From John Nichols at The Nation
So it is in the U.S. Senate, where the Finance Committee finally got around to finishing its health care reform assignment.
The vote on the measure -- which does not include a public option to hold insurance companies to account -- was 14-9, with all Democrats on the committee and Maine Republican Olympia Snowe voting Tuesday to toss the measure into the legislative sausage-grinder that will eventually produce final legislation for the Senate to consider.
The important thing to remember is that for all of Tuesday's attention to the finance committee vote, the full Senate will never vote on this particular measure.
Senate Health, Education, Labor and Pensions Committee chair Tom Harkin, D-Iowa, has said throughout the process that "the bill that (the Finance Committee) proposes is just that – a proposal."
Harkin is too polite to state the obvious: The Finance Committee proposal is no more likely to become law than the slacker student's last-to-be-handed-in homework assignment is to be awarded academic honors.
That's a good thing because the Finance Committee bill falls far short of real health care reform. It steers billions of taxpayer dollars into the accounts of insurance companies while failing to provide a realistic, humane or fiscally-responsible alternative to their profiteering. The problems with the Finance Committee's proposal extend far beyond the fact that it fails to establish a government-run alternative to compete with the private insurers that will be ridiculously enriched by it.
But the lack of a "public option" should make the Baucus bill a nonstarter. As insurance-industry insider turned whistleblower Wendell Potter explained in an advertisement produced by MoveOn.org, the Baucus bill would, if enacted effectively, "kill health reform."
"Take it from me," argues Potter, "the Senate Finance bill is a dream come true of the health insurance industry. If there is no public option insurance companies aren't going to change. The choice of a public health insurance option is the only way to keep insurance companies honest." Perhaps that is why the other four congressional committees that produced health-care reform bills – three in the House and the Senate Health, Education, Labor and Pensions (HELP) Committee -- have included far more robust language with regard to alternatives to for-profit insurance companies. It is Harkin, not Baucus, who is the serious health-care reformer in the Senate.
It is Harkin, not Baucus, who has consistently promoted the public option and who continues to argue that it can and will be a part of any final legislation. "Look," says Harkin, "five committees have reported a bill out on healthcare. Four of them have a public option. One doesn't. So you would think the weight would be on the side of having a public option in the bill – and that's where it is."
And it is Harkin, the chairman who gets his work done on time and right, that we should be paying attention to now that Baucus has finally finished his silly sideshow.
From Kip Sullivan via PNHP:
But the actual provisions in the HELP Committee bill call for numerous “community health insurance options,” not the single "Medicare-like" plan promised by "public option" advocates. That means the individual "options" will probably be as small and weak as the co-ops now under discussion in the Senate Finance Committee. More importantly, these "community options" will almost certainly be run by insurance companies. Section 3106 is a mess, but its meaning becomes clear after several readings. Section 3106 does not create the "Medicare-like" program promised by Jacob Hacker, HCAN, Howard Dean, and other "option" advocates. Instead it proposes a program that authorizes DHHS to create numerous health insurance companies tied to geographic areas, and to contract with members of the existing insurance industry to create and possibly run those companies.
Leaders of the "public option" movement have an obligation to advertise the HELP Committee bill truthfully. It is not accurate to say the HELP Committee bill creates a "robust" or "strong" public option. It is not even accurate to say the HELP Committee bill creates one "option." The truth is the "option" is balkanized and very weak. In fact, HCAN, Andy Stern, Howard Dean and other "option" advocates who have praised the HELP Committee bill should do more than cease to praise it. They should tell Congress they oppose it.
by slinkerwink
Here are the major points of the public option in the Senate HELP Bill:
• HHS-based plan: The Community Health Insurance Option would be run by the Department of Health and Human Services. The government would pay for the first three months of claims as a way to capitalize it; this would be a loan to be repaid over time. For the first two years and longer if necessary, this strong public option would also qualify for “risk corridor protections” which offset or reclaim excessive losses and gains which could result during the start-up period (identical to those in Medicare Part D). Subsequently, its premiums would be set to make it self-sufficient. This would make the public health insurance option quickly available in all areas of the country.
• Plays by the same rules: The public option would be one of the Gateway choices. It would follow the same rules as private plans for defining benefits, protecting consumers, and setting premiums that are fair and based on local costs.
• Provider payments and participation:
• Pooled purchasing power: This public option can pool the purchasing power of its enrollees nationwide to leverage lower prices to compete with private plans. Similar negotiation power has been used by states to get drug rebates in Medicaid beyond the statutory minimum. It has been used by large businesses to drive delivery system change. This negotiation would be backed by a ceiling of paying no more than average local rates.
• Flexibility and incentives to innovate: Unlike administered pricing, the negotiation for payment rates gives the Secretary the ability to quickly and aggressively promote payment policies that promote quality and best practices. In addition, the State Advisory Councils would tailor delivery system reform for the public option, with a financial bonus for success.
• Lower administrative overhead: The public option would not need to raise premiums to support shareholder profits, extensive marketing, and extra risk reserves required by require to protect enrollees from plan insolvency or mismanagement of funds.
Here are the major drawbacks to the public option in the Senate HELP draft:
1. It's not open to all Americans, only to the uninsured and to those with small businesses with 50 and below employees. For example, you wouldn't be allowed to choose the public option if you were currently in group employer health insurance. You'd have to go without a job or convince your employer to eat the $750 fee to drop your coverage in order to choose the public option.
2. The national insurance exchange is weaker in the HELP draft than it is in the Tri-Committee House draft.
3. It doesn't use Medicare bargaining rates and the Medicare provider network. Basically, doctors and medical providers aren't required to participate in the public option so hospitals and doctors could refuse to take you on if you're on the public option.
4. States would be allowed to require extra health benefits and to bear the costs for that on top of the basic health benefits currently required in the HELP legislation. So that means if you live in a red state, you wouldn't get the extra coverage afforded by those in blue states.
5. Employers are required to pay 60% of the premium costs.
I just submitted this as a question to Ezra Klein over at his live chat today and he says the public option in the Senate HELP bill is weaker than in the House Tri-Committee version:
Ezra Klein: No, it's a lot weaker. The Tri-Committee draft uses Medicare bargaining rate and the Medicare provider network and is open to everyone through a robust national health insurance exchange. The HELP plan can't partner with Medicare and is in a much weaker health insurance exchange -- CBO predicts that only 27 million people will have access to it by 2019. Right now, we're in a better position today due to having two bills, one from the House Tri-Committees, and one from the Senate HELP Committee, with a good public option. If the Senate HELP Committee makes it through the Senate intact with its public option, and is the one supported over Max Baucus's Finance Bill, then it'll have to be reconciled with the House Tri-Committee version. So theoretically the public option in that could be made stronger in the conference process.
Here's Christy Hardin Smith from Firedoglake who just got off a conference call with the Senate HELP committee:
For consumers to buy into the public plan, there is a firewall built-in if you are already part of an employer-based health plan. If your plan costs more than 12 1/2% of your annual salary, then you can contemplate switching to the public option. If not, then you are stuck with your employer-based plan, whether or not you are satisfied with it. It's a cost containment decision, with the hope that competition from the public plan will, over time, shift the operations of private insurers.
Sen. Brown emphasized that this plan is designed to reward "best practices" for insurers -- and that each state will have an advisory council to monitor local competition in an effort to keep insurers more competitive and, hence, he says, more honest. He used the stuent loan industry as an example. I'm not certain that was the best example, frankly, given the profit-grubbing nature of any number of lenders in that industry, but there you are.
It's why we have to support the progressives in the House and to KEEP on cracking the whip on them for the public option! Read it all at Daily Kos
Democrats on a key Senate Committee outlined a revised and far less costly health care plan Wednesday night that includes a government-run insurance option and an annual fee on employers who do not offer coverage to their workers.
The plan carries a 10-year price tag of slightly over $600 billion, and would lead toward an estimated 97 percent of all Americans having coverage, according to the Congressional Budget Office, Sens. Edward M. Kennedy and Chris Dodd said in a letter to other members of the Senate Health, Education, Labor and Pensions Committee. The AP obtained a copy.
By contrast, an earlier, incomplete proposal carried a price tag of roughly $1 trillion and would have left millions uninsured, CBO analysts said in mid-June.
The letter indicated the cost and coverage improvements resulted from two changes. The first calls for a government-run health insurance option to compete with private coverage plans, an option that has drawn intense opposition from Republicans.
"We must not settle for legislation that merely gestures at reform," the two Democrats wrote. "We must deliver on the promise of true change."
Additionally, the revised proposal calls for a $750 annual fee on employers for each full-time worker not offered coverage through their job. The fee would be set at $375 for part-time workers. Companies with fewer than 25 employees would be exempt. The fee was forecast to generate $52 billion over 10 years, money the government would use to help provide subsidies to those who cannot afford insurance.
The same provision is also estimated to greatly reduce the number of workers whose employers would drop coverage, thus addressing a major concern noted by CBO when it reviewed the earlier proposals.
Kennedy, D-Mass., and Dodd, D-Conn., circulated their letter a few days before lawmakers return from their July 4 vacation, with the Health Committee one of several panels expected to take action on health care legislation that President Barack Obama has placed atop his domestic agenda.
Kennedy, the committee chairman, was diagnosed with a brain tumor more than a year ago and has been absent from the Senate for weeks, although he and his aides have been heavily involved in the deliberations on a health care bill. Dodd, the next senior Democrat on the committee, has presided at committee sessions and taken an increasingly public role.
With its government option, the proposal is unlikely to gain any bipartisan support in the committee.
Separately, Democrats and Republicans on the Senate Finance Committee are at work trying to reach agreement on an alternative that calls for creation of nonprofit cooperatives to sell insurance in competition with private industry. Agreement has been elusive on that and other issues, and it is not clear whether a deal is possible before Democrats opt for a more partisan approach.
In their letter, Kennedy and Dodd said the Congressional Budget Office "has carefully reviewed our complete bill, and we are pleased to report that CBO has scored it at $611.4 billion over 10 years, with the new coverage provisions scored at $597 billion. ...The completed bill virtually eliminates the dropping of currently covered employees from employer-sponsored health plans.
"In addition, our bill, combined with the work being done by our colleagues in the Finance Committee, will dramatically reduce the number of uninsured — fully 97 percent of Americans will have coverage, a major achievement."
Three committees in the House have been at work for weeks on a plan expected to come to a vote by the end of July. Source: The Associated Press
Dropping in at 615 pages is the Senate Health, Education, Labor and Pensions Committee's attempt to fix the broken health care system. The HELP Committee is chaired by Sen. Ted Kennedy (D-Mass.). The second-ranking Democrat, Sen. Chris Dodd of Connecticut, had a large hand in drafting the bill as well, given Kennedy's absence from the committee while he battles brain cancer. The bill can be read here. {PDF} A HELP Committee aide cautioned that the bill is not in its final form and that part of the reason for filing it is to meet a committee rule that requires a bill to be filed seven days before a vote can be held.
Committee Democrats will be meeting with their Republican counterparts Wednesday and Thursday to hash out the bill's details. Read More at Huffington Post
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