FDL is reading the merged Senate health care bill: Many red flags

[seafan]

Jon Walker at Firedoglake is reading the merged Senate health care reform bill, and is not liking what he's finding:


November 19, 2009

1) Delays Start Until 2014 – One of my biggest criticisms is the delayed timing. The House bill starts most of the reforms in 2013; I already thought that late start was both a moral and political disaster. Many Americans desperately need reform now, not several years from now. I also would not want to be a Democrat who voted for health care reform trying to explain why there were still so many uninsured Americans during both the 2010 and 2012 elections. To make the Senate bill appear cheaper, Reid made the disastrous decision to push back the start date until 2014! In effect, his bill is not really cheaper than the House bill, it is just scored over only six years instead of seven years.

2) Pre-Reform Public Option Opt-Out – I’m relatively pleased with the general design of the public option, but I’m very disappointed with the design of the opt-out provision. It allows states to opt-out right away, years before reform begins. It basically insures that many red states will opt-out sometime between now and when public option would be made available. This problem is made even worse because reform is pushed back until 2014.

3) Multiple Exchanges - The bill would create two exchanges per state. There would be an exchange for individuals and a “Small Business Health Options Program” know as the SHOP exchange for businesses. This is, pure and simple, a dumb idea. The more customers using one exchange the larger the risk pool and the better the bargaining power. Creating multiple exchanges is unnecessary administrative waste. It also does not move our country towards one, single, integrated health care system. States would be allowed to merge the individual and SHOP exchanges, but that should already be the default.

4) Nationwide Plans Gutting State Regulation - The merged bill still has the “nationwide plans” (formerly “national plans”) from the Senate Finance Committee bill. They are a top priority of the health insurance lobby. National plans would not be required to follow the minimum benefit laws in the states in which the policies are sold. These “nationwide plans” effectively gut state law regulating insurance coverage.

5) “Free Rider” Provision – Instead of the employer mandate there is the terrible “free rider” provision. The CBPP does a good job explaining why this terrible provision would disadvantage many low income Americans.

6) Incredibly Low Actuarial Value – The minimum actuarial level of the lowest level qualified health insurance is 60%. This level is far too low. This is even lower than the requirement in the Senate Finance Committee bill, which was 65%.

7) No Coverage For Undocumented Immigrants With Their Own Money - Undocumented immigrants will not be able to buy private health insurance even with their own money. This policy is not just cruel, but also bad fiscal policy. Undocumented immigrants will be forced to go to the emergency room for their medical care. Everyone else will be forced to pick up the tab for this uncompensated care. If an Undocumented immigrant wants to buy health insurance with their own money, so as not to be a burden on our health care system, that is not something we should discourage.

8) Sell Insurance Outside The Exchange – Health insurance companies will still be allowed to sell health insurance outside of the new exchanges. Until you get every insurance company playing by the same rules, in the same marketplace, you are never going to address the cherry-picking and efforts to game the system.

Added to this:

CBO: Opt-Out Will Deny The Public Option To A Third Of The Country

The CBO has concluded that the design of the opt-out provision will end up denying the public option to roughly a third of the population in this country.

CBO’s analysis took into account the probability that some states would opt not to allow the public plan to be offered to their residents. Rather than trying to judge which states might opt out, CBO applied a probability recognizing that public opinion is divided regarding the desirability of a public plan and that some states might have difficulty enacting legislation to opt out. Overall, CBO’s assessment was that about two-thirds of the population would be expected to have a public plan available in their state.

This estimates sounds a bit low to be honest. There are currently eleven state governments completely controlled by Republicans. (AZ, FL, GA, ID, NE, ND, SC, SD, TX, UT, VA) Roughly 79 million people (26% of Americans) live in these states, and I would not be surprised if everyone of them opt-out of the public option right away, or at least sometime before 2014. In addition to these eleven, there are easily another dozen conservative states where I suspect the Republican party can gain complete control of the state government for at least some period of time in the next 4 years. Add to that that not all Democrats fully support the public option, and I estimate it is more likely that over 40% of the country will be opted out of the public option before it is ever made available.

It’s great to see that the Democrats have put the health care of the people of Texas at the tender mercy of Rick Perry. I guess the new motto is: Universal affordable quality health insurance for everyone lucky enough not to live a red state.

Not to mention the pitched battle over the Stupak-Pitts Amendment.


Not to mention the forced individual mandates to purchase health insurance from the same corporations that got us into this unsustainable mess is the first place.


Not to mention that all of this protects the massive, skyrocketing profits of Big Health Insurance, Big Pharma, Big Medical Equipment and their lard-filled CEO coffers.




Until we surgically remove the profit-driven motive of Big Health Insurance from blocking the delivery of health care to Americans, nothing is going to change.

[abelenkpe]

1. Can someone please explain

the taxing of 'cadillac plans'. What does it mean that the individual and family plans are 8000/23,000 a year? Any help appreciated!

[glowing]

3. Anyone with premiums that high will be taxed.. which may end up being Union members

who have negotiated good plans for their members.. not necesarily the high-end bankers and wallstreet goons/ execs that normally get plans like these as a perk.

[abelenkpe]

5. Work plans too?

My work raised the cost of healthcare for all employees to 6 percent. With healthcare costs rising rapidly will this end up including many workers? Even non-union workers? Seems unreasonable to put a tax on something when the pricetag is going up for everyone and they can't negotiate it down.

Or am I not getting it?

[glowing]

9. Eventually, I'm assuming everyone would be caught in this trap.

However, if you make a certain amount, you are only charged a % of your income.. and the govt picks up the rest of the tab.. This means this bill is a huge subsidy give-a-way to the ins. ind. that adds absolutely nothing to healthcare. This is why opening up medicare to all would be the sane sollution if we weren't dealing with bought/ corrupt politicians. Its why many Americans are pissed off that they are stalling and talking out the sides of their mouths.

[seafan]

4. From what I understand, people with dangerous jobs, for example, use 'cadillac plans'...

...because they are at increased risk for serious or catastrophic injuries, and these health plans offer more benefits.



The kicker is that these plans include many workers inside labor unions.


Taxing these robust 'cadillac plans' is just another way for Big Corporate to kick Labor in the knees for wanting to protect workers in high-risk jobs in the event of injury/illness.

[abelenkpe]

6. Interesting paper on reason

healthcare is different in US vs. Europe.

Apparently during the industrial revolution increased worker injury led to many lawsuits. In Germany the courts made the corporation liable and in the US the courts ruled the corporation exempt.

Check it out if you like:

From Strict Liability To Workers Compensation

http://74.125.155.132/search?q=cache%3AaDonf3R_t_8J%3Awww.law.nyu.edu%2Fecm_dlv2%2Fgroups%2Fpublic%2F%40nyu_law_website__journals__journal_of_international_law_and_politics%2Fdocuments%2Fdocuments%2Fecm_pro_059586.pdf+alfred+krupp+attitude+towards+workers&hl=en&gl=us

[jwirr]

2. It took more than Democrats to put the health care of Texans at risk.

Texas has continually elected the people who are standing in the way of this bill. They share the blame and will reap the anger of the people when they see states who stayed in the program succeeding. Having said that I am not in favor of an opt out at all but if that is the only way we can get around these idiots then it will have to be up to each state to protect their own citizens. If they do not they will feel the anger at the polls if not before then.

[abelenkpe]

7. You think

that red states may turn blue if they opt out of the public option?

Might be a silver lining there?

I think many more will be eliglible for the public option if unemployment continues to rise, which it appears to be doing given that the gov is more concerned with bailing out wall street than main street. I hope they come up with and introduce a real WPA style jobs program soon....

[jwirr]

8. I love the idea of WPA and CCCamps for helping with the jobs - as

an archivist at a museum in Northern MN we had many artifacts from the CCCamps and many older men would stop by to talk about their experience in them. It was so inspiring. This is one way to direct the anger toward doing something positive and also direct change in the direction we want it to go. Going to work each morning I drive past several stands of pine trees that were planted by the workers back then - it serves to remind me that there is hope.