Ouch! Ouch! And Ouch! The Downside of current House HCR Bill

[truedelphi]

Oh and here's an important thing

This House Plan submitted on Thursday offers insurance only somewhat.

For instance - take the high risk pool, please... (As in "Take my wife, please)

How does Congress even define Insurance?

For instance, if you feel that you will end up in a high risk pool, due to being non-eligible for normal insurance plans, you must have proof that you have been rejected by the normal insurers.

You also must be uninsured for six months.

But get this - they have capped the damn high risk pool - if too many people use it, and the plan goes above its cost allowances, then:

1) there could be an increase in premiums, even above the set limits
2) there could be a lessening of coverage
or 3) there could be a waiting list.

So just how "insured" will those on the waiting list be? And how "insured" will you be when you face a "lessening" of coverage? Or when your premiums are unaffordable.

But there are considerations that Congress has built in should you feel that the premiums are not affordable. They are called PENALTIES! The Budget Office is relying on

One Hundred And Sixty Seven Billion Dollars

to come from penalized consumers to help offset the government's 1.1 Trillion dollar expenditures between 2013 - 2019.

And it is also interesting to note that the most prevalent term or expression used in the 27 page summary of the 1,900 page House HCR Bill is the word "Mandates."

[truedelphi]

1. Here are URLs so you can get the skinny on the Bill

http://www.scribd.com/doc/21849473/CBO-House-Health-Car...
27 page summary

http://docs.house.gov/rules/health/111_ahcaa.pdf
That's the link to the version released Thursday. Have at it! COBRA mentioned early on.

It is 1,900 pages long, but there is a nifty Table of Contents so you can find the section you are concerned about, and then use the "Go To" function to pull your cursor to that page. Unless of course you plan on reading the whole 1,900 pages.

[nightrain]

2. knr. it's a sham and a fraud. Neither "public", nor an "option"

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=103&topic_id=492584&mesg_id=492584

[stray cat]

3. So Liebermann and the GOP are heroic figures stopping a bad bill?

if the bill is really that bad - Lieberman and the GOP are acting in the people's best interests and the dems are evil and trying to snow us.

[truedelphi]

4. I am reading the bill and this is what I am finding out.

I have no interest in proving that Lieberman is a nice person. Nor do I have any illusions that the GOP will save us.

I am just telling you what I am reading.

You are welcome to read along.

[Oregone]

5. The Democrats have complete perceptual control right now

Its their fault on the fallout. They could make a "decent" bill, force a fillibuster, and scapegoat the GOP for blocking it to boost their 2010 election momentum (then come back to the table with something like single payer)

Or they can throw up a mediocre bill with a lot of good mixed in with a lot of bad, and let the GOP be heroes for blocking the bad.

Their other option is to just pass a piece of shit into law.

[SandWalker1984]

15. We need to kill the MANDATES in both bills!

It is now obvious that the Democrats, with some noted exceptions, are no more interested in providing real health care reform than the Republicans. The insurance lobby money is just too big to ignore for them.

We must therefore do everything we can to KILL THE MANDATES in both bills so we are not forced by law to buy private insurance from the bottom feeding blood suckers that created this mess we call health care in the US.

Otherwise, this will end up being a mandate for everyone to buy private, expensive health insurance and we will be getting screwed much worse than we were before the so called health care reform.


This is coming from Ms Impeachment and Single Payer is off the Table. I'm not surprised.

[truedelphi]

21. Totally agree. n/t

[TorchTheWitch]

29. The only thing in any bill that is not negotiable is the mandate

The mandate is a done deal and the only thing in this whole debate that is not negotiable. The only way to get rid of the mandate is to kill the bill.

[grahamhgreen]

35. no pay or punish crapsurance! no way no how.

[Bonn1997]

30. Leiberman is an immoral person with immoral motives who is accidentally doing something good

[ProleNoMore]

6. Why Is One Not Surprised That Democrats Would Settle For Such A Weak Bill

eom

[truedelphi]

7. My guess is because by now we all know that we get

The Best Government that Money Can Buy!

And A big welcome to DU.

[ProleNoMore]

11. Thank You For The Welcome

eom

[Greyhound]

44. Experience. n/t

[lumberjack_jeff]

8. First off

The only place "high risk pool" can be found is in the section entitled "immediate reforms".

If your intent is to mislead, you're doing a great job.

Once the exchange is up and running, there is no high risk pool because everyone is eligible for coverage.

[truedelphi]

9. It matters a lot to people who are in that category

The next four years could be the most critical years of their lives, or their children's lives.

As far as my misleading people - WTF? We have a Congress and a President who somehow all managed to avoid having the most important conversation of all - the fact that the skyrocketing costs of every phase of the Health Care Industry are driven by the profit motive, and that alone. Have we seen our President discussing the fact that drugs manufactured 400 pills for a nickel are then dispensed to us for 20 pills for
$ 182.50. (I am not against a profit motive, but when a standard drug mark up is 2,000 to 8,200 PERCENT of cost of manufacture, something is terribly wrong, and not in Denmark, either. As in Denmark they have Single Payer Universal HC For All, and the whole plan in Denmark can fit easily onto four or five pages.)

As a health care worker, I have worked in hospitals where the bandages labeled "Sterile" are no longer sterile due to being over eight years old. I have worked privately for women who were booted out of the hospital almost immediately after having a mastectomy - and with their right arm swollen beyond belief, told to go home and change the wound dressings themselves.

So while health care costs are going up, we the consumers are getting shoddier and shoddier treatment. We needed an Executive Leader who was willing to have the discussion about how the costs are so inflated that they needed to be rolled back, and we needed that discussion before we ever tackled having a health care bill.

And then we needed to see that the costs were indeed rolled back.

We especially needed that discussion from a President whose single most touted sound byte has been the "importance of a bill that is deficit neutral."

[Ruby the Liberal]

10. Off topic, but a question here

How is it that a hospital could have unused sterile bandages for 8 years? Do these folks not understand FIFO (First in, first out) and inventory rotation? What a waste of money.

[truedelphi]

17. I have the feeling that these "elderly" bandages

Were being shipped into the hospital.

Which was, BTW, not in some ghetto hospital somewhere, but Sutter Operated Marin General Hospital. The third most affluent county in our nation.

A nurse I know who spent her time there trying to do things properly was canned. They went back years into her record and found a place wherein she gave a patient a "genreic" version of the doctor's ordered drug. But used that as a reason for her termination, when the real reason was that she tried to keep the hospital on the straight and narrow.

[Ruby the Liberal]

20. That is a horrifying thought.

[lumberjack_jeff]

23. It absolutely *does* matter to a lot of people.

The main criticism of HR3200 was that it does nothing now.

The section dealing with immediate reforms creates an insurance pool for those who are currently uninsured IMMEDIATELY... in advance of the permanent reforms taking effect.

The ability of DU'ers twisting something good into something bad vexes me a great deal.

If Pelosi had proposed a high risk pool for the uninsured last year, she would have been a hero.

[eridani]

32. Spoken like someone who has not a clue about what outrageous premiums such pools charge

Oh, but we'll subsidize them. Subsidizing shitstains who treat the sick like a cash crop? Fuck that. Just treat high risk people like we treat disabled people now and let them into Medicare early. Put the subsidies into Medicare to handle the extra expense.

[Laelth]

40. If she did that without the individual mandate, she'd still be a hero.

The individual mandate is a disaster waiting to happen, and Democrats will be badly punished for it at the polls (and rightly so).

:dem:

-Laelth

[ipaint]

12. 177 billion in penalties.

Bet that is a low estimate.

The arrogance and disdain for americans written into this bill is unbelievable.

[truedelphi]

19. You're right. My failing grey matter

Transposed the Penalty figure into a lower, incorrect number.

[SandWalker1984]

13. House bill sets up Public Option to fail -- and they know it!

The House version of a public option is designed to fail and Pelosi & all know it.

Because they will limit the number of people that can access this version of a public option, because many of those that do will be people with pre-existing conditions & already shunned by the health care corporations, the PREMIUMS ARE EXPECTED TO BE HIGHER THAN THOSE OF PRIVATE INSURANCE.


Public Option, RIP? The Congressional Budget Office explains the perils of compromise and the limits of its own interest in health costs.
By Timothy Noah Posted Friday, Oct. 30, 2009

I've had a bad feeling since Tuesday that Connecticut Sen. Joe Lieberman's pledge to filibuster any variety of public option eliminated its chances of becoming law. Continuing recalcitrance from moderate Democrats didn't help, either. But I never figured that the final death blow would come from the Congressional Budget Office.

Here's the killer sentence, spotted by Politico's Carrie Budoff Brown on Page 6 of the CBO's analysis of House Speaker Nancy Pelosi's "blended" House bill: " public plan paying negotiated rates ... would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges."

Whaa? Most analyses of the public plan, including mine, have assumed that even the watered-down "level playing field" version (i.e., the version in Pelosi's bill and also—with an "opt out" provision slapped on—in Senate Majority Leader Harry Reid's yet-to-be-scored Senate bill) would set premiums lower than private insurers. But the CBO says that's wrong.

More specifically, here's what the CBO says: "The public plan would have lower administrative costs than those private plans but would probably engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees. (The effects of that 'adverse selection' on the public plan's premiums would be only partially offset by the 'risk adjustment' procedures that would apply to all plans operating in the exchanges.)"

snip

The CBO is saying that a public option that was required to be self-sustaining financially and that was barred from aligning its doctor and hospital fees with Medicare's—as Pelosi's level-playing-field version would be—would see its role as sanctuary doom its role as price competitor. Private insurers would engage in aggressive "management of utilization by its enrollees," i.e., dumping or avoiding the people most likely to need the services of doctors and hospitals, leaving them no place to go except the public option. This would drive down private insurers' costs and drive up the public option's. The CBO acknowledges that Pelosi's public option would have lower administrative expenses than private plans. But because its ability to drive down doctor and hospital fees would be somewhat inhibited by its level-playing-field structure, its cost advantages would be outweighed by its cost disadvantage in serving a disproportionately unwell population.

In short: Private insurers have been fretting that a public option would doom them, but the CBO is saying the opposite: Private insurers would doom (or at least put at a significant disadvantage) the public option.

This is a nightmare scenario that Paul Starr, the sociologist and Hillarycare veteran, has been warning about for some time. "Over-constrained," Starr wrote this past June in the American Prospect ("Perils of the Public Plan"), "the public plan could go into a death spiral ... as it becomes a dumping ground for high-risk enrollees, its rates rise, and it loses its appeal to the public at large." I've long thought that Starr was being too pessimistic because Congress would never design a public option this vulnerable. According to the CBO, however, that's just what Pelosi did.

Please read the rest of the story at
http://www.slate.com/id/2234175/pagenum/all/#p2


THE PUBLIC OPTION, AS PROPOSED IN THE HOUSE BILL, IS DOOMED TO FAIL AND PELOSI KNOWS IT!!!!

The health insurance CEOs must be laughing their asses off at how gullible we all are!!

It's time to kill this scam, this fake health care reform, and try again later than to let the insurance corporations receive millions of new victims as their new corporate slaves in the name of health care.

[truedelphi]

18. I'll add to the discussion the parts of the link Nighttrain proposed

We examine (His very early response to this topic)

Author-- Miles Mogulescu

The so-called "public option" -- as it remains in the bills being proposed in the House and Senate -- is a fraud and a sham. It bears no resemblance to the "robust" public option originally sold by its supporters as the most pragmatic, "uniquely American" multipayer way of achieving affordable universal health care, instead of importing successful single payer models from other democratic capitalist countries which provide better health to its citizens at considerably lower costs.

The pygmy public option now being proposed in the House and Senate will not be a viable competitor to mandated private insurance.

• It will not put any meaningful pressure on private insurance companies to moderate their premiums.
• It will not have the market power to pay lower fees to doctors and hospitals than private insurance and will thus not be less expensive than private insurance.

• It will not even be available to most Americans.

• Since it will be unable to effectively compete with private insurance, it will end up with few, if any customers.

[Laelth]

41. +1 n/t

:dem:

-Laelth

[L0oniX]

14. It's what they call a "poison pill".

[Kansas Wyatt]

16. I hope their Health Care Scam FAILS!

To those of you who think this this is a 'foot in the door' and the best we can get...

Have the Democrats changed Bush's Prescription Medicare Plan (giveaway to the Pharma Industry, while screwing people) yet?
WHY NOT?

The DEMOCRATIC PARTY controls the Government with a MANDATE from the people, so why can't they deliver what they told the American People?

Don't fucking tell me that this is the "best" we can get, because it's the BEST the Insurance Industry can get. And don't tell me that it is a few bad apples holding it up, because NOBODY ever stood up and fought for what the American People wanted. Offering Chump Change Token Efforts is NOT fighting for the American People!

On edit: 'NOBODY' means those who are in the White House or hold leadership positions in Congress.

[johnaries]

22. Bullshit and spin.

I encourage everyone to read the CBO report for themselves. Although it was generously provided in the first reply, Here's the link again:

http://www.scribd.com/doc/21849473/CBO-House-Health-Care

please notice key points that directly contradict the OP's statements. such as:

Policies purchased through the exchanges (or directly from insurers) would have to meet several requirements: In particular, insurers would have to accept all applicants, could not limit coverage for preexisting medical conditions, and could not vary premiums to reflect differences in enrollees’ health. (page 4, paragraph 1)

So, then, if all applicants to be accepted and coverage could not be limited, who would be "un-insurable"?

To further put the lie to your OP, read the Public Health Insurance Option description here:
http://www.centerforpolicyanalysis.org/id57.html

Individuals in the Exchange can choose freely among the private carriers and the public option. Employers who participate in the Exchange cannot dictate employees ’ participation in a particular plan.

As for the penalties - yes, those penalties revenues come from employers who refuse to offer Health Care Benefits and individuals who think they are invulnerable and don't need insurance. A lot of whom end up in the emergency room.

It also increases funding for Community Care centers and expands eligibility for Medicaid. But you conveniently left those parts out, didn't you?

[zalinda]

25. Let's look at these sections you quoted

Policies purchased through the exchanges (or directly from insurers) would have to meet several requirements: In particular, insurers would have to accept all applicants, could not limit coverage for preexisting medical conditions, and could not vary premiums to reflect differences in enrollees’ health. (page 4, paragraph 1)

Individuals in the Exchange can choose freely among the private carriers and the public option. Employers who participate in the Exchange cannot dictate employees ’ participation in a particular plan.


These sections do not say that insurance companies can't raise their premiums so high that people can't afford them, and that's exactly what they will do so that they won't have to take "high risk" patients. The only time that they CAN'T raise premiums is if you are already in the system, so to speak. They will find a way to get around insuring those who've had a heart attack, or over weight, or diabetic, or family history of any one of the genetic diseases. To believe that they won't find a way around this is like believing that Rush Limbaugh is an honest news caster.

People at the lower end of the economic scale are going to get screwed again. Apparently in the world of politicians $1200.00 a month for health insurance should be easy to do when you are making minimum wage or slightly above. Because there is no way that any one making less than $100,000 a year is going to be able to afford health insurance easily. Anything that the health insurance industry will offer to those who can pay the least, will cover practically nothing, with high co-pays and deductibles. Red lining will be rampant, and one insurance company will be almost exactly like the next. There really won't be any choice.

zalinda

[lumberjack_jeff]

26. The bill also establishes rating criteria.

"high risk" isn't one of the criteria. A 50 year old male hypertensive diabetic cancer survivor gets the rate as any other 50 year old man. Sure, insurers could raise the rates for a variety of reasons, but to weed out the infirm isn't one of them.

And the bill also dictates the total premium range, IIRC something like 3:1 maximum differential between the lowest criteria group and the highest.

[johnaries]

27. That means they would have to raise their premiums for all.

"could not vary premiums to reflect differences in enrollees’ health".

If they raise their premiums for all, then they cannot compete.

[bvar22]

24. I am beyond disgusted.

Kabuki Theater

From the get-go, the entire "Health Care Reform" has been a scam to transfer Mega-Billions of Public Money to the For Profit Health Insurance Industry.
This does NOT include the BILLIONS of out-of-their-own-pockets dollars that Americans will be FORCED to give to the worst, immoral Industry in the WORLD.

The "Public Option" (Not available to The Public, and not much of an option offering no real price advantage) is nothing more than a "shiny object" used to distract the peasants while the treasury is given to the predators.

Health Insurance Reform should have NEVER been bundled together with the establishment of a Public Option.

Nobody beyond those who own a Health Insurance Corporation is going to be happy with this.

They WILL blame The Democrats.
Rightly so.



Do the MATH:

Cost = $900Billion for 10 years

Enrollment in Public Option = LESS than 10 million (and THAT was before the PO was weakened last week)

Who gets rich?
Follow the Money.

[truedelphi]

28. Correction on cost amounts -- The 900 Billion bucks is the

Money allocated from the Government.

However, and moreover, we as individuals still have to pay out for premiums. I have no idea if anyone has done any analysis of what the average human will be paying.

And the only reason that I can figure out why things need to wait out till 2013 to kick into gear is that by 2013, I am betting my seweet booties that the Health Care Insurance "Providers" will have seen to it that various provisons guaranteeing them EVEN MORE PERKS will be attached to various other pieces of legislation, and thus stealthily placed inside the HCR bill.

[bvar22]

31. The REAL reason why they have delayed implementation?

Because THAT puts it past the 2012 Elections.

They KNOW that most Americans are "low Information voters", but the damage will be impossible to ignore when they open their new HealthCare package and find a BIG bill from the For Profit Health Insurance Industry.
They WILL blame The Democrats, and rightly so.

Only a complete cheer leading idiot would believe the cover story that it takes 4 years to get this pathetically small PO
("Thin Sliver") up and running.

Medicare was up & running in less than a year and had a 93% enrollment.



"There are forces within the Democratic Party who want us to sound like kinder, gentler Republicans. I want us to compete for that great mass of voters that want a party that will stand up for working Americans, family farmers, and people who haven't felt the benefits of the economic upturn."---Paul Wellstone

[truedelphi]

36. Very very good point bvar. Thanks for

Bringing it to the fore.

[slipslidingaway]

33. Generating revenue to cover the plan's cost over the 10 year period...

bottom of page 7 in the CBO report. While the program itself sounds good, notice how this new piece reduces the deficit by 72 billion in the 10 year window.

Nice way to reduce the cost for Now.


http://www.cbo.gov/ftpdocs/106xx/doc10688/hr3962Rangel.pdf

"H.R. 3962 includes a number of other provisions with a significant
budgetary effect. They include the following:

 Community Living Assistance Services and Supports (CLASS)
provisions, which would establish a voluntary federal program for
long-term care insurance. Active workers could purchase coverage,
usually through their employer. Premiums would be set to cover the
full cost of the program as measured on an actuarial basis. However,
the program’s cash flows would initially show net receipts in early
years, followed by net outlays in later years. In particular, the
program would pay out far less in benefits than it would receive in
premiums over the 10-year budget window, reducing deficits by
about $72 billion over that period..."

[truedelphi]

38. The points you make are considerations that every American supporting this bill

Should mull over.

We get this inane pice of legislation that entails further curtailing Medicare pay outs to providers.
And then another clause, supposedly, on its surface, offering way to pay for long term nursing care support (Something every American needs by the way - we are all just one slip in the shower or one car or biking accident away from needing long term care) But if the plan pays out LESS in benefits thann it takes in, what the heck is that about?

[slipslidingaway]

39. The headline news was that this bill would reduce the deficit by 104 billion...

BREAKING: CBO Releases Numbers On House Health Care Bill : Reduce Deficit by $104 Billion
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8722280&mesg_id=8722280

...so where did that reduction come from, it appears a large portion (72 billion) is due to this new long term care insurance, aka CLASS.

While that is something to celebrate, the plan would have people paying in over the 10 year budget window for something they will need in the future, naturally this will be all gains until people start drawing from the fund. For reference this is shown on page 26, Table 3 of the CBO report.

It reminded me of the SS Trust Fund that was pre-financed and helped to reduce the deficits, especially during the Clinton and Bush years...now some are saying the money is all gone and how will the general budget be able to afford paying back the 2.5 trillion. Fun with numbers I suppose.

:shrug:

I need to read more about the Medicare aspect of this, starting on page 6 of the CBO report.

"...Provisions Affecting Medicare, Medicaid, and Other Programs

Other components of H.R. 3962 would alter spending for Medicare,
Medicaid, and other federal health programs. The bill would make
numerous changes to payment rates and payment rules in those programs
(the budgetary effects of which are summarized in Table 1 and detailed in
Table 3). In total, CBO estimates that enacting those provisions would
reduce direct spending by about $426 billion over the 2010–2019 period.

In addition, the effects of certain Medicare and Medicaid and other provisions would increase
federal revenues by about $14 billion over the 2010–2019 period.

Numerous changes to Medicare and Medicaid would reduce direct
spending over the 2010–2019 period. The provisions that would result in
the largest budgetary effects include these:

 Permanent reductions in the annual updates to Medicare’s payment
rates for most services in the fee-for-service sector (other than
physicians’ services), yielding budgetary savings of $229 billion
over 10 years. (That calculation excludes interactions between those
provisions and others—namely, the effects of those changes on
payments to Medicare Advantage plans and collections of Part B
premiums.)

 Setting payment rates in the Medicare Advantage program on the
basis of Medicare spending per beneficiary in the fee-for-service
sector and changing the way that payments to Medicare Advantage
plans reflect differences in the health status of enrollees, yielding
savings of an estimated $170 billion (before interactions) over the
2010–2019 period.

 Increasing Medicaid’s payment rates to physicians and other health
care professionals for the provision of primary care services to
Medicaid beneficiaries, costing roughly $57 billion over 10 years.

CBO expects that the Centers for Medicare and Medicaid Services (CMS)
will soon announce payment rates and changes in payment rules for
physicians’ services and other services that are set on a calendar year basis.
Those payment rates and rules may differ from the current-law assumptions
underlying CBO’s baseline projections. If so, CBO will update its estimates
of Medicare spending under current law to reflect those changes and will
revise these preliminary estimates of the impact of H.R. 3962 to reflect the
effects of the new rules on spending under current law and under the bill..."

[eridani]

34. Look, just get rid of subsiding insurance company shitstains--

--and recycle the usefull parts of the bill.

[truedelphi]

37. I am for re-cycling the wonderful ideas of one

Barack Obama, who when running for the Illinois Senate, stated in countless speeches that
"I am for Universal Single Payer Health Care. It is the best solution. But to get there, we will need majorities in the Senate and the House, and a Democrat in the White House."

No truer words were ever spoken. It wasn't until Dec 2007 that he started amending the sentiment of this statement into some weird offspring "SPUHC is the best solution, but since there is a system in place, we need to work within that system."

Universal Single Payer Health Care for all

[eridani]

42. Me too. But for the time being, it is urgent not to get stuck with a pile of crap

Pare off the parts of the current bills that are useful, and do them as separate legislation. Leave the mandate crap out.

[truedelphi]

43. I like your notion of separate legislation for the parts of the

Bill htat are beneficial, and of course, I love the idea of leaving out the mandates.