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  •  I don't think Grassley is a lost cause. (1+ / 0-)
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    Vexed

    Enzi, however, is.  Jonathan Cohn explains:

    And on health care, [Enzi] has a long history of advocating strong conservative positions--like, for example, allowing the purchase of individual insurance policies across state lines. ...

    Consider the amendments that Enzi proposed during the markup hearings for the Health, Education, Labor, and Pensions (HELP) Committee, on which he also sits. No public list of these amendments is yet available, as they are still being compiled. But sources who followed the deliberations closely say Enzi made all of the following proposals. (I'm still awaiting final confirmation from Enzi's staff, which is going through their records, but I'm confident these are fundamentally correct.)

    1. Slashing the government subsidies to people who need help buying insurance. The Democrats’ HELP bill, like the House bills, would provide assistance to people making as much as 400 percent of the poverty line. Enzi wanted to cut off assistance at 250 percent. And since the subsidy levels gradually phase out with income, that would have meant less assistance for most people.
    1. Shrinking the minimum benefits package that all insurance policies would have to provide. Reform bills set a standard for coverage by "percentage of actuarial value"--which translates, very roughly, as the percentage of medical bills a policy will cover for the average person. (Somebody with serious medical bills would, most likely, have to pay more.) It's a crude, imperfect measure but one that gives you some rough sense of the kind of financial protection a policy offers. The HELP bill was at 75 percent. Enzi wanted to make it 60. For a sense of comparison, the standard federal employees policy is around 80 percent, the typical large employer plan is around 75, while the least generous plan in the new Massachusetts scheme is around 70.
    1. Scaling back regulations to prevent discrimination against the sick. All reform bills would prohibit insurers from varying premiums based on pre-existing medical condition. But they’d all make a exceptions for a few criteria, including age. The idea is to make sure young people accustomed to paying very low rates don’t face sticker shock, but if the variation is too high--and there are not generous subsidies to offset the effect--older people can be totally priced out of the market. The HELP bill, like the House bill, would have allowed insurers to vary rates for age by a factor of two. Enzi wanted to make it five.

    A reform bill that included these provisions would be a pretty far cry from the kinds of reforms Obama and his supporters have been promising. With subsidies scaled down to 300 percent poverty, minimal actuarial value at 60 percent, and large age-rating bands, working and middle-class people would get very little assistance--while remaining exposed to serious medical bills.

    Yet these are the positions Enzi is also pushing within the Finance committee, apparently with some success. As the Washington Post reports today, their working arrangement would now reduce subsidies 300 percent from 400 percent. Past reports have indicated the age rating bands are likely to go to five. Separately, multiple sources confirm that the latest Finance draft pegs actuarial value for minimum insurance policies at 65 percent--and that Enzi has pushed for lower than that.

    In other words, if Enzi has his way, the bill will be eviscerated.

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