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View Diary: Senate HELP Committee Passes Health Reform Bill (246 comments)

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  •  Tri-Committee much better than HELP (2+ / 0-)
    Recommended by:
    Mimikatz, Actuary4Change

    Tri-Committee is scored by CBO to cover 94% of the total non-elderly American population and 97% of the legal non-elderly population. The Kennedy-Dodd HELP bill scores out at 88% and 90% respectively. The question at hand is whether we are going to boost government expenditures over the next ten years by $600 billion to solve about half of the problem of the uninsured (Senate HELP) or a $1 trillion dollars to solve almost all of it (House Tri-Committee). Dodd and Kennedy did yeoman work give the constraints they had given Senate makeup and rules but really progressives should be pushing for compromises closer to the Waxman-Brown-Miller-Rangel version.

    And yes Baucus is between a rock and a hard place. The working assumption among Republicans and Blue Dogs that the more comprehensive the public plan the higher the ultimate cost. The current CBO scoring of the revised HELP (less than half the price of the initially scored version with no public option at $600 billion to $1.3 trillion) plus their scoring of the broader coverage Tri-Committee plan has the wingnuts scrambling with their 'fiscal discipline' being revealed for what it really is: 'protection of private insurance profits'.

    •  I think you're mixing some stuff up (0+ / 0-)

      The current HELP bill doesn't include Medicaid expansion, which is why it is one reason it is estimated as covering far fewer than the Tri-Committee bill.  The $1.3 trillion or so was the estimate cost with Medicaid expansion included.  The Senate HELP Committee does not have jurisdiction over Medicaid, so could not include this in the bill.  With Medicaid expansion, I thought it was supposed to cover something like 95% or 97% of legal residents.

      I'm also pretty sure the CBO explicitly stated that the public option in this bill is expected not to reduce costs significantly because they are using a level playing field plan, which would result in similar reimbursement rates to private insurers, which keeps premiums at a similar level to private insurers.  The House Tri-Committee bill had a strong public option, which resulted in about a 10% lower premium.

      •  Anyone who wants can check the links (0+ / 0-)

        I supplied them with the following posts
        Tri-Committee Bill with CBO scoring
        Kennedy-Dodd Bill with CBO scoring

        I didn't spend a lot of time looking at the original scoring of the partial HELP bill that came out to $1.3 trillion but IIRC that version didn't have the more robust plan included in the HELP bill that CBO scored at $600 billion.

        It is true that it is sometimes frustrating to compare CBO scores across bills because both the bills and the scoring are not exactly apples to apples. But I find it a little odd that the Health, Education, Labor and Pensions Committee does NOT have jurisdiction over Medicaid. What committee would?

        •  Senate Finance has jurisdiction over Medicaid (0+ / 0-)
        •  Original HELP bill was more expensive because (0+ / 0-)

          it didn't have an employer mandate.  And it only took a small bite out of the uninsured population, something like a third.  The combination of an employer mandate and a more clearly defined individual mandate reduced government expenditures and increased the number of insured.  The CBO in its letter to Kennedy explicitly stated in its estimate that:

          The new draft also includes provisions
          regarding a "public plan," but those provisions did not have a substantial effect on the cost or enrollment projections, largely because the public plan would pay providers of health care at rates comparable to privately negotiated rates—and thus was not projected to have premiums lower than those charged by private insurance plans in the exchanges.

          The letter from the CBO also states:

          The draft legislation does not include a significant expansion of the Medicaid program or other options for subsidizing coverage for those with
          income below 150 percent of the federal poverty level (FPL); such provisions may be incorporated at a later date. By CBO’s estimate, about three-quarters of the people who would remain uninsured under this version
          of the legislation would have income below 150 percent of the FPL.

          The bill results in 12% of all non-elderly residents (including unauthorized immigrants) remaining uninsured, or 10% of all non-elderly residents excluding unauthorized immigrants.  The CBO claims 3/4 of these are beneath 150% of the federal poverty line.  So say that extending Medicaid takes out about half of them, because a lot of Medicaid-eligible families fail to enroll.  All of a sudden you have coverage for somewhere around 95% of the non-elderly population.

          However, the Senate HELP Committee has NO jurisdiction on Medicaid expansion.  They may have jurisdiction on some aspects of Medicaid, but certainly not on who qualifies for Medicaid and how to pay for this expansion.  This has been established numerous times by very reliable commentators.  Expanding Medicaid would significantly increase the cost of the bill, raising it to over $1 trillion, which actually makes it pretty similar to the House Tri-Committee bill.


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