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Wed Dec 5, 2012, 12:36 PM

 

Not getting any media coverage even before the election-U.S. Set to sponsor Health Public Option

U.S. (OBAMA) Set to Sponsor Health Insurance (the public option sought by many liberal Democrats)

Source: New York Times

U.S. Set to Sponsor Health Insurance
By ROBERT PEAR
Published: October 27, 2012


WASHINGTON — The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.

These multistate plans were included in President Obama’s health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies.

The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.


................

Walton J. Francis, the author of a consumer guide to health plans for federal employees, said the personnel agency had been “extraordinarily successful” in managing that program, which has more than 200 health plans, including about 20 offered nationwide. The personnel agency has earned high marks for its ability to secure good terms for federal workers through negotiation rather than heavy-handed regulation of insurers.

Read more: http://www.nytimes.com/2012/10/28/health/us-to-sponsor-health-insurance-plans-nationwide.html?_r=0

26 replies, 1679 views

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Arrow 26 replies Author Time Post
Reply Not getting any media coverage even before the election-U.S. Set to sponsor Health Public Option (Original post)
SugarShack Dec 2012 OP
frazzled Dec 2012 #1
ProSense Dec 2012 #2
leftstreet Dec 2012 #3
ProSense Dec 2012 #4
Report1212 Dec 2012 #6
ProSense Dec 2012 #8
leftstreet Dec 2012 #9
ProSense Dec 2012 #11
leftstreet Dec 2012 #12
RC Dec 2012 #15
RC Dec 2012 #14
ProSense Dec 2012 #17
RC Dec 2012 #19
ProSense Dec 2012 #22
RC Dec 2012 #23
ProSense Dec 2012 #24
Hoyt Dec 2012 #26
BlueCaliDem Dec 2012 #5
frazzled Dec 2012 #7
ProSense Dec 2012 #10
BlueCaliDem Dec 2012 #18
frazzled Dec 2012 #20
ProSense Dec 2012 #21
frazzled Dec 2012 #25
LongTomH Dec 2012 #13
RC Dec 2012 #16

Response to SugarShack (Original post)

Wed Dec 5, 2012, 12:49 PM

1. This is not the public option

Read carefully what you posted:

These multistate plans were included in President Obama’s health care law as a substitute for a pure government-run health insurance program


These will be exchanges of private insurance offered to consumers in every state: much like the exchanges that government workers (including Senate and House members) are able to choose from. It's good, but it's not the same thing as a public option, which was a government-run insurance program, like Medicare.

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Response to frazzled (Reply #1)

Wed Dec 5, 2012, 01:00 PM

2. Actually,

"It's good, but it's not the same thing as a public option, which was a government-run insurance program, like Medicare."

...the plans in the OP are closer to the public option than to Medicare. Unlike Medicare, the public option was not single-payer.

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Response to ProSense (Reply #2)

Wed Dec 5, 2012, 01:07 PM

3. But is it in the hands of for-profit insurers? n/t

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Response to leftstreet (Reply #3)

Wed Dec 5, 2012, 01:18 PM

4. "at least one of the nationwide plans must be offered by a nonprofit entity"

From the OP article:

Under the Affordable Care Act, at least one of the nationwide plans must be offered by a nonprofit entity. Insurance experts see an obvious candidate for that role: the Government Employees Health Association, a nonprofit group that covers more than 900,000 federal employees, retirees and dependents, making it the second-largest plan for federal workers, after the Blue Cross and Blue Shield program.

The association, with headquarters near Kansas City, Mo., was founded in 1937 to help railway mail clerks with their medical expenses, and it generally receives high scores in surveys of consumer satisfaction.

Richard G. Miles, the association’s president, expressed interest in offering a multistate plan to the general public through insurance exchanges, but said no decision had been made.

<...>

To be eligible to participate in the multistate program, insurers must be licensed in every state. The Government Employees Health Association recently bought a company that has the licenses it would need.

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Response to ProSense (Reply #4)

Wed Dec 5, 2012, 01:25 PM

6. This is the plan kent conrad, baucus were pushing

That would undermine an actual public option.

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Response to Report1212 (Reply #6)

Wed Dec 5, 2012, 01:30 PM

8. This is

"That would undermine an actual public option."

...nonsense!

How the hell would a not-for-profit plan administered by the government undermine a public option that was private insurers administered by the government?

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Response to ProSense (Reply #8)

Wed Dec 5, 2012, 01:32 PM

9. Boeing military contracts are 'administered by the government'

But Boeing makes the profits

I think that's the question here

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Response to leftstreet (Reply #9)

Wed Dec 5, 2012, 01:39 PM

11. You already,

Boeing military contracts are 'administered by the government'

But Boeing makes the profits

I think that's the question here


...got the answer here: http://www.democraticunderground.com/?com=view_post&forum=1002&pid=1931584

I'm fairly certain that you aren't confusing the federal health care plan that members of Congress enjoy with Boeing contracts (defense contracting).

And again, one of the plans must be non-profit.

Also see: http://www.democraticunderground.com/?com=view_post&forum=1002&pid=1931588

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Response to ProSense (Reply #11)

Wed Dec 5, 2012, 01:42 PM

12. Wow. We're all getting the healthcare Congress gets?

sWeET !!

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Response to ProSense (Reply #11)

Wed Dec 5, 2012, 02:11 PM

15. Our Congress Critters are Federal Employees.

 

They get to choose from the same health insurance plans any other federal employee does. Most of those plans are Blue Cross/Blue Shield. They can afford the higher priced plans, so people think they have something special the rest of do not.

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Response to ProSense (Reply #8)

Wed Dec 5, 2012, 02:05 PM

14. It is not administered by the Government

 

GEHA (Government Employees Health Association) is a self-insured, not-for-profit association providing health and dental plans to federal employees and retirees and their families through the Federal Employees Health Benefits Plan (FEHBP) and the Federal Employees Dental and Vision Insurance Program (FEDVIP).

The company currently offers traditional fee-for-service health plan options with a preferred provider organization (PPO) along with a high deductible health plan (HDHP) that can be paired with a health savings account (HSA). On the dental side, GEHA offers two options under the Connection Dental Federal FEDVIP plan.

In 2006, the Office of Personnel Management (OPM) chose GEHA as one of a select number of companies to offer supplemental benefits to federal employees under the Federal Employee Dental and Vision Insurance Program (FEDVIP).

GEHA also has a contract with the federal government to administer benefits for the Pre-existing Condition Insurance Plan, which will be a transitional program until 2014. "GEHA now provides benefits to almost 1 million covered lives worldwide."

http://en.wikipedia.org/wiki/GEHA


The GEHA is a private, not for profit insurance company. Just because the cater to government employees, does not make them government, nor administered by the government.

Their home page: http://www.geha.com/
Notice the .com and not .gov?

There are plenty of "not for profit" health insurance companies around, that insure government employees. They can be just a predatory as any for profit health insurance are. That said, GEHA seems to be following the rulers better than most health insurance companies do now a days.
They would not need a contract with the federal government if they were a government agency.
Therefore going this route undermines the needed Single Payer most of the rest of the world has had for decades.

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Response to RC (Reply #14)

Wed Dec 5, 2012, 02:29 PM

17. Yes, it is.

Factsheet: Proposed Rule for the Multi-State Plan Program

On November 30, 2012, the U.S. Office of Personnel Management (OPM) published a Notice of Proposed Rulemaking setting forth the proposed standards for the Multi-State Plan Program (MSPP). The MSPP is a new program established by the Affordable Care Act. The MSPP will promote competition in the insurance marketplace and ensure consumers have more high quality, affordable insurance choices.

The Affordable Care Act directs OPM to enter into contracts with private health insurance issuers to provide at least two multi-State plans (MSPs) to be offered on Exchanges beginning in 2014. At least one of these issuers must be a non-profit entity. Health insurance issuers who wish to participate in the MSPP will apply to OPM. OPM will determine which issuers are qualified to become MSPP issuers, enter into contracts with them, and certify their MSPs to be offered on Exchanges.

OPM is committed to ensuring the MSPP promotes competition and that the MSPs operate on a level playing field with other plans on the Exchanges in all States. OPM continues to work with various stakeholders, including States, to meet these goals. OPM aims to administer the MSPP in a manner that is consistent with State insurance laws and that is informed by input from a broad array of stakeholders.

We encourage the public to comment on this proposal.

Objectives of the MSPP

The proposed rule sets forth the following objectives in administering the MSPP:

  • To ensure a choice of at least two high-quality products to consumers participating on each Exchange;

  • To promote competition in the health insurance marketplace to the benefit of all consumers;

  • To offer plans from the same issuer to families or small businesses that may reside or operate in more than one State;

  • To provide strong, effective contractual oversight of the issuers that choose to offer MSPs; and

  • To work cooperatively with States and the U.S. Department of Health and Human Services (HHS) to ensure a level playing field for qualified health plans (QHPs) and MSPs.

Drawing on OPM’s Experience in Contracting under the Federal Employees Health Benefits Program (FEHBP) to implement the MSPP

The Affordable Care Act directs OPM to implement the MSPP “in a manner similar to the manner in which the Director implements the contracting provisions with respect to carriers” under the FEHBP. OPM is drawing on its successful experience of more than 50 years administering FEHBP in implementing the MSPP. OPM has been able to administer this robust health insurance program efficiently, keeping administrative costs low.

- more -

http://www.opm.gov/insure/mspp/factsheet.asp

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Response to ProSense (Reply #17)

Wed Dec 5, 2012, 04:18 PM

19. It is a contractual agreement between the Federal government and a private health insurance company.

 

The insurance company manages the insurance. Otherwise why are they
needed?

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Response to RC (Reply #19)

Wed Dec 5, 2012, 06:10 PM

22. It's administered by the federal government.

The government sets the terms of the agreement and structures the plan.

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Response to ProSense (Reply #22)

Wed Dec 5, 2012, 06:33 PM

23. The government negotiates the terms of the agreement and structures the plan, yes, but

 

It it is administered by the insurance company.
Look up 'administer'

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Response to RC (Reply #23)

Wed Dec 5, 2012, 06:39 PM

24. "Look up 'administer'" Maybe

you should look up the facts:

OPM aims to administer the MSPP in a manner that is consistent with State insurance laws and that is informed by input from a broad array of stakeholders.


More: http://www.democraticunderground.com/?com=view_post&forum=1002&pid=1931936

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Response to RC (Reply #23)

Wed Dec 5, 2012, 08:18 PM

26. Medicare is also administered by for-profit companies like Blue Cross, United, etc.


But, they have to do it as the gubment says, or face some hefty penalties. Consequently, they usually do. And they do it relatively economically.

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Response to leftstreet (Reply #3)

Wed Dec 5, 2012, 01:19 PM

5. No. It's going to be a totally Federal gov't sponsored

health insurance option, not part of the ProfitCare cartel of corporations.

From the article:

The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.


Also, if it worries the Heritage Foundation that it might be a "robust public option", it's good for the American people.

Also from the article:

Robert E. Moffit, a senior fellow at the conservative Heritage Foundation, said he worried that “the nationwide health plans, operating under terms and conditions set by the federal government, will become the robust public option that liberals always wanted.”


Seems to me, a robust public option that might even include dental care, is on its way.

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Response to ProSense (Reply #2)

Wed Dec 5, 2012, 01:27 PM

7. And unlike the private option ...

these multi-state plans are not run by the federal government. They will be run under contract to the federal government (and yes, at least one must be a nonprofit agency.)

Look, I don't know why you're arguing with me. I'm fine with this plan. I'm just trying to point out to the OP that, in contradistinction to the header that was written, this is not the same as the public option (actually, several public option plans) that were proposed. Okay?

This is an old article, and it's been discussed here a number of times.

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Response to frazzled (Reply #7)

Wed Dec 5, 2012, 01:33 PM

10. What?

"And unlike the private option ...these multi-state plans are not run by the federal government."

The public option was administered by the govenment, same as the OPM would do for these plans.

You are portraying the public option as a government-run program like single-payer, which it was not.

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Response to ProSense (Reply #10)

Wed Dec 5, 2012, 03:01 PM

18. As you've noted the Public Option is NOT a single-payer

program. Some believe it's one and the same, and that's where the confusion lies.

Thanks for pointing that out, ProSense.

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Response to ProSense (Reply #10)

Wed Dec 5, 2012, 05:53 PM

20. No, here's the difference

The public option was an insurance option (like an insurance company) wholly run by the government, which would have competed with other (private) health insurance companies. What this article is describing is more like an exchange that the government would administer.

Please read the explanation in full; here is a snippet:

Robert Pear wrote this weekend about the “multi-state health plans” that the United States will soon launch. The federal government will negotiate the “premiums and benefits” for this insurance coverage, which legislators included as a substitute for the public option.

These plans are not, however, actual public options. “This is not government-sponsored, and it’s not a public plan,” says Tim Jost, a law professor at Washington and Lee University who focuses on health policy. “These are plans that contract with the federal government.”

The health law’s multi-state plans function in a much different way that a public plan would, relying on a private carrier to administer benefits. There’s even concern among some consumer advocates that these plans could hurt the health-care law, as they get an exemption from key Affordable Care Act requirements.

The original idea of the public option was to have the federal government act as an insurance company. That would mean going to doctors and negotiating how much they charge patients for everything from an annual physical to an ambulance trip to the hospital. If enough people enrolled, the thinking went, the public option would have greater leverage in demanding lower prices. That’s how Medicare and Medicaid work right now. Perhaps the public option could even join forces with Medicare and Medicaid, further increasing its leverage.

http://www.washingtonpost.com/blogs/wonkblog/wp/2012/10/30/no-the-public-option-has-not-returned-from-the-dead/




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Response to frazzled (Reply #20)

Wed Dec 5, 2012, 06:08 PM

21. Wrong

"The original idea of the public option was to have the federal government act as an insurance company. "

That would have made the public option single payer. It was never that. If the public option was even close to that, single payer advocates would have supported it.

That's how Medicare operates, and that confuses people: http://www.democraticunderground.com/10021854665

http://www.ssa.gov/history/ssa/lbjhistory.html

The public option was a federally administered plan.

You also asked whether the federally administered “public plan” that would be offered under the legislation as introduced would have a substantial effect on federal spending for health care. Under that proposal, the public plan would be managed by the Department of Health and Human Services, would pay negotiated rates to providers of health care, and would have to be financially self-sufficient (albeit with the government bearing some risk, as discussed below). Given those provisions, CBO’s assessment is that premiums for the public plan would typically be roughly comparable to the average premiums of private plans offered in the insurance exchanges—and thus the existence of such a plan would not directly affect the amount of federal subsidies for health insurance under the legislation.

http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/105xx/doc10553/09-10-response_to_enzi_for_web.pdf

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Response to ProSense (Reply #21)

Wed Dec 5, 2012, 08:10 PM

25. You know better than the experts quoted in the Washington Post

Tim Jost, law professor at Washington and Lee University who focuses on health policy:

“This is not government-sponsored, and it’s not a public plan. These are plans that contract with the federal government.”



John McDonough, health policy adviser to Ted Kennedy and now professor at Harvard University School of Public Health:

No one at the time, however, thought the multi-state plan would work much like a public option at all. “It’s not really similar at all. It’s something that’s going to be more like one private plan choice.”


Why do you keep focusing on the idea of single payer? The public option was originally conceived as one of the insurance options that would be on the exchange: a government-run option, which would be able to set the rates it paid doctors for specific services. That's how it was going to inject competition into the exchanges to keep the prices down among the commercial insurers. Now the government will simply contract with private insurers.

Please, this is about whether the multi-state plan that is going into effect is "the public option," as the OP stated. It is NOT, by any stretch of the imagination.

Second, read your own quotes: the CBO says the public option "would pay negotiated rates to providers of health care." Providers means DOCTORS. They would negotiate with doctors for rates to be charged for services.

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Response to SugarShack (Original post)

Wed Dec 5, 2012, 01:48 PM

13. Could this be at least a step toward a true public option?

And, dare we hope, eventual single-payer?

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Response to LongTomH (Reply #13)

Wed Dec 5, 2012, 02:12 PM

16. Sorry, this is a step away from Single Payer.

 

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