Queen Olympia, You've Done It Again! You're Eviscerating the Reform Bill.
By Susie Madrak Tuesday Oct 06, 2009 4:00pm
Queen Olympia has decided that the very thing that would make insurance exchanges work is the thing that has to go. And you know when the queen speaks, the Senate listens! (Do you ever get the impression that the Queen is actually wearing no clothes?)
Olympia Snowe looks set to reprise her role in hobbling the stimulus bill in exchange for providing the key pivotal vote for it by killing John Kerry’s amendment, “Empowering State Exchanges to be Prudent Purchasers.” Jon Cohn explains:
In the bills that passed three House committees and the Senate Health, Education, Labor, and Pensions (HELP) Committee, the exchange would be a “prudent purchaser.” In other words, it would have a staff that bargained with insurers to bring down premiums — and that made sure all plans lived up to strict guidelines for coverage and customer service. In effect, any insurer that wants to offer coverage through the exchanges has to get the equivalent of a “Good Housekeeping Seal of Approval” from the administrators. This is precisely how it works in Massachusetts.
By contrast, the Senate Finance bill envisions much weaker exchanges. Instead of choosing which plans to make available, the exchange administrators would, by law, have to accept any plan that meets a relatively minimal set of standards.
There are several problems with this. One is that it’s going to be a mess for consumers. Another is that it threatens to turn the exchanges into playgrounds of implicit risk-shifting efforts wherein companies try to design policies specifically around dissuading high-need people from signing up. Thus ever-more burden is going to be placed on the untested risk-adjustment machinery that’s supposed to even this all out. Ezra Klein observes that Jon Kingsdale is basically the only person in America’s who’s run anything like the exchanges envisioned in all the different bills—he does the job in Massachusetts—and he views the prudent purchaser rule as absolutely essential. Against that Snowe is pitting, I guess, her intuition that this is too much government involvement.
TNR's Jonathan Cohn lays out his argument here:
The bills moving through Congress all set up exchanges modeled more or less on what Massachusetts has done. But there are a few critical differences. Among the most important is a difference in how the exchanges would select which plans to offer people.
In the bills that passed three House committees and the Senate Health, Education, Labor, and Pensions (HELP) Committee, the exchange would be a "prudent purchaser." In other words, it would have a staff that bargained with insurers to bring down premiums--and that made sure all plans lived up to strict guidelines for coverage and customer service. In effect, any insurer that wants to offer coverage through the exchanges has to get the equivalent of a "Good Housekeeping Seal of Approval" from the administrators. This is precisely how it works in Massachusetts.
By contrast, the Senate Finance bill envisions much weaker exchanges. Instead of choosing which plans to make available, the exchange administrators would, by law, have to accept any plan that meets a relatively minimal set of standards.
Jon Kingsdale, who runs the Massachusetts exchange, calls that a recipe for "policy disaster," as consumers faced a dizzying array of more expensive, less regulated choices. "It would be like telling your grocery store they have to offer every single kind of bread baked by every single bakery. ... The exchanges would be nothing more than an automated Yellow Pages."
Kingsdale is among several Massachusetts-based policy experts who have been ringing the alarm bells about this flaw in the Finance bill. And it's no coincidence that it's a Massachusetts senator, Kerry, who now proposed to fix it by giving the exchanges the same powers envisioned in the House and HELP bills.
But when Kerry introduced his plan last week, he couldn't get the votes to pass it. The reason, several sources on Capitol Hill say, was opposition from Olympia Snowe, the Maine Republican who also sits on Senate Finance. Snowe seems to be concerned that a more aggressive exchange would amount to more government--which, in fact, it would be. But, as Massachusetts has shown, sometimes more government is exactly what health care needs.
Chances are reasonably good that Kerry's vision of reform will prevail, if not during the Senate floor debate then afterwards, when a conference committee merges whatever passes from the two congressional chambers. But it's not a sure thing, which is why this seemingly narrow question deserves a lot more attention.
Exchange design doesn't get the attention of controversies like the public option, abortion, or supposed death panels. In the long run, though, it could be far more decisive in whether reform works.
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How many on the left have described the Massachusett program as a failure. More than a few.
Calling Abbybwood…
Conflicting statements here:
So there are critical differences, let's hear what they are…
But now you say that is the same as Massachusetts…
What am I missing.
??OUR??? NO the corporate government is out of control and it is time to stop them from pushing us farther down the cliff.. We are being sold a bill of goods and this is another bait and switch as the banking bailout was..
How come there is never a debate to investigate , stop and cut the funds when the government gives it to Banking empire , the auto empire , foreign nations for the public programs and military equipment.
AND the U.S. military budget which is larger than ALL other countries combined....
Start off with if these health insurance companies were not making enough money the would not be raising h... to keep their hands on the health insurance money.. Then if they did not like it why in the h... are they paying billions of dollars to the persons creating their hand feed bill and others to vote for it..
H... it would be cheaper in the long run for ALL Americans if the health companies would pull up shop and try to deceit and BS another country into letting them selling their BS their..
Anything other than a single payer options will not stop the greedy insurance companies from screwing over American policy holders.
When they FORCE American to buy something that is too d... expenses and cut real coverage to you then we do not want it...
So why has the government now forcing Americans to buy these piece of sh.. they are passing and if they don't they will be FINED.. Do your realize when they receive 20 million to 30 million new policies the income they will receive.. At the very low figure of $4,000 time 10 million new FORCED policy holders it would be 40 billion dollars of new income.. Well they claim the average for health insurance is $12,000 and would make it 120 billions new income for 10 million new FORCED policy holders... Lets take the high figure of 30 million people time $12,000 a policy and that would be $360 billion NEW income a year..
Now they are also talking about cutting services and or tests which will be anywhere from $500 million plus from what they already spend... Then there is word that all persons which can not get insurance now will still not receive insurance, and the ones that do will pay a much higher price..
So what does this do for the Seniors and other persons with medical problems ,,,,, They again are screwed..
Now the Government is telling American you will pay for this health policies even if you do not have to take it from your food , rent or heat to do it..
So they knew from the very start they are passing a piece of sh.. that has been written by the Health Empire to force down our throats..
This bill does nothing new except to FORCE Americans to buy a policy form these crooks.
They have never even look into a single payer option and the to actually find out if in the long run if it is cheaper..
All Civilize countries have a single payer health system That works and is at least 1/2 the cost of our... and they love it..
All this BS about we can not afford it is BS... The real reason is that the Health Empire would not be able to screw over us if they really pass a health reform bill and the persons involve have received too much d... money to retract their policies if they wanted to..
Let face it these elected officials are no longer working for you and me but these Global empires with their big bucks..
Keeping private insurance companies involved at all is just dispicable. When I think of the CEO of Cigna and his MILLIONS...
then I think if the fucking idiots who believe Glenn Beck.
But I am working with a dynamo who developed this website with Trudy Lieberman from the Columbia Journalism Review:
www.masshealthlawtruth.org
The best way I can respond to this thread is to share the words of my colleague, Dianne, who has been a Massachusetts resident her whole life. She and I were with Howard Fineman Sunday evening at the local temple here in Pittsfield and she gave him a packet jam packed full of information on what is REALLY happening in Massachusetts. She spends most of her days on the phone with various Senate/House member staffers questioning them on the guts of the various bills.
Here's an excerpt from a recent e-mail she sent to one of the organizers for the DNC's "Organizing for America":
"Are you familiar with what is in these bills, and that they are replicas of the failed MA plan but worse? They are more punative and will leave millions paying high premiums that are unaffordable to use.
Those who are found to be eligible for Medicaid have no other choice and will be auto-enrolled per HR3200 and the Baucus bill; not clear in the HELP bill. This is blatant discrimination! Medicaid is a rotten program. People have difficulty finding doctors who will take them, nevermind having a "choice" or keeping the doctors who are treating them.
Medicaid also contains an estate recovery program for age 55 and up (starts at a lower age in some states). This is a federally-required program for all states that receive Medicaid funding and mandates that estates be recovered for hospital and RX but can be recovered for any and all medical costs. This means many millions of Americans will be getting a mandated loan.
He is also cutting funding to Medicaid which already has issues. The poorer the state; the worse the program.
I have done much research on this and have also spoken at length with a CMS. These are little known facts that senators and reps try to brush off by saying estate recovery isn't in the bills. However, it doesn't have to be. Medicaid and the expansion thereof is an integral part of these bills, and this statute is part of the Medicaid requirements which will still apply.
A Kennedy health care aide told me a few months ago when I brought this up that they aren't concerned about discriminating because it would be against a minority of people as most don't know about estate recovery. A Baucus aide told me two weeks ago when I said that Medicaid had been revamped to expand the FPL (Federal Poverty Level), age, allow childless adults in and dropped the asset test but asked if they had amended federal statute under OBRA 1993 so that NO states are required and NO states are ALLOWED to recover assets. He said no, and they have no plans to do that.
A Kerry aide told me: If you don't want to be in Medicaid, get a better job.
How can I support a senator whose aide speaks that way to constituents? How can I support so-called health care reform that exploits low-to-modest income citizens?
If you have something good to say about these bills, I sure would love to hear/read it. So would many of my friends because we wake up in dread every day from what is happening. And we are all either uninsured in MA paying penalties OR paying for expensive premiums that are unaffordable to use which means pure profit for the insurance companies.
In fact, two friends had to drop their coverage as of today because it is too expensive, and they have the cheapest state-approved plan. I couldn't afford the subsidized based on prior year taxes and NONE of my doctors were in the ONE and ONLY network available in Berkshire County, plus the estate recovery clause langauge is a crock! Attorneys have said anyone who signs one of those "Commonwealth Care" forms is not protected.
Well, in the national bills, people won't even know about estate recovery because enrollment will be by phone or auto. The federal statute stipulates the applicants be informed of this and other Medicaid requirements before or upon application and re-determination. Kind of sleazy the way this will be hidden from people, and that it will still be used under a national mandate.
Did you know that the penalty for being uninsured in HR3200 is 2.5% of your modified adjusted gross income? Modified - check that out - it means that any tax exempt interest accrued or received in a taxable year will be included in your adjusted gross and the penalty paid on that.
In the Baucus bill, eligibility and affordability for subsidized plans is based on modified adjusted gross - same deal. And in all the bills, eligibility for subsidized goes by PRIOR year tax return. If you have a drastic change, you can appeal but have to prove your situation. If your prior year turns out to be less than the current year, but you don't know this until toward the end of the current year (earned and/or unearned income changes - hard sometimes to know ahead of time, especially if self-employed or working several part-time jobs), you will owe the difference for having had a cheaper premium (more of a subsidy).
Did you know that if you are at 400% FPL (HR3200), before you can get a subsidy, you first have to spend 12% of your adj. gross? The less you make, the less the %. However, copays, deductibles and coinsurance not included in this %. Can you afford that? I can't. Neither can most people I know.
And the horrific details go on.
Candidate Obama said that people in MA were worse off than before - paying penalties and still uninsured. He said this to Tim Russert. He said this on the stump standing in front of Kennedy and Mass. Gov. Deval Patrick.
Then he stopped saying this.
He said no mandate except for kids. Then he said, a mandate because the insurance companies were on board. Then he said it's like car insurance - to live in America you must have car insurance. Well, that's not true. I know a number of people in this country who don't own a car or don't drive and aren't penalized. You may also know some. This bogus analogy is straight out of the Mitt Romney playbook and was also used by Senator Moore and former Speaker DiMasi.
So, I ask again that you please tell me something good about Obama's health insurance plan because we don't see it. We see more of the same broken system with everyone forced to buy the failed product or pay costly penalties before they even can afford food, heat, property taxes, etc.
We don't see the insurers complying with non-denial of pre-existing or non-recission of policies because they will be the crux of the entire plan and will do whatever they want just like the credit card companies and Wall Street continue to do. We see the American people being sold to the medical industrial complex because the key players have all been bought and paid for many times over, and no one booted them out due to conflicts of interest.
No bill is better than a bad bill."
And that's what is REALLY going on with "The Mass Plan".
(Sorry for the length of this post Susie, but this is pertinent information related to the thread...thanks).
http://www.youtube.com/watch?v=AbkbGF27JyY
BTW, how'd you like that Rick Roll earworm?
Wow.
Nothing I’ve been able to read about HR3200 leaves me to believe that there is a “Public Option” in it. As far as I can tell, it is mandated for-profit insurance coverage. THAT is worse than no bill at all. The Medicaid (as opposed to Medicare) provisions you are describing help no one but the destitute. The destitute do not make up the Public (at least not yet).
This has been my biggest fear all along. Not that the insurance companies will derail “Insurance Reform”, but they will profit from it.
HR 3200 does contain a crippled public option, though it is worth very little.
As for help for the destitute, estate recovery means they go after everything and everyone they can to pay the bills. It is no better, actually worse, than Medicaid. Very few Doctors will accept Medicaid and that would continue to be the case. Not much of a prospect for the low to modest income folks.
We are completely on the wrong road with all of this.
Single payer is the only way.
Yeah, I don't have high hopes that any of this pending legislation will turn out well. Single payer solves most problems for everyone but those with the deepest pockets. They are the ones writing it.
At this point, Obama and the Dems need to check this mess off as a win - so they are desperate to pass anything and declare victory.
If we can't have single payer, then I would prefer a bill that simply bans health insurance companies from denying coverage based on pre-existing conditions. Then the spineless Dems can manufacture a victory out of this train wreck and not make things worse.
At least then we would not have a single penny of tax payer money going to the parasites.
There is something much less coercive about paying for something in the way of federal taxes than being forced to cut checks to a private company in exchange for garbage. Just think about a federal law requiring that we write checks to Halliburton to fund the Iraq war.
.... also a federal law making it illegal for a private health insurance company not to cover a treatment or procedure recommended by the patient's doctor.
Abbybwood, thank you for such a detailed reply. I read it in the entirety, I will read it again.
It gives me confidence but no comfort to believe that I have been correct in the assessment so far that we are being sold a bill of goods. But no goods are going to be delivered.
to catch this thread.
I hope lots of people get to read all this vital information.
A mandate with anything but a real robust Government run public option will fail, if we don't end up paying the government for healthcare then it not a real public option. Co-ops are not going to work period. I story about Snow or anyone else weaking co-ops even more should not matter since Co-Ops even the strongest kind will not work.
Anything but the stats quo is not acceptable No mandate without a Solid public option Period. Anything less is not real reform no ifs ands or buts about it.
they provide NO COMPETITION AND NO COST CONTROL! They are also state weighty and take years to bring up..Ridiculous..This idea is a Corporate giveaway..
Call them and remind them they work at the pleasure of the people not corporations!!!1.877.264.4226 or 1.800.828.0498!
Shameless!
that healthcare 'reform' without a real public option or without being strictly regulated aka utilities would be a disaster for the American middle class and unsustainable. Obama and the Senate Finance Committee is trying to fob off a disaster on the American people.
Seems to think anything but the current system is some how an improvement. I thought Bush's No Child Left Behind would have forever shown that changes for the sake of change are not a good thing. As NCLB has become a bane to Public Schools. It's very simple if there no solid Government run public option then there is no real healthcare reform period, and a new system with a mandate and no solid public option will fail and only make things much worse.
That we don't all misconstrue "The Public Option" for a "Single Payer: Medicare" program.
My understanding is that at the very MOST only 17 million of the currently 50 million uninsured Americans will even qualify for "The Public Option". Here's a great video link with Christopher Hayes of The Nation that explains "The Public Option" pretty well:
http://www.thenation.com/doc/20090831/publico...
With a "Single Payer" plan ALL Americans would qualify and it would be paid for with our tax dollars. No premiums. No deductibles. No "co-pays".
When all the dust settles, and even "IF" there is a "Public Option", it is not as if all Americans will be able to drop their current expensive Blue Cross/Blue Shield policies and jump into the "Public Option".
What I'm afraid of is that "The Public Option" is being "marketed" to the American people as some magic panacea that is really just a bunch of "smoke and mirrors" for but a few of us.
People had better wake up BEFORE this bill is consolidated into one monster piece of legislation for Obama to sign.
Every poll I have seen has pointed to the fact that there is too much confusion in the public right now. IMHO it will be flat-out UN-AMERICAN if any bill goes through that turns out to be nothing but a charade to the American public.
The sad part of this is, that we won't really "get it" until Jan. 1, 2013....
Watered down laughable at best Public options. We need a real public option were if someone can't afford to get heathcare insurence in the privite sector they can buy into a affordable public government run plan Period. Can't pay for a privite plan and don't qulifity for Medacare/medicade well then you can buy this government plan period no if and or buts. Anything less is not reform. What they have billed as a public plan is bs it a "well even if we are forced into this we still come out ahead" for the special intrests.
We don't have to do single payer, We can have a real public option and have real reform the problem is all the current versions of the public option does not go far enough and are infact set up to fail.
It's just a Snowe job.
This GOP semi-slug isn't large or in charge.
Beck loses more advertisers - The GOP cries "UNCLE" on Grayson . . .
Most real patriots were offended by the cheers about losing the Olympics. . .
The Big O is making the GOP crazier and crazier!
I'm loving it!
How could they behead queens back then?
What with all the collars and ruffs
How could they find the neck?
How many strokes of the blade?
Now that's just naughty.
;)
I could make a very off-color joke about "queens" and "head", but because of this one sentence:
(Do you ever get the impression that the Queen is actually wearing no clothes?)
I am now just TOO ill.
Thanks for that Susie. ;)
breech?
Just curious.
Ha!!!!!
The very best thing that could happen is for the senate to scuttle health care reform.
First, we don't need health care reform as much as we need health INSURANCE reform.
Second, ANY bill that this congress could possibly pass would be so riddled with perks and protections for the insurance companies and big pharma as to be absolutely worthless to citizens. You don't need 1,000 pages to do what HR 676 does in 27. The biggest benefit will probably be another couple of pages on our tax returns.
Finally, if congress is seen as killing something that 70% of the American people want, there will be some interesting changes in the next election cycle (2010) when the entire house and 1/3 of the seats in the senate are up for grabs.
That's the better scenario. The other one - the worse one - is congress passes some corporate bailout for insurers and Obama signs it into law instead of vetoing it.
End the monopolies! Enforce anti-trust law against the health insurance and pharmaceutical industries!
And they ARE industries! NOT health care providers!!!
Actually, the insurance companies are doing just fine, this is a taxpayer funded gift to corporations that don't need the money, no "bailout" is necessary.
I can't even believe we've come to equating insurance exchanges as some sort of progress. I can't wait until we're mandated to buy insurance with $10,000/year deductibles for $300/month, exchange provided or not.
have been bought and paid for by the insurance industry. There's no other way to explain the politicians' complete lack of mental ability, compassion, or forward-thinking. I hope to hell that every single politician who is not doing the bidding of their constituents (not the lobbyists or corporations they've been paid by) gets dumped on their collective asses next time they're up for election.
Ms. Pelosi said there'd a public option in the final House bill. The hope is that when the House and Senate come together, the bill can be made whole in that process.
Please watch the Christopher Hayes video regarding "The Public Option". At best only 17 million of America's 50 million uninsured will be eligible for this plan. It is highly likely that they will be some of the sickest in the population. Which means if the Congress DOES vote in a Public Option that it may be doomed to fail.
I am so cynical about anything that is happening in Congress right now due to the ENORMOUS influence of the corporate health insurance industry. It seems if there is a Public Option that it will be crafted to fail so the right wing can say, "See!! It didn't work!".
Sadly, I have lost faith in Obama and the Democrats in Congress. The Republicans are an obvious write-off as greedy, idiotic, ethnocentric fools.
Here's the link with Christopher Hayes from "The Nation" regarding "The Public Option":
http://www.thenation.com/doc/20090831/publico...
Just to keep our Chris Hayes links together
your link
here
here
His observation at the end will be doubly true if add health care. In year with a jobless recovery and the Banksters profiteering happily along on dime. Just this horrific health bill having been passed. Or for that matter, not having been passed.
Not doing ANY of what they said they would do should have some cost.
be the option to give more then any working person can afford over to the unregulated insurance monopolies or get sick and die.
that the ones WITH good health care are doing their damnedest to stop other people from getting it? This moment in history will not look good in the future.
Vote them all out.
"The rich stay healthy, while the sick stay poor."
Not much has changed.
I WAS willing to support a STRONG healthy public option but no more! A REAL Single Payer universal health care system or nothing now! Because all that's coming out of Congress except for HR676 is a bunch of garbage give-aways to the corporate insurance whores at the expense of every working American!
How about let's call it "THE STRONGLY ROBUST AND VERY HEALTHY PUBLIC OPTION"?!
Ha!!
But all kidding aside, you know I agree with you 100%!!!
What I am looking forward to is the historic full House debate/vote on the Weiner amendment to H.R. 3200 (which is Conyers/Kucinich H.R. 676: Single Payer/Medicare for All). This should be happening within the next few weeks. We all need to keep our radar up for this.
MUST SEE TEEVEE (C-SPAN).
what bills are actually brought to the floors of both houses of Congress. Most of the Senate bills are a waste of time and will end up causing more pain and suffering (physical and financial) for the very people who need it the most. I hope that Pelosi will keep her word and allow HR676 to be introduced on the floor.
In the meantime, I'll continue to regularly email my Sens and Rep and remind them they work for and are supposed to representing the best interests of the Americans who live in their state/district - not those of the CEOs of greedy global corporations. I'll also remind them that every other CIVILIZED nation provides access to health care for every citizen - and that since the US is the best darn country ever - it's damn well past time that we do the same.
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