Who Would Be Eligible For A Public Option? Far more than “10%” of the Population

[redqueen]

If anyone has evidence that any of this is incorrect I'd appreciate corrections.

It seems that most of the discussions about HCR are filled with more with rhetoric than facts, so I'm posting this for those more interested in the latter.

Who Would Be Eligible For A Public Option? Far more than “10%” of the Population

Very likely you have heard that only a “tiny group” of Americans will be eligible for the public plan. But if you read the House bill approved by three House committees (HR 3200) carefully, (this is the proposal that provides the most detail on the public option) it appears that 20 percent to 25 percent of all Americans would be eligible to sign up for the public plan in 2013. In the years that follow, the Exchange will be open to all Americans.

The notion that only “10 percent of the population” will be eligible to enter the Insurance Exchange and choose between private sector insurance and Medicare for Everyone is fast becoming an urban myth. Some commentators are using the number to minimize the importance of the public plan.

In fact, the uninsured, the self-employed, the owners and employees of small companies, and those who are temporarily uninsured will be able to sign up for the public plan, if they choose, in the very first year of reform. The Census Bureau reports that over 15 percent of Americans are uninsured, while 10 percent (including the self-employed and early retirees) pay directly for private health insurance. Together, they comprise 25 percent of the population.

Those who buy their own insurance are now paying very high individual rates; in the Exchange, they will become part of a group, and eligible for much lower premiums. While some of the uninsured might not be eligible to shop the Exchange (illegal immigrants, for example) we’re still looking at 20% of the population—or more. Add the owners and employees of small businesses, and the number grows. (In 2013, the Exchange will be open only to very small firms; the next year, companies with up to 30 employees will be eligible)

(more at link)

Well worth reading IMO.

[lumberjack_jeff]

1. Additionally, people who elect to decline their employer's plan are eligible.

The main large groups who are unable to access the exchange already have free care from the government.

[Phoebe Loosinhouse]

3. I'm not sure that is the case - wasn't that the whole point of the Wyden amendment

that didn't get added? He wanted people to be able to have the choice between their employer plan and the PO. My impression was that if people had employer provided healthcare they HAD to stick with it which is a big bone of contention for many.

[SpartanDem]

12. The Senate HELP exchange is designed differently

in that bill it is limited to those with out employer coverage or those with it whose coverage cost too much.

[redqueen]

5. If I'm reading it correctly, that only applies if the employer plan is unaffordable...

based on the cost of the employer plan's premiums and the employee's salary.

[lumberjack_jeff]

20. I don't think that's the case.

HR3962 allows employees to decline coverage, and requires employers to provide compensation in lieu of coverage if they do.

See sections 412 and 413

http://www.scribd.com/doc/21803801/H-R-3962-Affordable-Health-Care-for-America-Act-as-Introduced

[abluelady]

8. From What I've Read

it sounds like if your employer offers insurance, you're stuck with it.

[Statistical]

13. Not true at all.

The is part of the "problem".

Many of the 15% who are uninsured DO HAVE insurance "available" but they chose not to take it because they can't afford the premiums, the coverage is weak, or they are young and willing to risk no insurance.

If your employer offers coverage that meets the minimum requires of the HCR then you absolutely have no choice of using the public option and/or exchange.

[lumberjack_jeff]

17. Read page 274 of HR3962

http://www.scribd.com/doc/21803801/H-R-3962-Affordable-Health-Care-for-America-Act-as-Introduced


section 412, (c) 2

employees have the option to reject employer coverage.

If they do, then section 413 "employer contributions in lieu of coverage" takes effect.

From what I read, the Wyden amendment is built into the house bill.

[Statistical]

Not sure how you are reading into that.

here is exact quote

pg 273-274 (beginning on line 18 on pg 273)

(c) AUTOMATIC ENROLLMENT FOR EMPLOYER SPONSORED HEALTH BENEFITS.

(1) IN GENERAL.—The requirement of this subsection with respect to an employer and an employee
is that the employer automatically enroll such employee into the employment-based health benefits
plan for individual coverage under the plan option with the lowest applicable employee premium.

(2) OPT-OUT.—In no case may an employer automatically enroll an employee in a plan under paragraph (1) if such employee makes an affirmative election to opt out of such plan or to elect coverage under an employment-based health benefits plan offered by such employer. An employer shall provide an employee with a 30-day period to make such an affirmative election before the employer may automatically enroll the employee in such a plan.

If my reading is correct the only thing that 412 deals with is that employers must enroll all employees into cheapest healthcare plan (unless employee opts out) this is done because if the employee doesn't opt into a plan they will get the penalty/tax/fine for the year.

There is nothing that indicate that if an employee opts out they get to enroll in public option and/or exchange.

[lumberjack_jeff]

40. The bill doesn't prevent anyone not covered by their employer to go without insurance.

My read is that if you reject your employer's coverage, you can get cash in lieu of coverage and take it to the exchange to purchase whichever plan you want (but without the subsidy).

[Statistical]

42. No if you reject your employers coverage you get an IRS penalty.

Nothing indicates anyone who has "acceptable coverage" (as defined by the bill) will have a choice of either:
a) employer plan
b) no insurance & penalty

[lumberjack_jeff]

45. Incorrect.

Section 302 says that anyone who is not enrolled in acceptable coverage is eligible to particpate in the exchange. It doesn't make a distinction between those who can't get coverage from their employer and those who have simply rejected that which is offered.

However, people who have been offered coverage by their employer are not eligible for affordability credits (which makes sense, because their employer gave them compensation in lieu of coverage), but they are eligible to purchase coverage through the exchange. See section 342.

Additionally, beginning in year two, if employees reject coverage because their share would exceed 12% of their income, they can get affordability credits.

http://energycommerce.house.gov/Press_111/health_care/hr3962_Section_by_Section.pdf

[Raineyb]

32. No they're not. If a plan is offered to you no matter how shitty, so long as it's "qualified"

you have to take it or go without as you'll be ineligible for the exchange.

[lumberjack_jeff]

34. Read post 17. n/t

[ProleNoMore]

2. And This Is Part of The Problem - The Democratic Leadership, Including the Obama Administration, Is

Not adding much clarity or insight.

[Cant trust em]

4. I've felt like CBO has been muddying the waters also.

They keep doing these projections and I'm not sure what they're based on.

[John Q. Citizen]

19. They are based on the facts. You are confused by the OP. The CBO projected how

many people would be enrolled by 2019 - At most, 10 million.

The article and the OP don't address how many people would be enrolled. They address how many are eligible to be enrolled, if they want to pay the higher costs of insurance that are to be found in the PO.

Remember all that stuff about "a level playing field?" Well it was put into both the house and Senate bills. Which means that the cost of being in the PO won't be an advantage over the cost of traditional private insurance. In fact the cost of starting up the new pool and attracting care providers to see the members of the new pool will make the cost of insurance in the PO higher than is from private plans.

The CBO is there to estimate the effects of legislation. It's there job, they are the government office charged with that task. So when they say that by 2010 there will be at most 10 million enrolled, that is the best estimate. When they say that the PO will have zero effect on the cost of insurance, that is the best estimate.

Everyone in the country is eligible to buy a New York City upper Eastside Co-Op building. But not everyone in the country is going to buy one. many can't afford it. But they are eligible to, if they win the lottery, or get an inheritance, or can swing a loan or if they already have the money in the bank.

See, that's the point of that article, to confuse you. And they did a good job of it.

[inna]

23. +1. The "public options" currently before the House and Senate are both grossly inadequate.

Even with the stronger House plan, CBO predicts only 2% of Americans - 6 million people - will join by 2019.

And that doesn't even take into account the opt-out option.




http://www.huffingtonpost.com/2009/11/01/public-option-plan-will-c_n_341408.html

http://www.huffingtonpost.com/miles-mogulescu/the-public-option-in-cong_b_340501.html

[lumberjack_jeff]

28. -1

They aren't facts, they are projections of consumer behavior without any data to project from.

The CBO simultaneously projects that the public option will be more expensive than the private plans because, unlike the private plans, subscribers care won't be rejected AND that only a few people will choose it, despite the fact that the subsidy is set up in such a way that, for most people, cost is irrelevant.

A superior product at the same price will get market share.

[John Q. Citizen]

31. The PO will be run by private insurance companies for the government. Do you

think they will run them to hurt their own interests?

[lumberjack_jeff]

33. Show me where it says that.

http://www.opencongress.org/bill/111-h3962/show

Don't post bullshit. Like medicare, some of the functions may or may not be outsourced but that doesn't imply that insurance companies "run" it.

[John Q. Citizen]

36. Since you want it, you got it! See, this isn't "like Medicare." That's a myth.

http://pnhp.org/blog/2009/11/01/what-role-insurance-companie/

For soemone who hasn't even learned the process of how a bill pases, you are sure quick to assume someone is posting "bullshit."

I don't think you are posting "bullshit" i just assume that you are ill-informed about what's in the house and senate bills, how they will function, and what they will actually do. Since you don't even know, by your own admission, how a bill becomes a law, I would find it rather amazing that you would think you know what's actually in either of the bills and what they do.

I mean congress passes laws each and every month year in and year out, but you don't know how? But you are an expert on the health care bills in the house and senate? Yeah, right.

[lumberjack_jeff]

39. Get a primary source.

PHNP is not a primary source, nor are they unbiased.

If you're going to lecture me about ignorance of what's in the bills, show me where in the house bill...

http://www.scribd.com/doc/21803801/H-R-3962-Affordable-Health-Care-for-America-Act-as-Introduced

... your assertion can be found. No op-eds or speculation from lobbying groups allowed.

[John Q. Citizen]

46. Kip Sullivan's article is sourced with primary sources. You can click on them and read

the primary sources yourself.

You haven't even read the articles, have you?

Or if you have, why do you have zero rebuttal to them?

You can't refute them. You can only try to ask me to rewrite and resource them for you. But the sources, the primary sources are right their in the article.

They aren't op-ed. They aren't opinion, they are analysis.

What is it about the analysis that you find faulty? Or do you agree but wish to remain obtuse? Why is an article that's sourced not worthy of you refuting what you see as inaccurate or incorrect? If you see something that is inaccurate or incorrect that is.

You can't refute those articles, because you either haven't read them, or you know they are correct.

[redqueen]

6. As for me, I have no problem reading. (nt)

[Taverner]

7. Darwin I hope so!

[John Q. Citizen]

9. If you read the Congressional Budget Offices report you will see why what you posted is misleading

The Congressional Budget Office, the official government organization whose sole reason for existence is to estimate the effects of legislation, says that the House PO will have at most 10 million enrollees by 2019.

Where you make your mistake is in confusing eligibility with actual enrollment. The PO is projected to enroll between zero and two percent of the population.

http://pnhp.org/blog/2009/11/01/what-role-insurance-companie/


The CBO in their analysis says that the "Pubic Option" as defined in the house Bill will have to sell insurance at greater expense than can be found on the open market. So while employers could choose to pay more money for less and join the public option, they won't. Which will drive down enrollment and further drive up costs inside the option.

Remember the stuff about "a level playing field" That got passed and put into the legislation. That means that the PO has to act like it were a for profit insurance pool and incur all the expenses that a for profit insurance pool incurs. It doesn't get to function at an advantage over other plans.

Also, the public option will most likely be run by private insurance companies as the legislation is currently written. If you would like some good analysis of the legislation as written I suggest reading Kip Sullivan;s pieces on the public option. He's an expert and he has the only in depth analysis i've been able to find on what the legislation will actually do in the real world.

Maggie Maher starts out saying who is eligible. She never said that just becaus someone is eligible that they will want to pay more and enroll in the public option, now did she?

She says that the exchange (of which the public option is just one choice of many choices) will drive down costs. Well that hasn't happened in MA where they have an exchange. In fact MA has some of the higher cost insurance in the country right now. People are having their benefits cut because prices are going up. But even if the exchange does help with pricing, it doesn't then mean that every plan available on the exchange with be cheaper, and it scertainly doesn't mean that the public option will effect prices at all. She didn't claim it would in her article. So don't assume it will. In fact the CBO says it won't.

http://pnhp.org/blog/2009/07/20/bait-and-switch-how-the-%e2%80%9cpublic-option%e2%80%9d-was-sold/#comment-1475

[redqueen]

10. I didn't confuse anything. As the title clearly conveys, this is about eligibility. (nt)

[John Q. Citizen]

16. Great. You are eligible to buy an apt building on the upper east side. Does that help with housing?

No. Because being eligible for something you can't afford doesn't do you any good.

So is your point that the weak tiny pitiful public options in the bills are useless to people, even if they are eligible?

Or what is your point? Is it to mislead people about the usefulness of the weak pitiful PO?

[Statistical]

11. You can't count all 15% of uninsured.

Some people have health insurance "available" at work (like every single Walmart employee) however they are uninsured because
a) they can't afford the premiums
b) the plan sucks
c) they are young and feel it is cheaper/better to skip insurance.

Counting all 15% of currently uninsured and assuming they will all be eligible for public option is apples & orange comparison.

[tinrobot]

14. Perhaps they're downplaying it to limit opposition.

10% is a lot easier to sell to a moderate than 25%. The people on the left will raise a ruckus, but they'll generally go along, even though they're disappointed. Without some support from the middle, however, nothing gets passed.

[lumberjack_jeff]

27. I suspect this is true. n/t

[SpartanDem]

15. Thanks for posting this

I think too often we're confusing total eligibility with CBO estimates. We shouldn't take CBO as the word of God remember they severely underestimated the number sales in cash for clunkers.

[emulatorloo]

18. Plus outfits like AP want to spin the CBO reports as negatively as possible for some reason n/t

[John Q. Citizen]

21. You are mistaken,. The CBO didn't estimate eligibility for the PO, they estimated utilization.

Since the PO was constructed as a level playing field, it won't have a cost advantage.

Since it's starting from scratch it won't have any care providers and it won't have any patients to offer care providers so coverage will be more expensive than private plans.

Since coverage will be more expensive, not many people will want to pay more money for less coverage.

Which is why the CBO estimates that the PO will have a utilization rate of from zero to 2%, or 10 million people at best, by 2010.

[Junkdrawer]

22. +1

[SpartanDem]

37. I'm saying not take to those use estimates as the word of god

The fact that it will be non profit is a major cost advantage

CBO says that it have higher risk customers, but since insurance companies must take everyone I don't just see the justification that the PO will have higher cost compared to any other exchange plan. They're all coming from the same pool of people.

I do think they're right with the cost associated with start up, but I see that short term problem.

More cost less coverage? I suspect the PO will offer similar if not better coverage and be less hassle on claims. Increasing cost, but also customer satisfaction which could lead to it getting more customers.

[John Q. Citizen]

41. No they aren't because right now the major insurors have eliminated all the high risk people from

their already established pools. So they already have millions of the lowest risk people enrolled.

And since they are going to be cheaper, no one is going to switch, or star off paying more. They will go to the cheapest plans they can get.

Secondly, the PO will have to pay care providers more than the established insurance pools will because they can't offer volume when they start up. They have no enrollees. So they will have to ask care providers how much and the providers will charge more because there isn't any volume.

Since they are charged more, then the price of insurance will be more and their isn't any volume since people won't pay more for less.

Here is a very good in depth analysis by a professional who has been working for the last 25 years on health care reform. He explains why the way the PO has been structured under the bills isn't going to save any money and probably isn't going to work like so many people think it will, people like yourself, for instance. They are long and detailed but they are also very readable by non-experts.



http://pnhp.org/blog/2009/07/20/bait-and-switch-how-the-%e2%80%9cpublic-option%e2%80%9d-was-sold/

http://pnhp.org/blog/2009/11/01/what-role-insurance-companie/

[no limit]

24. Umm, HR 3200 is dead in the water, has been for a while now.

The public option the senate wants to put out is much weaker.

[lumberjack_jeff]

26. HR3962 is the replacement.

It is the bill that the house will vote on this week.

http://www.opencongress.org/bill/111-h3962/show

[no limit]

29. But right now isn't it really up to the senate?

Then based on what they approve it will go to the house since the senate is so conservative?

I could be missing something.

[lumberjack_jeff]

30. I'm muddy on process, I just know that Pelosi has scheduled a vote on this.

I think it then waits for a bill to pass the Senate, the two will then be reconciled.

I do not claim to be an expert on the process at all.

[John Q. Citizen]

35. The house will vote on their weak bill. The Senate will vote on thier weaker bill, then

if both pass it will go to conference where the final details will be hammered out and then voted on by both houses.

[HamdenRice]

25. Any bill that would help some of us to get past "previously existing conditions" is an improvement

That's what some people seem not to get. A bill might not be all we want but if it helps some people it's an incremental step in the right direction, and will be improved later.

There are a lot of people who don't want the bill to help anyone.

As it is, I agree with you, the p.o. will be available to far more people than the naysayers are giving credit for, and given history, it's almost certain to be expanded in the future.

[John Q. Citizen]

43. Yes! Just like the Iraq war vote. It had it's draw backs, but it clearly helped the Shiite

majority get rid of their long time oppressor, Sadam Hussain.

It wasn't all we wanted, but it's an incremental step toward freedom.

Sure to be improved in the future.

Thanks. A lot.

[HamdenRice]

49. Completely different. I'm going paralyzed from the neck down from a previously existing condition

and it's the one thing I can't get insured for.

I find those to be very different -- voting in favor of the war, and voting in favor of a bill, however flawed, that might provide coverage for people like me.

[John Q. Citizen]

53. And in about 5 years you might get covered if this bill passes. Of course

you could move to MA today, and get the exact same thing this bill does. Romney Care is available right now in MA. You don't have to wait until we get it nationally.

But better do it quick. Romney care doesn't contain costs, so already MA has some of the highest priced insurance in the country. And yes, it's subsidized, but they are cutting benefits because they can't afford the rapidly raising costs.

The same thing is true for this national HCR bill. There is no cost containment, but if you get in at the right time it might help you until it gets too expensive. But if you get care, don't worry about your kids or other people. Just because it's a stupid short term fix that isn't sustainable, at least you will get yours, and that's what counts, right?

Don't worry about doing it right. Just worry about getting yours.

[eridani]

51. Except for the absence of enforcement mechanisms n/t

[Greyhound]

38. Since this scam has become a vehicle for a massive direct corporate welfare program

as well as codifying that the American public will continue to pay these parasites to kill us, you should realize that if too many people "qualify" for this fig leaf, Congress will simply cut funding and services to force as many as possible back into servitude.

The popular idea that "we can make it better, later" is as likely cutting the defense budget by 60%.

[Odin2005]

44. LOL, this is the apocalyptic "the elites will never let real reform happen" BS I was talking about.

Armchair revolutionaries = :eyes:

[Greyhound]

47. Student of history.

You will learn, if you live.

[Odin2005]

50. I'm a student of history, too, buddo.

Nice try.

[Greyhound]

55. Yet you haven't learned.

[Odin2005]

56. Or maybe I have a more optimistic view of history than you do.

:hi:

[Greyhound]

57. History has nothing to do with optimism or pessimism, it is what was and serves

as a pretty reliable guide to what will be again.

[John Q. Citizen]

48. Will if the elites will let real reform happen why haven't they? It's not in this bill. Time to put

up or shut up.

[Odin2005]

52. because people are too content whining and bitching on message boards.

Get off your ass and primary the damn Blue Dogs.

[John Q. Citizen]

54. I went to DC and lobbied both my Senators, Baucus and Tester. But it's also

Wexler and Pelosi. They are in some ways worse because they claim to be progressive yet they are the insurance industry's best friend when push comes to shove.

[Greyhound]

58. I prefer a fire-breathing, kill-em-all wingnut to these poseurs.

You know where you stand with the misnamed conservatives.