably on a sliding scale) to those earning up to 300% of poverty (roughly $32,000 for an individual; $66,000 for a family of four). Earlier those subsidies would have been more generous, going up to 400%. What that means is that if you earn just over that level, you will be REQUIRED to purchase insurance, but the government won't be giving you any help to do it. These subsidies are why health care reform is so expensive.
.
There is also a big expansion of medicaid (which is a public plan), but not as big as they had earlier been talking about.
.
And, of course, the coop is not the same as a public plan. but what I saw in that document was very sketchy, so I can't really tell you how MUCH weaker it is.
.
Nor have they made any decisions about the employer mandate, except that firms over a certain size are going to have to pay some kind of penalty if they don't insure their workers. -
4
Thanks KT.
.
But here is the reason why I ask the question that I did. And the below is from November of 2008.
.
Health Plans Propose Guaranteed Coverage for Pre-Existing Conditions and Individual Coverage Mandate
.
Washington, DC – Health plans today proposed guaranteed coverage for people with pre-existing medical conditions in conjunction with an enforceable individual coverage mandate.
.
Under the new proposal, health plans participating in the individual health insurance market would be required to offer coverage to all applicants as part of a universal participation plan in which all individuals were required to maintain health insurance.
.
Health plans also said that premium support for moderate-income individuals and broad spreading of risk was necessary to promote affordability and maintain premium stability in the individual health insurance market.
.
To ensure that all Americans can access coverage, health plans also reiterated their long-standing support for making eligible for Medicaid every uninsured American living in poverty and strengthening the Children's Health Insurance Program.
.
“No one should fall through the cracks of our health care system,” said Karen Ignagni, President and CEO of America's Health Insurance Plans (AHIP). “Universal coverage is within reach and can be achieved by building on the current system.”
.
The announcement follows a nationwide listening tour conducted by AHIP as part of its Campaign for an American Solution. Concerns about coverage for pre-existing conditions, continuity of coverage for those between jobs and maintaining affordability for those with insurance were raised repeatedly across the country.
.
“AHIP's Board of Directors is responding to the concerns of the American people by offering a workable solution to ensure that no one is left out of the health care system because of their health, age, income or employment status,” said Ignagni.
.
The new proposal builds on the series of comprehensive reform plans that AHIP's Board of Directors began releasing in November 2006. Further reform proposals addressing the affordability, accessibility and quality of health care are anticipated in the weeks ahead.
.
Summary of AHIP's Proposal to Guarantee Coverage for Pre-existing Conditions and Promote Affordability in the Individual Insurance Market:
.
*
Guarantee-issue coverage with no pre-existing condition exclusions;*
Establish an individual coverage requirement with an insurance coverage verification system, an automatic enrollment process and effective enforcement of the requirement that all individuals purchase and maintain coverage;*
Promote affordability by: providing refundable, advanceable tax credits for moderate-income individuals and working families; and promoting tax equity whether coverage is obtained through an employer or the individual market; and*
Ensure premium stability for those with existing coverage through a broadly funded reimbursement mechanism that spreads costs for the highest-risk individuals.
.
Background on the Individual Market and Guarantee Issue
AHIP's survey of the individual market shows that individually purchased health insurance is far more affordable and accessible than is widely known. The survey found that 9 out of 10 applicants undergoing medical underwriting were offered coverage. The plans commonly purchased by consumers provided substantial financial protection and a wide range of benefits, including coverage for behavioral health, prescription drugs and preventive services.
.
Some individuals are unable to purchase individual health insurance coverage in the private market because of their health status. One approach taken by states to address this issue has been the enactment of guarantee issue legislation requiring health plans to offer coverage to all applicants. These well-intentioned reforms have often resulted in severe unintended consequences, including significantly higher costs for all policyholders.
.
http://www.ahip.org/content/pressrelease.aspx?docid=25068 -
5
OT, or is it? Avi Lewis' "Schwarzenegger's Shock Therapy - Poor Pay For Sins Of The Rich" He says of CA: "the state is a Petri dish for some of the most virulent strains of American political culture," which seem apt re: health care. And his Fault Lines documentary is great:
~
http://www.commondreams.org/view/2009/06/18-14 -
6
all that stuff is in there, as it has been in every serious reform plan we have heard since the presidential campaign. because this bill has an individual mandate--which is what the insurance industry wants more than anything else, because it means tens of millions of new paying customers and a much broader spreading of risk--the industry is willing to make those other reforms, like getting rid of pre-existing conditions.
-
7
"all that stuff is in there, as it has been in every serious reform plan we have heard since the presidential campaign. because this bill has an individual mandate--which is what the insurance industry wants more than anything else, because it means tens of millions of new paying customers and a much broader spreading of risk--the industry is willing to make those other reforms, like getting rid of pre-existing conditions."
.
Are we talking about serious reforms to help the American people or the "insurance companies?"
.
Because what I get from what you just said is that we are beholden to the wishes of the industry and not to the American people. So, with all due respect to you and Ezra, this is a bunch of bullsh*t that gives into all the industry demands and none of the American people. Unless of course you work for a health insurance company. -
8
Will the top 3 health insurance company CEOs car pool their corporate jets on Thursdays in months that start with M though? They are sacrificing so much already. But maybe that little bit of effort will be a sign of good faith.
-
9
Gunny, don't be so naive.
'
> Because what I get from what you just said is that we are beholden to the wishes of the industry and not to the American people. So, with all due respect to you and Ezra, this is a bunch of bullsh*t that gives into all the industry demands and none of the American people.
'
You don't really think that Congress has We the People in mind, do you? Only marginally. We don't fund PACs, or other lobbying agents, to pad the election war chests of influential politicians. Insurance companiess do. Therefore, of course they get greater consideration. When was the last time you heard of a "voters' lobby" that got to sit in on meetings with lawmakers to draft new laws? Or, heck, just draft the laws themselves, and have it submitted by a Congress-person?
'
No, see, even though we pay for their salary and benefits, that, by itself, does not mean that we get prime consideration. Nope. If you want the attention of a legislator, you need to pony up the gravy. -
10
Sigh.....
.
http://www.allaboutscience.org/first-law-of-thermodynamics-faq.htm
.
What is the First Law of Thermodynamics?
.
In its simplest form, the First Law of Thermodynamics states that neither matter nor energy can be created or destroyed. The amount of energy in the universe is constant – energy can be changed, moved, controlled, stored, or dissipated. However, this energy cannot be created from nothing or reduced to nothing. Every natural process transforms energy and moves energy, but cannot create or eliminate it.This principle forms a foundation for many of the physical sciences.
.
The First Law of Thermodynamics is one of the absolute physical laws of the universe. Everything in the entire universe is affected by this law, as much as time or gravity.
.
It might be really fun to bash Insurance companiy executives and make jokes about corporate jets, but the sad fact is that in order for people who currently can't get Medical care paid for to be able to begin getting it paid for, someone has to put up the money.
.
To think that Congress can simply pass a law that will pay for coverage is to open yourself up to precisely the attacks that the Republicans like to depict as "Tax and Spend."
.
We need to get past wishful thinking and actually count the money we have available to make this happen. -
11
Ezra's willingness to make excuses for a bill that represents a betrayal of health care reform is how/why he got his gig with the Washington Post. (Froomkin's refusal to play the "make the politicians/sources look good game" spelled his doom at the post.)
_
In other words, Ezra got his "peek" because he's now a reliable conduit for the insurance lobby -- why Karen continues to treat him credibly is a whole nother question.... -
12
Gunny, don't be so naive.
.
Sorry. I can't help it. I still believe that there has to be someone that gives a sh*t about us all. Even though I'm proven wrong each and every day. Consistently. -
13
"In other words, Ezra got his "peek" because he's now a reliable conduit for the insurance lobby -- why Karen continues to treat him credibly is a whole nother question...."
.
I'm persuaded that Karen is offering the glass-half-full viewpoint for our consideration but is just as "concerned" about the corporate ownership of the public policy as you or me. You just described why she can't be more direct, or critical, and still keep her employer-subsidized health care. -
14
"I still believe that there has to be someone that gives a sh*t about us all."
.
It's called the Progressive Caucus. It's not much, I know, compared to the forces arrayed against us. Now I give campaign money here:
.
http://www.actblue.com/ -
15
It is amazing how the 50% of the population that is worried about deficits are very important people who cannot be ignored, but the 70 or 80% of the population that wants a public counterweight to the insurance crooks literally does not exist. I keep saying that maybe they are really going to send a public option plan to get scored by the CBO one of these days and they want all the disappointing Lieberdem compromises out of the way prior to that, but I am just kidding myself right?
I might just go down to a busy intersection one of these days with a sign that says "Honk if your Health Insurance Sucks" just to pass my time. It sure sounds more fulfilling than reading the cascade of reports about how more Democrats are pulling the ole Benedict Arnold every single day. -
16
I think this needs context. Karne, how does a bronze plan, under this legislation, compare to what our senators get in terms of costs and benefits? How about a gold plan? Anything that leaves my senator with better coverage than I have is unacceptable to me.
-
17
KT, commenters:
.
Read the outline.
.
It's the worst of all health care reform worlds.
.
It's welfare.
.
The mandates provide welfare for insurers, the subsidies are welfare for people who qualify through lack of income (most working Americans won't qualify).
.
Non-profit Metropolitan Transit Authority-type "Coop" administration to supposedly create lots of little health insurance pools (for some unknown reason) --get this-- by being granted loans to start up presumably non-profit health insurance groups that must be paid back to the government. No pooling via Medicare, no nothing. Ludicrous as a solution to current problems.
.
Presumably because the "Coop" is an inevitable failure, they provide for "Exchanges" which are State-by-State "groups" who share customer service telephone banks, enrollment forms and --I swear to God it's really in there-- "marketing". "Exchanges" may be approved by HHS Secretary to "compete" after five years. What a timely solution!
.
Workers with employer-provided health care can't get into bogus State-based "Exchange" unless they don't make enough to afford their contributions to their current provided plans.
.
Increases in Medicare eligibility for (as they put it) "low income populations".
.
Idiotic sales brochure language specifying "Bronze, Silver, Gold & Platinum Plans"...
.
It's as if John McCain gave up on his idea of lifting the employer subsidy for employee insurance, but then wrote a plan anyway that was a little bit extra generous to its presumed welfare recipients.
.
This is a f*cking joke.
.
I won't even insult your intelligence by describing their "Promote Personal Responsibility"-style "provisions" to Medicare that do nothing whatsoever to reduce the cost to the program in terms of adding people to the pool to negotiate lower health care provider fees and charges.
.
I swear to God if Obama gets up and makes a lofty speech about how "This is the fundamental reform the American people have been waiting for...and now they do not have to wait any longer for the health care they deserve!" to sell this abortion, i.e. adds insult to injury...I don't know what I'm going to do, but it won't be to give money and votes to Democrats, that's for sure.
.
This is awful. This is something right out of the 1970s. It's the kind of thing that most middle-class people won't see a single benefit from. It changes nothing. It reforms nothing.
.
This isn't "health care reform", it's the new "health care welfare" for Republicans to run against when we still don't have enough money to keep Medicare running without raising taxes, and people are still going bankrupt from out-of-pocket expenses.
.
Remember when we voted for Democrats to end the Iraq war in 2006?
.
Remember what they did?
.
This is that, except in 2009 with a majority in both Houses and the Presidency.
.
We're f*cked. I'm f*cked.
.
What if I don't like my coverage? What if I make too much money to qualify for this outline's subsidies, so I can't leave my employer's plan --even though I know from experience that they won't actually cover the treatments I need, except they determine that retroactively, and left me with a 5 thousand dollar bill after I saw physical therapists?
.
What about the people whose spouses get sh*tty insurance through their employers, and so won't qualify for their idiotic State Exchanges, or non-existent "Coops" with God-knows-what application processes?
.
Where are the choices? Where is the real alternatives for people who over 3 times the f*ckiing poverty line? How do we escape employer-based coverage by insurance companies that are out to f*ck us? Eventually my taxes are going to go up to pay for all of the absurd waste in our most expensive system in the world, and what I get for it is...this?
.
I'm trying to be calm about this, but it's really difficult not to see this as betrayal.
.
How did we get here?
.
This can't really be the outcome...no f*cking way. -
18
Ezra writes:
.
Another way of looking at the plan is that it remains a significant step forward.
.
Yes...that certainly is "another way of looking at the plan".
.
Another way to say that is:
.
It's something, and it allows political leaders to say "Hey, we got something done!"
.
It may do something significant...for some people. -
19
What a bunch of carp. Look. There is a way to pay for it. I'm willing to pay more in taxes. I don't think anyone, who is for real reform, is unwilling to do so.
.
This is a pointless low down dirty boatload of fecal matter.
.
Forgive me SZ, this is just an approximation off the top of my head, but most Americans later in life will be making medical decisions about life and death that can involve many hundreds of thousands of dollars under the current system.
.
Teetotal arfing bankruptcy. I have a brother in law who last year incurred a $550,000 medical bill. This is common.
.
And 65% of that is what? FYI, he was making $15 / hour. That is common too!
.
I call it a diarrhea splatter fart... -
20
"I don't know what I'm going to do, but it won't be to give money and votes to Democrats, that's for sure."
.
And the GOP has better plans? They have nothing... -
21
By the way, Karen, how many calories does spin have?
.
Can I barbecue it? Can I slice and dice it? Will my wife eat it and like the way it tastes?
.
Is it really as nutritious as you say it is? -
22
Update
.
Senator Chris Dodd just sent me a fundraising email:Dear Stuart,
.
One thing is crystal clear: you want substantial health care reform, and you want it now.
.
I've been reading through your ideas and comments about health care reform, and the common thread through virtually all of them is that you want a real solution to cover all Americans and reduce costs.
.
Many of you shared your personal stories highlighting the desperate need for real reform in our system. Here are just a few examples of the problems Americans are facing every day.
Senator, I have been a registered nurse for 30 years, predominantly in the mental health field. One of the biggest problems I saw was the fact that virtually none of my patients had insurance. This precluded them from having a choice in providers. -Carl
.
The health insurance premium through our small business for my family of three is so high monthly that we forgo regular check ups and preventative care. What's wrong with this picture? -Jane
.
My wife and I have two children ages 4 and 3. I'm self-employed. Health insurance is by far my biggest business expense, and, as an individual, I have little to no buying power or leverage with the insurance company.... To create a 21st-century American economy that fosters innovation and entrepreneurship, a public health-insurance option is absolutely critical. -Andy
.
What happens if my sister, who is battling ovarian cancer, can no longer work? She is 48 years old, and the waiting period for Social Security and Medicare typically takes a couple of years. I pray that she will beat this, but even with good coverage, she has already incurred enormous out-of-pocket costs.... I can only imagine that millions of American stories are even scarier than ours. There is nothing American about inadequate health care! -Connie
I'm committed to real health care reform for these families, for yours, and for millions more all across America.
.
Your commitment to this issue is vitally important as we move forward with reform legislation. Yesterday, the Senate began its historic work to make comprehensive health care reform a reality for all Americans. As we continue our work, input like yours will make a big difference.
.
I will keep you updated regularly with progress reports and more ways you can help.
.
Thank you for your support,
.
Chris Dodd...There's a huge yellow "DONATE" button, of course.
.
Really, Senator, how does "Andy"'s statement "To create a 21st-century American economy that fosters innovation and entrepreneurship, a public health-insurance option is absolutely critical." square with the inadequate proposal currently under consideration by health insurance lobbyists...excuse me, your colleagues in the Senate?
.
How dare you ask me for money that will soon go to out-of-pocket expenses, Senator Dodd?
.
Until it is actually "crystal clear" to you and the rest of your fellow Senators that I want "substantial health care reform, and I want it now", you'll get less than nothing from me, and I suspect that a few other people may feel the same way. -
23
53_3:
.
And the GOP has better plans?
.
This is the GOP's "plan". That's the problem.
.
This is John McCain's plan without the taxing of employer health insurance benefits.
.
This is a plan that seems designed to get at least 10 Republican votes in the Senate. -
24
"This is a plan that seems designed to get at least 10 Republican votes in the Senate."
.
I know, Stuart, it was a rhetorical question, and the big, big, big question is why?
.
We have the tools to do real reform. The 'reconciliation procedure' that was adapted in the budget. Why in pluperfect hell are we even doing this charade.
.
One thing that Baucus did get right was that this is a Rube Goldberg contraption. But that is the only thing anyone has gotten right.
.
Think of the burden lifted from businesses! Their playing field would be much more level with the rest of the world knowing they don't have to provide it. The jobs Americans don't want to do? They don't, partly because many of them are shopping for health insurance as well as a job, because they need both.
.
And the 1.6 trillion spent? What about the money saved, and the enormous boost to business? -
25
FYI Stuart, I saw an article on CNN news a couple days ago referring to the benefits to business, but I can't find it.
- ktumulty @LATimesrainey Could you get them to check for my earrings? I lost a pair of silver ones and have been hunting all over the house for them. - 12 hours ago
- ktumulty @TeresaKopec @fishbowlDC thanks! am declaring my age to be the avg of mine and fellow bday girl jen psaki. - 16 hours ago
- ktumulty New Blog Entry, "Health Bill: What Would It Cost Me?" - http://tinyurl.com/y8uxg5w - 1 day ago
Most Popular »
- White House Hypocritical Attack on Politico
- Gleeks and Shrieks: Fox Unveils Midseason, Glee Gone Until April
- The Dreaded X
- FX's Former Lawman Gets Justified
- Jay Leno a Failure; Also, Jay Leno a Success
- Jane Austen and Zombies and TV (and Twitter)
- Cheney: 'No Aspirations' for Further Office
- It's a Deal: 25 Days of Free MP3 Holiday Song Downloads
- The Kick-Ass Trailer
- Looking for Reasons to Care About Tiger Woods
- Want to Boost Your Memory? Sounds During Sleep Can Help
- Helicopter Parents: The Backlash Against Overparenting
- Tiger Woods Car Crash Bad Publicity for Rich Isleworth
- The End of the 2000s: Goodbye to a Decade from Hell
- Dubai's Woes a Blow to Ambitious Ruler Sheik Mohammed
- The Muppets Perform 'Bohemian Rhapsody'
- Italian Town Dreams of a White (No Foreigners) Christmas
- The Women of Islam
- Could White House Party Crashers the Salahis Go to Jail?
- Study: Loneliness Can Be Contagious
Quotes of the Day »
RSS