Reid says he’s moving forward with a Senate bill that has a public option with an opt-out in it "with the support of the White House, and Senators Dodd and Baucus." He says that the Senate bill will also have co-ops included - which confuses me a bit. My hope is that he is not considering the co-ops a public option. And of course, just who will be allowed to participate in the Public Option is still fuzzy. So while we don't know just what the Public Option will look like, the best news is that we don't have the "trigger" deeply disappointing Olympia Snowe.
Fueling the push for a new government insurance plan, Senate Majority Leader Harry Reid (D-Nev.) said today that his chamber's healthcare bill would include a compromise that would create a nationwide public option but give states the right to opt out.
"The public option is not a silver bullet, [but] I believe it's an important way to ensure competition and to level the playing field for patients with the insurance industry," Reid said. "Under this concept, states will be able to decide what works for them."
Reid sent the proposal to the nonpartisan Congressional Budget Office to be analyzed today, a key step before he can bring a bill to the floor for debate.
His decision does not settle the debate roiling Democratic ranks over how to create a government plan that would give consumers who don't get coverage through their employers an alternative to plans offered by commercial insurers.
The "opt-out" compromise is still two votes shy of the 60 Reid needs to overcome a Republican filibuster, according to a senior Democratic aide on Capitol Hill who requested anonymity when discussing the plan.
Reid and House Speaker Nancy Pelosi (D- San Francisco) are advancing separate healthcare bills in the Senate and House, which would have to be reconciled later this year before they are sent to the White House for President Obama's signature.
But Pelosi indicated Friday that the opt-out alternative could be included in a reconciled bill.
For now, House Democrats are poised to pass a bill that would create a nationwide government plan, although there is still disagreement about how much such a plan should pay doctors, hospitals and other medical providers.
Liberals, including Pelosi, favor a proposal that would link those payments to the existing Medicare program, which often pays providers less than commercial insurers. Proponents believe such an arrangement would save money and help drive down costs.
But many conservative Democrats, particularly from rural areas where Medicare typically pays less, want the government plan to negotiate its rates with providers, as commercial insurers do.
Pelosi hopes to settle those differences in time to unveil a bill later this week, according to her office.
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.
BILL MOYERS: You know from the news that early next week the Senate Finance Committee is expected to vote on its version of health care reform. And therein lies another story of money and politics.
Polls show the overwhelming majority of Americans favor a non-profit alternative -- like Medicare -- that would give the private health insurance industry some competition. But if so many Americans and the President himself want that public option, how come we're not getting one?
Because, the medicine has been poisoned from day one, in part because of that same revolving door that Congresswoman Kaptur and Simon Johnson were just talking about. Movers and shakers rotate between government and the lucrative private sector at a speed so dizzying they forget who they're working for.
When the Finance Committee eventually gets around to voting on the bill they cobbled together last week, it's still not entirely certain that it will pass...
To put it more directly, the exchange as set up in the Baucus bill will be open to just 25 million people, most of whom have been uninsured, un-doctored, untreated for a long time. It's enough to make one think they're setting not just the public option but the exchange to fail.
The hostility among the committee's senior members, particularly those on Baucus's Gang of Six, to the Wyden Free Choice amendment just reinforces that impression. Jon Walker at FDL has the whole sordid story of how Baucus blindsided Wyden on that late night of markup, when Baucus ruled his amendment out of order because it hadn't been scored by the CBO. Except that the amendment that Wyden offered had been scored, more than a week before the markup.
To put it more directly, the exchange as set up in the Baucus bill will be open to just 25 million people, most of whom have been uninsured, un-doctored, untreated for a long time. It's enough to make one think they're setting not just the public option but the exchange to fail.
The hostility among the committee's senior members, particularly those on Baucus's Gang of Six, to the Wyden Free Choice amendment just reinforces that impression. Jon Walker at FDL has the whole sordid story of how Baucus blindsided Wyden on that late night of markup, when Baucus ruled his amendment out of order because it hadn't been scored by the CBO. Except that the amendment that Wyden offered had been scored, more than a week before the markup.
There are two issues at play here--Baucus's actions as committee chair which have shown him essentially incompetent to achieve a decent bill of this scope and dishonest in dealing with his colleagues. But the more important issue for the moment goes back to Rockefeller's problem with the bill--the half trillion dollar gift it is to the insurance industry, made an even bigger gift by the crippled exchange it creates.
There's going to be tremendous pressure on Wyden and Rockefeller, from Baucus, from the White House, from Reid, to vote for this crappy bill to get it out of committee so the process can move on (pressure that should have been on Baucus months and months ago, since it's his fault we're now well into October with no bill). As long as there's a Snowe-inspired delay why the CBO does it's work on the crappy bill, Wyden and Rockefeller should hold out on saying how they'll vote. They should be using this time to extract as many concessions as possible from Reid and the White House before agreeing to anything.
Senate Majority Leader Harry Reid (D-Nev.) and Finance Committee Chairman Max Baucus (D-Mont.), once in polite disagreement over the idea of a public option component in healthcare legislation, are approaching a breaking point over the issue.
Reid and Baucus have staked out opposing positions on the central question of a government role in health reform — Reid has consistently stood in favor, but Baucus has consistently said the idea doesn’t have enough Senate support.
Having deferred the issue to Baucus this summer, Reid signaled on Thursday that he is prepared to join Sens. Charles Schumer (D-N.Y.) and John Rockefeller (D-W.Va.), who both pushed a public option amendment that failed in a committee vote last Tuesday.
“We are going to have a public option before this bill goes to the president's desk," Reid said in a conference call with constituents on Thursday, as reported by the Las Vegas Sun. “I believe the public option is so vitally important to create a level playing field and prevent the insurance companies from taking advantage of us.”
On the same day, Harkin gave The Des Moines Register the same message, suggesting clearly that he will side with Reid against Baucus.
The bill coming out of Senate Finance is far from perfect, but they finished up last night with some key improvements adopted that mean some of the worst elements have been softened, and some of the worst Republican amendments were fought off. There's still some ugly there, though, for Harkin, Reid, and Baucus to deal with as the bills are merged, and when it eventually comes to the floor.
Probably the most significant improvement on affordability came last night when Schumer and Snowe successfully lowered the "Max Tax". The bill still has an individual mandate, but the penalties have been reduced.
Here's one of the uglier ones they passed, and in basic secrecy, that would give states increasing flexibility to drop Medicaid patients, starting next year.
They will meet sometime next week to vote on reporting the bill out. After that, assuming that Rockefeller, Cantwell, and Wyden feel their primary objections have been met and vote for it, it's on to the merging process, where hopefully Senator Harkin will be able to prevail on a strong public option.
Liz Fowler, a former public affairs executive for Indianapolis-based health insurance giant WellPoint, helped to craft health-care reform legislation being proposed by Senate Finance Committee Chairman Max Baucus.
It's a connection that is drawing criticism from some reform advocates who support the creation of a public health plan that would compete against commercial insurers such as WellPoint. Baucus' bill does not call for the creation of a public plan.
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"This just sounds like another example of the revolving door between government and industry," said Dr. Robert Stone, a Bloomington physician who also is director of the advocacy group Hoosiers for a Commonsense Health Plan. "We don't really know how much influence her job at WellPoint had."
Healthcare overhaul legislation moving through the Senate Finance Committee would put crucial rule-making authority in the hands of a private association of state insurance commissioners that consumer advocates fear is too closely tied to the industry.
The National Assn. of Insurance Commissioners currently writes model laws and regulations that individual states are free to accept or discard. Under the bill by Sen. Max Baucus (D-Mont.), it would craft a model rule governing "health insurance rating, issuance and marketing requirements" that would become "the new federal minimum standard without any further congressional action." States would be permitted to deviate from the standards only by appealing to the Department of Health and Human Services.
In effect, the bill would allow the group to write many of the new rules on issuing and marketing insurance to millions of uninsured Americans who would be required to purchase policies.
"The NAIC is clearly an organization that is dominated by the insurance industry," said California Lt. Gov. John Garamendi, a former state insurance commissioner.
While the Senate Finance Committee is slogging through more than 530 amendments to Sen. Max Baucus’ flawed health care reform bill, more than 2,700 lobbyists are working overtime to protect the private health insurance industry and other health care corporations.
Yesterday, AFL-CIO President Richard Trumka called for an investigation into the connection between the millions of dollars that health insurance companies are spending on lobbying expenses to kill health care reform and soaring premiums. Today, Bloomberg News reports that more than half of the health care industry’s hired-gun lobbyists are former congressional staffers, White House employees or government agency veterans—55 are former members of Congress.
Sen. Jay Rockefeller (D-W.Va..) and Sen. Chuck Schumer (D-N.Y.) each plan to offer a public option amendment next week. Says Rockefeller:
A health-care plan without a public option is a much weaker health plan because insurance companies continue to rule. [A public option] is going to force other companies to bring down costs over time.
All 10 committee Republicans will oppose the amendments and it may not win enough of the 13 Democratic votes. If it fails in committee, Schumer says he will take the fight to the floor when the full Senate votes.
Senator Rockefeller pointed out that there was a gigantic loophole in the Baucus bill that would leave half of Americans subject to potential discrimination by private insurers. Apparently due to existing federal law, large companies can call themselves "self-insurers" even though they provide coverage through a major insurance company. These sort of self-insurance plans are mostly exempt from state regulations and are allowed to deny coverage based on pre-existing conditions.
The Wonk Room has done a good job explaining many of the more important modifications made to the Baucus bill.
Sen Max Baucus (D-MT) has just released a Chairman’s amendment to his mark. The new amendment enhances the bill’s affordability measures and increases the threshold on so-called Cadillac health care plans for ‘high-risk’ Americans. The modified amendment also preserves a subsidy to certain Medicare Advantage plans.
Better Ombudsman Office Baucus decided to significantly strengthen the new ombudsman office by basically adopting the Bingaman amendment I discussed the other day. Originally the consumer would need to fully exhaust all internal appeals before being able to seek help from the ombudsman's office. Now, if the appeals last longer than three months, they can get professional help from the ombudsman's office. Access to the ombudsman's services still needs to be improved, but this is a step in the right directions.
No Multiple Exchanges The bill would no longer allow states to create multiple exchanges. Originally, states could allow “other entities” to operate multiple exchanges in the state. This was a bad provision that would not only dilute the bargaining power of individuals using the exchanges, but could easily have become a way for insurance companies to game the system.
National Plans Restricted Baucus's bill would have allowed insurance companies to sell “national plans,” which would be exempt from state benefit mandates. This has been a long time goal of the health insurance industry, and would have effectively gutted most states' insurance regulations. Fortunately, this provision has be changed to allow individual states to opt-out of allowing national plans to be sold in their state. States with very good benefit mandates can now at least prevent their state from being flooded with lower quality “national plans.”
The first big fight over the Senate Finance Committee’s health care legislation erupted Tuesday night: a rollicking brawl over a deal that the Obama administration cut with the pharmaceutical industry to achieve $80 billion in savings on drug costs over 10 years, money that would help pay for the legislation.
Top House Democrats have hated the deal from the get-go. Senate Democrats are now bitterly divided. And Senate Republicans are eagerly jumping into the fray to needle the Democrats over their divisions.
The fight over the deal with PhRMA actually stems from the legislative battle over the Medicare prescription drug legislation that Republicans successfully pushed through Congress in 2003. As a result of that legislation, about 6 million elderly Americans who had been receiving drug benefits under Medicaid, the government insurance program for the poor, were instead shifted into the new Medicare drug program, resulting in the government paying far high prices for drugs.
Representative Henry Waxman, Democrat of California, and now the powerful chairman of the House Energy and Commerce Committee, has long complained about that switch. And the House health care legislation, of which Mr. Waxman is a main author, seeks to reverse the arrangement and to recoup the extra money that the government has been spending by restoring the old Medicaid drug discounts or “rebates” as they are known.
That would save the government at least $86 billion over 10 years, but would potentially cost the drug industry far more.
The White House has said that its deal with PhRMA would help narrow a gap in Medicare coverage of prescription drugs that is know as the doughnut hole, which forces people to pay some of their drug costs after a certain level. But there are also questions about the extent to which the drug industry also benefits, because the increased drug coverage for seniors means that the government will pay for more medication on their behalf, particularly brand-name drugs. In some cases, seniors now stop taking medication or switch to generics when they reach the doughnut hole.
Since the White House reached its deal with PhRMA in June there has been some disagreement between the industry and the administration over the precise terms of the arrangement. PhRMA has insisted that the White House agreed not to seek any additional concessions from drug manufacturers and to block Mr. Waxman’s plan in the House legislation. And the industry said that its support of the health overhaul was specifically aimed at Mr. Baucus’s proposal.
Mr. Baucus had previously announced that the first votes on amendments would not take place until Wednesday, so a final outcome of the fight was postponed.
...the Obama administration is investigating the activities of health insurance giant Humana--a participant in Medicare Advantage that's been telling its aging consumers that the government plans to slash benefits as it reforms the U.S. health care system, and urging them to tell Congress not to touch the program.
Medicare Advantage plans are private health care plans that seniors can buy into with federal assistance in lieu of participating in traditional Medicare, and under terms the government erected, those insurers face strict limits on how they communicate to beneficiaries. The regulations exist to protect seniors from acting under the pressures of their insurers, who control their benefits. In response to a request from Sen. Max Baucus (D-MT), the Center for Medicaid and Medicare Services has demanded the lobbying effort cease, and is investigating the company to determine whether it violated those rules.
Senate Minority Leader Mitch McConnell, who represents Humana's home state of Kentucky, and has received tens of thousands of dollars from the company over the years, called the CMS actions a "gag order"--a characterization that has been echoed by House Minority Leader John Boehner and Rep. Dave Camp (R-MI)--ranking member on the House Ways and Means Committee--who fired off an angry letter to CMS acting administrator Charlene Frizzera.
The bipartisan "gang of six" senators who helped craft the health care reform bill going before a key Senate committee Tuesday represent less than 3 percent of the U.S. population - but they hold a lot of power at a crucial policy-shaping moment in Congress.
Three Republican and three Democratic senators in the group, all of them members of the Senate Finance Committee, received an average of $74,600 from health industry lobbyists, according to The Chronicle's analysis of records through June.
That is about 25 percent more than the average of $59,632 in such donations that the gang's other Senate colleagues raked in from lobbyists for the pharmaceutical, hospital, insurance and nursing home industries, according to the analysis, which was based on records compiled by the Center for Responsive Politics, a nonprofit watchdog group.
"Money buys access," said Henry Brady, a professor of public policy and dean of the Goldman School of Public Policy at UC Berkeley.
Six Senate Finance Committee members who negotiated a health reform plan that goes before the committee Tuesday represent about 3 percent of the nation's population but received 25 percent more in campaign funds from health care interests than their Senate colleagues through June 30.
RJ Eskow presents the top 5 reasons that the Baucus bill sucks. We mean really sucks.
1-0the bill allows insurers to charge up to five times as much for some enrollees as for others, based on age.
2- the mandate to buy insurance remains in place, but does nothing to reduce costs because of the ability to charge prohibitive higher prices to older people.
3- the provision to tax so-called Cadillac plans will encourage employers to discriminate against costlier older employees.
4- no public option alternative to private insurance.
5- "[Purchasing councils for co-ops] shall be prohibited from setting payment rates for health care facilities and providers." So small, state based co-ops are expressly prohibited from pooling their purchasing power to force lower prices.
Sen. Jay Rockefeller (D-WV) appeared on the Charlie Rose Show to discuss Senate Finance Committee Chairman Max Baucus’ (D-MT) bill. He said he will introduce at least 17 amendments to the Baucus proposal. "This is my chance, having not be a part of the Gang of Six," to improve the legislation.
I want to say a little more about the "free rider" provision in the Baucus health plan, which Tim highlighted this morning. The HELP Committee and House bills require most employers to provide health insurance for their workers. But the Baucus plan does not include such an employer mandate. Instead, it requires companies to partially reimburse the government for the insurance affordability credits of uninsured workers and their dependents.
This creates some very perverse incentives. It discourages companies from hiring single people, who don't have a spouse whose employer-provided insurance will cover them, thus offering the employer an "out" on the subsidy payback. It encourages employers to pressure married, uninsured workers to go into their spouse's health plans, even if the worker feels they'd get better coverage for a lower cost on the exchange. And worst of all, it particularly discourages firms from hiring single people with children, because they'd have to pay for the children's subsidies, as well.
We know who'll be affected most by this bad, bad idea: low-income women, who are already pushed into "pink collar" jobs with more unstable hours, less benefits, and less pay than similarly educated men. Now even those jobs will be harder for single moms to get, as employers weigh whether a worker earning $15,000 or $20,000 a year is worth paying an extra several thousand dollars for, because of this subsidy payback requirement. Why not just hire someone without kids? Or someone married?
None of the health reform bills in front of Congress do enough to dismantle the link between work, marriage, and health insurance. This system especially hurts women, since only 38 percent of women have health coverage through their own job, compared to 50 percent of men. It is unjust for women to have to consider what will happen to their health coverage -- and their children's -- if they leave an abusive relationship, for example. But while the House and HELP bills mostly maintain the status quo, the Baucus bill would make things much worse.
health insurance co-ops are not a real alternative to private health insurance and they are not a substitute for a strong public plan option, and we should not suggest to the American people that they would be.
Sen. Rockefeller did research on the history of coops and the applicability to the heath insurance field. He wrote letters to the National Cooperative Business Association (NCBA), the United States Department of Agriculture (USDA), and the Government Accounting Office (GAO) requesting detailed information about the current role of insurance coops in the heath care field.
In his letter to Baucus and Grassley, he describes what he found out as "astounding."
Illinois Sen. Roland Burris served notice a short time ago that Democrats might have problems other than the Republican variety in getting health-care reform legislation out of the Senate.
Burris, a Democrat, announced that any legislation lacking provisions establishing a public entity to compete with insurance companies would not get his vote in the Senate.
Given that the new legislation unveiled today by Sen. Max Baucus lacks the so-called public option in favor of less controversial cooperatives, Burris’s decision could signal trouble from liberals in the Senate as well as in the House.
