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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 11:14 AM
Original message
Sen. Conrad's desperate lie about reconciliation; Sen. Grassley makes no sense
Edited on Sun Aug-23-09 11:14 AM by ProSense
(CBS) Senator Charles Grassley (R-Iowa), the leading Republican in the Senate Finance Committee said House Speaker Nancy Pelosi should reconsider requiring a public option in health care legislation if she seeks any Republican support in Congress on "Face the Nation" Sunday.


"If you have a public option and you eventually get to only one option then there is no choices," he said.

Senator Kent Conrad, a North Dakota Democrat, has been on the record saying that if there is a public option in health care legislation it cannot pass the Senate.

"It is very clear that in the United States Senate the public option does not have the votes," Conrad said Bluntly. "If we have to get to sixty votes we cannot get there with the public option."

The membership controlled co-op alternative is "the only proposal that has bipartisan support and therefore going to get 60 votes," he argued.

Moderator Bob Schieffer asked about the possibility of a reconciliation - which would allow the Senate bypass the requirement of 60 votes.

Conrad said that while it was an option, "it does not work very well" and the strategy was designed for deficit reduction.


(emphasis added)

Wait, why the hell is Grassley commenting on what Pelosi should do? Conrad is proving that he is determined to stand in the way of a public option.

Five Democrats stand in the way of including a public option in the Finance Committee bill

Fuck 60 votes!

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panader0 Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 11:18 AM
Response to Original message
1. It shouldn't be about what the senators want
It should be about what their constituents want, and we want the public option, and by more than 60%. Wake up senators, and listen to those who elected you.
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John Q. Citizen Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 11:27 AM
Response to Original message
2. The only way to use reconciliation would be to split the legislation in half. You know
Clinton tried to go the reconciliation route in '93 and he couldn't.

The problem is that reconciliation has all kinds of limitations on it. All the stuff in the bill about insurance reform can't go through reconciliation. And even if a teensy tiny puny public option or a big beefy mega public option were passed separately through reconciliation, it's only good for what, four years before it has to go back and be passed the regular way? What good would that do? Before the big or small public option is even slated to begin, it would have to passed again.

You have to ask yourself ProSense, why doesn't Obama just say, "We will do it with reconciliation!" Why Doesn't Dodd just say "We will do it with reconciliation!"

The answer is because reconciliation won't work very well. So get pissed at Conrad for telling you the truth, or better yet, learn the truth yourself so you aren't in the position of finding it out from Conrad.

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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 11:39 AM
Response to Reply #2
3. "So get pissed at Conrad for telling you the truth..."
What truth?

Conrad is simply trying to sell his failed plan.

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drm604 Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 11:40 AM
Response to Reply #2
4. That's the first I've heard the four year thing.
Can you explain that further, or do you have a link?
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SpartanDem Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 12:35 PM
Response to Reply #4
6. Bush tax cuts for example are due to expire 2011
Edited on Sun Aug-23-09 12:38 PM by SpartanDem
they were passed under reconciliation. Sometimes we talk about budget reconciliation, which is what it's really called, as if were some magic procedure that let's us use 51 votes. Reconciliation was not meant to pass substantive legislation so for parts of the bill not effecting the budget the GOP could a file motion and if the Senate Parliamentarian finds then to be not germane they would stripped out of the bill.

Under the 1974 Congressional Budget Act, reconciliation bills were given special Senate protection and allowed to pass by simple majority votes, after limited debate, to give senators the ability to make the kinds of tough decisions required to cut the deficit.

At the same time, Senator Robert C. Byrd, the West Virginia Democrat and longtime protector of the prerogatives of the Senate, came up with a complex set of rules intended to impede those who would dare to use reconciliation to rewrite federal policy rather than produce budget savings.

Under the Byrd rule, provisions where the fiscal consequences are merely incidental to the true intent of the legislative provisions can be stricken from the bill unless 60 senators vote to waive the rule. Reconciliation measures are traditionally scoured for such provisions, in what is known around the Senate as giving the bill a Byrd bath.

Because Republicans would most likely be so incensed that Democrats were trying to force through a sweeping health plan by simple majority vote, they would no doubt challenge many elements of the bill and could strip them out.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 12:43 PM
Response to Reply #6
7. How many people will be willing to reverse reform?
Frankly, I'm not convinced the public option doesn't have 60 votes. Still, if passed via reconciliation, does anyone really think that it wouldn't be extended and made permanent?

Get it done.

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John Q. Citizen Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 01:06 PM
Response to Reply #7
9. Somebody has to actually introduce a public option in the house or senate first
before they can take it to reconciliation.

Do you know when someone is planning to do that?

And who will it be?
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 01:12 PM
Response to Reply #9
10. Disingenuous much?
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John Q. Citizen Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 01:43 PM
Response to Reply #10

I suggest reading the original at the url provided because it has all the links to document the analysis. I would very much appreciate you reading this analysis and then commenting on it. I'd like to hear if you agree with the authors conclusions or not, and why you do or don't agree with the authors conclusions. Thanks!

The Senate HELP Committee public option will be multiple options, and these will be run by insurance companies
Posted Friday, Aug 14, 2009

By Kip Sullivan, JD

When the Senate Health, Education, Labor and Pensions (HELP) Committee passed a bill on July 15 creating an anemic public option program, Health Care for America Now (HCAN) and other public option proponents were ecstatic. They welcomed the public option in the HELP committee bill, proclaiming it strong or robust. But the actual provisions in the HELP Committee bill call for numerous community health insurance options, not the single Medicare-like plan promised by public option advocates. That means the individual options will probably be as small and weak as the co-ops now under discussion in the Senate Finance Committee. More importantly, these community options will almost certainly be run by insurance companies.

Finding the HELP Committee bill

To determine what the HELP Committee public option proposal is, one must first find a final version of the legislation that came out of the committee. Ordinarily, that is not a difficult process. But for some reason, the HELP Committee bill still has no bill number and, three weeks after it was voted out of the HELP committee, still is not available for the public to read. That might sound like a sloppy way to run a Senate committee, but I have confirmed with two sources that there is no final bill available. An aide in the Washington office of Senator Al Franken (D-MN), with whom I spoke on August 7, referred me to the draft bill posted at the HELP Committees Website. At this Website, the draft bill appears in two pieces, one labeled the Affordable Health Choices Act and the other labeled the additional Chairmans mark on coverage. It is in the Chairmans mark segment of the bill, beginning at page 77, that we find Section 3106: Community health insurance option.

Summary of Section 3106 in semi-plain English

Section 3106 is difficult to read. It fails to offer clear definitions of critical terms, it uses different terms to describe the same thing, and it contains unnecessarily abstract language. Because it is poorly written, it requires at least two readings to understand it. I will tell you first what I derive from it in the plainest language possible, and then discuss some of its provisions so you can judge for yourself whether I got it right.

Section 3106 requires the Secretary of the Department of Health and Human Services (DHHS, the federal agency within which Medicare and Medicaid are housed) to create multiple health insurance companies that, together, will make public health insurance available for sale to the non-elderly in every state in the country. The Secretary will not be using federal employees to make this happen. The Secretary is required, rather, to contract with nonprofit insurance companies to create health insurance policies that will qualify as community health insurance options. (Some of the bills language seems to be confusing by design. What meaning is conveyed by adding community and options to health insurance?)

The corporations that contract with the Secretary to create these community health insurance companies will be required to meet the same standards insurance companies currently must meet in order to serve as Medicare Administrative Contractors (MACs) to administer Medicares traditional program. These corporations must, in other words, be insurance companies.

To get some idea of which insurance companies meet current MAC standards, and are therefore the ones likely to get contracts with the Secretary under the HELP Committee bill, consider this list of the companies that now have MAC contracts with the Centers for Medicare and Medicaid Services (CMS, the agency that runs Medicare):

Cahaba Government Benefit Administrators, a subsidiary of Blue Cross and Blue Shield of Alabama;
First Coast Service Options, a subsidiary of Blue Cross and Blue Shield of Florida;
Highmark Medical Services, a division of Highmark Blue Cross Blue Shield of Pennsylvania;
National Government Services, a subsidiary of WellPoint, the nations largest health insurance company measured by enrollment (as opposed to revenues);
National Heritage Insurance Corporation, which is a subsidiary of Electronic Data Systems (the firm Ross Perot founded) which is now a subsidiary of Hewlett Packard;
Noridian Administrative Services;
Palmetto GBA, a subsidiary of Blue Cross Blue Shield of South Carolina;
Pinnacle Business Solutions, a subsidiary of Blue Cross Blue Shield of Arkansas;
Trailblazer Health Enterprises, a subsidiary of Blue Cross Blue Shield of South Carolina;
Wisconsin Physicians Services Health Insurance Corporation.

Most of the large health insurance companies, such as United HealthCare and Cigna, have also held similar contracts in the past.

Now that Ive tried to explain Section 3106 in the Mother Tongue, it is time to immerse ourselves in the actual bill language. In the next section I review the language that indicates Section 3106 is proposing multiple options, not a single Medicare-like program. In the section after that I review the language that indicates the multiple options will be created by nonprofit insurance companies like Blue Cross Blue Shield.

Decoding Section 3106: Is it one option or multiple options?

Section 3106 proposes multiple options, not a single Medicare-like program, but this is not apparent at first. The first three sentences contradict each other. The very first sentence says there will be multiple options serving communities (not the whole country):

Nothing in this section shall be construed to require a health care provider to participate in a community health insurance option.

The second sentence says the same thing about individual patients and repeats the phrase a community health insurance option. These first two sentences indicate the HELP Committee is referring to an entity at the community level, not the national level, and the Committee anticipates there will be many of these entities, not just one of them.

But the third sentence confuses the reader by referring to the local entities as a single program:

The Secretary shall establish a community health insurance option to offer health care coverage throughout the United States.

But as we read on, we encounter provision after provision that indicates the HELP Committee definitely envisions a balkanized option. Some provisions reveal that intention by referring to options plural. Others reveal it by giving the states the authority to determine essential features of options sold within their boundaries, such as the required reserve levels and maximum benefits. A single national program cant have 50 different reserve requirements and 50 different benefit levels.

Here are two examples of the use of options plural in Section 3106: (1) Under a section entitled Applicable rules, we learn a previously enacted law shall apply to community health insurance options; and (2) a section entitled Ombudsman begins, In establishing community health insurance options, the Secretary shall.

Here are two examples of provisions giving the states authority to define key features of options: (1) The only sentence in a section entitled States may offer additional benefits reads, A state may require that a community health insurance option offered in such State offer benefits in addition to the essential health benefits required under ; and (2) under a section headed Solvency, we find, A community health insurance option shall be subject to the solvency standard of each State in which such community health insurance option is offered.

A patchwork of 50 different reserve requirements and 50 different benefit levels seems a far cry from public option proponents vision of a single, Medicare-like plan covering the whole country.

Decoding continued: Option means Blue Cross Blue Shield

The second major cause of confusion in Section 3106 is its use of four terms, all of them vague, to describe the insurance companies that will sell the options. The bill uses these four terms interchangeably: community health insurance option, qualified carrier, qualified entity, and contracting administrator.

A brief example: In subsection 1 of a section entitled Start-up Fund, the bill establishes a Health Benefit Plan Start-up Fund to provide loans for the initial operations of a community health insurance option. But subsection 2 says loan money from this fund is supposed to go to carriers, and subsection 3 says it shall go to contracting administrators. (Carriers is a term Medicare just phased out after four decades of use. The term referred to insurance companies which processed claims from doctors. Medicare now uses the term Medicare administrative contractors. The HELP Committees bill writers no doubt meant to refer to contracting administrators, not carriers. As I indicated above, contracting administrators will look almost exactly like the MACs that now serve Medicare.) Finally, subsection 5 says the loans must be repaid by the community health insurance option (not carriers or contracting administrators).

The only reasonable interpretation of this goulash is that insurance companies known as contracting administrators will be put in charge of creating health insurance companies all over the country that will contain community health insurance in their titles.

This interpretation is confirmed by subsequent provisions in Section 3106. In a section entitled Authority to contract, the bill says the Secretary may enter into a contract with a qualified entity to perform the same duties MACs perform for Medicare, and once this contract has been signed the entity becomes a contracting administrator. (These contracts must last at least five years and may not last more than ten years.) In addition to meeting the MAC standards, contracting administrators have to be:

able to offer a community health insurance option;
eligible to offer health insurance (I assume this strange phrasing means the insurance company is licensed in the state where it hopes to sell options);
able to achieve delivery of benefits; and
able to promot high quality clinical care.

The requirement that the contracting insurers be able to promote high quality clinical care is a tip-off that the HELP Committee wants the insurance companies that will run the community options to use managed care cost-control tactics. A second tip-off is that Section 3106 does not guarantee patients the right to choose their own clinic and hospital. Instead the bill only requires that a community insurer will be one that offers a wide choice of providers. In short, an entity that meets the MAC standards plus the additional criteria in Section 3106 amounts to your basic, non-profit managed care insurance company. The big ones these days include many Blue Cross Blue Shield companies and the nonprofit HMOs such as Kaiser Permanente, Group Heath of Puget Sound, and HealthPartners.

The only conceivable development that could keep existing non-profit insurance companies from winning the contracts to develop and run the community options would be the birth of dozens of non-profit companies with the expertise of insurance companies between the time Section 3106 becomes law and the time the law takes effect. In theory, that could happen. But it is extremely unlikely. It is unlikely because of the short time period between the date Section 3106 is enacted and the time it takes effect, and because of the difficulty of creating corporations with the expertise to create health insurance companies.

Section 3106 does contain language that should please HCAN and other public option advocates who were expecting the HELP Committee to endorse a Medicare-like option. In two places, Section 3106 says the Secretary shall negotiate provider rates. But without a guarantee that the options in each state will enroll tens or hundreds of thousands of people, and without a requirement that providers participate, this is a meaningless provision.

This leads me to my last observation about Section 3106. How are contracting administrators supposed to create a customer base and a network of providers? Can they do it with whatever loans will be made available to them from the Start-up Fund? Section 3106 offers no answers to these questions.


If my interpretation of Section 3106 is correct if the Senate HELP Committees option program is going to be balkanized and run by the nonprofit wing of the insurance industry then reasonable people have to conclude that the deck is really stacked against the Committees option program. Even if Section 3106 authorized public employees, not Blue Cross Blue Shield employees, to create the dozens or hundreds of community health insurance options called for by Section 3106, the program would fail to pose any challenge to the insurance industry and might even die in the cradle. The health insurance industry has been very difficult to break into since at least the 1980s, and has become more so in the wake of the merger madness that swept through the industry in the early 1990s. But if public employees are not going to be directly responsible for creating the community options if the nonprofit wing of the insurance industry is going to be doing that then the entire community option project of the Senate HELP Committee amounts to a cruel joke on the public. Should the public trust corporations like Blue Cross and Kaiser Permanente to make a good faith effort to build competing insurance companies?

Section 3106 is a mess, but its meaning becomes clear after several readings. Section 3106 does not create the Medicare-like program promised by Jacob Hacker, HCAN, Howard Dean, and other option advocates. Instead it proposes a program that authorizes DHHS to create numerous health insurance companies tied to geographic areas, and to contract with members of the existing insurance industry to create and possibly run those companies.

Leaders of the public option movement have an obligation to advertise the HELP Committee bill truthfully. It is not accurate to say the HELP Committee bill creates a robust or strong public option. It is not even accurate to say the HELP Committee bill creates one option. The truth is the option is balkanized and very weak. In fact, HCAN, Andy Stern, Howard Dean and other option advocates who have praised the HELP Committee bill should do more than cease to praise it. They should tell Congress they oppose it.

Kip Sullivan is a member of the steering committee of the Minnesota Chapter of Physicians for a National Health Program.

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John Q. Citizen Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 12:58 PM
Response to Reply #4
8. I've been looking but I haven't found it. I think I read it yesterday but i can't
remember where.

If I run across it I'll PM you, if it's in the next few days.

Dang, now I'm wondering myself "Where did I read thet?"
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drm604 Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 02:36 PM
Response to Reply #8
13. Actually, it does make some sense.
If budgets are only valid for four years then anything passed under budget reconciliation would only be good for that long.

The question is whether or not it would be made permanent before then. If it were to actually provide good coverage at a reasonable price and lots of people were to take advantage of it, then it would be hard politically to not make it permanent.

Another question is whether or not it could be done in a way that would be acceptable to the parliamentarian. I've heard that if they simply open up Medicare to anyone who wants to buy in, that could legitimately be considered to be relevant to the budget. I'm not sure if that's correct or not.
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John Q. Citizen Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 03:06 PM
Response to Reply #13
14. One problem is that as wrtten, the public option won't starrt until 2013, So it wouldn't
have any time to be tried out before it would need to be reauthorized. That's in HR3200 by the way.
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drm604 Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 03:18 PM
Response to Reply #14
15. I assume that they would change that if they tried to make it a budget item.
It wouldn't make much sense otherwise.

If they were to simply open up Medicare, then I would think that it could be started up pretty quickly since the infrastructure is already in place.
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John Q. Citizen Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 03:28 PM
Response to Reply #15
16. Yes
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Cha Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 11:42 AM
Response to Original message
5. Thanks , Pro Sense for you
work on this..a few around here trying to keep it really real.
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grantcart Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 02:06 PM
Response to Original message
12. Conrad is about to find out just how focues the House of Representatives can be

He has fallen into a trap and knows that he is about to be a party of 3 or 4

How does it feel to be all alone Mr. Conrad.
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