The House "Public Option" won't kick in until sometime in 2013!!!! Let's diddle daddle around!

[Better Believe It]

And after the Senate is finished weakening the bill, who knows, it might not kick in until 2020 or later or they may include a so-called trigger.

Read pages 117 and 14 of the House healthcare bill at:

http://energycommerce.house.gov/Press_111/20090714/aahca.pdf

A Daily Kos writer knew this a month ago:

My Thoughts On The Public Option In House Draft
by slinkerwink
Daily Kos
June 21, 2009

Here's what Wonk Room had to say about the House bill below:

"Unlike the HELP bill and the draft (leaked) language of the Senate Finance Committee, the Tri-Committee proposal seems to contain a fairly robust public insurance option. While details are still being worked out, the proposal establishes a public plan in 2013 that will compete with private insurers, within the Exchange, on a level playing field. The public option will be required to abide by all marketing, operations, and rating rules and would initially be allowed to use Medicare plus rates. After some time, the plan would have to independently negotiate fees with providers."

And there it seems that it might be wrong about the public option in the Tri-Committee proposal being available everywhere on day one. How can it be available on day one if it's supposed to be available in 2013 and the National Exchange that's proposed to cut down on costs is established in 2013 as well? This is one of the sticking points for us to push back on starting tomorrow. We'll have to ask the House Education and Labor Committee if the private insurers will have to be regulated immediately after the passage of the legislation or if the regulation starts in 2013. The delay for this puzzles me.

Always remember, the devil is in the details.

Another sticking point for us to push back on is that the public option will have to stop using Medicare plus rates at a certain point in time. Here's more from Karen Tumulty at Time Magazine on what that means:

"In the early stage, the public plan would reimburse health care providers at rates that are "similar to those used in Medicare"--that is, significantly lower than most private insurers pay them. This is something that the insurance industry, doctors and hospitals will all hate."

According to the summary, this tie to Medicare rates would be "severed over time as more flexible payment systems are developed." In other words, this public plan would eventually evolve into something that looks--and competes--more like a private insurance company, albeit one that happens to be run by the government."

This is the biggest sticking point for us to push back on along with the one about the public option having to be self-sustaining only on premiums, and we'll need to ask the Congressional Progressive Caucus to push back on this as well. Basically, we'll have a strong public option at first, but over time, it'll be weakened. I don't think this is right.

Please read the complete article and what you can do to demand a strong public option at:

http://www.dailykos.com/storyonly/2009/6/21/745208/-My-...

[sasquatch]

Fuck that shit

Release the hounds!

[Oregone]

1. Better than nothing. But this is just to start with....

wait till the Senate gets their crack at it.

[JVS]

2. Ridiculous!

[Better Believe It]

3. I wonder how long it took to implement Social Security & Medicare after the bills were signed?

I bet a lot less than a year but maybe someone can research that and come up with some hard data.

[liberalpragmatist]

6. Social Security...

... was FAR from universal in its early years.

Most women and minorities were excluded from the benefits of unemployment insurance and old age pensions. Employment definitions reflected typical white male categories and patterns.<11> Job categories that were not covered by the act included workers in agricultural labor, domestic service, government employees, and many teachers, nurses, hospital employees, librarians, and social workers.<12> The act also denied coverage to individuals who worked intermittently.<13> These jobs were dominated by women and minorities. For example, women made up 90% of domestic labor in 1940 and two-thirds of all employed black women were in domestic service.<14> Exclusions exempted nearly half the working population.<13> Nearly two-thirds of all African Americans in the labor force, 70 to 80% in some areas in the South, and just over half of all women employed were not covered by Social Security.<15><16> At the time, the NAACP protested the Social Security Act, describing it as “a sieve with holes just big enough for the majority of Negroes to fall through.”<16>

It was gradually expanded throughout the '50s and '60s and then into the 1970s.

[SpartanDem]

12. FDR signed the Social Security Act in 1935,

payroll deductions began in 1937, monthly payments started in 1940. Medicare coverage started in 1966 a year after signing you have to remember though it was passed as an amendment to Social Security laws.

[Oregone]

14. Too bad they wont admend the Medicare legislation to extend it to everyone instantly

:) Yeah, Im dreamin, eh?

[JVS]

21. But that would be too easy and not allow the gutting of Medicare in the future!

[Zynx]

18. Social Security, passed in 1935, didn't really kick in until 1937.

In the form we presently know it, it took many more years than that.

[Thrill]

4. Thats something that can be fixed in Conference or with Amendments

Just keep up the pressure

[Better Believe It]

5. Keep up the pressure but remember how the House stimulus bill was "fixed" in conference?

The Senate tore the guts out of it in order to achieve "bi-partisanship".

I really don't expect the Senate to strengthen the public option and other important parts of the House proposal nor do I think they will propose an early start up date.

Let's hope some amendments making the public option stronger, setting Medicare rates and the standard, making the start up date 2010 and other progessive changes occur during markup.

[inna]

41. "I really don't expect the Senate to strengthen the public option"

lol. anyone who does is delusional or clueless.

[Autumn]

7. 2013 on a level playing field

fuck that . Hope the Senate does better than that.

[Better Believe It]

8. Level so that private insurance doesn't have to compete!

[Autumn]

20. A public plan that will compete with private

insurers, so only difference is if we don't buy it we get fined, if you can afford the fines. Amazing

[liberalpragmatist]

9. Implementation in 2013 is a budgeting decision

Besides the time needed to set up the program, starting the public health insurance option in 2013 dramatically cuts the 10-year cost of the bill.

http://voices.washingtonpost.com/ezra-klein/2009/07/why_health-care_reform_begins.html

Most of the major provisions in the House's health-care reform bill begin in 2013. That's a bit of a lengthy ramp-up period, but these things happen. Jon Cohn, however, makes a point I haven't heard before: The Congressional Budget Office scores bills across a 10-year budget window. And, even more arbitrarily, we seem to have decided that the final bill will cost $1 trillion over that period.

The slow start is a way of holding down costs in the 10-year budget window. If the bill begins in 2010, but the subsidies don't kick in until 2013, then that's three years that are under the budget but aren't costing much money. That means the new health-care system can really cost an average of $140 billion each year, as opposed to $100 billion, and that means you can afford a better system.

I'm not saying I agree with it, but that's the rationale.

[jgraz]

11. For some reason, budgetary considerations never come up when we're funding war

But when we're keeping citizens from dying for lack of healthcare, suddenly we're worried about the budget.

[Telly Savalas]

16. You said it.

The question "how are we going to pay for it?" has never come up in any of the discussions of war funding bills.

[Autumn]

17. Isn't that the truth,

something so fucking wrong with that.

[Zynx]

19. That's a different discussion.

[jgraz]

24. No, I really don't think it is

In the end it all comes down to money. The folks with money want wars, so they get wars. The folks with money don't want poor and middle-class Americans to have healthcare, so we won't get healthcare.

[uponit7771]

25. AMEN !!!!

[avaistheone1]

32. Stop Congress' personal health insurance til 2013 & then they will see how long a time period it is.

This bill is too little too late.

It does nothing for the middle class that is overwhelmed with the cost of health insurance.
I am very disappointed.

[Telly Savalas]

15. That's just goofy.

For the 10 year budget window from 2013-2022, the cost of the plan is the same whether it starts in 2010 or 2013.

If the plan has provisions for a self-sustaining revenue source (which it should, otherwise it's dogshit), it shouldn't matter when it starts.

Thanks for posting the link, though.

[lumberjack_jeff]

10. Don't distort. This IS the pony.

The Kos article you're cribbing from points out that the tri-committee bill is the best bill currently being proposed.

Getting more people into medicare in the short run is a good thing, it will hold down costs while the exchange gets up and running.

The bill seems pretty clear to me, the immediate problem is solved getting people into medicare plus while the finished "public plan" is designed.

[Phx_Dem]

13. I wouldn't start bitching about that yet since it hasn't been passed yet.

But figures that Daily Kos would choose to bitch about a tentative start date when NOTHING has even been voted on yet, and with the Blue Dogs' insistence that abortions not be included in the public option, who knows if it will pass at all. My guess is it will, without an abortion option, but that remains unclear.

First things first people.

[Better Believe It]

22. Some good and bad, a summary review.

- ThomCat provided the following review of and thoughts on the House proposal in another string. I'm reposting ThomCats two posts here.-


--------------------------------------------------
Some good and bad, a summary review.

1. (Bad) Right from the beginning, the stated purpose in Division A (on page 4) is to reduce the growth of cost of health care. Not to reduce the cost, but to slow down how quickly it gets more expensive. How is health care going to be affordable if reducing the cost is not part of the goal?

2. (Good) Includes a Public Option.

3. (Bad) using the term Spouse when referring to partners who are dependents, so Domestic Partners are excluded by this language as long as DOMA is still in force.

4. (Good, sort of) Age based pricing on individual health plans cannot vary by more than 2 to 1. So the cost of a health plan for someone elderly cannot be more than twice as expensive as it is for someone young.

5. (Bad) Rates can still vary by region, with limit on how much they can vary, though the regions are not defined and can/will be defined by the commissioner for this insurance later. This will mean that lobbying is going to determine how much more we get charged in cities compared to suburban or rural areas, and how much more in big cities vs smaller cities. This is a big loophole as far as I am concerned, and could become a big giveaway to insurance companies.

6. (Good and Bad) There is an effort to make mental health care and substance abuse care more available, but there are a lot of caveats, complicated referrals between sections in this bill, so that only a lawyer can figure out if any health plan really has to offer any care, what types, and with what availability or restrictions. It's good that the attempt is here, but clearly a lot of lobbying was done to make this complicated, so this looks like it's probably just a symbolic attempt.

7. (Good, maybe) The commissioner will create standard guidelines for how to determine the Medical Loss Ratio, the rate paid out in medical coverage relative to the amount charged in premiums. This is good because each company won't have their own way of calculating their MLR to best hide their profits. One set of rules apply to everyone. Though, there don't seem to be any teeth for catching them if they don't use this methodology, or for doing anything about it. The commissioner "can" do audits "in response to complaints." That seems to means that if the rule-braking gets too blatant and obvious, and the complaints get too loud to ignore then the commissioner will do an audit, but otherwise anything goes.

8. (Good) Once a standard Medical Loss Ration methodology is set, the commissioner will tell insurance companies what MLR to use, in other words, how much profit they can reasonably make from the premiums they take in. The rest HAS to go towards providing health care. Again, I don't see anything in here for verifying this, or doing anything to companies that take extra profit. It's probably going to be buried in future rules.

9. (Good, maybe) There will be minimum standards for plans. Though, no word on how low the minimum will be, or how variable and confusing the minimum options and choices could be. It's good to have a minimum, but it's better if the minimum is clear, consistent and set at a high enough level to ensure quality care. Nothing here requires that it be clear, consistent or set at a useful level. It looks like this section was heavily influenced so that the minimum can be set very, very low just so they can say there is a minimum down there somewhere, and to weed about the grossest abuses without really effecting most plans at all.

10. (Very Good) "A qualified health benefits plan may not impose any restriction (other than cost sharing) unrelated to clinical appropriateness on the coverage of the health care items and services." This seems to be a very straight forward clause prohibiting plans from arbitrarily refusing to cover certain services if those services are listed as covered, or refusing to cover them for select or certain people. There are other, more explicit non-discrimination clauses in this bill too. So, to the extent that anyone obeys this bill it's wonderful, but to the extent that this bill is toothless and enforced by a toothless new agency (read below) it is symbolic but at least it's there.

11. (Very Good) Qualified plans are prohibited from having annual and lifetime caps on services!

12. (Very Bad) The standard for a Qualifying plan is the "average prevailing employer-sponsored coverage." So if employers start offering less to their employees, the standard for these government qualified plans goes down. They have pegged the quality of Everyone's care to employer provided health care as a way of making it Necessary to preserve employer provided health care.

13. (Very Bad) The Cost Sharing (amount they make you pay in co-pays and deductibles) starts out at $5,000 per year per person for the basic plan and can go up each year linked to the consumer price index. Enhanced plans can not only cost more, they can also have a higher rate of "cost sharing," meaning you pay a greater rate relative to what you get. If you want more than basic, you have to be willing to pay more, and then pay extra for it. How the Fuck is any of this considered Affordable? This section all by itself is going to keep health insurance out of the reach of the Vast Majority of Americans.

14. (Bad) An advisory panel of medical and "Other Experts" will recommend what is to be covered on various levels of plans. 17 members are appointed by the President, only 8 of whom are federal employees. 9 more are appointed by the Comptroller General of the U.S. There are guidelines for trying to avoid stacking the panel with lobbyists, but even so I can easily see at a glance that over half of the panel could be stacked. (Can you say "rewards for largest campaign contributors") This means insurance lobbyists, pharma lobbyists, health care lobbyists, "experts" on corporate payrolls, and a token public advocacy doctors.

15. (Good, maybe) There will be an Ombudsman's office to help people within this new Government Department. But the duties of the Ombudsman seem to be defined mostly as providing information and helping to fill out paperwork, not really acting as an advocate to resolve serious disputes. Nor does the Ombudsman have any authority, because even the Chairman doesn't seem to have much authority. The Chairman is referred to state agencies and directed to "work with them" to get anything done. The Ombudsman would have vastly less influence and authority than even that. Just what we need, toothless advocacy.

16. (Very Bad) Repeatedly, it is stated that nothing in here supersedes state laws. This means that this new government agency will have to negotiate a hodge-podge of 50 sets of rules to implement their influence over insurance, and has to be weaker than the weakest of those 50 sets of rules. This guaranteeing that this new government agency will be toothless and absolutely no threat to the insurance industry. It looks like the lobbyists won.

17. (Good, maybe) There is a whistle-blower protection section in here. But it simply gives whistle-blowers the right to bring legal action under existing laws if they face retaliation, and we know that existing laws are absolutely insufficient and ineffective in protecting whistle-blowers. So it's good that this is in there, but it's useless until the underlying law is updated and improved.

I'm sorry, that's as far as I can get right now. I'll dig into this further later tonight

-------------------------------------------

That 3% not covered is a pipe dream. It's going to be much, much higher than that. There is no way the basic plan is going to be affordable to people making less than upper middle class income.

After paying the premiums it will Start at $5,000 per year per person for co-pays and deductibles for a person who needs to use their insurance. How many people do you know who will be able to pay the premium, and then if they need to use the insurance pay $5,000 in co-pays and deductibles just to get access to that insurance?

That is for the absolute minimum insurance plan, the one that most people will end up with because (income distribution being what it is) most people are poor

[inna]

39. it's INSANE!!!! this makes me want to bang my head on the wall, repeatedly.

<<After paying the premiums it will Start at $5,000 per year per person for co-pays and deductibles for a person who needs to use their insurance. How many people do you know who will be able to pay the premium, and then if they need to use the insurance pay $5,000 in co-pays and deductibles just to get access to that insurance?

That is for the absolute minimum insurance plan, the one that most people will end up with because (income distribution being what it is) most people are poor>>



we've been completely sold out, this is just RACKET. this is worse than Wall Street bailout.


:banghead:


:grr:

:argh:

[depakid]

23. Interesting how whenever corporations or some moneyed interest has a need

it's taken care of- fast. Bills kick in within a matter of months- and appropriations rarely run into trouble.

[European Socialist]

26. 2013 ?--Can't they say the money is for war or for rich people's

tax cuts so we have it in 2010.

[Better Believe It]

27. Congressional aides say about 9 million will be insured by public plan by 2019 !

2019!!!????

------------------


Congressional aides said about 9 million people would be insured by the public plan, with 21 million insured by private companies in the exchange by 2019.

* Another 164 million would be insured through their employers.

http://www.reuters.com/article/governmentFilingsNews/idUSN1429323020090714

[Autumn]

30. I finally got to read all of the links

so what I am seeing is that this is a bone tossed to us ,with all of the meat carefully removed.:wtf:

[earth mom]

28. Let's see, the banksters got their money immediately, but the people have to wait years & years?!

:wtf:

Fucking fuckers!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:grr:

[Better Believe It]

29. It appears that the "public plan" may not kick in for employers with more than 20 employees .....

unless "the Commissioner" permits larger employers to join the public plan in 2015!

----------------------------------

The Health Insurance Exchange: It's run nationally, though states can opt out of the national structure and go it alone if they choose, and if they follow federal rules. In the first year, it accepts those without health insurance, those who are buying health insurance on their own, and small businesses with fewer than 10 people. In the second year, it accepts small businesses with fewer than 20 people. After that, "larger employers as permitted by the Commissioner." In other words, expansion is discretionary, not mandated. The only people able to access the public plan in the early years will be on the exchange, and the exchange will be, relative to the population, pretty limited. So the public plan will be limited, and so too will any anticipated savings.

http://voices.washingtonpost.com/ezra-klein/2009/07/the...

[scheming daemons]

31. It was 5 years after Social Security passed that the first checks went out....

Seriously, some people expect big government overhauls like this to be implemented immediately.


It doesn't work that way.

[avaistheone1]

34. Congress and the Senate can only move quickly for important stuff like bank bailouts and war.

It only took a matter of few weeks for the Wall Street banks to get a trillion dollars - far more than it would cost to for single-payer health plan for every man, woman and child in this country.

Health care for the people is evidently not so important. Congress has got theirs.

[Better Believe It]

35. You're wrong. The first payments went out in January 1937. The Act was signed on 8/14/1935

The Social Security Act was signed by FDR on 8/14/35. Taxes were collected for the first time in January 1937 and the first one-time, lump-sum payments were made that same month.

[SpartanDem]

36. You're both right

the lump sum payments were made in 1937, but monthly payments didn't begin until 1940

[scheming daemons]

37. Monthly checks didn't start going out until 1940... Taxes were first collected in 1937

So it wasn't FULLY implemented until nearly 5 years after passage.

[tomm2thumbs]

33. K&R (to compensate for fake U's)

the devil is always in the details - if someone is just promoting a watered down version so they can say 'lookie what I did' they may as well just promote the status quo and rename it 'American Health Plan United' and just say 'lookie what I did'.

Same difference if there is nothing to crow about

[ipaint]

38. 1 year to get 90% enrollment in Medicare in 1965.

It's interesting, because before Medicare passed, which is in 1965, we had older people, either uninsured or going to private insurance. And within a year of the time Medicare passed, the disruption, meaning that they were actually able to disrupt not having health insurance or having under insurance, 90 percent of them were already in Medicare. So, we already have a model in this country of how non disruptive it is.

DR. SIDNEY WOLFE

http://www.pbs.org/moyers/journal/05222009/transcript2.html

[bigwillq]

40. But, but...it's the chess.

:eyes: