Brian Beutler of TPMDC has the details of what is supposed to be the grand compromise that will allow Harry Reid to pass a health care reform bill through the Senate at the 60 vote threshold. Beutler’s report is more detailed and somewhat contradicts what Dana Bash is reporting for CNN. According to Bash, the public option was jettisoned in favor of expanding Medicare to people aged 55 and creating an option for people to buy into the Federal Employees Health Benefits Plan. But Beutler reports that the public option is still alive in trigger form.
As has been widely reported, one of the trade-offs will be to extend a version of the Federal Employees Health Benefits Plan to consumers in the exchanges. Insurance companies will have the option of creating nationally-based non-profit insurance plans that would [be] offered on the exchanges in every state. However, according to the aide, if insurance companies don’t step up to the plate to offer such plans, that will trigger a national public option.
Now, why would for-profit private insurance companies create non-profit nationally-based plans? Would they do that purely to avoid triggering a public option? I suppose that that might make some kind of business sense, but it’s pretty convoluted.
Here’s the Medicare part of it.
That buy-in option would initially be made available to uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized–people will have to pay in without federal premium assistance–and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.
This means that you can pay into a single-payer plan, which might be some sort of moral victory but doesn’t seem to make a lot of policy-sense either. And it doesn’t do much for people who are too old to stay on their parents’ plans and not yet fifty-five. We’re still going to be screwing people in their peek earning years (the group that is most tax-averse and most conservative).
There was some talk of expanding Medicaid to people earning up to 150% of the poverty rate. That is what the House bill calls for. But the deal allegedly keeps that rate at 133%.
Harry Reid thinks he has 60 votes for this deal, pending Congressional Budget Office (CBO) scoring of the Medicare expansion. I don’t know if that means Olympia Snowe will look favorably on the trigger or Ben Nelson will back down on his abortion threat. But it looks like something will pass the Senate before Christmas. And then the House will get involved again. Each house of Congress will meet to merge their two versions into one final conference report. And that will be the bill both houses have to pass to get a bill to the president’s desk.
It’s too early to say whether the bill will be good at expanding access to affordable health care or help the budget deficit. But it will be a very good bill for health insurance reform. And that is something.
