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Obama OK with ditching public option

Health Care Public Option 2009

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#81 Spectacles

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Posted 19 August 2009 - 04:43 PM

Oh, Lin, I'm so sorry about Samantha....
"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#82 Spectacles

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Posted 19 August 2009 - 04:50 PM

Can anyone figure out what the hell is going on? The White House's sources are all over the place on the public option.

Jane Hamsher at Firedoglake has been working this policy like crazy for months, and she's pretty much convinced that the White House was never really committed to the public option but used it only as a bargaining chip. Meanwhile, in behind-the-scenes meetings with health care lobbyists, the Obama administration assured them that any reforms would not hurt their bottom lines. This was to keep Big PhRMA and other big players from supporting the GOP in midterm elections. In short, the public option was a smokescreen, according to Hamsher. (Go to Firedoglake for documentation and support of this theory.)

And Marc Ambinder is reporting that the public option really is kaput.

http://politics.thea...artisanship.php

Someone wake me when this is over and tell me what kind of health care reforms we end up with. I have a feeling that the health care industry is going to be really pleased; the public, not so much.

Change you can count. Period.

Edited by Spectacles, 19 August 2009 - 04:51 PM.

"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#83 Spectacles

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Posted 19 August 2009 - 05:04 PM

Oh well.

It's a good excuse to watch this amazing video of the The Who performing "Won't Get Fooled Again":




It helps. Momentarily.

Edited by Spectacles, 19 August 2009 - 05:05 PM.

"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#84 Cait

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Posted 19 August 2009 - 05:26 PM

View PostSpectacles, on Aug 19 2009, 03:04 PM, said:

Oh well.

It's a good excuse to watch this amazing video of the The Who performing "Won't Get Fooled Again":




It helps. Momentarily.


I hope so too Specs.

As to the public option, I think we can see that Obama's lack of experience is really showing here.  The inability to stay on message, the lack of clarity on the plan, all of it is inexperience.  He had big plans, but literally no experience in dealing with Congress to get a consensus.  I think he thought he could just 'tell them to do it' and he didn't have to do anything more.  That's absurd, and any experienced DC politician knows it.  He's being run around by everyone and can't seem to reign any of it in.  That's inexperience.

He'll probably remain popular.  Popular enough to help keep the Dem's majority in 2010, but they won't gain any seats.  However,  much more of this ineptitude and his re-election chances might not be so good.  He might even get a primary challenger.

Rules for surviving an Autocracy:

Rule#1: Believe the Autocrat.
Rule#2: Do not be taken in by small signs of normality.
Rule#3: Institutions will not save you.
Rule#4: Be outraged.
Rule#5: Don't make compromises.
Rule#6: Remember the future.

Source:
http://www2.nybooks....r-survival.html


#85 Palisades

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Posted 19 August 2009 - 05:57 PM

View PostSpectacles, on Aug 19 2009, 03:50 PM, said:

Can anyone figure out what the hell is going on? The White House's sources are all over the place on the public option.

Sure. All you have to know is that
1) the Obama administration made a secret deal with PhRMA, and now, PhRMA not only supports the health care 'reform' but has started a massive advertising campaign in favor of it.
2) The public option's supporters in Congress won't commit to taking it for themselves even if it is passed.
3) Under the current target set by the Senate Finance Committee, people with subsidized insurance will pay 35% of their medical bills out-of-pocket.
4) Policy is being shaped behind the scenes by health insurers through their lobbying, campaign donations, and the health care information they helpfully provide to members of Congress.
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"In truth, 'too big to fail' is not the worst thing we should fear – our financial institutions are now on their way to becoming 'too big to save'." —Simon Johnson

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#86 Spectacles

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Posted 19 August 2009 - 06:47 PM

Hi Cait. Yep to all that you said. The self-identified "progressives" are going to be hopping mad if there is no public option, and there will be talk of starting a new party. But at the end of the day, as long as the GOP panders to people who think Rush Limbaugh and Sarah Palin are right about most things, most people will hold their noses and vote for whoever will more likely defeat a Republican in most places. The GOP's walk on the extreme side will help the Dems. There won't be so much talk about inspiration--just "lesser of two evils."

View PostPalisade, on Aug 19 2009, 06:57 PM, said:

View PostSpectacles, on Aug 19 2009, 03:50 PM, said:

Can anyone figure out what the hell is going on? The White House's sources are all over the place on the public option.

Sure. All you have to know is that
1) the Obama administration made a secret deal with PhRMA, and now, PhRMA not only supports the health care 'reform' but has started a massive advertising campaign in favor of it.
2) The public option's supporters in Congress won't commit to taking it for themselves even if it is passed.
3) Under the current target set by the Senate Finance Committee, people with subsidized insurance will pay 35% of their medical bills out-of-pocket.
4) Policy is being shaped behind the scenes by health insurers through their lobbying, campaign donations, and the health care information they helpfully provide to members of Congress.


I agree with 1 and 4  because I've seen evidence of it. I know that some report indicates #3, but that's so absurd that I have to think someone has misinterpreted something. It would be political suicide to support such a bill, regardless of party. When things sound that crazy, usually something is incorrect. As for #2, how many have been asked? Also, public option as defined how? It's becoming so watered down that it's probably defeating its purpose--which seems to be the intent anyway.

Considering the massive sell-out to the health industries going on here, don't you think it's sad that some people are up in arms about Obama's "socialistic" plan? Like Jefferson said, when the people become misinformed, democracy is in danger. (rough paraphrase.) Thanks to the propaganda out there--which is pretty much the same old propaganda, except they've erased "Hillarycare" and replaced it with "Obamacare"--people are all fired up about something that doesn't exist and no one is proposing. Pitiful....In the meantime, we're getting a replay of the Bush coziness with K street, only now the Dems are doing it.

...Time to watch The Who video again.... :(
"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#87 Nittany Lioness

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Posted 20 August 2009 - 07:41 AM

Stop it!!!  Stop painting objection to this massive push as a bunch of kooks fired up by puppet masters!

There are legitimate objections and people are going through legitimate means to express their concerns!
The overwhelming outpouring ought to tell us there's a real pulse there.

Some of you ought to ease off the huffington drip and look elsewhere for a few days to see what ramifications real citizens are worried about and stop looking at your favorite hyperbolic catch phrases to hold up as an excuse to dismiss the heard of pink elephants in the room.
I don't want the federal gov't to run a healthcare option like the Post Office, like Medicare, like Native American care, like the stimulus, like the budget, like the bailouts!  I don't think it's a sound idea!  And so you're calling for the paddy wagon.

Meanwhile, remember when Obama promised to air all meetings with health care on C-span.  Remember when on the campaign trail (there's video) where he dissed the Pharma deal to not compete for medicare prices, and actually mentioned the CEO and now he's in bed with said CEO?!

Transparency you could modestly shower behind.

Jesus F!ckin' Christ.

Edited by Nittany Lioness, 20 August 2009 - 08:09 AM.

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#88 Spectacles

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Posted 20 August 2009 - 09:18 AM

^Yes, I've pretty much acknowledged my disappointment with Obama in this thread--as have others. And no reform under discussion would take away people's choice to buy into Blue Cross or whatever. The public option would be just what it says, an option. If the government does such a terrible job administering non-profit health insurance (though more people are satisfied with Medicare than with their private plans), then there is no threat whatsoever to private insurers. So what's the fear?


Palisade, you misunderstood that 65% payout on claims standard. That does not mean that the Senate Finance Committee is setting up a 65-35 split on payouts, with the insured having to pick up 35% of the tab. That would be absurd. No one could afford that sort of insurance and no one would want it.

What the 65-35 split refers to is an "industry-friendly standard" (because the Senate Finance Committee and its chair, Democrat Max Baucus,  are nothing if not industry-friendly) that says it's kosher for insurers to pay 65% of each premium dollar received on claims, using the other 35% for administration, ads, profits. And profits are through the roof.

Here's an interesting critique of this:

http://www.thedailyb...teach-congress/

Quote

The nation’s health-insurance industry—long a behemoth if not an outright monopoly—is now an unabashed racket, surpassing even the trillion-dollar worldwide gambling industry. Among the many startling revelations in Bill Moyers’ recent blockbuster interviews with longtime Cigna executive Wendell Potter was the fact that insurance companies are conspiring to reduce their “payouts” on medical claims. This medical loss ratio is a “measure that tells investors or anyone else how much of a premium dollar is used by the insurance industry to actually pay medical claims,” Potter said in the July 10 televised interview.


As recently as the early 1990s, 95 cents out of every dollar paid to insurance companies in premiums was used to pay claims, according to Potter, who spent more than 20 years of his professional career as an industry insider. In 2008, that percentage had dropped to “just slightly above 80 percent.” As if that 20 percent profit were not staggering enough, the Senate Finance Committee last spring was considering a 76 percent average reimbursement rate until, after fierce lobbying by insurance giant UnitedHealth Group, it settled on what Business Week has called “a more friendly industry ratio” of 65 percent. Though the final percentage is still being debated, the possibility that 35 cents on every premium dollar might go toward corporate profits does not signal reform that favors the consumer.

Edited by Spectacles, 20 August 2009 - 09:21 AM.

"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#89 Spectacles

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Posted 20 August 2009 - 09:42 AM

This must stop:

http://www.msnbc.msn...rsonal_finance/

Quote

Medical bills make up half of bankruptcies
Study finds most bankruptcy filers had health insurance

  
updated 7:43 a.m. ET, Wed., Feb. 2, 2005

BOSTON - Costly illnesses trigger about half of all personal bankruptcies, and most of those who go bankrupt because of medical problems have health insurance, according to findings from a Harvard University study to be released Wednesday.

Researchers from Harvard’s law and medical schools said the findings underscore the inadequacy of many private insurance plans that offer worst-case catastrophic coverage, but little financial security for less severe illnesses.

“Unless you’re Bill Gates, you’re just one serious illness away from bankruptcy,” said Dr. David Himmelstein, the study’s lead author and an associate professor of medicine. “Most of the medically bankrupt were average Americans who happened to get sick.”
Story continues below ↓

Why does this happen? People with insurance through work become ill and lose their jobs, and lose their insurance. Also, the insurers make their $$ by paying out less in claims than they take in with premiums. Combined, these factors make even those of us with good insurance vulnerable.
"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#90 Vapor Trails

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Posted 20 August 2009 - 09:46 AM

{{{{{Lin}}}}}

:(
Posted Image

Politicians are like bananas; they hang together, they're all yellow, and there's not a straight one among them.

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#91 Vapor Trails

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Posted 20 August 2009 - 09:49 AM

View PostSpectacles, on Aug 20 2009, 09:42 AM, said:

This must stop:

http://www.msnbc.msn...rsonal_finance/

Quote

Medical bills make up half of bankruptcies
Study finds most bankruptcy filers had health insurance

  
updated 7:43 a.m. ET, Wed., Feb. 2, 2005

BOSTON - Costly illnesses trigger about half of all personal bankruptcies, and most of those who go bankrupt because of medical problems have health insurance, according to findings from a Harvard University study to be released Wednesday.

Researchers from Harvard’s law and medical schools said the findings underscore the inadequacy of many private insurance plans that offer worst-case catastrophic coverage, but little financial security for less severe illnesses.

“Unless you’re Bill Gates, you’re just one serious illness away from bankruptcy,” said Dr. David Himmelstein, the study’s lead author and an associate professor of medicine. “Most of the medically bankrupt were average Americans who happened to get sick.”
Story continues below ↓

Why does this happen? People with insurance through work become ill and lose their jobs, and lose their insurance. Also, the insurers make their $$ by paying out less in claims than they take in with premiums. Combined, these factors make even those of us with good insurance vulnerable.

Without getting into details...I just got some dental work done that I was forced to pay out of pocket-money that I need for something else. :angry:

This has only added to the stress of a truly unbearable year :wacko:
Posted Image

Politicians are like bananas; they hang together, they're all yellow, and there's not a straight one among them.

"We're relevant for $ and a vote once every two years. Beyond that, we're completely irrelevant, except of course to consume, and preach the gospel according to [insert political demigod here]."--Cait

#92 Palisades

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Posted 20 August 2009 - 10:05 AM

Spectacles, given what you've posted it does appear that I incorrectly described what the 65%/35% split meant, but the way I described it is the same way it was described by the BusinessWeek article I read. You can see the relevant paragraphs quoted in the first post in this thread.

Regarding people in Congress supporting the public option but being unwilling to eat their own cooking, there have been a number of bills and amendments put forward requiring or urging any member of Congress who votes for the public option to take it themselves and give up the health insurance they get for being a member of Congress. All those bills and amendments have died quickly. Plus, there are some quotes from supporters of the public option trying to explain why they wouldn't take it for themselves, but I can't find that link anymore.

Regarding propaganda and disinformation, I don't approve of it, regardless of who does it. That includes Obama, It is not true that if you like your current health insurance plan through your employer you will necessarily be able to keep it. As the WaPo reported, "Legislation written by three House committees and the Senate Committee on Health, Education, Labor, and Pensions would allow eligible employers to move workers into a new marketplace for insurance, where they could choose from various coverage options, [which may be better] but Democratic legislative aides said there is no assurance that any of the options offered in the exchange would be the same as employees' current coverage." This is on top of employers who simply drop their health coverage because of the legislation, which as the same Post article notes, White House spokesperson Linda Douglas concedes will happen.

Edited by Palisade, 20 August 2009 - 10:15 AM.

"When the Fed is the bartender everybody drinks until they fall down." —Paul McCulley

"In truth, 'too big to fail' is not the worst thing we should fear – our financial institutions are now on their way to becoming 'too big to save'." —Simon Johnson

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#93 Spectacles

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Posted 20 August 2009 - 10:19 AM

^ I agree. We need facts, not lies, not spin.

Obama's remark doesn't apply to anyone's coverage, even now. As most of us who get our health insurance know, plans are always subject to change at the employer's discretion, unless a union is involved to protect employees' preferences.

With insurance costs rising into the unaffordable range, it's not uncommon for eligible employers to drop insurance altogether or shift to a less expensive, less comprehensive plan with higher co-pays and deductibles.

So no one's health insurance is guaranteed even now. What is true of the proposals is that no one will be forced to choose the public option. It would be part of a menu of available coverages to those who do not have insurance through their workplace, through Medicare, or through Medicaid.
"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#94 Nittany Lioness

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Posted 20 August 2009 - 10:42 AM

You refuse to believe it's even feasable the potential scenario where employers, who you just acknowledged drop or adjust plans offerings based on cost, would choose to opt out altogether- let Obamacare be their employees' choice.  If enough companies ring that bell, the momentum may carry the workforce that way.  So there's one "fear", which has been articulated on this board alone, many times now.  
And with that shift toward single payer - how goes eventual quality-of-care?  What of the incentive to become a doctor?  An outstanding doctor?  What becomes of leading research in all aspects of healthcare; machines, testing, pharmaceuticals?  
Using the taxes of over $250,000 earners to pay for all this is another "fear".  Medicare is flat broke essentially and we go further in debt to pay for gov't programs already in place.  People are content with the coverage, but not the broken economics of it all.  And yes, the going in the red has been blazing for a long time now.


By the way, I just saw a rep for a group representing many large insurers mention that they were involved in reform debate and offered to take pre-existing conditions off the table.  Wow.  Looking at their site now to see who they are ...
http://www.ahip.org/
http://www.ahip.org/...spx?bc=39|25680

Edited by Nittany Lioness, 20 August 2009 - 11:01 AM.

I'm cold Howard.jpg


#95 Spectacles

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Posted 20 August 2009 - 11:05 AM

http://healthcarefactcheck.com/

Employers with more than X employees will be fined if they do not provide insurance. I have mixed feelings about continuing to tie insurance to employment, but this move is designed to protect large, private insurers--as it seems most of the reforms are going to do. (Which is why the claims that "Obamacare" is some sort of socialist plot would be funny if any of us were in any position to laugh about our increasingly UNaffordable and UNreliable health insurance.)

The politicians--in both parties--are looking after their corporate benefactors. So we can rest easily: Blue Cross is not in any danger of going belly up. We MAY be able to get rid of the pre-existing condition denial of insurance. And we MAY be able to make insurance available to a few more of the uninsured--small business employees and those unemployed who can afford premiums . But it looks like nothing else is going to change. Premiums will continue to rise through the roof. People will continue to fall through the cracks when they get sick and end up bankrupt--even with their All-American private insurance (with fine print clauses that enable them to deny claims). So all will be well, if the current system is largely satisfactory.
"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#96 Spectacles

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Posted 20 August 2009 - 11:12 AM

^^Yep. AHIP has worked closely with the White House and the Blue Dog Dems on fashioning "Obamacare"--if "Obamacare" means those reforms that Obama seems to support, rather than "a very scary plan to sneakily socialize medicine."

Be sure to look at the end of this National Journal piece and follow the money:

http://undertheinflu...s-but-not-c.php
"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#97 Nittany Lioness

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Posted 20 August 2009 - 12:52 PM

quote:
"Employers with more than X employees will be fined if they do not provide insurance."

Ahh, and this takes us down another rabbit hole - since when does the government dictate a penalty for something that has always been an incentive, voluntary benefit?  Is there precedent?  Is this currently even legal?
How many is X?  How many will it be?
This country's economy is well oiled by small business.  
And further - What will the fee be?  Are you sure?  What if the fee is less than the cost of offering an ins. plan to its employees?  There may well be a steady migration to the public plan to defacto socialized med for all.  Now, maybe as a reaction to fees, private ins. co's would lower their prices to be attractive.  I'm willing to hear that debated.  But more troubling to me is the concept to begin with - seeing companys fined for conducting their employment affairs- that's bad enough and then it's also a slippery slope issue.

"People will continue to fall through the cracks when they get sick and end up bankrupt--even with their All-American private insurance (with fine print clauses that enable them to deny claims). So all will be well, if the current system is largely satisfactory."

So all involved better put their shoulder to the grindstone and work through the large problem which will need a multitude of solutions and TIME to root out.  And quit harumpfing that if the public option isn't a GO, then nothing else will help, that no other combination of answers should be debated, and that we all then must be hunky dory the status-quo.

I'm pretty content with several of the plans I've had but the increasing cost is where I see a huge problem.
I benefitted from a private co-op of sorts to obtain health ins. once upon a time -and I see those self employed or sm. businesses who otherwise couldn't, being able to get into a pool and I'd like to see this debated more in our political scene.
Cost, cost, cost!!!  How 'bout it?!
Maybe you have faith that sweetheart dealings with Rx co.s and lawyer groups, and creating a Postal Service brand of plan, will meaningfully reduce costs, but I'm skeptical.  He may not be socialistic, but our Pres. is proving to be a true blue Chi-town dealer.  Was doesn't he just appoint Blago Health Reform Czar and be done with it.
But on that point- what do the pharm. co's and lawyers care if there is a single payer?  They made their back door deals and we have the whatever-ya-say cost of Rx's via gov't programs to prove to them they'll be coasting.  It's the private insurance co's that need to play ball now.

Oh-  and you're not going to get me to shriek in horror over lobbiest activity.  "Blucher!"
My husband's family are lobbiers, and I know intimately that its force generally speaking is not the root of all evil.
But we've been there before.

Edited by Nittany Lioness, 20 August 2009 - 01:02 PM.

I'm cold Howard.jpg


#98 Spectacles

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Posted 20 August 2009 - 02:17 PM

Here's a summary of the bill thus far:


Quote

SUMMARY  

America’s Affordable Health Choices Act provides quality affordable health care for all Americans and
controls health care cost growth.  Key provisions of the bill released today include:  


COVERAGE AND CHOICE  

AFFORDABILITY  

SHARED RESPONSIBILITY

CONTROLLING COSTS

PREVENTION AND WELLNESS

WORKFORCE INVESTMENTS

I. COVERAGE AND CHOICE  
The bill builds on what works in today’s health care system and fixes the parts that are broken. It
protects current coverage – allowing individuals to keep the insurance they have if they like it – and
preserves choice of doctors, hospitals, and health plans.  It achieves these reforms through:  


A Health Insurance Exchange.  The new Health Insurance Exchange creates a transparent and
functional marketplace for individuals and small employers to comparison shop among private and
public insurers.  It works with state insurance departments to set and enforce insurance reforms
and consumer protections, facilitates enrollment, and administers affordability credits to help low-
and middle-income individuals and families purchase insurance.  Over time, the Exchange will be
opened to additional employers as another choice for covering their employees.  States may opt to
operate the Exchange in lieu of the national Exchange provided they follow the federal rules.  

A public health insurance option. One of the many choices of health insurance within the health
insurance Exchange is a public health insurance option.  It will be a new choice in many areas of our
country dominated by just one or two private insurers today.  The public option will operate on a
level playing field.  It will be subject to the same market reforms and consumer protections as
other private plans in the Exchange and it will be self-sustaining – financed only by its premiums.  

Guaranteed coverage and insurance market reforms.  Insurance companies will no longer be able
to engage in discriminatory practices that enable them to refuse to sell or renew policies today due
to an individual’s health status. In addition, they can no longer exclude coverage of treatments for
pre-existing health conditions. The bill also protects consumers by prohibiting lifetime and annual
limits on benefits.  It also limits the ability of insurance companies to charge higher rates due to
health status, gender, or other factors.  Under the proposal, premiums can vary based only on age
(no more than 2:1), geography and family size.

Essential benefits.  A new independent Advisory Committee with practicing providers and other
health care experts, chaired by the Surgeon General, will recommend a benefit package based on
standards set in the law. This new essential benefit package will serve as the basic benefit package
for coverage in the Exchange and over time will become the minimum quality standard for
employer plans.  The basic package will include preventive services with no cost-sharing, mental
health services, oral health and vision for children, and caps the amount of money a person or
family spends on covered services in a year.  

II. AFFORDABILITY  
To ensure that all Americans have affordable health coverage the bill:


Provides sliding scale affordability credits. The affordability credits will be available to low- and
moderate- income individuals and families.  The credits are most generous for those who are just
above the proposed new Medicaid eligibility levels; the credits decline with income (and so
premium and cost-sharing support is more limited as your income increases) and are completely
phased out when income reaches 400 percent of the federal poverty level ($43,000 for an
individual or $88,000 for a family of four).  The affordability credits will not only make insurance
premiums affordable, they will also reduce cost-sharing to levels that ensure access to care.  The
Exchange administers the affordability credits with other federal and state entities, such as local
Social Security offices and state Medicaid agencies.  

Caps annual out-of-pocket spending.  All new policies will cap annual out-of-pocket spending to
prevent bankruptcies from medical expenses.  

Increased competition:  The creation of the Health Insurance Exchange and the inclusion of a
public health insurance option will make health insurance more affordable by opening many
market areas in our country to new competition, spurring efficiency and transparency.  

Expands Medicaid. Individuals and families with incomes at or below 133 percent of the federal
poverty level will be eligible for an expanded and improved Medicaid program.  Recognizing the
budget challenges in many states, this expansion will be fully federally financed.  To improve
provider participation in this vital safety net – particularly for low-income children, individuals with
disabilities and people with mental illnesses – reimbursement rates for primary care services will be
increased with new federal funding.

Improves Medicare.  Senior citizens and people with disabilities will benefit from provisions that fill
the donut hole over time in the Part D drug program, eliminate cost-sharing for preventive services,
improve the low-income subsidy programs in Medicare, fix physician payments, and make other
program improvements.  The bill will also address future fiscal challenges by improving payment
accuracy, encouraging delivery system reforms and extending solvency of the Medicare Trust Fund.

III. SHARED RESPONSIBILITY
The bill creates shared responsibility among individuals, employers and government to ensure that all
Americans have affordable coverage of essential health benefits.  


Individual responsibility.  Except in cases of hardship, once market reforms and affordability
credits are in effect, individuals will be responsible for obtaining and maintaining health insurance
coverage.  Those who choose to not obtain coverage will pay a penalty of 2.5 percent of modified
adjusted gross income above a specified level.

Employer responsibility. The proposal builds on the employer-sponsored coverage that exists
today.  Employers will have the option of providing health insurance coverage for their workers or
contributing funds on their behalf.  Employers that choose to contribute will pay an amount based
on eight percent of their payroll.  Employers that choose to offer coverage must meet minimum
benefit and contribution requirements specified in the proposal.  

Assistance for small employers. Recognizing the special needs of small businesses, the smallest
businesses (payroll that does not exceed $250,000) are exempt from the employer responsibility
requirement.  The payroll penalty would then phase in starting at 2% for firms with annual payrolls
over $250,000 rising to the full 8 percent penalty for firms with annual payrolls above $400,000.  In
addition, a new small business tax credit will be available for those firms who want to provide
health coverage to their workers.  In addition to the targeted assistance, the Exchange and market
reforms provide a long-sought opportunity for small businesses to benefit from a more organized,
efficient marketplace in which to purchase coverage.

Government responsibility. The government is responsible for ensuring that every American can
afford quality health insurance, through the new affordability credits, insurance reforms, consumer
protections, and improvements to Medicare and Medicaid.

IV. PREVENTION AND WELLNESS
Prevention and wellness measures of the bill include:


Expansion of Community Health Centers;

Prohibition of cost-sharing for preventive services;

Creation of community-based programs to deliver prevention and wellness services;

A focus on community-based programs and new data collection efforts to better identify and
address racial, ethnic, regional and other health disparities;  

Funds to strengthen state, local, tribal and territorial public health departments and programs.

V. WORKFORCE INVESTMENTS
The bill expands the health care workforce through:


Increased funding for the National Health Service Corp;

More training of primary care doctors and an expansion of the pipeline of individuals going into
health professions, including primary care, nursing and public health;

Greater support for workforce diversity;

Expansion of scholarships and loans for individuals in needed professions and shortage areas;  

Encouragement of training of primary care physicians by taking steps to increase physician training
outside the hospital, where most primary care is delivered, and redistributes unfilled graduate
medical education residency slots for purposes of training more primary care physicians.  The
proposal also improves accountability for graduate medical education funding to ensure that
physicians are trained with the skills needed to practice health care in the 21st century.

VI. CONTROLLING COSTS
The bill will reduce the growth in health care spending in a numerous ways.  Investing in health care
through stronger prevention and wellness measures, increasing access to primary care, health care
delivery system reform, the Health Insurance Exchange and the public health insurance option,
improvements in payment accuracy and reforms to Medicare and Medicaid will all help slow the
growth of health care costs over time. These savings will accrue to families, employers, and taxpayers.


Modernization and improvement of Medicare. The bill implements major delivery system reform
in Medicare to reward efficient provision of health care, rolling out innovative concepts such as
accountable care organizations, medical homes, and bundling of acute and post-acute provider
payments.  New payment incentives aim to decrease preventable hospital readmissions, expanding
this policy over time to recognize that physicians and post-acute providers also play an important
role in avoiding readmissions.  The bill improves the Medicare Part D program by creating new
consumer protections for Medicare Advantage Plans, eliminating the “donut hole” and improving
low-income subsidy programs, so that Medicare is affordable for all seniors and other eligible
individuals.  A centerpiece of the proposal is a complete reform of the flawed physician payment
mechanism in Medicare (the so-called sustainable growth rate or “SGR” formula), with an update
that wipes away accumulated deficits, provides for a fresh start, and rewards primary care services,
care coordination and efficiency.  

Innovation and delivery reform through the public health insurance option.  The public health
insurance option will be empowered to implement innovative delivery reform initiatives so that it is
a nimble purchaser of health care and gets more value for each health care dollar.  It will expand
upon the experiments put forth in Medicare and be provided the flexibility to implement value-
based purchasing, accountable care organizations, medical homes, and bundled payments.  These
features will ensure the public option is a leader in efficient delivery of quality care, spurring
competition with private plans.  

Improving payment accuracy and eliminating overpayments.  The bill eliminates overpayments to
Medicare Advantage plans and improves payment accuracy for numerous other providers,
following recommendations by the Medicare Payment Advisory Commission and the President.
These steps will extend Medicare Trust Fund solvency, and put Medicare on stronger financial
footing for the future.  

Preventing waste, fraud and abuse.  New tools will be provided to combat waste, fraud and abuse
within the entire health care system.  Within Medicare, new authorities allow for pre-enrollment
screening of providers and suppliers, permit designation of certain areas as being at elevated risk of
fraud to implement enhanced oversight, and require compliance programs of providers and
suppliers.  The new public health insurance option and Health Insurance Exchange will build upon
the safeguards and best practices gleaned from experience in other areas.

Administrative simplification.  The bill will simplify the paperwork burden that adds tremendous
costs and hassles for patients, providers, and businesses today.






PREPARED BY THE HOUSE COMMITTEES ON WAYS AND MEANS, ENERGY AND COMMERCE, AND EDUCATION AND LABOR
JULY 14, 2009

Of course, the public option part is now in doubt, but the rest seems fairly set. For more details, google America’s Affordable Health Choices Act .
"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#99 Spectacles

Spectacles
  • Awaiting Authorisation
  • 9,632 posts

Posted 20 August 2009 - 02:26 PM

Quote

Ahh, and this takes us down another rabbit hole - since when does the government dictate a penalty for something that has always been an incentive, voluntary benefit? Is there precedent? Is this currently even legal?

Of course. Government has regulated business and commerce for ages. And in the specific case of insurance, automobile insurance is required by law in most states.

The group of insurers that you seemed to respond positively to have negotiated a deal to stop denying coverage to people with pre-existing conditions as long as the government requires people to buy health insurance--which will greatly increase their pools.

In other words, government and private insurers are working together in developing this thing. You can bet that what we end up with will not be something that private insurers will not want. How much these industry-friendly reforms help the consumers remains to be seen.

But the Fox/Rightwing propagandists are still stuck on the old "Democrats are anti-private business" meme, which has never been true and is especially not so now.

As for lobbyists, sure. Some are merely agents of education and advocacy. Others are agents of bribery. It all depends on the situation. Lobbying in and of itself is not evil. The problem is that because politicians require millions of dollars to win and hold office, their votes are very much for sale. We can see that clearly as the health care industries dump lots of money in the PACs of Democrats.
"Facts are stupid things." -Ronald Reagan at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

"Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing." -- Paul Krugman

#100 Nittany Lioness

Nittany Lioness

    Craving a little perspective.

  • Islander
  • 3,537 posts

Posted 20 August 2009 - 03:25 PM

I'm asking if the government has ever required business, private business, to extend a benefit, a perk, or to pay a fine.
Not counting minimum wage which isn't a bonus, and not counting taking Soc. Security etc ... which is mandated savings for retirement and ret.'s health, or funding for the poor; not a requirement for those currently working.
I think having Uncle Sam require saving for retirment (including health care for the elderly) is about as far as I want this country to go in being involved in personal choice and the free market.  
But I shall read that summary in full when I get back from chores.  Quickly perusing I'd say that the public funded premiums paying for the actual claims sounds good (in theory, if the gov't is good at creating and sustaining a profit :Oo:), until you get to all the other expansions and funding plans.

Ins. programs wanting to require all americans to purchase is indeed a bridge too far.  But it's the start of a volley, and at least it's upfront.  The link I had said something about getting states to ... I think it was talking about SChip.  But I need to read it more thoroughly.  Now I'm wondering if the Pharma. and malpractice groups have detailed public literature.  I made a distinction because they seem ominously silent, but maybe not.

I'm cold Howard.jpg




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