Ezra Klein: The Baucus Bill: Affordability

[flpoljunkie]

The Baucus Bill: Affordability

This hasn't really changed from the framework Baucus released last week. So let me direct you to this post, or better yet, Nick Beaudrot's terrific analysis of how the Baucus bill compares to Massachusetts, and to a hypothetical version of the Baucus bill with more money.

The basic lay of the land here is that the premium subsidies aren't where they need to be, but are pretty good, particularly for folks making up to 300* percent of the poverty line. The question is what happens when you get sick. And the answer is pretty much that people making more than 200 percent of the poverty line will be less ruined than they'd be under current law, but still facing tens of thousands of dollars in out-of-pocket expenses a year.

Medical bankruptcy, in other words, isn't going away. One fairly dramatic way to think about this is that health-care costs are so high in this country that we can talk about spending almost $900 billion helping low-income Americans afford coverage and still be left with a situation where coverage is unaffordable and illness rips through a family's savings.

By Ezra Klein | September 16, 2009; 1:12 PM ET

*300% of the Federal Poverty Level for a family of four for 2009 is $66,150.

Links here: http://voices.washingtonpost.com/ezra-klein/2009/09/the...

[Mass]

1. It is not affordable for the middle class, particularly when you consider that

it allows a ration of 5:1 for age. Middle class people of 50 + will not be able to afford their insurance, when they probably need the most.

Not sure why Ezra Klein insists trying to find positive in this bill. Yes, it closes a few loopholes, but leaves so many open that the insurance companies must be more than happy.

[flpoljunkie]

5. Those above 400% of FPL have to make co-pays, deductibles- in addition to no more than 13% of AGI

This makes the cost for a family of four right at 400% of the FPL $11,466 for their premium alone--plus their co-pays and deductibles.

How on earth is that affordable? It does seem that former Cigna executive Wendell Potter was right when he called the Baucus plan a 'giveawway to the insurance companies.'

[Mass]

6. 300 % in Baucus Bill, which makes it even worse.

But I do not get Klein at all. He has another post where he says that the bill is good because it allows everybody to enter the exchange in .... 2022.

http://voices.washingtonpost.com/ezra-klein/2009/09/the...

2012.... Really, and he is impressed by this (or did working for WaPo include some brainwashing of some sort?)

[ProSense]

2. Pretty good? The House and HELP bills

set it 400 percent, which is a little more than $88,000.

EXCLUSIVE: Finance Bill Won't Increase the Cap on Subsidies

Now it looks like this just isn't going to happen. Sources close to the negotiations say the subsidy levels will remain exactly as they were in the original Baucus framework--at 300 percent above the poverty level. Those between 300 and 400 percent will have their premiums capped at 13 percent of income. But, as one Democratic aide points out, "almost nobody's going to pay that high a percentage of their income in premiums" after the other insurance reforms are passed, so the cap will only affect a tiny percentage of the population. For many liberals, this will come as a disappointment--both the HELP and House bills set the cut-off at 400 percent.

[Cassandra]

7. Maybe what's good about it...

and all the other lousy proposals is that they make single-payer look better and better.

[sui generis]

3. it's stupid.

We need to provide healthcare to the uninsured. Where did we get lost?

Oh yeah, so now we're going to mandate insurance, instead of mandating healthcare.

Weird. Oh and, we haven't discussed a single limit or cap on what a premium can be based on pre-existing or chronic. And finally, we make no requirement that policy holders of this insurance get annual primary / preventative healthcare physicals. We don't require that hospitals take care of you regardless of your insurance status, even though we're going to fine you for not having insurance at a time when the hospital refused you healthcare.

Hmmmmm. It stinks.

[BzaDem]

9. This post is incorrect on several points.

The bill does not allow premiums to be raised based upon pre-existing conditions or health history. It allows some (capped) variation based upon age/family size/tabacco use/etc, but not health history.

While the bill doesn't require people get physicals, it does require that plans cover preventive care.

Healthcare is provided through health insurance in this country. While you may have a vision where healthcare is somehow provided without health insurance, rest assured that none of the bills that have passed any committee in either house adhere to this vision. Even the strongest public option requires premiums that the public option can sustain itself off of.

[sui generis]

12. Well isn't that the point of healthcare reform?

You're saying accept the status quo, this is the only way it can be done. That's not healthy thinking on this topic.

And here's where it goes astray: Insurance companies ONLY profit when they reduce what they pay on claims. That means private insurers (by definition, for profit) have a vested interest in collecting premiums. Now they have a legal mandate that we pay premiums. We have a nuance of the law that says charging people for a service you don't provide is considered racketeering. Charging people for insurance on a mandate and administering those programs to accommodate shareholder profit without guaranteeing actual health CARE is just plain wrong. Baucus deserves the public crucifixion he's about to face.

This plan is not America. It's absolutely not socialism - this is capitalism ad absurdia.

What is the difference between premiums and tax? A monthly payroll tax vs. a monthly premium? I can answer that - when it's a tax you have protections that require congressional intervention to change. You have a representative voice. When it's a premium, you have no representative voice in what those private companies do to avoid paying for your healthcare.

[Oregone]

4. Medical Bankruptcy is a huge issue for me

I just had a friend in the states lose their home. They moved into a tent. This is hitting so many people so hard. Its needs to be done with.

I proposed a few times, a good compromise would be a catastrophic single-payer mechanism. A high deductible (based on a reasonably affordable amount of out of pocket costs) free plan everyone is automatically enrolled in. Once you go over the thresholds, the government pays the rest. Why? Because the system failed you, and thats the fault of the government for inadequate reform. If the reforms work, its wouldn't cost a penny.

There is something in BC called Fair Pharmacare (http://www.health.gov.bc.ca/pharmacare/plani/planiindex... ). After 2-4% of your income, you get 100% coverage.

Doing this would INSTANTLY lower premiums because it sets a max payout cap on each person in the risk pool. It would be a real solution. Incrementally lowering the deductible would be a straight path to single-payer. Its sad no one care about ideas like this.

[Hippo_Tron]

11. I agree with this idea and I think John Kerry was in favor of it in '04

Also it seems like something insurance companies would want to get behind because the government essentially mitigates their risk.

[wiggs]

8. Still broken with Baucus bill, then. Just occurred to me that really most

of the country (under 65) does not have access to the best health care. Yet all of the country contributes to taxes that fund new research, drugs, and techniques. Aside from the moral issue of medical bankruptcies and choosing between food and health care, there is something also fundamentally wrong with all of us helping fund the best medical care that is available to only the wealthiest of our citizenry.

If the huge engine of government, taxation, public university hospitals, medical schools, research funding (not a small amount), etc only exists because of the work and taxes of ALL of us, why do only a portion of us get to benefit from it?

And why does the Baucus bill cost so much? Can't we just pass laws that limit immoral corporate activity (like cherrypicking and denying coverage and buying legislators)? Why does stopping the pillaging of citizenry wealth by insurance companies have to cost the taxpayers? Are we somehow paying the insurance companies NOT to rip us off so badly? Are we doing something about compensation, like the CEO of UHC who got 1 billion dollars for less than a decade of work?

I DON'T GET IT!!

[MarjorieG]

10. What happens to affordability for all plans, plus coverage, if Medicare dropped to 55 and fix

Advantage plans. Public support would be there.

[olegramps]

13. If this is actually ends up to be the final so-called reformation of health care...

Will President Obama veto it. How could he agree to force people to buy health care insurance that is going to bankrupt them and not provide adequate protection?