The Senate compromise seems to be this:
For the slice of the population age 55 - 64 that would have gone into health exchanges with subsidies – uninsured, self-employed – let them instead buy in to Medicare. Except without subsidies.
The Medicare Part B premium is now means-tested – that is, based on annual income. It covers 25% of the cost of the program. Individuals earning less than $85,000 a year pay no premium; going up from there from about $44 a month to about $353 a month. Buying in to Part B alone could presumably cost 4 times those amounts, or between zero and $1400 a month. Plus the $155 deductible.
Offer the same group, under age 55, the choice of 2 nonprofit health plans, administered by the federal Office of Personnel Management.
No public option.
Til now we’ve heard that Congress would abolish lifetime caps on what the plans would pay. Now we’re hearing the caps may be back. (After which you’re on your own.)
The great thing about Medicare is that it has the clout of 40 million beneficiaries and the federal government when it comes time to negotiate with Sutter Health. So sure, add more folks in over there.
But. If they’re the oldest and sickest, and everyone under 55 is still left to the depredations of the private insurance industry…Well. Perhaps at least a few more of them will be covered.
And rumor has it that the Senate would also require the companies to spend 90% of the premium dollar on actual benefits (a big hike from the 70% or so that some plans spend now).
Ok marginally a little better than nothing. But so diluted from the House bill, in terms of a stepping stone to the future: less public involvement than any proposed public option (so less cost control), less affordability, less coverage. Makes you think that maybe the regular legislative process has some advantages over the Gang of 10 system.
Painful as it may be, and tempting as it is to go for expanding Medicare by any means necessary, it’s looking like getting something through the Senate, to be followed by a conference with the House’s better bill, is our best hope.
Showing posts with label Senate. Show all posts
Showing posts with label Senate. Show all posts
Saturday, December 12, 2009
Wednesday, December 9, 2009
The Senate: Getting to the Public Option
It is important that health reform continue to move forward through the Senate. The most recent announcement offers some elements that sound attractive. As a whole, though, the package seems to leave a lot of gaping holes, that the Senators will need to address, or that will be resolved in conference.
What the proposal is, as far as we can tell:
Opening up something like the Federal Employees Health Benefits Plan (FEHBP) to the public, through the Office of Personnel Management.
Offering some or all people age 55-64 the chance to buy in to Medicare.
A trigger to create a public option in the future.
Progressives need 3 things:
1. An expanded role for the public sector, in order to effectively control the charges by health care providers: drug companies, hospitals, medical supply companies, hospitals. Doctors too. Private insurance companies have no stake in controlling prices and are often too weak to bargain successfully with organized providers.
2. To the extent there will continue to be private for-profit insurance companies in the mix, they need to be strictly regulated, so that the uninsured will have a fair shake at getting covered, and the insured and underinsured have a fair shake at getting our claims paid.
3. Subsidies to make insurance affordable, and to put some pressure on the government as prices rise.
Increasing enrollment in Medicare for seniors, while expanding coverage for middle age/middle income people, would be a great step forward.
But marginally opening up Medicare selectively to a subset of seniors does not accomplish these objectives. It likely will not increase significantly the number of beneficiaries; and they will be the most expensive to treat.
FEHBP has the same inflationary insurance spiral as any other set of private insurance plans. It does function somewhat like the proposed health insurance exchanges. It is not a public option. A trigger needs to be pulled now.
The Illinois Campaign for Better Health Care proposes this:
"It is NOT an either or - we demand a strong public option, strong insurance reforms, and expanding access to Medicare to all individuals 55 and older. Better yet, let everyone join Medicare."
Call your U.S. Member of Congress at 1-888-801-4426. Tell them:
For Democratic reps: "Stay firm on the public option plan on which you have already voted yes and on expanding Medicare eligibility."
For Republican reps: "Quit playing politics with my and my family's life. Support the American people and support health care reform."
What do you think?
What the proposal is, as far as we can tell:
Opening up something like the Federal Employees Health Benefits Plan (FEHBP) to the public, through the Office of Personnel Management.
Offering some or all people age 55-64 the chance to buy in to Medicare.
A trigger to create a public option in the future.
Progressives need 3 things:
1. An expanded role for the public sector, in order to effectively control the charges by health care providers: drug companies, hospitals, medical supply companies, hospitals. Doctors too. Private insurance companies have no stake in controlling prices and are often too weak to bargain successfully with organized providers.
2. To the extent there will continue to be private for-profit insurance companies in the mix, they need to be strictly regulated, so that the uninsured will have a fair shake at getting covered, and the insured and underinsured have a fair shake at getting our claims paid.
3. Subsidies to make insurance affordable, and to put some pressure on the government as prices rise.
Increasing enrollment in Medicare for seniors, while expanding coverage for middle age/middle income people, would be a great step forward.
But marginally opening up Medicare selectively to a subset of seniors does not accomplish these objectives. It likely will not increase significantly the number of beneficiaries; and they will be the most expensive to treat.
FEHBP has the same inflationary insurance spiral as any other set of private insurance plans. It does function somewhat like the proposed health insurance exchanges. It is not a public option. A trigger needs to be pulled now.
The Illinois Campaign for Better Health Care proposes this:
"It is NOT an either or - we demand a strong public option, strong insurance reforms, and expanding access to Medicare to all individuals 55 and older. Better yet, let everyone join Medicare."
Call your U.S. Member of Congress at 1-888-801-4426. Tell them:
For Democratic reps: "Stay firm on the public option plan on which you have already voted yes and on expanding Medicare eligibility."
For Republican reps: "Quit playing politics with my and my family's life. Support the American people and support health care reform."
What do you think?
Monday, October 5, 2009
Why It Matters: A Strong Public Plan, Medicare Rates, and Affordability
Let’s start from the end. You want health reform. Republicans say they want it. The insurance industry wants it. People who pay individually for health insurance want it - they can’t afford coverage. People with insurance want it – they too often have their claims denied – 1 in 5. 44,000 people die every year because they are uninsured. Medicare is going broke because prices are going up outside of the Medicare system, and lots of families are going bankrupt for the same reason.
To put the middle in the middle: Getting there means finding 218 members of the House of Representatives, plus 51 Senators, to convince the White House they will vote for reform.
Keeping it there after it passes means we all need to be able to afford it, and still get the care we need.
Here is the part to nail down this week: A strong public option, that pays Medicare rates and uses Medicare providers, is the only way to make the plan affordable.
There are 2 parts to making insurance affordable. The first part is limiting how much we pay providers – hospitals, doctors, drug companies. Basing payments on Medicare rates is the key here.
The second part is making sure these limits get passed back to you, in the form of lower insurance company premiums.
We need a strong public option for both.
The Congressional Budget Office says using Medicare rates saves $110 billion over 10 years, $85 billion more than a public option that doesn’t use Medicare rates.
Medicare already establishes payment rates to hospitals and doctors on behalf of 40 million Americans. These rates are accepted by all hospitals and most doctors, but aren’t susceptible to the hyper-inflation that has driven prices in the private sector over the last 10 years. Adding millions of enrollees to this system will help put the brake on payment rates.
So if the public plan limits payments to providers, how will that translate into lower premiums? The public plan won’t pay profits or bonuses, and will benefit from lower overhead than private plans. All the savings go right back to you, in the form of lower premiums.
Private insurance companies on the other hand can charge whatever they want, even if they are paying providers less. They have to charge higher premiums, to pay their shareholders and executives. This is true even if they paid less to hospitals and doctors – they have no reason to pass those savings on to you, in the form of lower premiums, and every reason to just do what they always do: hold onto the money themselves. Unless, of course, they have to compete with a public plan.
A public plan will charge lower rates, be affordable for people who need care, and set a standard on prices that both providers and insurance companies will have to compete with.
Will doctors still treat you if you are on the public plan, even if it pays less than private plans? For those who think Medicare rates are too low, the version of the public option linked to Medicare rates gives plenty of flexibility. First, we’re not talking about today’s Medicare rates. The bill will require changes in rates to address regional differences, including adjustments for rural areas, and ways to promote quality. Second, it provides an extra 5% (Medicare +5) for individual providers. Third, it allows any provider to opt out – and the decision can be made (and reversed) each year. Finally, it gives the HHS Secretary authority to go higher than Medicare rates if necessary to attract doctors, hospitals and other providers based on local conditions.
Why not negotiate the rates the new public plan will pay providers? Simple: They'll be higher. That's why providers and insurance companies want them. A new plan, with new enrollees, needs to build on the strongest platform we have. That's improved Medicare rates, with a cap of 5% extra. (Even a public plan with negotiated rates saves $25 billion more than relying solely on private insurers.)
Again: A public plan will charge lower rates, be affordable for people who need care, and set a standard on prices that both providers and insurance companies will have to compete with.
So here we are with the beginning for this week:
We need a public plan.
That pays Medicare rates plus 5%.
And includes Medicare providers.
Pass it on to 218 of your friends in the House, and 51 Senators.
To put the middle in the middle: Getting there means finding 218 members of the House of Representatives, plus 51 Senators, to convince the White House they will vote for reform.
Keeping it there after it passes means we all need to be able to afford it, and still get the care we need.
Here is the part to nail down this week: A strong public option, that pays Medicare rates and uses Medicare providers, is the only way to make the plan affordable.
There are 2 parts to making insurance affordable. The first part is limiting how much we pay providers – hospitals, doctors, drug companies. Basing payments on Medicare rates is the key here.
The second part is making sure these limits get passed back to you, in the form of lower insurance company premiums.
We need a strong public option for both.
The Congressional Budget Office says using Medicare rates saves $110 billion over 10 years, $85 billion more than a public option that doesn’t use Medicare rates.
Medicare already establishes payment rates to hospitals and doctors on behalf of 40 million Americans. These rates are accepted by all hospitals and most doctors, but aren’t susceptible to the hyper-inflation that has driven prices in the private sector over the last 10 years. Adding millions of enrollees to this system will help put the brake on payment rates.
So if the public plan limits payments to providers, how will that translate into lower premiums? The public plan won’t pay profits or bonuses, and will benefit from lower overhead than private plans. All the savings go right back to you, in the form of lower premiums.
Private insurance companies on the other hand can charge whatever they want, even if they are paying providers less. They have to charge higher premiums, to pay their shareholders and executives. This is true even if they paid less to hospitals and doctors – they have no reason to pass those savings on to you, in the form of lower premiums, and every reason to just do what they always do: hold onto the money themselves. Unless, of course, they have to compete with a public plan.
A public plan will charge lower rates, be affordable for people who need care, and set a standard on prices that both providers and insurance companies will have to compete with.
Will doctors still treat you if you are on the public plan, even if it pays less than private plans? For those who think Medicare rates are too low, the version of the public option linked to Medicare rates gives plenty of flexibility. First, we’re not talking about today’s Medicare rates. The bill will require changes in rates to address regional differences, including adjustments for rural areas, and ways to promote quality. Second, it provides an extra 5% (Medicare +5) for individual providers. Third, it allows any provider to opt out – and the decision can be made (and reversed) each year. Finally, it gives the HHS Secretary authority to go higher than Medicare rates if necessary to attract doctors, hospitals and other providers based on local conditions.
Why not negotiate the rates the new public plan will pay providers? Simple: They'll be higher. That's why providers and insurance companies want them. A new plan, with new enrollees, needs to build on the strongest platform we have. That's improved Medicare rates, with a cap of 5% extra. (Even a public plan with negotiated rates saves $25 billion more than relying solely on private insurers.)
Again: A public plan will charge lower rates, be affordable for people who need care, and set a standard on prices that both providers and insurance companies will have to compete with.
So here we are with the beginning for this week:
We need a public plan.
That pays Medicare rates plus 5%.
And includes Medicare providers.
Pass it on to 218 of your friends in the House, and 51 Senators.
Monday, August 31, 2009
Sen. Feinstein: Time to Lead on Health Reform!
Sen. Feinstein has issued, at long last, a thoughtful statement on health reform. There is much to applaud, but there is too much unresolved. She makes the case that this is a vital issue for our state. We should demand clearer leadership on her part.
She rightly notes that California stands to benefit from reducing our high percentage of uninsured, and must protect our extensive system of public hospitals and safety net clinics. She recognizes that most Californians want relief both from the health insurance
industry’s exorbitant premiums and from its unfair practices. She demands that private insurance companies limit spending on administration and profits to no more than ten percent of revenues – a critical issue, and a level even better than the House’s bill. She supports offering the option of a public insurance plan.
However, while criticizing current proposals for not going far enough to assure that health care will be affordable, she opposes the necessary subsidies on abstract grounds of deficit control. She takes the opportunity for an unjustified swipe at entitlements generally, reviving the call for a commission to review not only Medicare, which is threatened by runaway costs in the private system that it cannot control, but also Social Security, a perfectly solvent system that requires well known tweaks to survive with no difficulty.
Finally, she bows to the possibility that a nonprofit coop could take the place of a public plan, in providing an effective and competitive counterpoint to private insurance. This concept has no legs, as everyone knows but the small-state senators whose judgment she questions.
Sen. Feinstein does not serve on the Senate Finance Committee, which has yet to offer a bill. But the people of our state desperately need reform, and we’ve fought for it actively. We have twice passed single payer legislation, the gold standard for effective reform. It is time for Sen. Feinstein to join the majority of the state’s Congressional delegation in unequivocal support for a bill that includes a meaningful public plan option, available to everyone, and that finally makes health care affordable. She’s halfway there. She should complete her deliberations by the time the Senate reconvenes next week.
She rightly notes that California stands to benefit from reducing our high percentage of uninsured, and must protect our extensive system of public hospitals and safety net clinics. She recognizes that most Californians want relief both from the health insurance
industry’s exorbitant premiums and from its unfair practices. She demands that private insurance companies limit spending on administration and profits to no more than ten percent of revenues – a critical issue, and a level even better than the House’s bill. She supports offering the option of a public insurance plan.
However, while criticizing current proposals for not going far enough to assure that health care will be affordable, she opposes the necessary subsidies on abstract grounds of deficit control. She takes the opportunity for an unjustified swipe at entitlements generally, reviving the call for a commission to review not only Medicare, which is threatened by runaway costs in the private system that it cannot control, but also Social Security, a perfectly solvent system that requires well known tweaks to survive with no difficulty.
Finally, she bows to the possibility that a nonprofit coop could take the place of a public plan, in providing an effective and competitive counterpoint to private insurance. This concept has no legs, as everyone knows but the small-state senators whose judgment she questions.
Sen. Feinstein does not serve on the Senate Finance Committee, which has yet to offer a bill. But the people of our state desperately need reform, and we’ve fought for it actively. We have twice passed single payer legislation, the gold standard for effective reform. It is time for Sen. Feinstein to join the majority of the state’s Congressional delegation in unequivocal support for a bill that includes a meaningful public plan option, available to everyone, and that finally makes health care affordable. She’s halfway there. She should complete her deliberations by the time the Senate reconvenes next week.
Wednesday, July 15, 2009
The Good, the Bad and the Murky: Health Reform on July 14
Here’s (a partial, one-person view of) what happened:
The House released a 1,017 page reform bill, summarized in 35 pages, promising progress and peril over the next 4 years. It improves affordability of health insurance, and proposes to regulate “rescissions” and other worst practices. The public plan option is semi-strong: it’s available to anyone who gets coverage through the new Health Insurance Exchange, but it’s less affordable for people covered by an employer. And it postpones indefinitely including large employers in the Exchange, running the risk that the Exchange and the public plan will drown in high payments for people likely to need health care.
Bill and summary online: http://www.centerforpolicyanalysis.org/id41.html
More below on the new House bill.
The Senate Health, Education, Labor and Pension (HELP) Committee gamely marched through amendments to its bill. Sen. Bernie Sanders’ state single payer amendment elicits shining and shameful moments: Strong statements of support from Senators Tom Harkin (“We have a dysfunctional system”), Jeff Merkley, and Sherrod Brown. Listen To Your Staff Demerit for Barbara Mikulski (“Can’t states enact single payer anyway?” [She is reminded that states need waivers for ERISA, and transfers of federal funds.] “Oh.” She still voted No. The amendment failed, but may come up again to the full Senate.) Hero award to Kennedy chief staffer David Bowen, at the table full time, accurately describing every technical foible of the draft bill, and every amendment.
The Mainstream Media fuss about the tab. Washington Post and NYT focus on taxes on the wealthiest. Very not the point.
Preliminary Details: The House Bill: Big questions for consumers and providers are: Will it make insurance affordable and dependable?
The bill targets the worst insurance company abuses: pre-existing condition exclusions, rescissions of coverage after the fact, denial of coverage or renewal to sick people. They will have to spend most of the premiums on health care. But enforcing these rules will depend on the existence of a real alternative. Here’s the murky part.
Most employers will have to offer insurance, covering about 70% of the premium, or pay an 8% payroll tax to a Health Insurance Exchange. The Exchange offers Qualified Health Benefits Plans that meet certain rules. The Public Plan is one of the options. Anyone eligible for the Exchange can enroll in the Public Plan. (Why do I see images of Holly Hunter demanding that George Clooney prove he is “bona fide”?)
But until 2013, the Exchange is open only to individuals without coverage, and to small employers.
And after 2013, it is up to the new Health Choices Commissioner to determine whether or not larger employers will be included.
There are affordability limits on what individuals will have to pay, that are better than proposed earlier: Sliding scale subsidies for premiums up to 400% of the federal poverty limit, if premiums cost more than 11% of your adjusted gross income. There are limits on total out-of-pocket spending (premiums, co-pays, deductibles).But: Subsidies in the first 3 years are only available to those who do not have an affordable offer of employer-sponsored insurance.
So you can quit your employer's crummy plan if you don't like it, and join another plan offered thru the Exchange, as long as you can afford to do so without the affordability credits, until 2013.
Payments to providers would be tied to Medicare rates. This is a boon to cost control and affordability in the long run. (There are other benefits that keep provides in the plan.)
Drug Bust: The Health Choices Commissioner can negotiate for drug prices.
The Medicare doughnut hole will close – by 2023!!! We can do better.
Quality Improvements: Many good proposals to improve the quality of care, through Medicare and other programs. The bill would tilt reimbursement and training to primary care providers, gerontologists, and nurse midwives. Needed funds for prevention and public health.
State Options. Still to be explored; from the Summary:
Sec. 208. Optional operation of State-based health insurance exchanges. Permits states to offer their own Exchange or join with a group of states to create their own exchange in lieu of the federal Health Insurance Exchange, provided that the state(s) perform all of the duties of the federal Exchange as approved by the Health Choices Commissioner. The Commissioner has authority to terminate state exchanges if they are not meeting their obligations.
Coming up: House Committee mark-ups starting – today! Get online. Take notes. One way or the other, history is happening.
The House released a 1,017 page reform bill, summarized in 35 pages, promising progress and peril over the next 4 years. It improves affordability of health insurance, and proposes to regulate “rescissions” and other worst practices. The public plan option is semi-strong: it’s available to anyone who gets coverage through the new Health Insurance Exchange, but it’s less affordable for people covered by an employer. And it postpones indefinitely including large employers in the Exchange, running the risk that the Exchange and the public plan will drown in high payments for people likely to need health care.
Bill and summary online: http://www.centerforpolicyanalysis.org/id41.html
More below on the new House bill.
The Senate Health, Education, Labor and Pension (HELP) Committee gamely marched through amendments to its bill. Sen. Bernie Sanders’ state single payer amendment elicits shining and shameful moments: Strong statements of support from Senators Tom Harkin (“We have a dysfunctional system”), Jeff Merkley, and Sherrod Brown. Listen To Your Staff Demerit for Barbara Mikulski (“Can’t states enact single payer anyway?” [She is reminded that states need waivers for ERISA, and transfers of federal funds.] “Oh.” She still voted No. The amendment failed, but may come up again to the full Senate.) Hero award to Kennedy chief staffer David Bowen, at the table full time, accurately describing every technical foible of the draft bill, and every amendment.
The Mainstream Media fuss about the tab. Washington Post and NYT focus on taxes on the wealthiest. Very not the point.
Preliminary Details: The House Bill: Big questions for consumers and providers are: Will it make insurance affordable and dependable?
The bill targets the worst insurance company abuses: pre-existing condition exclusions, rescissions of coverage after the fact, denial of coverage or renewal to sick people. They will have to spend most of the premiums on health care. But enforcing these rules will depend on the existence of a real alternative. Here’s the murky part.
Most employers will have to offer insurance, covering about 70% of the premium, or pay an 8% payroll tax to a Health Insurance Exchange. The Exchange offers Qualified Health Benefits Plans that meet certain rules. The Public Plan is one of the options. Anyone eligible for the Exchange can enroll in the Public Plan. (Why do I see images of Holly Hunter demanding that George Clooney prove he is “bona fide”?)
But until 2013, the Exchange is open only to individuals without coverage, and to small employers.
And after 2013, it is up to the new Health Choices Commissioner to determine whether or not larger employers will be included.
There are affordability limits on what individuals will have to pay, that are better than proposed earlier: Sliding scale subsidies for premiums up to 400% of the federal poverty limit, if premiums cost more than 11% of your adjusted gross income. There are limits on total out-of-pocket spending (premiums, co-pays, deductibles).But: Subsidies in the first 3 years are only available to those who do not have an affordable offer of employer-sponsored insurance.
So you can quit your employer's crummy plan if you don't like it, and join another plan offered thru the Exchange, as long as you can afford to do so without the affordability credits, until 2013.
Payments to providers would be tied to Medicare rates. This is a boon to cost control and affordability in the long run. (There are other benefits that keep provides in the plan.)
Drug Bust: The Health Choices Commissioner can negotiate for drug prices.
The Medicare doughnut hole will close – by 2023!!! We can do better.
Quality Improvements: Many good proposals to improve the quality of care, through Medicare and other programs. The bill would tilt reimbursement and training to primary care providers, gerontologists, and nurse midwives. Needed funds for prevention and public health.
State Options. Still to be explored; from the Summary:
Sec. 208. Optional operation of State-based health insurance exchanges. Permits states to offer their own Exchange or join with a group of states to create their own exchange in lieu of the federal Health Insurance Exchange, provided that the state(s) perform all of the duties of the federal Exchange as approved by the Health Choices Commissioner. The Commissioner has authority to terminate state exchanges if they are not meeting their obligations.
Coming up: House Committee mark-ups starting – today! Get online. Take notes. One way or the other, history is happening.
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