My name is Noelle Cigarroa Bell, and I've been working for the past year on health care reform as a grassroots advocate. I would like to announce exciting news--we're working with Darcy Burner on the FixItAndPassIt! Project. Here's what our project is about:

Healthcare Reform: Fix It and Pass It! is a project of the Progressive Congress Action Fund, a 501(c)(4) non-profit organization dedicated to connecting the progressive movement, ideas, and Congress.

I've started this movement with Eve Gittelson, a noted health care activist, and Darcy Burner, the Executive Director of ProgressiveCongress.org. We're starting a massive push to make 1,000,000 calls to Congress on February 24th and February 25th around the time of President Obama's bipartisan summit to push for a reconciliation fix to the Senate bill. Will you please help join us to fix the bill and get it passed?

Democracy For America is onboard with us for our effort, and we're working on an even bigger push next week to get this job done. Speaker Pelosi has it right when she says she doesn't have the votes for the Senate bill. She's whipped her caucus, tried to get them to a "yes" vote, but they're not going to do it because the Senate bill is political poison because of the lack of a public option, the Medicare buy-in, the excise tax, the sweetheart deals with PhRMA, and the Nebraska Cornhusker Kickback deal.

We're pushing to fix this bill by calling for these items in the reconciliation fix--the public option, the Medicare buy-in, excising the excise tax, increasing the subsidies, drug reimportation, and kicking the Nebraska cornhusker kickback deal out of the Senate bill. The votes won't materialize otherwise. It's the harsh reality. This just doesn't stop here, because truly, this Senate bill even if it gets passed by an Act of God, isn't enough. We will continue to fight for better health reform. Let's get this done and leave it all on the road on February 24th and February 25th.

Thank you for joining us at FixItAndPassIt.org! You can also follow us on Twitter @ProgActionNow.

I extend my sincere thanks to the editor team at Crooks and Liars and to John for allowing this guest post through.

DOWNLOADS: 1573

PLAYS: 273

Embed

Nancy Pelosi held a conference call today on health care and spent about 30 minutes discussing what's happening now and taking Q's. (I think it's important to get these conference calls up to our readers.)

The HOUSE does not trust the Senate and will not move forward unless Harry Reid gets the Senate rolling first. She's not alone. The Senate has lost the trust of the American people completely. She reaffirmed that the Senate bill has no chance of passing the HOUSE as is.

Brian writes:

Pelosi has insisted for some time now that the Senate health care bill can not pass the House unamended, but that she can probably round up the votes if the Senate and the House both pass a sidecar bill making a number of pre-emptive changes to it.

"Don't even ask us to consider passing the Senate bill until the other legislation has passed both houses so that we're sure that it has happened, and that we know that what we would be voting for would be as effected by a reconciliation bill or whatever parliamentary initiative they have at their disposable," Pelosi said on a conference call this afternoon.

Senate aides have complained that her plan presents them with a big parliamentary difficulty: they don't know if they can pass legislation amending a bill that hasn't been signed into law yet.

Pelosi says that's simply not true.

"No. It is not an obstacle to this path forward."

She talks about repealing the anti-trust exemption, fixing the excise tax and the public option, "reconciliation' as well as some other issues about HCR. I didn't have time to write up a detailed review on today's call so please listen to the above audio.

She was surprisingly confident today about getting something done and says we're close. We'll see. She didn't want to talk for the Senate at all either.

And the operator was awful handling the call because a lot of us had questions and she didn't translate that to the Speaker so it appeared that there were hardly any questions coming in for the Speaker, That led to question hogs.(LOL) I was going to either ask about the public option or the Stupak amendment.

As expected, the healthcare bill will now move ahead. I suspect if Martha Coakley loses the special election, we might be looking at reconciliation again:

Reporting from Washington - The White House and labor leaders agreed Thursday on a formula to tax high-cost insurance plans, removing one of the last obstacles to President Obama's healthcare overhaul, officials said.

Under the agreement, reached after an intense round of negotiations this week, union leaders dropped their opposition to the so-called "Cadillac tax" in exchange for concessions to limit its scope. Organized labor had bitterly opposed the healthcare tax, arguing that union members had negotiated generous benefits in lieu of pay increases.

The compromise would raise the value of family plans subject to the tax from $23,000 to $24,000 and exempt the cost of dental and vision plans.

It also would postpone the tax's application to healthcare plans negotiated under union contracts.

"This is a milestone," said AFL-CIO President Richard Trumka, who helped lead the negotiations.

Senior Democrats must now take the proposed financing package to rank-and-file lawmakers in the House and Senate -- and find revenue sources to offset reductions in the Cadillac tax. Late Thursday night, Democratic leaders returned to the White House to try to reconcile differences between the House and Senate healthcare bills.

Labor leaders also will have to convince their members that the watered-down Cadillac tax is not a betrayal of Obama's campaign promise to oppose new taxes on their benefits.

Addressing the House Democratic Caucus at the Capitol on Thursday, Obama candidly acknowledged the political challenges the healthcare overhaul would pose for lawmakers ahead of November's midterm elections.

"Believe me, I know how big a lift this is; I read the polls," Obama said. But he reassured party lawmakers that the climate would shift once voters learned more about the bill's impact.

"If Republicans want to campaign against what we've done by standing up for the status quo and . . . for insurance companies over American families, that is a fight I want to have," Obama said.

Republicans immediately criticized the Cadillac-tax compromise, especially the provision postponing its application to union health plans until 2018. Labor leaders said that transition time was needed to accommodate unions and employers with multi-year agreements.

Antonia Ferrier, a spokeswoman for House Republican leader John A. Boehner of Ohio, said: "This union kickback is the latest in a long line of backroom payoffs and sweetheart deals on a healthcare bill that the American people overwhelmingly do not support. A lot of people across the country will be angry, and who can blame them."

Continue reading »

Krugman wades into the question of whether Jonathan Gruber's work is suspect in light of his government grant:

For those who haven’t been following this, Gruber — who is one of the three or four top health care economists in the nation — turns out to have a large research grant from the Department of Health and Human Services, for modeling the consequences of various reform plans. This has led some people, mainly Marcy Wheeler at Firedoglake, to question Gruber’s objectivity.

The truth is that this is no big deal. Gruber’s grant is from HHS, not the West Wing; it’s basically the same kind of thing as, say, an epidemiologist receiving a grant from the National Institutes of Health. You wouldn’t ordinarily say that this tarnishes the epidemiologist’s credentials as an independent analyst on infectious diseases, unless you want to say that nobody receiving a research grant can be considered independent.

The only reasons you might see this differently would be if Gruber were either receiving a sweetheart deal, or seemed to have changed his views to accommodate his sponsors. Neither is remotely true. Gruber is very much the go-to guy on modeling reform: it’s hard to think of who else could be doing the work better. And his position on reform has been entirely consistent.

Should Gruber have made a fuller disclosure? Yes — I think he was being too much of an academic, taking for granted that everyone understands the difference between being a political hired gun and receiving a research grant. Should he disclose the contract every time he writes anything? Well, maybe — but a brief mention should suffice. When you’re writing 800-word op-eds, you need to reserve as much space as possible for real content.

And I have every intention of continuing to cite Gruber on matters related to health care. He’s the top micro-modeling expert, and getting this stuff right is more important than this essentially trivial controversy.

[...] What the folks at Firedoglake should ask themselves is this: do you really want to become just like the right-wingers with their endless supply of fake scandals?

Even though I posted Marcy's story, I thought this probably wasn't as big a deal as it sounded. And that's one reason why I try not to jump to conclusions when I first read or see a story -- odds are high that the information is incomplete or out of context, by very nature of the 24-hour news cycle.

And jumping to conclusions is the same thing I hate about cable news. I'm not eager to follow in their footsteps.

We've been so often misled by the media that it's good to stay skeptical, but let's also retain a willingness to see how a story unfolds.

DOWNLOADS: (690)

PLAYS: (840)

Embed

From This Week with George Stephanopoulos, a conversation with Christina Romer, chair of the White House Council of Economic Advisers about the proposed excise tax on "Cadillac plans" to fund the healthcare bill.

As someone who got into the nuts and bolts of union health care plans when I was a reporter, I can tell you there's almost always some lard in there. (I remember one contract that covered a week-long hospital stay for normal childbirth.) The insurance broker is usually politically connected, and the premiums are inflated so the broker can kick back a percentage to the politicians. So theoretically, this tax will put some useful pressure on inflated plans - but create some very unhappy politicians:

STEPHANOPOULOS: Senator Harry Reid, though, the Democratic leader in the Senate said that has to wait until health care is done and the negotiations between the House and Senate have begun this week. The president weighed in with the leaders on behalf of this so-called Cadillac tax, the excise tax on high-priced health insurance plan. That is facing some real resistance in the House. Here's Congressman Joe Sestak.

(BEGIN VIDEO CLIP)

SESTAK: They're not just pulling the Cadillac. They're pulling the Chevrolets. By 2019, because they index it to a wrong inflation rate, we're going to have one-third of all the workers in employer-based plans paying a middle-class tax. No, this has to change.

(END VIDEO CLIP)

STEPHANOPOULOS: He and labor leaders like Gerry McEntee say this is going to be a middle-class tax increase that could hit up to 40 percent of union workers.

ROMER: All right, so the -- the important thing the president has said that he thinks that this excise tax on Cadillac plans is important. He's been convinced by experts across the ideological spectrum that say this is one of those things that genuinely slows the growth rate of costs, and anybody that's worried about the budget deficit knows that we've got to -- to do that.

You know, what the president has said is, you know, he's always open to -- you know, there are design issues here. He's going to be continuing to -- to work with the Congress to say, are there ways to -- to make it work better? But we want to maintain that -- that crucial focus on cost containment.

STEPHANOPOULOS: Even if it's a middle-class tax increase?

ROMER: You know, I think that the numbers that you were hearing, you know, that the levels where this is being set -- I think the current number is something like $23,000 for a plan, a family plan -- that's a very high level and -- and exempts an awful lot...

(CROSSTALK)

STEPHANOPOULOS: Well, except union leaders say it's not. They say that at $23,000, it affects 1 in 4 union members. If you raise the threshold to $27,000, it'll be 1 in 14. Are you willing to raise that level?

ROMER: No, you -- you absolutely -- I think you've got to be very careful on the numbers. They're actually, as it's being developed -- they're being, you know, changes made to make sure that, if you've got just older workers and that's why your costs are higher, or things like that, if you're a first-responder, so we've been very receptive to -- to, you know, arguments like that, and, also, the -- you know, sort of the -- the level at which you set.

I think the important thing is the -- you know, the incentives that it provides to genuinely slow the growth rate of costs (ph). If this thing works just right, nobody hits it, right, because -- precisely because it slows the growth rate of costs.

ABC News

(ABC News)

STEPHANOPOULOS: Well, that's because insurance plans might be dropped, as well. But, still, even with this in there, the Senate bill, your own chief actuary of Medicare and Medicaid says that this is going to increase health care costs by $222 billion over the next 10 years.

ROMER: All right, so you need to be very careful. There are lots of estimates out there. I think, you know, the Congressional Budget Office...

STEPHANOPOULOS: But that's your own actuary.

ROMER: The -- the actuary is independent, right, and the Congressional Budget Office is nonpartisan, highly respected organization, as well. They have said that the Senate bill as it came out would genuinely reduce the deficit over the 10-year window and, even more important, said that it would slow the growth rate of costs so that those -- that deficit reduction was going to be growing over time.

So I do think you need to -- to -- to look at the range of estimates. And we, certainly, have looked very hard at the CBO estimates and -- and think they're very reasonable.

Watch the video - it's short, and it sums up why Krugman so often has a fresh perspective on issues, rather than an insular academic bent.

And speaking of, Krugman weighs in on the excise tax question in the healthcare reform bill, asking whether the tax-deductions for employer-provided health insurance should be limited:

The counter-arguments seem to run along three lines.

First, there’s the argument that many “Cadillac” plans aren’t really luxurious — they reflect genuinely high costs. That’s surely true. A flat dollar limit to tax deductibility has real problems. At the very least, the limit should reflect the same factors insurers will be allowed to take into account in setting premiums: age and region.

Second, there’s the argument that any reductions in premiums won’t be passed through into wages. I just don’t buy that. It’s true that the importance of changing premiums in past wage changes has been exaggerated by many people. But I’m enough of a card-carrying economist to believe that there’s a real tradeoff between benefits and wages.

Maybe it will help the plausibility of this case to notice that we’re not actually asking whether a fall in premiums would be passed on to workers. Even with the excise tax, premiums are likely to rise over time — just more slowly than they would have otherwise. So what we’re really asking is whether slowing the growth of premiums would reduce the squeeze rising health costs would otherwise have placed on wages. Surely the answer is yes.

He's right. When you put it that way, it's a lot more plausible.

The last argument is that this hurts unions which have traded off lower wages for better benefits. This would be a bigger issue than I think it is if the excise tax were going to kick in instantly. But it won’t, giving time to renegotiate those bargains. And bear in mind that this kind of renegotiation is exactly what the tax is supposed to accomplish.

A last general point: we really don’t know what it will take to rein in health costs, but that’s a reason to try every plausible idea that experts have proposed. Limiting tax deductibility is definitely one of those ideas.

Bottom line: the details of the excise tax should be fixed, but it’s on balance a good idea.

If there's anything that makes me want to scream, it's the vast, tangled web of financial interests that make up the D.C. policy, advocacy and media establishment. It's gotten to the point where, whenever I attend a conference or political event, my first question of people is: "So! Who's paying you?"

Great catch via Marcy:

MIT health economist Jonathan Gruber has been the go-to source that all the health care bill apologists point to to defend otherwise dubious arguments. But he has consistently failed to disclose that he has had a sole-source contract with the Department of Health and Human Services since June 19, 2009 to consult on the “President’s health reform proposal.”

He is one source for the claim that the excise tax will result in raises for workers (though his underlying study is in-apt to the excise tax question). He is the basis for the argument that the Senate bill reduces families’ risk–even if it remains totally unaffordable. Even Politico stenographer Mike Allen points to Gruber’s research.

But none of the references to Gruber I’ve seen have revealed that Gruber has a $297,600 contract with HHS to produce,

a technical memorandum on the estimated changes in health insurance coverage and associated costs and impacts to the government under alternative specifications of health system reform. The requirement includes developing estimates of various health reform proposals on health insurance coverage and cost. The alternative specifications to be considered will be derived from the President’s health reform proposal. [my emphasis]

Here's Gruber's response.

The progressive "journo/blogospere" is sharply split over the Senate health bill. Some, like Jane Hamsher and Matt Taibbi, are saying "kill it." Others, like Paul Krugman, Ezra Klein, and Jonathan Cohn, are saying "pass it" - as is. Steve Benen says " it's worth appreciating the vibrancy, energy, and seriousness with which progressives are engaging in the debate."

I say maybe - but there's been a lot of condescension and hostility, too. And what bothers me even more is the tendency of some bloggers - good people, people who are seen not only as advocates but as as information gatherers on health policy- to ignore data that undercuts their position while pushing a false political choice. I'm not saying their decisions are deliberate, and I assume they're not. But it's disappointing, and it's worth discussing.

It's difficult for me to name names, since I respect their work a lot, but I'm talking about people like Jonathan Cohn, David Leonhardt of the New York Times, and Ezra Klein (who has been very friendly and helpful to me since the beginning.) Since I know they're people of good will, I can't help wondering if the polarized nature of this debate has something to do with what's been going on.

I've been working on a campaign to resist the excise tax, which I have long thought was based on flawed logic and would turn out to be counterproductive both as politics and policy. (Let the first part of that statement - "I've been working on a campaign" - serve as a disclaimer and full disclosure regarding what follows.) Both Klein and Leonhardt have written admiringly about the tax's ability to "bend the cost curve," but a broad range of studies have been released that challenge that assumption, whole polls have shown that its likely to be highly unpopular politically.

These are not unscientific, flaky studies. Two papers were published in the highly respected journal Health Affairs. These are studies from respected firms that seem to overturn the conventional economic wisdom behind the excise tax. Citizens for Tax Justice has reviewed data from the Joint Committee on Taxation (pdf) and drawn negative conclusions about the tax. Other studies by top benefits consulting firms like Martin E. Segal, Watson Wyatt, Mercer, Towers-Perrin, and Hewitt (whose livelihood depends on a corporate clientele) challenge the arguments made in support of the tax, while polling from a well-regarded firm suggested the tax would have a devastating political impact in front-line states. So how much have Klein, Leonhardt, or Cohn written about all of this new and revelatory information?

As far as I can tell, not a word.

The silence bothers me more than disagreement ever could. These guys are viewed as experts in health policy and as gateways and interpreters of the latest research. Sure, they've come out foursquare for accepting the Senate bill, but does that really excuse the silence? Maybe they're too busy to write about these reports. Maybe they haven't seen them (although I sent a few links to one of them.) Maybe - and I hope this isn't true - they're so concerned about ensuring that a bill passes that they'd rather not muddy the waters with new data that undercuts that position.

Or maybe I'm out of line. Maybe people don't see them as reliable sources for all the new health policy info. Perhaps they're perceived as strong advocates for a certain position, with no newsgathering brief. If so, I apologize - sincerely. But, if I'm right, they really need to address these studies. They can argue that they're methodologically flawed , or that they're inconclusive, or that it's too late to change anything now. But ignore them? That's disturbing.

"Gah," writes Paul Krugman, who also presses for passing the Senate bill. "I see that some people are still using the Rasmussen polling on MA’s health care reform. You shouldn’t do that ..." I'm one of those who has used those polls - but I've written about and linked to his critique, which includes another poll he likes better. That's what we should all be doing if we want to have a serious debate. (Now, as it turns out, I don't interpret the poll data the same way he does - but I'm acknowledging its existence, responding, and letting people decide for themselves.)

I identify with Prof. Krugman's frustration, though. Gah, why are people still saying the excise tax "bends the curve"?

There's a basic structural flaw in the Klein/Cohn/Krugman position, too: that it's either this health bill or nothing. I believe that's a false choice. Opponents of the Senate draft don't all believe that no reform is better than this bill. But they should act as if they do. Once you say the Senate bill is good enough, the negotiations with the left are over.

The Senate health bill has been improved in some areas, including strengthening the Medicare cost containment commission and - most critically - once again lifting lifetime caps on coverage. Like McJoan, I believe that's a direct result of the outcry on the left. Fear of a progressive backlash has already improved this bill, and it may continue to do so - if we don't back down too soon. In a very practical sense the Deans, Hamshers, and Taibbis are accomplishing more than any other progressives to get a better bill.

There are many people who disagree vehemently with that statement. By all means, let's keep talking about it. But let's do so openly, with all the information at our disposal, and without either hostility or manipulation. I'm not out to antagonize anyone here. I'd really like to see debate that's based on data and grounded in strategy - and not in false choices.

Recently the Senate passed Sen. Barbara Mikulski's Women's Health Amendment, which requires health insurance companies to provide free mammograms and other preventive health services for women. Sounds good, doesn't it? Women's health needs have traditionally been underserved by the insurance system. But, ironically, the Senate's excise tax will force many women to pay indirectly for these "free" services.

Here's how: For one thing, the cost of the services mandated in the Mikulski Amendment will cause even more health plans to exceed the cost cap for the excise tax. And it's expected that 20% of plans will already be over the limit when the tax takes effect. In practical terms, any added costs for new services provided by these plans (like those mammograms) will be taxable. So, in one very real sense, the Senate plans to tax some of this preventive care for women - at a staggering 40% of cost.

The Mikulski Amendment looks like a step forward, but many women will pay for these services indirectly - in the form of higher premiums or increased out-of-pocket costs. One hand giveth and the other taketh away. And speaking of irony ...

Guess who voted for the Mikulski amendment? Some Senators who haven't even committed themselves to voting for the final bill, including Lieberman, Landrieu, and Snowe (who even cosponsored the amendment. Here's an idea: They can make sure these women's services really remain "free" by supporting the Sanders-Franken-Brown Amendment, which would replace the excise tax with a tax on the extremely wealthy (the way the house does it.)

That would remove the irony in the Senate's actions and replace it with fairness.

There's a rapidly growing body of research showing that the Senate tax on high-cost health plans (misnamed "Cadillac plans") is a really bad idea. For example, the Mercer consulting group found that 19% of employer health plans would be affected by the tax in 2013, its first year. (That contrasts only slightly with the CBO's estimate that 19% of plans would be affected by 2016.)

That's one out of every five plans. And, as we explain here, that means this tax will affect coverage for more than one worker in five. So "Cadillac tax" is a misnomer - this tax would hit middle-class people far more than it would wealthy executives. It would further erode the social safety net for working families. And more critical information was published today that could turn the tide.

Continue reading »