The Obama health care plan is now posted at the White House website. There is some initial analysis at the New York Times. No, there is no public option. The bill generally follows the Senate bill for both good (no Stupak Amendment) and bad (an excise tax, no nationally-based health exchanges). It’s obviously an inferior bill to what the House passed. But it is probably somewhat stronger than what the House and Senate would have settled on at the 60-vote threshold. For example, it has more Medicaid money for the states and more generous subsidies for people with the lowest incomes.
Take a look, and tell me what you think.
Since we are going with the mandate/subsidy route, national exchanges were one of the few policy ideas that seemed very promising and effective. It would help individuals and small businesses with Insurance. They would make Insurance companies compete with one another and be regulated strongly.
They were far more important than some watered down public option that no one would be eligible for. Sigh.
I still have hard time how Democrats are going to sell the whole, “Evil Insurance companies can no longer screw you but you will be fined if you do not buy their product from now on.”
If the national exchanges aren’t there yet they give the ability to the executive to prevent excessive rate increases is…I suspect the national exchange isn’t there for one of two reasons:
1.) National exchange can’t make it through reconciliation and Biden isn’t willing to overrule the parliamentarian. Playing politics with the excessive rate increase: dare Republicans to vote against it.
2.) They don’t have 50 votes for the national exchange.
Some things I noticed.
Members of Congress must buy from the exchange. If there are only state exchanges, does this mean the exchange in their home state or the exchange in DC?
It uses federal funds to rebate Medicare Part D enrollees for doughnut hole expenses in order to close the doughnut hole faster.
It removes the Cornhusker subsidy but increases federal share of Medicaid for all states.
Everyone gets the “labor compromise” on the excise tax.
It holds harmless the Social Security Trust Fund for impact under any part of the bill.
There is no repeal of antitrust exemption, but I think the House and Senate are pursuing this as a standalone bill.
It keeps Bernie Sanders’s funding for community health clinics.
If members of congress must buy from their respective state exchanges, I wonder if they also intend to move all federal employees in a given state into the exchanges, along with all of the federal health plan options for that state. There are enough federal employees in most states that this would be a good starter risk-pool even in the smallest states to make insurance for individuals and small businesses really competitive.
I understand that the Federal Employee Health Benefit Program will be considered an “exchange” under the bill.
So we get to keep giving them those cushy subsidies for their insurance.
Those cushy subsidies are our reward for agreeing not to strike.
BTW, the plans I had when I worked in the private sector were much more rewarding and cost me much less.
The community health clinics seem like an overlooked part of the plan. Could they become the seed for a network of nonprofit healthcare providers authorized to collect mandated premiums? With the fed subsidies and the limit on exec compensation they could compete with Big Insurance if they could organize — kind of like credit unions that issue internationally valid credit cards, for instance.
Personally I’d prefer something like that to the public option. Real competition is not a bad thing, and they’d provide a testbed for a range of ideas for getting the best healthcare delivery for the buck. Pipedream, or could this grow into a great medical care system?
Dunno, but Bernie Sanders has something in mind.
I’ve been reading here at work.
no robust public option?
no dice.
and like the other commenter, i fail to see how “you won’t be screwed by the insurance companies anymore, but you’re forced to buy their shitty product” is a winning message for democrats in 2010.
Greg Sargent says that the White House is not ruling out a vote on the public option, so they are at least swinging that sword of Damacles over the Republicans.
The idea appears to be to offer an entirely reasonable compromise and dare the Republicans to reject it out of hand. If they do, then the shithammer comes down and all bets are off. The proffered bill can certainly be strengthened in light of wholesale Republican intransigence. The only question is how much momentum can Obama build for strengthening the bill. And that comes down to creating a comfort level for vulnerable Democrats.
Yeah that’s more or less what I’m getting as well. However, what I’m also getting is that this would be the bill pushed through reconciliation.
So basically, the dare to Republicans is allow us a up or down vote on HCR or we will pass the bill through with 50 votes and include a public option?
that’s optimistic. But it could happen. I think the public option and the national exchange are both problematic under the Byrd Rule. But a vote is possible.
It really depends on what Joe Biden is willing to do, doesn’t it.
The ONLY way to get the Repubs to the table is to find a large club to hit them with. The threat of “public option unless you vote honestly” may do it.
Obama is simply not showing much knowledge of actual politics. His “political understanding” seems to be simply theoretical. He needs to understand how to compell people to do stuff.
Well, the Dems need to pass something on health care, and this is better than the Senate bill.
Pass this into law. Now, how they get it thru the Senate with Mr. 41 sitting in Kennedy’s seat mystifies me.
Pass something.
I think the regulatory power for HHS is the best bit given they can’t do a national exchange and pass this through reconciliation. But combined with the state based exchanges; this regulatory power will be furthur pressure for sustained reform IMO. The AHIP must be shitting bricks because that’s a mother of a vote to defend since 6 states are raising rates and more are likely to follow suite; and the AHIP itself concedes the market is broken.
I don’t like the timing, I wish they’d move stuff up, but it’s a good bill. Now pass it.
“We took our best shot at bridging the differences.”
Pfeiffer’s statement hints at what Booman has maintained for months is the Obama strategy: forcing Congress to take ownership of the issue by not putting forward a White House bill. Obama’s proposal is presented as merely a draft compromise of what the House and Senate have each already passed.
Politically, it seems designed to paint the Republicans further into a corner. By removing the “Cornhusker Kickback”, Obama demonstrates his “no backroom deals” credentials. By not adding in the public option, he weakens the Republicans’ ability to claim that he’s strongarming them and subverting what Congress has already done.
It’s not health care reform as I, or most progressives, would write it. It’s health care reform that’s winnable given this Congress.
P.S. If Obama wins by passing major health care reform legislation, repealing “Don’t Ask, Don’t Tell”, and on an additional major issue (say some kind of substantive energy legislation) in 2010, he kind of undercuts this month’s pop political wisdom that modern presidents can’t accomplish anything significant beyond their first year in office.
Does anyone know why National Exchanges can not get support compared to state ones? Is it purely legal bribes from the Insurance Industry? Maybe state exchanges will work if Govt caps rates that Insurance companies can raise.
Some Democratic Senators think that having state regulators involved insulates them from the charge of a federal government takeover of healthcare.
The way you have state regulators involved is in regulating the exchange(s) in their states.
Now how that works with a federal regulator of rates remains to be discussed.
Most reformers oppose letting state regulators having the responsibility because of many instances of corruption of state insurance commissioners.
I think that your last sentence may be what Diane Feinstein thinks. And it takes off pressure for a public option while optically (and maybe actually) dealing with the Anthem-BC/BS-California 39% rate increase.
I kind of like the burden being put on state regulators and pols, as long as fed money prevents a race to the bottom on tax policy. We might just grow a better political/social environment if we refrained from making healthcare the sole responsibility of the big bad distant feds and made it clear that statewide decisions have consequences for individuals. There has to be a strong fed requirement for total transparency, though.
It’s basically the ol’ propaganda about the evil federal government stomping on “states’ rights”. I think you make a good point about regulation being able to accomplish the same thing, maybe without the bleating from insuranceco patsies.
Plus, frankly, if the majority of a state population is so stupid/nuts as see the better service and rates they have next door and still not throw their own bastards out, maybe they’re just born to suffer and that’s what they need. Some tribes only learn by shooting themselves in the foot enough times to figure out that it still hurts.
I hope it passes.
I think it’s the seed of real reform and has the potential to grow into a world-class system. The most urgent provisions, seems to me, are having at least the insurance reform aspects and community clinics kick in now and move the rest sooner than 2014, and keeping or expanding the premium subsidies.
According to the NYT article, a family with an income of $33,000 would pay around $100/month for premiums. One with an $88,000 income would pay around $700/month — which is steep but not confiscatory by any means. Hopefully the subsidies will end up closer to the House bill, though.
Now lets see if the alleged left tries to shoot this whole thing down on account of the obsession with the PO.
My reading of the “alleged left” is that they will push for the public option in reconciliation – the vehicle being the Bennet letter as a both/and solution.
Congress will act however Congress acts and that will be it.
But then, the issues will not go away because it is an imperfect bill in an imperfect political climate. So expect the “alleged left” to continue this issue into the November campaigns in order to get a mandate for further reform. That can only help progressive Democrats.
Now the confirmed cynics are not going to do anything one way or the other but carp.