The Senate HELP Committee has just passed their health reform bill. As Jon Cohn noted yesterday, this isn’t quite historic, as HELP’s predecessor committee passed a bill out during the health reform fight under Clinton, but taken in context, health reform is moving in a way it never has before.
As a review, here’s what HELP was discussing, and likely what just passed (I’ll have an update once I’ve seen all the amendments):
The individual mandate: If you have affordable coverage available to you — and I don’t know exactly how, or if, "affordable" is defined — and you don’t purchase it, HELP envisions a penalty of not less than half the price of the coverage.
The Health Insurance Exchanges: States would run them. They would be available for the uninsured, people on the non-group market, and small businesses. There would be a so-called "firewall" preventing larger employers from using the exchanges. In the scenario where employees of a large employer are not offered coverage meeting the minimum standards and costing less than 12.5 percent of their income, then and only then can they go to the exchange. (For more on health insurance exchanges, see this primer.)
The public plan: In a slightly weird turn of events. HELP is calling its public option "the Community Health Insurance Option." You have to wonder if that’s not an effort to steal some of Sen. Kent Conrad’s co-op compromise thunder. It’s a level-playing field style plan, and it’s available on only the health insurance exchanges.
Yesterday, the House unveiled their tri-committee health reform bill and the Education and Labor Committee will start marking it up today. That bill contains:
- Generous subsidies, available to people making up to 400 percent of the poverty line
- Expansion of Medicaid to cover people making less than 133 percent of the poverty line
- Guarantees of solid benefits for everybody, with limits on out-of-pocket spending
- Strong regulation of insurers, including requirements that insurers provide insurance to people with pre-existing conditions without higher rates
- An individual mandate, so that everybody (or what passes for everybody in these discussions) gets into the system and assumes some financial responsibility
- A public plan, one that appears to be strong, although I’ll reserve judgment on that until I hear from the experts
- Choice of public and private plan, at first just for individuals and small businesses, but later for larger businesses and–possibly–eventually for everybody
- Efforts at payment reform, if not necessarily as strong as they could be
- Investment in primary care and prevention, which is not sexy but potentially important for general health.
Scarecrow has much more analysis.
So, let’s review the political space. The Senate HELP Committee has just referred a bill to the floor of the Senate with a strong public option. The House is starting in on a bill that meets all of Health Care for America Now’s principles for actually achieving quality, affordable health care for all in this country. And the President and his grassroots army are out there pushing for strong reform by the August recess.
Yes, we’ve got one more committee that has yet to start in on their work, the Senate Finance Committee, but overall, reform is moving forward like it wasn’t in the 1990s. There’s no Harry and Louise on the air. Republicans can barely muster a response. Progressives are united behind real reform, and we’ve actually got something in Congress we can support. It’s really happening, folks.
(also posted at the NOW! blog)
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a first step, and [cliché alert] we make the road by walking. Thanks for the update, Jason.
Ian Walsh doesn’t like the House plan, neither does hipparchia, nor lambert.
Public option does not kick in until 2013, cuts to Medicaid and Medicare to provide funds for vouchers for health insurance, looks like a bail out for the industry with high administrative costs.
Erm, it’s a bit early to call what’s strong and what’s not, I should think.
This is much more what I expected. It ain’t going to happen, what’s needed, unless the president shows some leadership in this jumble on the Hill.
I’m not sure how anything with a strong public option can be a bailout, but ok…
What is not being mentioned is most of this doesn’t even begin until 2013 which, during this period of unemployment, job loss and tough economic times, does us no good. In 4 years hopefully we’ll be back to work and the economy probably will have returned to normal.
However, in 2010 the health insurance companies won’t be able to cancel you because of pre existing conditions. The states will be implementing the public option also which doesn’t thrill me, especially if we have a rethug governor.
I don’t see why will take 4 years to implement. That does not work for me.
It’s insurance based, therefore, the process has been corrupted. The senate wants to feed the people the shit sandwich. We want the care you get for free, period. You get it and you get paid bribes by the companies that want your vote. You score twice. We only want health care. Then we will get around to your absolute corruption.
This bill sounds like all we need at the moment (more than we need really). I was glad to see a penalty for those who can afford insurance but will not buy it. That’s long overdue.
What’s affordable? If your premiums are $1,000 a month and you make $1,000 a month it’s affordable.
One problem….it sounds like a lot of my tax dollars are going to be going to fund others health insurance. I guess I need to get on the receiving end of the gravy train.
Now the socialists can go out and party in the streets.
Change should come slowly. That’s why four years.
The single payer wouldn’t kick in till 2013, but the public option is now. Right?
it’s the mandate.
you know, the law that says we have to purchase insurance?
no single payer. Public option in 2013.
no, public option will not kick in until 2013.
But, of course, you have a choice not to give your money to the insurance industry, so not really a bailout.
Bernie Sanders has an amendment that will help states run their own single payer systems, if the bill that emerges from conference has the Sanders amendment in it, then it will be worth passing, otherwise we are better off with what we have now. This is just a bail out for the health insurance companies, who pretty much wrote this bill.
i agree. i think (please correct me if i’m wrong!) this bill doesn’t even meet the very modest criteria of jane’s whipping action:
i had same question for the house bill.
… lots of reading and thinking to do, and am looking forward to analyses from you and others.
And, I believe the current House bill has something like that in it, see http://voices.washingtonpost.c…..alth-.html
The House bill meets the whipping criteria.
no single payer in these bills now being worked on in committee. public option only.
BUT!
both bernie sanders in the senate and dennis kucinich (along with some others) in the house are submitting amendments that will at least PERMIT some states to TRY single payer on their own if they want to. if no one beats me to it, i’ll get the links a little later….
Insurance companies wrote a bill that would require them not to deny coverage?
Boy, they got some sucky lobbysts then.
The insurance industry will be pushing immediately. We need to be pushing the otherway quickly.
ho ho ho, there it is!
I hope they included some spending for special jails for people who won’t pay the fines!
isn’t it great when the least worst outdo themselves and actually manage some serious worst worst?
The lobbiests earn their money in the fine print.
Oh they’ll get their money-just like the IRS. Take it out of your tax refund or suspend your drivers license or some other underhanded bullshit.
But of course WE THE PEOPLE have to wait 4 years to get covered.
How is the “from day one” pledge met when it doesn’t kick in until 2013?
From day one is about implementing a plan automatically, as opposed to the trigger proposal which only implements a public option based on conditions.
There will always be lead time to set things up. We’re talking about building $1 trillion of health care infrastructure. Not sure how that can be done the day after this bill is passed…
is kip (see link below) wrong that public option will only be available within the exchange and that “CBO projects that only 30 million Americans will qualify for the exchange (less than 10% of us)”
i read that to mean that all of us would be required to have insurance, but only 10% of us would be allowed to choose the public option.
note: quote is from kip sullivan’s comment on a previous thread (recommend the whole thing):
http://seminal.firedoglake.com…..ment-56463
It’s a lot of reading, but the most important part seems on the face of it to fit the prediction made by Robert Reich over a month ago, to wit,
requirement for “available nationwide” is met when less than 10% will be allowed to choose the public option?!
that was going to be my next question. thanks for beating me to it!
Well it sounds like the ball is in play, and you can bet the corporate lobbyists have all their players on the field.
Is whipping the amendments the best course of action now to try to salvage something decent out of the reform that’s starting to seem inevitable?
We could whip the Sander’s amendment to give the states the option to pursue their own single payer systems.
update from pnhp:
Senate HELP rejects enabling legislation for state single payer experiments
could still, i think, be brought up on the floor or in conference committee.
Understood, but it seems like a very long time. In addition I don’t see how this works politically. Obama warned the Dems that there will be hell to pay if they don’t pass healthcare. Now people will be waiting threw two election cycles till they see real change.
Obama never was for true single payer. Neither was Hillary. Only Kucinich was, IIRC.
So yeah, leaving insurance and the shadow health care industry in place will leave the problem intact. The problem is, the parasitic industries that have nothing to do with delivering health care, but suck up billions anyway. Nobody seems to have the political will to touch that. Well except Kucinich and a few others I suppose.
From here:
agree lots of reading. mostly questions for now.
Let’s be clear about what we’re talking about. The House version of the bill introduced yesterday allows for pretty much everyone in the exchange if they want. The HELP version is vastly reduced access. So, the House version is definitely available nationwide, the HELP version as it stands, not quite.
thats great – the public option will provide another layer of paperwork for health care providers to deal with – more inefficiency, and you will probably need professional assistance to qualify for it! Hello specialized law firms – a new revenue stream!
It doesn’t take four years to put together a public option, and the notion that it does is pure lobbyist bullshit.
From appearances at this point, the “public option” being offered is a classic bait and switch, and those who are defending this four year lead time to have an “option” that practically no one will qualify for are doing a very grave disservice to the American people.
There is no excuse but politics as usual.
ah but this is where the logic of the Least Worst takes us – a public option in 4 years, or even 15 years! – that practically no one will qualify for – qualifies as ‘least worst’ compared to a botched kludge of corporate welfare without a public option.
therefore, according to the logic that the Netroots has adopted, it must be supported, advocated, whipped for, and then spun as a ‘victory’ for our heros, the Democrats!
Washington had the capacity to put together the network to distribute $787 billion of the stimulous package in a matter of weeks.
It should be embarrassing and outrageous. It’s been sixty years since Truman first proposed universal health care in this country. I know, what’s another four — or fifteen — years?
But the idea that a decent public health insurance option can’t be implemented for at least four years after legislation is passed, and then it can’t serve more than a tiny fraction of the people, and we should support it because it’s better than nothing borders on fundamental contempt for the people.
There is no universal coverage without state coercion.
With NHS and single-payer models, you’re coerced into paying for it via taxation, with the penalties that attach to not paying them — garnishment, attachment, etc.)
With Swiss/Dutch/German models, you’re coerced into buying insurance, with penalties attached — civil fines, which if they have teeth will also entail garnishment, attachment, etc.)
If there is no coercion, the ‘universal’ goes away — the problem of free riders and the Tragedy of the Commons comes into play.
There may be reasons to prefer an NHS-shaped system, or single payer, or an insurance mandate-with-subsidies-and-a-catchall, or hybrids thereof, but those reasons don’t involve one of those being more or less coercion-free than the others.
Not true, seeing as only 10% of stimulus funds have been paid out, and they’re going out through already developed channels, whereas here, we’d have to build entirely new infrastructure.
For those saying this can be done faster, what proof do you have?
Which is why we read all the articles about how only 1/4th of it has been spent, now, almost six months later?
There is a medicare as well as Tri-care model that can be used as basis or model. While 10 to 15% of the money has gone out the infrastructure for the entire amount is in place. It should be capable of being done in half of the time. Just make believe we are gearing up to invade Iraq. Additionally, a failure to get it implemented before 2013 could put final implementation into the hands of a new administration that could be hell bent on seeing it fail.
could you please give me a link to your info on the house version? because i’m looking at the timeline from the house committees (via scarecrow’s link) and under 2013 it says (my typos and my bolds):
that’s not everyone
dude! 4 years to collect all those wonderful campaign contributions!
Four years for the vulture insurance industry to continue looting.
The 2013 date is basically required to get the ten-year-average expenditure (CBO’s time frame) under $1 trillion. (President Nelson’s and President Baucus’ magic number.)
It’s not driven by time needed implementation — that would take about 12-16 mo. after final passage, counting from, say, October, based on the roll-out of Medicare in ‘65-’66-’67.
That’s right. In 2013 you have individuals and small businesses, which would be around 100 million people (50 mil uninsured, 15 mil in the individual market, maybe 30 million in small businesses as these numbers change). After that, in 2015, the exchange is opened up on the basis of the Secretary of HHS’s discretion.
Ah, ok, thanks, that’s a helpful data point.
and even then, not available to everyone (if i’m looking at the correct docs).
more reading for me….
p.s. forgot where i got the link, but excellent npr (shocking i know *g*) report on healthcare reform: How To Reform Health Care Reform
it says:
not all individuals. but regardless, different numbers but NOT everyone on day 1 (even if day one = 2013) as you claimed above.
Not to parse too closely, but I believe the wording is available nationwide on day one.
That said, individuals without other coverage is all individuals. If they wanted to join the exchange, all they would have to do is end their current coverage, and then they’re individuals without other coverage, right?
are you asking or do you know?
in MA, i read that at one time (i don’t know if this is still the case), in order to get covered under the state subsidized plan (2006 reform) an individual had to prove 2 months of non-coverage and then could still have application rejected if for some reason did not meet other criteria.
if something like that (having to forego coverage for some period of time) is not the case, i have no idea why the language of the bill reads as it does. see sec. 202 from pages 73, 74:
in any event there are other important issues, so i’m going to read more. but my earlier point still stands:
this bill does not seem to qualify as “available nationwide on day one.”
Jeeze. “Public option” is not available to everyone, and it is not available on “day one.” Period. There should be no parsing or any other backflipping required to make this sow’s ear into a silk purse. What is being proposed is a mandate that everyone (with few exceptions) purchase coverage, the blessed mandate; initially it will have to be from private extortionist/insurance companies, who, allegedly, will not be allowed to turn you down for previous conditions (progress!), but who knows.
The key to what is being proposed — and what is making all the stakeholders (not including you and me) slobber and drool — is the mandate to purchase, with penalties for holding out for a rational and decent public plan. In other words, you don’t get that option. You either get or have health insurance from the extortionist/insurance companies or you are penalized.
This should make the extortionists shut up for a while. At least there’s that.
Yes, this is “better than nothing” — like Medicare Part D — and it is an enormous payoff to the extortionists (like Medicare Part D) and most people will grumble and go along with it — because things could be worse.
But it’s hard to see why any progressive would promote something like this as a decent and rational way to provide everyone with health care coverage at reasonable (and controllable) costs. It’s not.
The real reason for the four year delay is to get everyone (or nearly everyone) signed up to a private plan first, then make it “unreasonable” for them to switch to a public plan when it is finally available — if it ever is.
Right, it is available everywhere in the country (not state by state, as in co-ops or triggers), and it is available as soon as it is set up everywhere in the country (not based on conditions like the trigger, but a timed rollout that happens automatically and cannot be changed without another act of Congress).
So, let’s say I’m on the individual market and have health insurance now. I could cancel my coverage and then I would fit the definition for acceptance into the Exchange, as I wouldn’t have other coverage. So anyone on the individual market would be eligible.
The big question here is the employer market. Right now it’s set at firms with less than 10 employees to start, with larger firms opening up at the discretion of HHS. That could change. It started at 10 employees in HELP, and now it’s at 25, which makes a huuuuge difference in terms of numbers of people who have access. But if we’re talking individuals, the House bill has them in the Exchange as soon as the Exchange is open.
I am all for Healthcare Reform and a Public Option (if it can be efficient), but what kind of insanity is this mandate requiring individuals to pay for healthcare or be penalized?
What about all the people that use holistic and nurse practitioners, chiropractors, etc. that aren’t covered by ins. companies, and everyone that is opposed to conventional medicine for religious or personal reasons?
I feel my freedom slipping away when I hear that I will be penalized and forced to pay for other peoples inefficient 10 minute doctor visits and medicine cabinets full of pills while then not being able to afford my own choice of healthcare that ins. companies do not cover. When I do need conventional medicine for trauma, etc. I pay out of pocket. How is this mooching off of anyone else? I don’t understand.
I just finished reading the Senate HELP Committee bill posted on the committee’s website. The “public option” provisions remain the same as they were in the draft. Which means CBO’s analysis of the PO in its July 2 letter to Sen. Kennedy remains valid. CBO said the PO in this bill would have no effect on enrollment or costs because it would be unable to set its premiums below those of the insurance industry. I found CBO’s explanation way too superficial to be helpful, but I have no doubt its conclusion is accurate.
So, unless the PO that was passed out of committee yesterday is different from the one described in the bill currently posted on the committee’s website, the PO in this bill is not “strong.” This isn’t even a weak PO. It’s a PO that probably won’t even get off the ground in most states.
Without a powerful PO, this bill is just an insurance industry bailout.
Kip Sullivan
Well, I wouldn’t call a public option that gets 9 million enrolled by 2019 “strong,” would you?
And it’s a bailout because it guarantees the insurance companies a market, and nails their business model of denying health care for profit into place. Does this help?
So, it’s available everywhere, just not everywhere? In what world is a so-called public option that’s means-tested available everywhere? That’s like saying you can take public transportation unless you own a car!
What it boils down to is that I’m going to be forced to buy junk insurance to provide a guaranteed market for the insurance companies.
Maybe that’s why Nancy Pelosi said public option was second best after single payer?
Of course the act bails out the insurance companies. It guarantees them a market, and it ratifies their business model.
ermm..
Harry and Louise: The Sequel