Chairman Max Baucus's bill has been roundly panned by Democrats on his own Senate Finance Committee, the Republicans who still refuse to vote for an essentially Republican health care bill that bans funding of abortions and health care access to illegal immigrants, and he seems to be the only one proud of his bill.
It's a bill that punishes the middle class with an individual mandate to buy private insurance plans they can't afford, including fines up to $3,800 for a family that makes more than $66,000 a year. It's a major giveaway to private insurers, with a community rating of 5:1 based on age. And the Chairman's mark says that families could face a community rating up to 7.5:1. That means they'd pay 7.5 times what a young person pays for their insurance policy.
Taking together all permissible risk factors, premiums within a family category could not vary by more than a 7.5:1 composite ratio.
And this, straight out of the Chairman's mark, is a wet dream for private insurers:
No later than 2013, the National Association of Insurance Commissioners (NAIC) shall develop model rules for the creation of “health care choice compacts.” Starting in 2015, states may form “health care choice compacts” to allow for the purchase of individual health insurance across state lines. “Health care choice compacts” may exist between two or more states. Once compacts have been agreed to, insurers would be allowed to sell policies in any state participating in the compact. Insurers selling policies through a “health care choice compact” would only be subject to the laws and regulations of the state where the policy is written or
issued.
It means that a private insurer in one state with incredibly lax insurance regulations could sell its own policy in that state across state lines to another state, thus superseding the insurance regulations of that state. It means you'd get the choice of an insurance policy that wouldn't be in compliance with your own state laws. However, the chairman's mark claims that states will still retain the authority to address market conduct, unfair trade practices, network adequacy and consumer protection standards, including addressing disputes as to the performance of the contract.
And from what I'm reading so far, there seems to be no national insurance exchange in the bill, rather state-based exchanges which won't even be open to large employers with 50 and more employees until 2017. It's on page 16 of the Chairman's mark for those who want to take a look at it. There's also a health coverage tax credit that's advanceable and refundable. People with employer-subsidized coverage would not be eligible for this tax credit, so they'd still have to pay their portion of the premium of whatever the employer
The credit is available on an advance basis through a program established and administered by the Treasury Department. The credit generally is delivered as follows: the eligible individual sends his or her portion of the premium to the Treasury, and the Treasury then pays the full premium (the individual’s portion and the amount of the refundable tax credit) to the insurer. Alternatively, an eligible individual is also permitted to pay the entire premium during the year and claim the credit on his or her income tax return.
There's an excellent comment from one of our kossacks, sullivanst, innyceve's diary about the so-called "consumer co-operatives" in the Baucus plan:
OK it envisages the possibility of national co-ops, implicitly. And it does appear to allow co-ops to group together to enhance leverage... except it completely hamstrings the collective bargaining:
Organizations participating in the CO-OP program would be permitted to enter into collective purchasing arrangements for services and items that increase administrative and other cost efficiencies, especially to facilitate start-up of the entities, including claims administration, administrative services, health information technology, and actuarial services. A purchasing council may be established to execute these collective purchasing agreements. The council shall be prohibited from setting payment rates for health care facilities and providers. There shall be no representatives of Federal, state, or local government or any employee or affiliate of an existing private insurer on the council. The council would be subject to existing anti-trust statutes.
In other words, they're only allowed to collectively bargain for stuff that should only be making up a small percentage of their operating costs. For the vast majority of the purchases they'll have to make, they're not allowed to bargain. And moreover, subjecting them to anti-trust raises the question of whether they'll even be allowed to do what Baucus claims they'll be allowed to do. And why subject the co-op council to anti-trust, when the private insurance industry is exempted? Disgusting. What a hack.
It's so bad that even Senator Rockefeller has threatened not to vote for the Baucus bill unless there are substantive changes made to it in the mark-up process. We've heard that there might be amendments that would increase the affordability provisions in the bill, and possibly an amendment with a public option in it. We don't know whether if that public option amendment, if so offered, would have a trigger on it. Here's the quote from Senator Rockefeller:
I have sat besides Max Baucus for 22 years on the Finance Committee. ... I'm probably one of his best friend among Democrats. But I cannot agree with him on this bill. ... There is no way in present form I will vote for it. Therefore, I will not vote for it unless it changes during the amendment process by vast amounts.
And I just realized that Senator Baucus's not the only one who loves this bill--Senator Conrad, the champion of the so-called cooperatives, which would benefit his major private insurer in North Dakota, Blue Cross Blue Shield, just came out in strong support of this bill:
"It's a good product," Conrad said on CNBC. "It is an attempt by the chairman to lay out what he thinks reflects best the discussions over this extended period of time. And I think the chairman has done a good job of capturing where the talks are at this point."
Included in the plan are non-profit healthcare cooperatives, an idea first floated by Conrad in lieu of the public option, along with several other concessions to Republican lawmakers.
"Many of the concerns that our Republican colleagues raised have been included in the chairman's proposal," he said, citing provisions in the bill on abortion funding, coverage for illegal immigrants, and taxes on high-value insurance plans.
Conrad maintained that the bill is simply a starting point, though, and would be open to amendments from both Republicans and Democrats in the weeks and months to come.
And McConnell comes out strongly against this "partisan" bill which has many Republican ideas in it:
"This partisan proposal cuts Medicare by nearly a half-trillion dollars, and puts massive new tax burdens on families and small businesses, to create yet another thousand-page, trillion-dollar government program," McConnell said in a statement. "Only in Washington would anyone think that makes sense, especially in this economy.”
It's at this point that both Senator Max Baucus and Senator Conrad need to be called out for what they are--obstructionists to real health care reform. Hell, even my dog Max is better than Senator Max at this point:
Just look at that cute little cuddly face. He doesn't whore around with private insurance lobbyists and doesn't get taken on nice hunting or fishing trips with insurance lobbyists. He can tell a bad person from a mile away. He's a good dog :-)
And then look at Senator Baucus. After all, this is the man who let a former WellPoint VP write this atrocious hand-out to private insurers. And the one that Wendell Potter, a former Cigna executive, called out for what it was:
"The Baucus framework is just an absolute joke," said Potter, Cigna’s former head of corporate communications who has been speaking out against insurance industry practices. "It is an absolute gift to the industry. And if that is what we see in the legislation, (America’s Health Insurance Plans chief) Karen Ignagni will surely get a huge bonus."
...
Potter said the proposal would not provide affordable coverage. It gives the industry too much latitude to charge higher premiums based on age and geographic location, fails to mandate employer coverage, and pushes consumers into plans with limited benefits, Potter said.
Private insurers "want to have ‘benefit design flexibility.’ Those are three very worrisome words," Potter said at a briefing arranged by the Center for American Progress, a liberal think tank. "By being able to have benefit design flexibility, they will be able to design plans that are so limited that more and more people will be in the ranks of the uninsured."
It's a great bill for private insurers, and has the backing of the Business Roundtable, which includes CEOs from Aetna, Cigna, WellPoint, Humana, and Medco Health Solutions.
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