This is a big step in the right direction, and it's something that would go a long way toward easing national insecurity (and not incidentally, expire after the midterms, leaving a possible Republican majority with a ticking time bomb):

With unemployment still hovering in double digits and no real relief in sight, a group of 30 Senate Democrats today is urging party leaders to extend emergency unemployment benefits through the end of 2010 — 10 months longer than current law dictates. In a letter to Senate Majority Leader Harry Reid (D-Nev.) and Senate Finance Committee Chairman Max Baucus (D-Mont.), the lawmakers argue that shorter extensions might be cheaper, but they leave state budgeters in a state of constant uncertainty.

Short term extensions, while still helpful to families, only add strain to state agencies that must constantly re-tool their computer systems, and at the same time, continue to assist the millions still searching for work. As our economy continues on a path to recovery, we need a robust extension of safety net programs that have provided a lifeline to families since the recession began.

Signing the letter were Democratic Sens. Tom Harkin (Iowa), Bob Casey (Pa.), Jack Reed (R.I.),
 Sherrod Brown (Ohio)
, Chris Dodd (Conn.),
 Jay Rockefeller (W.Va.),
 Jeanne Shaheen (N.H.),
 Al Franken (Minn.), Carl Levin (Mich.),
 Frank Lautenberg (N.J.), Debbie Stabenow (Mich.), 
Roland Burris (Ill.), Arlen Specter (Pa.),
 John Kerry (Mass.), Kirsten Gillibrand (N.Y.),
 Ron Wyden (Ore.), Edward Kaufman (Del.),
 Sheldon Whitehouse (R.I.), Barbara Boxer (Calif.),
 Patrick Leahy (Vt.),
 Robert Menendez (N.J.),
 Herb Kohl (Wis.),
 Tom Udall (N.M.), Ben Cardin (Md.),
 Robert Byrd (W.Va.),
 Daniel Akaka (Hawaii),
 Jeff Merkley (Ore.),
 Barbara Mikulski (Md.),
 Dianne Feinstein (Calif.) and Michael Bennet (Colo.), as well as Independent Sen. Bernie Sanders (Vt.).

Democratic leaders are working on legislation to tackle the continuing problems related to the economic downturn. The package is widely expected to include an extension of unemployment insurance, COBRA health benefits, food stamps and help for states faced with budget crises. They’d hoped to have health care reform out of the way first. Now, that’s looking unlikely.

Former CIGNA executive Wendell Potter says one of the most important things we can do to reform health care is to control the medical loss ratio - something Al Franken, Jay Rockefeller and other senators are attempting to do:

Today, insurers only pay about 81 cents of each premium dollar on actual medical care. The rest is consumed by rising profits, grotesque executive salaries, huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most.

This equation is known as the medical loss ratio (MLR), an aptly named figure that is widely seen by investors as the most important gauge of an insurance company's current and future profitability. In a private health insurance industry that collected $817 billion this year, a 14 percentage point difference in the MLR represents $112 billion a year! Over 10 years, that would be more than enough to pay for health reform.

Thanks to the efforts of several senators who pushed for a minimum MLR to be included in reform legislation, the current Senate bill requires insurers to provide an annual rebate to each enrollee if non-claims costs exceed 20% in the group market and 25% in the individual market.

Sen. Al Franken (D-Minn.) is now leading a group including Sens. Jay Rockefeller (D-W. Va.) and Blanche Lincoln (D-Ark.) to introduce an amendment that would go further by requiring that 90 percent of the money consumers spend on health insurance premiums go directly to health care costs.

The senators are proposing a reform that strikes at the heart of a health insurance system that puts profits first, and it would have a profound effect. When MLRs increase, that eats into profits, and Wall Street becomes very unhappy. A case in point is Aetna, the nation's third largest publicly-traded health insurance plan. Three years ago, the company reported that its quarterly MLR had inched up from 77.9 percent to 79.4 percent in 12 months. On the day this was disclosed, Aetna's share price plunged 20 percent as investors sold off their shares, reducing the company's market value by billions of dollars.

Wall Street investors expect insurers to pay as little as possible for medical claims. As a result, the nation's health insurance industry has evolved into a cartel of huge for-profit companies that together reap billions of dollars a year at the expense of their policyholders. The seven largest firms -- UnitedHealth Group, WellPoint, Aetna, Humana, CIGNA, Health Net, and Coventry Health Care -- enroll nearly one in three Americans in their health insurance plans. This year the industry will take about $25 billion in profits for getting between American

patients and their doctors, according to the industry's trade group.

And they do this by finding every excuse in the book not to pay a claim, even if it means

canceling individual policies when people get sick or ridding their rolls of unprofitable small business group policies if an employee or family member falls seriously ill. They issue confusing benefit statements to members so only highly motivated and persistent challengers of their denials stand a chance of reversing an unfair decision. And in the final analysis, when an insurance company has decided it no longer can make enough profit on a particular person or employer-sponsored group, it drives them away in a process known as "purging."

In this unconscionable profit-protection maneuver, an insurer will hike premiums so high that the policyholder has no choice but to pay outlandish rates for what may be a reduced benefit package, find another insurer, or simply go without coverage. The consequences of such decisions can be deadly -- but Wall Street always has the last word when profits are the main

consideration.

When Wall Street isn't calling the shots, the outcome is decidedly better for health care consumers. Government-operated plans, such as Medicare, and some organizations that provide coordinated care, consistently maintain higher medical loss ratios. Kaiser had a 90.6 percent MLR in 2007. Between 1993 and 2007, Medicare's MLR hasn't dropped below 97 percent.

The health care reform bill now being debated in the Senate must include a provision, such as that proposed by Sen. Franken, that sets a minimum medical loss ratio to keep insurers from gouging consumers and leaving patients without the care they need. Instead of being a formula to reward investors, a properly regulated medical loss ratio in combination with other cost containment measures in the legislation would be a reliable tool for keeping insurance company profits and administrative waste in check.

Every once in a while, Sen. Jay Rockefeller remembers the people who sent him to represent them and does them proud. Yesterday was one of those days:

Mr. Schumer said the public option would hold down costs because it would not have to generate profits, answer to shareholders or incur marketing expenses. His proposal would have required the public plan to negotiate rates with doctors and hospitals, rather than setting prices based on Medicare reimbursement rates. Under Mr. Rockefeller’s plan, the payment of doctors and hospitals would have been based on Medicare rates for the first two years.

Mr. Rockefeller said the Congressional Budget Office had estimated that a government insurance plan could slice $50 billion from the cost of Mr. Baucus’s bill, originally put at $774 billion over 10 years. The budget office predicted that eight million people would initially enroll in the public plan — about one-third of those who would seek coverage through new markets, or insurance exchanges.

“The public plan will be optional,” Mr. Rockefeller insisted. “It will be voluntary. It will be affordable to people who are now helpless before their insurance companies.”

From the West Virginia MetroNews:

Senator Rockefeller argued for his Consumer Choice Health Plan until the end. "It's a very serious decision," he said as the hours of debate came to a close. "It's a moral decision. It's an ethical decision. It's a human decision. It's a health care decision. It's writ large in our legacies."

The failed proposed public option program, as Rockefeller envisioned it, would have competed directly with private plans in a national health insurance exchange for those who do not have insurance. The CCHP would have been required to meet the same insurance regulations as private plans and be financially self sustaining.

"I think it's a real solution to protect American families and their economic security," Senator Rockefeller said early in the day on Tuesday. "I do not understand why we wouldn't do this."

Senator, campaign contributions aren't as huge a distraction to someone who grew up with money. If you really think about it, the answer's right there.

But thank you for your efforts.

Dr. Dean overcomes his natural shyness to share his thoughts on the Baucus bill and lobbies for using reconciliation to pass it:

Howard Dean, former Democratic National Committee chairman, minced no words about Sen. Max Baucus's health-care proposal, unveiled to the public this morning. "The Baucus bill is the worst piece of healthcare legislation I've seen in 30 years," Dean said last night at a healthcare town hall and book signing in Washington. "In fact, it's a $60 billion giveaway to the health insurance industry every year," he said. "It was written by healthcare lobbyists, so that's not a surprise. It's an outrage."

The Baucus bill leaves out some of the president's goals for healthcare reform, such as the controversial public option. While more palatable to Senate moderates, the Baucus proposal also drew criticism from Sen. Jay Rockefeller, a Democrat from West Virginia, who said yesterday he would not vote for it in its current form.

"I'm glad Senator Rockefeller is not going to vote for it. I wouldn't vote for it at all under any circumstances," Dean added.

Instead, Dean said Senate Democrats should and would end up using the reconciliation process to pass a plan with the public option. "It can be done, and that's how it will be done," Dean said, pointing out that a majority of Senate Democrats still support a more robust bill.

DOWNLOADS: (2539)

PLAYS: (1771)

Embed

Here's some of the latest on health-care reform. First, Max Baucus released the Senate Finance Committee's version of health-care reform. Such as it is.

Ezra Klein points out Baucus's dilemma:

Max Baucus will release the Chairman's Mark -- the official first draft of his bill -- later today. But things are not going according to plan. He's got a bill full of the compromises meant to attract Republican support, but no Republican support. Not even Olympia Snowe, at this point, has committed to backing the bill.

Meanwhile, the framework has conceded enough to the GOP that it's also losing Democratic support, including that of Jay Rockefeller, chairman of the Finance Committee's Health Care Subcommittee. And Rockefeller says that four to six Democrats on the committee feel similarly. Baucus is thus caught between a rock and a hard place. The absence of any Republican support makes it hard for him to justify his compromises. And his compromises make it hard for the Democrats on the committee to support his bill.

Nate Silver checks in with objections from the Senate Finance Committee:

Firstly, there's Jay Rockefeller, who opposes the lack of a pubic option.

Ron Wyden doesn't think the subsidies are sufficient.

Then there's Olympia Snowe, who doesn't like the funding mechanism.

John Kerry also has issues with the funding plan -- different issues than Snowe does -- and implies that the bill needs significant changes.

Mike Enzi and Chuck Grassley, who were never really on board in the first place, have a litany of objections.

Kent Conrad now wants the CBO to score the bill with a 20-year time window -- an unorthodox move which could have a variety of motives, but if nothing else introduces another wrench into the works.

At least Jeff Bingaman is still on board. For now.

These are not just any old random set of Senators opposing Baucus's plan -- these are the thought leaders on health care reform.

Negotiations are funny things. Sometimes the scariest moments come when you're closest to a settlement, as all sides feel emboldened to take the last opportunity to demonstrate resolve. Leverage in a negotiation is not necessarily a zero-sum affair, since nobody has any leverage if there's no hope to reach an agreement. So some of this maneuvering, perhaps, is a reflection of the bill moving closer to passage and not further away.

But let's be clear -- some of this is Baucus's chickens coming home to roost. When you make a unilateral decision to negotiate with only five other people from a 23-person committee and 100-person Senate, and two of those five people have clear electoral disincentives against supporting any plan that you might come up with, the negotiations are liable to end in failure far more often than not. The flurry of on-the-record statements against Baucus's reform plans -- not "leaks", not trial balloons -- points toward a defective process.

And that may suit Democrats just fine. There are at least three other starting points for a final showdown over health care: the House Tri-Committee bill, the Senate HELP bill, and possibly also the White's House's statement of principles, some of which remain vaguely defined. Many of the objections raised to BaucusCare would necessarily apply to one or more of those bills too -- but they'd appear to be starting from no worse a position than Baucus's plan itself.

Jay Rockefeller is actually the chair of the health subcommittee in the Senate Finance Committee. Any "Gang of Six," or really any legislation on the Committee, should at least have his input, if not his controlling hand. Yet Max Baucus froze him out of the legislation in favor of Republicans who will never sign on to the final version and worthless schemes like the Conrad co-op proposal (which is just a thin ploy to get Blue Cross of North Dakota, which controls 90% of the market in Conrad's state, the "co-op" label so it can access federal start-up funds). Rockefeller may have the last laugh when the bill moves into the full committee.

U.S. Senator John Rockefeller, a Finance Committee member and a strong backer of a government-run insurance option, said on Tuesday he will not support the panel's healthcare bill in its present form.

Rockefeller told reporters he was unhappy with the lack of a government-run "public" insurance option in the bill, which is scheduled to be made public on Wednesday, and had problems with some of its changes in children's health insurance and Medicaid, or healthcare for the poor.

In particular, Rockefeller wants a public insurance option instead of the weak co-ops, better affordability provisions so working people can actually use the bill, and changes to the way that Baucuscare deals with the Children's Health Insurance Program and Medicaid.

Rockefeller specifically said "There is no way in its present form that I will vote for it... unless it changes during the amendment process by vast amounts." Now, getting amendments through may not be an easy task. Each Rockefeller amendment in that committee would have to get the votes of all the Democrats plus at least a couple Republicans, if Baucus and Conrad hold firm on them. Considering that 10 of the 13 Democrats on the panel were completely shut out of the process during the Gang of Six talks, I'd expect a lot of support for what Rockefeller wants to do, but Baucus and Conrad can basically nullify anything meaningful on their own, should they want to.

Still, Rockefeller's advocacy is important because it sets the tone for Democrats with the full Senate, where votes like his will be needed. Jon Cohn explains.

A little over a month ago, right before the August recess, I spoke with Rockefeller at some length. And he was clearly wrestling with how to position himself.

No living senator has done as much to promote health reform as he has. It's the cause of his life and, for the first time, the goal is within reach. He admitted that voting against a package, even a flawed one, was difficult to imagine.

But Rockefeller also made clear his frustration with the compromises Baucus was making, whether it was replacing the public plan with a co-op or gradually reducing the subsidies to help people pay for insurance. He was particularly incensed about the changes to Medicaid and CHIP, programs to which he's devoted much of his time--and on which many West Virginians rely.

At the time, it seemed like Rockefeller was still on board, if only to help get a bill out of the Finance Committee and onto the Senate floor. But you got the feeling--well, I got the feeling--that he was near the breaking point.

Sometime since that interview, clearly, he's hit it.

Every vote is precious in the Senate, given that votes on the Republican side other than Olympia Snowe and maybe Susan Collins will not be forthcoming. Harry Reid has laid down the marker that anything less than 60 votes will lead him to go through the reconciliation process (and I don't think Reid's low poll numbers in Nevada will be much of a factor - the consequences of doing nothing on health care would be far graver for him). Therefore everyone in the Democratic caucus, essentially, represents an interest group to be satisfied. Rockefeller is standing up and saying that he's perfectly willing to vote against something that doesn't fulfill the promise of health care reform as he sees it. Bernie Sanders probably feels the same way. Maybe Barbara Boxer does. Or others. Max Baucus and his cronies will have to wrestle with that.

DOWNLOADS: (1465)

PLAYS: (2984)

Embed

Hold back the jello. Jay Rockefeller was on this morning with Andrea Mitchell and complained about the Kent Conrad "co-op" plan which he said was basically unworkable. He then went on The Ed show and hit it even harder. Jay is a supporter of the public option and was pissed that the co-op proposal was inserted in the Baucus bill since it was never even talked about during the general election. Isn't it nice that Baucus has killed the public option just to work with Republicans? Conservatives don't even have to win elections to get what they want. That's some deal they have.

Ed: It's not going to work. There's really no successful model out there to support the basis of signing on to a co-op. Would you sign on to a co-op or is that unacceptable?

Rockefeller: That's unacceptable and I can almost prove it. We've been in touch with all the folks that oversee, represent all the co-ops in the country on all subjects and they point out that there are probably less than twenty health co-ops in the country. There are only two that really work that well. One in Puget Sound, one in Minnesota, except for those two, they are all unlicensed. All present health co-ops are all unlicensed, they're unregulated. Nobody knows anything about them, nobody has any control over them and nobody has ever said, which is stunning to me, no government organization or private organization has ever done a study to what effect they might have in terms of bringing down the insurance prices.

They are untested, they are unlicensed, they are unregulated, they are unstudied. Why would we even think about putting them in as a control on this massive insurance industry instead of the public option?

There aren't any co-ops throughout much of the country, but to appease the conservative Dems we're supposed to throw six billion dollars around and hope that the states will try to make them workable. Is this insane? Watch the whole clip, but you get the idea from this one statement. Kent Conrad's big proposal is a complete sham, but President Baucus is trying to cram that down the throats of the country, which will render all health-care reform useless. All hail bipartisanship!

Well, if I embrace that philosophy, I can easily accept Leon Panetta as the new head of the CIA. Why? Because Sens. Dianne Feinstein and Jay Rockefeller, who both rolled over on torture, FISA and various other abuses, have a problem with him.

And under the circumstances, maybe that's a good thing. Maybe it'll be a good thing to have someone who isn't buddies with the people who perpetuated the horrors of the past eight years. Or maybe it won't, but what the hell, it's worth a shot.

And Salon's Joan Walsh agrees with me:

In other Obama news: I wasn't sure what to make of the appointment of Leon Panetta as CIA director -- until I heard that Sens. Dianne Feinstein and Jay Rockefeller opposed it. That's not entirely true: I thought the competent and popular Panetta, who came out strongly against Bush administration torture, detention and interrogation policies, was a clear message that Obama wants to change the way our intelligence agencies do business. The two Democrats' pique -- they say Obama didn't vet Panetta with them -- is a good sign that Panetta's not viewed as an insider who will simply roll over for what the intelligence establishment wants, since Feinstein and Rockefeller did little or nothing to stand up against Bush policies (and Glenn Greenwald agrees with me.)

On MSNBC's "1600 Pennsylvania Avenue," I said I trust Obama and Panetta on these issues far more than Feinstein and Rockefeller. Pat Buchanan and David Shuster predicted the opposition of Feinstein and Rockefeller would liberate congressional Republicans to savage Panetta in confirmation hearings; I trust he'll make it through, with Obama's strong backing.

Murray Waas:

"And did those leaks damage national security? The vice-chairman of the Senate Intelligence Committee, Jay Rockefeller (D-W.Va.) made exactly that charge tonight in a letter to John Negroponte, the Director of National Intelligence. What prompted Rockefeller to write Negroponte was a recent op-ed in the New York Times by CIA director Porter Goss complaining that leaks of classified information were the fault of “misguided whistleblowers...read on”

Senate Intelligence Committee, Republican Pat Roberts and Democrat Jay Rockefeller were on Meet the Press today.

RUSSERT: When will we see phase two of your investigation about the shaping or exaggeration of intelligence by policy-makers?

Video-WMP

Roberts:... And to go back in and to keep going over this over and over again, I'm more than happy to finish this, and I want to finish it, but we have other things that we need to do.

An important issue like this is now being swept under the rug.

MR. RUSSERT: The United States went to war...

That's right, we went to war because of information that the administration pressured to hear, and Roberts thinks we have better things to do, and is not happy to answer Tim's questions about it.

ROCKEFELLER: Pat and I have agreed to do it. We've shaken hands on it, and we agreed to do it after the elections so it wouldn't be any sort of sense of a political attack... If policy-makers are going to misuse or shape or hype or change or try to pressure that intelligence into being something different, they're the ones who decide, the policy-makers, whether we'll go to war or not, not the intelligence community. This is at the core of what we have to be prepared for, to do correctly for the next 30 or 40 years during the war on terrorism.

Transcript