The public option in the House Tri-Committee discussion draftis a stronger version of the Schumer proposal in the Senate. The public option has its good points and weak points in the discussion draft. I'll outline them below for you so we can figure out how to make the public option stronger by working to make it more like the public option supported by the Congressional Progressive Caucus.
Right now, it's a good competitive player, but it could be even BETTER as a competitive player against the private insurance companies . That's where you and me come in as the necessary grassroots pressure on the House Education and Labor Committee, which has its hearing on the public option on Tuesday at 9:30 a.m., and on the Senate HELP Committee, which has its mark-up on its bill on Monday. The Senate HELP Committee and the House Education and Labor Committee will receive our immediate focus tomorrow.
Here are the good points to the public option in the House Committee draft as pointed out by HCAN:
- The public option is available everywhere on day one.
- It's got affordability provisions up to 400% of the poverty level and caps on out-of-pocket expenses.
- There would be no deductibles or co-pays for preventative care.
- No denying care or increasing prices for pre-existing conditions.
And these are the goals supported by the Congressional Progressive Caucus for the public option:
The Congressional Progressive Caucus calls for a robust public option that must be:
• Unconditional. Enact concurrently with other significant expansions of coverage and must not be conditioned on private industry actions.
• Actually Public. Consist of one entity, operated by the federal government, which sets policies and bears the risk for paying medical claims to keep administrative costs low and provide a higher standard of care.
• Available to All. Be available to all individuals and employers across the nation without limitation
• Choice of Doctors. Allow patients to have access to their choice of doctors and other providers that meet defined participation standards, similar to the traditional Medicare model, promote the medical home model, and eliminate lifetime caps on benefits.
• Paid for Wellness, not Sickness. Have the ability to structure the provider rates to promote quality care, primary care, prevention, chronic care management, and good public health.
• Built on Proven Model of Medicare. Utilize the existing infrastructure of successful public programs like Medicare in order to maintain transparency and consumer protections for administering processes including payment systems, claims and appeals.
• Can negotiate payments. Establish or negotiate rates with pharmaceutical companies, durable medical equipment providers, and other providers to achieve the lowest prices for consumers.
• Equally Supported. Receive a level of subsidy and support that is no less than that received by private plans.
• Real Competition. Ensure premiums must be priced at the lowest levels possible, not tied to the rates of private insurance plans.
And this is the comparison chart from ThinkProgress's Wonk Room, along with their analysis of the Tri-Committee House discussion draft:
As you can see, the Senate Finance Committee bill is the weakest of all bills. It's basically a wet dream for AHIP and the murder-by-spreadsheet industry. No wonder why Senator Max Baucus is so heavily in the pocket of these insurance lobbyists! Here's what Wonk Room had to say about the House bill below:
Unlike the HELP bill and the draft (leaked) language of the Senate Finance Committee, the Tri-Committee proposal seems to contain a fairly robust public insurance option. While details are still being worked out, the proposal establishes a public plan in 2013 that will compete with private insurers, within the Exchange, on a level playing field. The public option will be required to abide by all marketing, operations, and rating rules and would initially be allowed to use Medicare plus rates. After some time, the plan would have to independently negotiate fees with providers.
On the whole, the bill’s affordability measures are impressive. Full details are after the jump but the plan offers subsidies on a sliding scale (up to 400 percent of poverty) and opens up Medicaid to Americans at or below 133% of the federal poverty level. While I haven’t seen the cost-sharing details, the robust public plan that could use Medicare plus rates would be able to force private insurers to aggressively negotiate with providers and pass on savings to consumers.
And there it seems that it might be wrong about the public option in the Tri-Committee proposal being available everywhere on day one. How can it be available on day one if it's supposed to be available in 2013 and the National Exchange that's proposed to cut down on costs is established in 2013 as well? This is one of the sticking points for us to push back on starting tomorrow. We'll have to ask the House Education and Labor Committee if the private insurers will have to be regulated immediately after the passage of the legislation or if the regulation starts in 2013. The delay for this puzzles me.
Always remember, the devil is in the details.
Another sticking point for us to push back on is that the public option will have to stop using Medicare plus rates at a certain point in time. Here's more from Karen Tumulty at Time Magazine on what that means:
In the early stage, the public plan would reimburse health care providers at rates that are "similar to those used in Medicare"--that is, significantly lower than most private insurers pay them. This is something that the insurance industry, doctors and hospitals will all hate. “A government-run plan that pays based on Medicare rates – for any period of time – is a recipe for disaster," Scott P. Serota, president and Chief Executive Officer of the Blue Cross and Blue Shield Association, said in a statement issued by the association. "Already in some parts of the country nearly 30 percent of Medicare enrollees report that they cannot find doctors willing to accept new patients, due to below market rates. Rural hospitals, in particular, are struggling to keep their doors open. These low payment rates would threaten the quality of healthcare and undermine the improvements that we believe reform can bring to communities across the country."
Advocates would argue, on the other hand, that those lower rates could be a powerful engine to bring down health costs. Which is why they won't be happy with what happens next. According to the summary, this tie to Medicare rates would be "severed over time as more flexible payment systems are developed." In other words, this public plan would eventually evolve into something that looks--and competes--more like a private insurance company, albeit one that happens to be run by the government. At the news conference, I asked the committee chairmen precisely what that means--When would that happen? And under what circumstances? They couldn't tell me, and demurred that this is the kind of thing that still needs to be worked out. Waxman said it would take "a period of time" for the public plan to get started, but that "they will at some point compete."
The House committee chairmen are trying to have it both ways on the public plan. That might work--or might just end up satisfying no one.
This is the biggest sticking point for us to push back on along with the one about the public option having to be self-sustaining only on premiums, and we'll need to ask the Congressional Progressive Caucus to push back on this as well. Basically, we'll have a strong public option at first, but over time, it'll be weakened. I don't think this is right.
I'll contact Darcy Burner tonight, and see if we can get our questions answered by the Congressional Progressive Caucus about having them push back against the weak points of the public option proposal by the Tri-Committee Caucus.
Here's what I'm planning for the action agenda tomorrow regarding our fight for a strong, robust Medicare-like public option:
- CALL Senator Dodd at (202) 224-2823 and ask him to put in OPTION A, which is the strong, robust Medicare-like public option, NOT OPTION B, which is the Conrad co-op proposal, in the markup on Monday.
- EMAIL the Senate HELP Committee at help_comments@help.senate.gov to ask them to put in OPTION A, which is the strong, robust Medicare-like public option, NOT OPTION B, which is the Conrad co-op proposal, in the markup on Monday.
- CALL the phone numbers of ALL the Senators on the HELP Committee with these talking points below:
Tell Senator [Name] that you DO NOT want the 7-year trigger for the public option and take it off the table, and that you want him to support an affordable strong, robust Medicare-like public option. We NEED a strong, robust Medicare-like public option NOW OPEN TO ALL AMERICANS AND AFFORDABLE, not more of the SAME broken system that's given us unaffordable premiums, little private insurance coverage, and rising co-pays. Also, DON'T TAX OUR EMPLOYER HEALTH BENEFITS. Instead, follow the proposal by President Obama to tax the wealthy above $250,000, eliminate the overpayments in Medicare Advantage, and put tax capital gains to help fund health care reform. TELL YOUR SENATOR NO ON THE SCHUMER COMPROMISE AND NO ON THE CONRAD CO-OP COMPROMISE.
- CALL ALL of the members on the House Education and Labor Committee to ask them to support a STRONGER public option than what is currently proposed in the Tri-Committee draft with these talking points below:
Tell Representative [Name] that you want the National Exchange and the public option to be started in 2010, NOT in 2013 because you desperately need affordable health care RIGHT NOW. Also, tell him or her that YOU DON'T WANT the public option's tie to Medicare rates to "severed over time as more flexible payment systems are developed." You want the public option to be based on Medicare plus rates, and that you don't want the public option to end up as a Fannie Mae or Freddie Mac. You want it to be administered by the government and NOT by any private insurance companies, and to be like Medicare based on its ability to negotiate rates with providers and pharmaceutical companies. Also, that you want doctors to be required to participate in the public option, so that you can have access to the public option anywhere you are. Say that you don't want your health benefits to be taxed, but that you support a raise in taxes for the wealthy to help pay for the public option. You don't want the public option to be self-sustained only by premiums because that will help hobble its viability, and that you NEED for it to have some financing from the government.
- We'll KEEP UP the pressure on these Senators and the White House as well.
What do you think of this action plan for tomorrow? I appreciate your feedback as always! REMEMBER, the fight isn't over. The Education and Labor Committee are having three days of hearings on the discussion draft this week, and the mark-ups then begin in July. So we have the time and power to effect change right now. And we do have the power to effect change with the Senate HELP Committee tomorrow and its members.
UPDATE: PLEASE DIGG UP THIS QUESTION to ask President Obama in his town hall on ABC News!!!!
Just remember to pass around my action diary tomorrow to your families and friends, and anyone else you know at your office or community area that might be interested in this. Don't forget to spread this on Twitter, and Facebook as well!