Insuring Resources Commentary:
As the Dept of Health and Human Services begins the process of developing the administrative rules to implement the PPACA the industry and advocates are gearing up to influence this process.
The article below discusses the implementation of the Medicaid expansion, the temporary high risk pools, the fines, and the numerous pilot programs that the PPACA authorizes. The federal HHS will also need to set up the rules for the COOP programs (which the articel below fails to mention). That program authorizes the creation of Consumer Operated and Oriented Plans (COOPs) ---- these are non-profit health plans that can be created in states using federal grant funds. These grants will allow the creation of the COOPs by 71/1/2013.
WISCONSIN:
In Wisconsin I'll be heavily involved as the Commissioner of Insurance has stated that his Health Insurance Advisory council (which I am appointed to) will play a large role in advising OCI on implementation of its rules.
For instance, the PPACA requires each state to establish an Ombudsman office to aide consumers in navigating the State Health Insurance Exchanges. The OCI will also develop the rules regarding the implementation of both state-based Exchanges. The Small business Health Options Program (SHOP) is a state- based exchange for small businesses. In addition there will be a Health Insurance Exchange for individuals to gain access to insurance if they don't have employer-based coverage.
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Next phase in health care war: Applying the law
Cabinet braces for lobbying blitz by industry advocates
April 27, 2010
By John Fritze
USA TODAY
WASHINGTON — The debate in Congress over President Obama's health care law is done. The battle over how to carry out the law is just getting started.
Dozens of special-interest groups that helped shape the 10-year, $938 billion health care measure over the past year — from insurance companies to patient advocates — are gearing up for a second wave of lobbying as the Obama administration prepares to implement the law.
The U.S. Chamber of Commerce, which opposed the measure in Congress, is fighting to protect businesses that might be required to provide insurance, for instance. Drugmakers who supported the bill are monitoring how much they may have to discount prices.
Watchdog groups say patients can get lost in the lobbying blitz. "Industry dominates this process even more than they dominate the legislative process," said Robert Weissman of Public Citizen. "It's more of an inside game."
Congress gave sweeping power to federal agencies, especially the Department of Health and Human Services, to fill in gaps lawmakers left in the 906-page legislation — an effort that will take years. The law refers more than 1,000 times to Cabinet secretaries who will make decisions on how to carry out the law.
For example, the law requires insurance companies to spend 80% of premiums on medical claims, as opposed to administrative costs, by 2011. But it directs the health department to decide whether gray-area expenses, such as health-and-wellness programs offered by insurers, count as care or overhead.
Karen Ignagni, president of the industry group America's Health Insurance Plans, said her staff is "already geared up" and is providing data and suggestions on that and other issues to the department. But, she said, agencies implementing the law will weigh many arguments before making a decision.
"I don't think regulators are influenced by the classic sense of lobbying," she said. "There's a level playing field."
Unlike the legislative process, much of the battle over regulations takes place behind the scenes, Weissman said. The public may comment on proposed decisions, but many groups try to gain access to decision-makers early on, he said.
The health department declined to discuss industry attempts to influence implementation, but Secretary Kathleen Sebelius said in a statement that the department is "working closely with states, insurers, providers and other partners. … We want to hear from everyone."
Other looming battles over the new law include: •The health department must create high-risk insurance plans to provide temporary coverage for people with pre-existing conditions. Private insurers are watching to make sure those plans don't affect their bottom line, said Mark Pauly, a University of Pennsylvania health economist.
•Firms with more than 50 full-time employees would face fines in 2014 if they don't provide health insurance to workers. The Treasury Department must determine who qualifies as a full-time employee, a decision that will affect businesses on the edge of the 50-worker threshold. "We really have to make our case early," said Randel Johnson with the U.S. Chamber of Commerce.
•Health department officials must develop a review process to judge dozens of pilot programs created in the law — and decide whether they should be expanded. The National Partnership for Women & Families, a patient-advocacy group, wants the process to take quality of care into account. "It can't just be about saving money," the group's president, Debra Ness, said. "We also want to make sure they deliver better care."
Health care interests spent heavily on lobbyists as the legislation worked its way through Congress. In all, health industries spent $652 million in 2009, up 14% from 2008, according to the non-partisan CQ Moneyline.
Last year, the Obama administration passed a sweeping series of rules requiring federal agencies to disclose contacts their officials had with lobbyists about the economic stimulus. Similar rules do not exist for the health care law.
"We all want to … meet with folks to describe some of the issues and concerns we think need to be navigated," said Ron Pollack of Families USA, which supports the law. "I have no doubt that industry and others are going to be doing the same thing."
Showing posts with label Co-ops. Show all posts
Showing posts with label Co-ops. Show all posts
Tuesday, April 27, 2010
Monday, September 21, 2009
564 amendments proposed to Baucus plan
Highlights, not all 564, are listed below
Source: Bloomberg.com
Sept. 21 Senate Finance Committee members signaled an aggressive effort to reshape health-care legislation proposed by Chairman Max Baucus, drafting 564 amendments for consideration when the panel meets this week.
Members of both parties want to make a host of changes to legislation designed to lower costs and expand coverage to the uninsured that Baucus introduced last week. They include expanding tax subsidies for low-income people to buy coverage, eliminating a proposed $215 billion tax on high-value health plans, and setting up a government-run insurance program to compete with private industry.
Baucus Plan Overview
Requires almost all Americans to have insurance or pay a penalty, expand Medicaid and provide subsidies to help millions of low-income people get coverage through an online exchange.
The nonpartisan Congressional Budget Office says his plan would lower the budget deficit over 10 years. It utilizes nonprofit cooperatives rather than a government program to compete against insurers, and drops a mandate that all employers provide health care to workers.
To pay for his plan, Baucus seeks savings in programs such as Medicare, the federal insurance plan for the elderly, and new taxes. He’s proposing a levy on costly “Cadillac” health plans and about $13 billion in fees on insurers, medical-device manufacturers, drugmakers and clinical laboratories.
Amendments proposed
Senator Olympia Snowe, a Maine Republican would create a government entity to provide insurance in any state unless coverage is deemed affordable to at least 95 percent of the residents. Coverage is judged unaffordable if the cost of premiums exceeds a percentage of a person’s income, ranging from 3 percent for those at 133 percent of the poverty level to 13 percent for those at 300 percent of the poverty level and above.
Public Option
Senator Jay Rockefeller, a West Virginia Democrat, is proposing to replace the nonprofit cooperatives with a government-run plan. Democratic senators Charles Schumer of New York and Maria Cantwell of Washington favor setting up a public program, with rules that require the Medicare-like system to compete on a more level playing field with private industry.
Rockefeller also wants to require that a series of insurance market regulatory changes -- including a ban on coverage exclusions for pre-existing conditions -- apply to plans offered by self-insured employers.
He wants to increase the number of uninsured who would qualify for Medicaid coverage. Baucus supports boosting the threshold for coverage to 133 percent of the poverty level; Rockefeller wants to lift that to 150 percent.
Tax Subsidies
Democratic Senator Ron Wyden of Oregon is seeking tax subsidies for insurance purchases available to those earning as much as 400 percent of the federal poverty level, rather than 300 percent as in the Baucus plan. Poverty guidelines for 2009 are $10,830 for an individual and $22,050 for a family of four, according to the Department of Health and Human Services.
Senator Robert Menendez, a New Jersey Democrat, is joining three other Democrats in a proposal to ensure that anyone below the 400 percent threshold who is utilizing either a subsidy or tax credit will pay no more than 10 percent of their income before getting the aid. Baucus has a maximum of 13 percent of income for some consumers at the top end of a sliding scale.
Baucus’s proposed new tax on high-valued insurance plans would be pared back under a proposal by Senator John Kerry, a Massachusetts Democrat. While Baucus imposes a 35 percent excise tax on plans valued at $8,000 for individuals and $21,000 for family coverage, Kerry wants to raise the threshold to $9,800 for individuals and $25,000 for families. He would offset the lost revenue by raising the excise tax to 40 percent and closing corporate tax loopholes.
Republican Changes
On the Republican side, lawmakers are taking aim at tax increases and industry fees. Senator Charles Grassley of Iowa, the top Republican on the committee, wants to eliminate $13 billion in fees that would be imposed on the insurance, pharmaceutical, clinical laboratory and medical-device sectors. He would offset that by tapping funds approved as part of this year’s economic-stimulus measure that haven’t yet been spent.
Senator Mike Enzi, a Wyoming Republican, wants to block any expansion of Medicaid that results in cost increases for states. Senator Orrin Hatch, a Utah Republican, wants to cut the Medicaid expansion altogether, as well as the cooperatives -- which under Baucus’s proposal get $6 billion in federal start-up funds.
Jon Kyl of Arizona is offering a requirement that legal immigrants show proof they have lived in the U.S. for at least five years before getting government help to buy insurance.
Baucus has the benefit of numbers in his favor. The committee is comprised of 13 Democrats and 10 Republicans. He and two other Democrats -- Kent Conrad of North Dakota and Jeff Bingaman of New Mexico -- could be a decisive swing bloc of votes against changes if many of the matters are otherwise decided on party lines.
Source: Bloomberg.com
Sept. 21 Senate Finance Committee members signaled an aggressive effort to reshape health-care legislation proposed by Chairman Max Baucus, drafting 564 amendments for consideration when the panel meets this week.
Members of both parties want to make a host of changes to legislation designed to lower costs and expand coverage to the uninsured that Baucus introduced last week. They include expanding tax subsidies for low-income people to buy coverage, eliminating a proposed $215 billion tax on high-value health plans, and setting up a government-run insurance program to compete with private industry.
Baucus Plan Overview
Requires almost all Americans to have insurance or pay a penalty, expand Medicaid and provide subsidies to help millions of low-income people get coverage through an online exchange.
The nonpartisan Congressional Budget Office says his plan would lower the budget deficit over 10 years. It utilizes nonprofit cooperatives rather than a government program to compete against insurers, and drops a mandate that all employers provide health care to workers.
To pay for his plan, Baucus seeks savings in programs such as Medicare, the federal insurance plan for the elderly, and new taxes. He’s proposing a levy on costly “Cadillac” health plans and about $13 billion in fees on insurers, medical-device manufacturers, drugmakers and clinical laboratories.
Amendments proposed
Senator Olympia Snowe, a Maine Republican would create a government entity to provide insurance in any state unless coverage is deemed affordable to at least 95 percent of the residents. Coverage is judged unaffordable if the cost of premiums exceeds a percentage of a person’s income, ranging from 3 percent for those at 133 percent of the poverty level to 13 percent for those at 300 percent of the poverty level and above.
Public Option
Senator Jay Rockefeller, a West Virginia Democrat, is proposing to replace the nonprofit cooperatives with a government-run plan. Democratic senators Charles Schumer of New York and Maria Cantwell of Washington favor setting up a public program, with rules that require the Medicare-like system to compete on a more level playing field with private industry.
Rockefeller also wants to require that a series of insurance market regulatory changes -- including a ban on coverage exclusions for pre-existing conditions -- apply to plans offered by self-insured employers.
He wants to increase the number of uninsured who would qualify for Medicaid coverage. Baucus supports boosting the threshold for coverage to 133 percent of the poverty level; Rockefeller wants to lift that to 150 percent.
Tax Subsidies
Democratic Senator Ron Wyden of Oregon is seeking tax subsidies for insurance purchases available to those earning as much as 400 percent of the federal poverty level, rather than 300 percent as in the Baucus plan. Poverty guidelines for 2009 are $10,830 for an individual and $22,050 for a family of four, according to the Department of Health and Human Services.
Senator Robert Menendez, a New Jersey Democrat, is joining three other Democrats in a proposal to ensure that anyone below the 400 percent threshold who is utilizing either a subsidy or tax credit will pay no more than 10 percent of their income before getting the aid. Baucus has a maximum of 13 percent of income for some consumers at the top end of a sliding scale.
Baucus’s proposed new tax on high-valued insurance plans would be pared back under a proposal by Senator John Kerry, a Massachusetts Democrat. While Baucus imposes a 35 percent excise tax on plans valued at $8,000 for individuals and $21,000 for family coverage, Kerry wants to raise the threshold to $9,800 for individuals and $25,000 for families. He would offset the lost revenue by raising the excise tax to 40 percent and closing corporate tax loopholes.
Republican Changes
On the Republican side, lawmakers are taking aim at tax increases and industry fees. Senator Charles Grassley of Iowa, the top Republican on the committee, wants to eliminate $13 billion in fees that would be imposed on the insurance, pharmaceutical, clinical laboratory and medical-device sectors. He would offset that by tapping funds approved as part of this year’s economic-stimulus measure that haven’t yet been spent.
Senator Mike Enzi, a Wyoming Republican, wants to block any expansion of Medicaid that results in cost increases for states. Senator Orrin Hatch, a Utah Republican, wants to cut the Medicaid expansion altogether, as well as the cooperatives -- which under Baucus’s proposal get $6 billion in federal start-up funds.
Jon Kyl of Arizona is offering a requirement that legal immigrants show proof they have lived in the U.S. for at least five years before getting government help to buy insurance.
Baucus has the benefit of numbers in his favor. The committee is comprised of 13 Democrats and 10 Republicans. He and two other Democrats -- Kent Conrad of North Dakota and Jeff Bingaman of New Mexico -- could be a decisive swing bloc of votes against changes if many of the matters are otherwise decided on party lines.
Wednesday, September 16, 2009
Baucus health plan released
Analysis of the key issues-
Pre-existing conditions are eliminated. Okay, that's a no-brainer.
Businesses are not mandated to provide coverage but instead must defray the cost of its employees share. This seems to be a potential administrative nightmare for small businesses. I'll need to look into this very closely. Shouldn't reform make it easier on businesses? What is the encourage ment for them to join the co-ops?
Public Option is nixed- Instead Baucus proposes nonprofit consumer-owned cooperatives. This is a non-issue if they pay the contracted doctors a salary instead of on a fee-for-service basis and put LEAN processes in place. But, why do I have a nagging feeling that they'll get this wrong and set up EVERYTHING on a fee reimbursement basis? Fee reimbursement would only cause health care costs to skyrocket at an even faster pace than we've seen before?
Penalty for non-purchase of health insurance- The devil is in the details on this as I have to research how this will interplay with the non-profit coops. What are the eligibility standards for getting into the co-op insurance, for instance?
Republicans- Every indication appears that few Republicans will support the Baucus plan yet it offers numerous concessions and seriously waters down true reform. The fact that there is no business mandate but instread allows defraying of employee costs just seems ridiculous on its face and thus requires me to do a lot of digging.
As always, stay tuned-in and please provide your feedback to your legislators. I really believe the next three months will be the most important in congress since the mid-60's when we saw the Civil Rights Act and the Great Society legislation.
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Soure: Politico.com
Senate Finance Committee chairman Max Baucus (D-Mont.) proposed an $856 billion plan Wednesday to overhaul the health care system, releasing a bill after months of bipartisan negotiations without any immediate Republican support.
The bill forces insurance companies to change the way they do business, such as prohibiting them from dropping or denying coverage based on preexisting conditions. To force competition with private insurers, Baucus chose creating nonprofit consumer-owned cooperatives over the public insurance option, which most Democrats prefer.
“This is a unique moment in history where we can finally reach an objective so many of us have sought for so long,” Baucus said in a statement. “We worked to build a balanced, common-sense package that ensures quality, affordable coverage and doesn’t add a dime to the deficit.”
The long-awaited bill sets off a battle over what could be the shape of a health reform deal that wins at least one or two Republicans votes in the Senate. By trying to add measures to appeal to some Democrats and some Republicans, Baucus has managed to upset all sides. But what he came up with could be viewed as the kind of balanced approach that threads the needle to achieve a final compromise.
None of the three Republicans involved in the bipartisan negotiations have signed onto the bill, saying there are outstanding issues that need to be resolved. But they said they would continue talking with Baucus and the other two Democrats in the so-called Gang of Six.
The lack of Republican support — at the outset, at least — suggests Democrats will need to make more concessions if they hope to produce a bipartisan bill. Otherwise, the Senate leadership may have to use a last-ditch procedural maneuver known as reconciliation to move the bill through the chamber with 51 votes.
The absence of Republicans could also damage President Barack Obama's efforts to convince Americans that his reform plan has broad support.
The Finance Committee markup is expected to begin Tuesday. Baucus will meet Thursday with the full committee, and amendments will be due Friday at 5 p.m.
The Baucus plan is a more conservative approach than those produced by three committees in the House and by the Senate's Health, Education, Labor and Pensions Committee, but it tracks closely with the concepts that Obama promoted in his speech to Congress last week. The bill is deficit neutral and fully paid for, and less costly than bills approved by other committees.
Baucus chose an alternative to the public insurance option – nongovernmental consumer cooperatives – to provide competition with private insurers.
The bill requires individuals to buy insurance, or else face penalties as high as $3,800 for a family. It would not mandate businesses to provide coverage for their employees – as the House bills do – but it would require them to defray the cost of any government subsidies for which their employees would qualify.
To pay for the overhaul, the legislation calls for imposing a 35 percent excise tax on high-end insurance plans, assessing fees on industry players, including device manufacturers, insurers and clinical laboratories, and making a series of tax code changes.
The bill expands Medicaid coverage to include adults whose incomes are 133 percent above the poverty line, and requires states to pick up more of the tab for the federal-state cost-sharing program. Government subsidies would be available to families between 100 percent and 300 percent of the poverty line to purchase insurance plans through a new marketplace known as an exchange.
For families with incomes 300 percent and 400 percent of poverty, their annual premiums would be capped at 13 percent of their income. It’s a level that Sen. Ron Wyden (D-Ore.) says is too high, but it would be less than the current average cost of a family insurance plan, which is $13,375, according to the Kaiser Family Foundation.
Sen. Olympia Snowe (R-Maine), the likeliest Republican to support the bill, said she is waiting for cost estimates from the Congressional Budget Office, which she has not yet seen.
Sen. Chuck Grassley (R-Iowa) released a statement Tuesday that was silent on his ultimate decision, but the tone of his message does not bode well for Baucus’s hopes of bringing him on board.
He ticked off a long list of concerns, saying the bill “does not meet the shared goals for affordable, accessible health coverage,” and it does not resolve outstanding issues dealing with abortion and illegal immigration. He suggested the bill does not include his alternative proposal to the individual mandate, nor does it include stronger medical liability reform measures he had pushed.
“We’ve been clear from the start that we’re willing to stay at the table,” Grassley said. “There’s no reason not to keep working until we get it right. In the end, legislation that impacts every American should have strong bipartisan support.”
Pre-existing conditions are eliminated. Okay, that's a no-brainer.
Businesses are not mandated to provide coverage but instead must defray the cost of its employees share. This seems to be a potential administrative nightmare for small businesses. I'll need to look into this very closely. Shouldn't reform make it easier on businesses? What is the encourage ment for them to join the co-ops?
Public Option is nixed- Instead Baucus proposes nonprofit consumer-owned cooperatives. This is a non-issue if they pay the contracted doctors a salary instead of on a fee-for-service basis and put LEAN processes in place. But, why do I have a nagging feeling that they'll get this wrong and set up EVERYTHING on a fee reimbursement basis? Fee reimbursement would only cause health care costs to skyrocket at an even faster pace than we've seen before?
Penalty for non-purchase of health insurance- The devil is in the details on this as I have to research how this will interplay with the non-profit coops. What are the eligibility standards for getting into the co-op insurance, for instance?
Republicans- Every indication appears that few Republicans will support the Baucus plan yet it offers numerous concessions and seriously waters down true reform. The fact that there is no business mandate but instread allows defraying of employee costs just seems ridiculous on its face and thus requires me to do a lot of digging.
As always, stay tuned-in and please provide your feedback to your legislators. I really believe the next three months will be the most important in congress since the mid-60's when we saw the Civil Rights Act and the Great Society legislation.
------- ------- -------- --------
Soure: Politico.com
Senate Finance Committee chairman Max Baucus (D-Mont.) proposed an $856 billion plan Wednesday to overhaul the health care system, releasing a bill after months of bipartisan negotiations without any immediate Republican support.
The bill forces insurance companies to change the way they do business, such as prohibiting them from dropping or denying coverage based on preexisting conditions. To force competition with private insurers, Baucus chose creating nonprofit consumer-owned cooperatives over the public insurance option, which most Democrats prefer.
“This is a unique moment in history where we can finally reach an objective so many of us have sought for so long,” Baucus said in a statement. “We worked to build a balanced, common-sense package that ensures quality, affordable coverage and doesn’t add a dime to the deficit.”
The long-awaited bill sets off a battle over what could be the shape of a health reform deal that wins at least one or two Republicans votes in the Senate. By trying to add measures to appeal to some Democrats and some Republicans, Baucus has managed to upset all sides. But what he came up with could be viewed as the kind of balanced approach that threads the needle to achieve a final compromise.
None of the three Republicans involved in the bipartisan negotiations have signed onto the bill, saying there are outstanding issues that need to be resolved. But they said they would continue talking with Baucus and the other two Democrats in the so-called Gang of Six.
The lack of Republican support — at the outset, at least — suggests Democrats will need to make more concessions if they hope to produce a bipartisan bill. Otherwise, the Senate leadership may have to use a last-ditch procedural maneuver known as reconciliation to move the bill through the chamber with 51 votes.
The absence of Republicans could also damage President Barack Obama's efforts to convince Americans that his reform plan has broad support.
The Finance Committee markup is expected to begin Tuesday. Baucus will meet Thursday with the full committee, and amendments will be due Friday at 5 p.m.
The Baucus plan is a more conservative approach than those produced by three committees in the House and by the Senate's Health, Education, Labor and Pensions Committee, but it tracks closely with the concepts that Obama promoted in his speech to Congress last week. The bill is deficit neutral and fully paid for, and less costly than bills approved by other committees.
Baucus chose an alternative to the public insurance option – nongovernmental consumer cooperatives – to provide competition with private insurers.
The bill requires individuals to buy insurance, or else face penalties as high as $3,800 for a family. It would not mandate businesses to provide coverage for their employees – as the House bills do – but it would require them to defray the cost of any government subsidies for which their employees would qualify.
To pay for the overhaul, the legislation calls for imposing a 35 percent excise tax on high-end insurance plans, assessing fees on industry players, including device manufacturers, insurers and clinical laboratories, and making a series of tax code changes.
The bill expands Medicaid coverage to include adults whose incomes are 133 percent above the poverty line, and requires states to pick up more of the tab for the federal-state cost-sharing program. Government subsidies would be available to families between 100 percent and 300 percent of the poverty line to purchase insurance plans through a new marketplace known as an exchange.
For families with incomes 300 percent and 400 percent of poverty, their annual premiums would be capped at 13 percent of their income. It’s a level that Sen. Ron Wyden (D-Ore.) says is too high, but it would be less than the current average cost of a family insurance plan, which is $13,375, according to the Kaiser Family Foundation.
Sen. Olympia Snowe (R-Maine), the likeliest Republican to support the bill, said she is waiting for cost estimates from the Congressional Budget Office, which she has not yet seen.
Sen. Chuck Grassley (R-Iowa) released a statement Tuesday that was silent on his ultimate decision, but the tone of his message does not bode well for Baucus’s hopes of bringing him on board.
He ticked off a long list of concerns, saying the bill “does not meet the shared goals for affordable, accessible health coverage,” and it does not resolve outstanding issues dealing with abortion and illegal immigration. He suggested the bill does not include his alternative proposal to the individual mandate, nor does it include stronger medical liability reform measures he had pushed.
“We’ve been clear from the start that we’re willing to stay at the table,” Grassley said. “There’s no reason not to keep working until we get it right. In the end, legislation that impacts every American should have strong bipartisan support.”
Tuesday, September 8, 2009
More specifics on Baucus compromise proposal
See the AP article below as there are more details emerging on Sen. Max Baucus' health care reform proposal. Baucus is a Montana moderate Democrat who chairs the Senate Finance Comm.
My Analysis-
When we consider many families of four now pay $400-500 monthly premium for their employee share AND are faced with annual deductibles of $5,000 - $3800 doesn't seem so bad. Likewise for an individual earning a decent income a $950 "fine" seems reasonable.
Again, and I'm getting tired of arguing this... the focus is on the WRONG issues. The public plan option is not the most important issue. There are better ways to drive down costs- get rid of the waste by mandating LEAN processes. It has proven to work in countless health plans from Washington state to Wisconsin and elsewhere. Make it a nationwide mandate by 2015.
In addition, does the Baucus plan eliminate pre-x conditions and individual underwriting? The article and the press at large again miss the target.
Obama must address the real issues when he attempts to re-frame the debate Wednesday evening. He must focus on eliminating pre-x and wasteful medical procedures and taks that do nothing to enhance quality care. It isn't a cost-effectiveness argument. Its pure waste that impedes quality.
-------------------------------------------------------
New plan in Congress says those who go without health insurance face fines up to $3,800
WASHINGTON From the Associated Press-- Sept 8, 2009
Americans who don't get health insurance once the system is overhauled would be fined up to $3,800 under a proposal that circulated in Congress on Tuesday as Democratic leaders cast doubt on prospects for creating a government-run insurance plan.
President Barack Obama prepared what he hoped would be a game-changing speech to a joint session of Congress on Wednesday, his top domestic priority in the balance.
After a month of contentious forums, Americans were seeking specifics from the president. So were his fellow Democrats, divided on how best to solve the problem of the nation's nearly 50 million uninsured.
A government health-insurance option overwhelmingly favored by liberal Democrats appeared to be losing critically needed support.
Into the breach: a bipartisan compromise that Sen. Max Baucus, D-Mont., a moderate who heads the influential Finance Committee, was trying to broker.
Baucus, meeting with a small group of fellow senators, promoted a plan that would guarantee coverage for nearly all Americans at a cost to taxpayers of under $900 billion over 10 years.
Some experts consider that a relative bargain because the country now spends about $2.5 trillion a year on health care. But it would require hefty fees on insurers, drug companies and others in the health care industry to help pay for it.
Just as auto coverage is now mandatory, so would a requirement that all Americans get health insurance. Penalties for failing to get insurance would start at $750 a year for individuals and $1,500 for families. Households making more than three times the federal poverty level - about $66,000 for a family of four - would face the maximum fines. For families, it would be $3,800, and for individuals, $950.
Baucus would offer tax credits to help pay premiums for households making up to three times the poverty level, and for small employers paying about average middle-class wages. People working for companies that offer coverage could avoid the fines by signing up.
The proposed fines pose a dilemma for Obama. As a candidate, the president campaigned hard against making health insurance a requirement, and fining people for not getting it.
"Punishing families who can't afford health care to begin with just doesn't make sense," he said during his party's primaries. At the time, he proposed mandatory insurance only for children.
White House officials have since backed away somewhat from Obama's opposition to mandated coverage for all, but there's no indication that Obama would support fines.
One idea that Obama championed during and since the campaign - a government insurance option - appeared to be sinking fast.
House Majority Leader Steny Hoyer, D-Md., told reporters a Medicare-like plan for middle-class Americans and their families isn't an essential part of legislation for him. Hoyer's comments came shortly after a key Democratic moderate said he could no longer back a bill that includes a new government plan.
The fast-moving developments left liberals in a quandary. They've drawn a line, saying they won't vote for legislation if it doesn't include a public plan to compete with private insurance companies and force them to lower costs.
Rep. Mike Ross, D-Ark., who once supported a public option, said Tuesday that after hearing from constituents during the August recess, he's changed his mind.
"If House leadership presents a final bill that contains a government-run public option, I will oppose it," Ross said.
Obama's commitment to a public plan has been in question and lawmakers hoped his speech to Congress would make his position on that clear.
He's called a public plan an important tool to help check the excesses of private industry. But his aides suggested on the weekend that he could sign legislation even if it does not include a public option.
In the Senate, the public plan is not part of Baucus' proposal. He's calling for nonprofit co-ops to compete in the marketplace instead.
An 18-page summary of the Baucus proposal was obtained by The Associated Press. The complex plan would make dozens of changes in the health care system, many of them contentious. For example, it includes new fees on insurers, drug companies, medical device manufacturers and clinical labs.
It would require insurers to take all applicants, regardless of age or health. But smokers could be charged higher premiums. And 60-year-olds could be charged five times as much for a policy as 20-year-olds.
People working for major employers would probably not see big changes. The plan is geared to helping those who now have the hardest time getting and keeping coverage: the self-employed and small business owners. New purchasing pools would be set up in each state, allowing them to band together and get some of the advantages big companies now have.
My Analysis-
When we consider many families of four now pay $400-500 monthly premium for their employee share AND are faced with annual deductibles of $5,000 - $3800 doesn't seem so bad. Likewise for an individual earning a decent income a $950 "fine" seems reasonable.
Again, and I'm getting tired of arguing this... the focus is on the WRONG issues. The public plan option is not the most important issue. There are better ways to drive down costs- get rid of the waste by mandating LEAN processes. It has proven to work in countless health plans from Washington state to Wisconsin and elsewhere. Make it a nationwide mandate by 2015.
In addition, does the Baucus plan eliminate pre-x conditions and individual underwriting? The article and the press at large again miss the target.
Obama must address the real issues when he attempts to re-frame the debate Wednesday evening. He must focus on eliminating pre-x and wasteful medical procedures and taks that do nothing to enhance quality care. It isn't a cost-effectiveness argument. Its pure waste that impedes quality.
-------------------------------------------------------
New plan in Congress says those who go without health insurance face fines up to $3,800
WASHINGTON From the Associated Press-- Sept 8, 2009
Americans who don't get health insurance once the system is overhauled would be fined up to $3,800 under a proposal that circulated in Congress on Tuesday as Democratic leaders cast doubt on prospects for creating a government-run insurance plan.
President Barack Obama prepared what he hoped would be a game-changing speech to a joint session of Congress on Wednesday, his top domestic priority in the balance.
After a month of contentious forums, Americans were seeking specifics from the president. So were his fellow Democrats, divided on how best to solve the problem of the nation's nearly 50 million uninsured.
A government health-insurance option overwhelmingly favored by liberal Democrats appeared to be losing critically needed support.
Into the breach: a bipartisan compromise that Sen. Max Baucus, D-Mont., a moderate who heads the influential Finance Committee, was trying to broker.
Baucus, meeting with a small group of fellow senators, promoted a plan that would guarantee coverage for nearly all Americans at a cost to taxpayers of under $900 billion over 10 years.
Some experts consider that a relative bargain because the country now spends about $2.5 trillion a year on health care. But it would require hefty fees on insurers, drug companies and others in the health care industry to help pay for it.
Just as auto coverage is now mandatory, so would a requirement that all Americans get health insurance. Penalties for failing to get insurance would start at $750 a year for individuals and $1,500 for families. Households making more than three times the federal poverty level - about $66,000 for a family of four - would face the maximum fines. For families, it would be $3,800, and for individuals, $950.
Baucus would offer tax credits to help pay premiums for households making up to three times the poverty level, and for small employers paying about average middle-class wages. People working for companies that offer coverage could avoid the fines by signing up.
The proposed fines pose a dilemma for Obama. As a candidate, the president campaigned hard against making health insurance a requirement, and fining people for not getting it.
"Punishing families who can't afford health care to begin with just doesn't make sense," he said during his party's primaries. At the time, he proposed mandatory insurance only for children.
White House officials have since backed away somewhat from Obama's opposition to mandated coverage for all, but there's no indication that Obama would support fines.
One idea that Obama championed during and since the campaign - a government insurance option - appeared to be sinking fast.
House Majority Leader Steny Hoyer, D-Md., told reporters a Medicare-like plan for middle-class Americans and their families isn't an essential part of legislation for him. Hoyer's comments came shortly after a key Democratic moderate said he could no longer back a bill that includes a new government plan.
The fast-moving developments left liberals in a quandary. They've drawn a line, saying they won't vote for legislation if it doesn't include a public plan to compete with private insurance companies and force them to lower costs.
Rep. Mike Ross, D-Ark., who once supported a public option, said Tuesday that after hearing from constituents during the August recess, he's changed his mind.
"If House leadership presents a final bill that contains a government-run public option, I will oppose it," Ross said.
Obama's commitment to a public plan has been in question and lawmakers hoped his speech to Congress would make his position on that clear.
He's called a public plan an important tool to help check the excesses of private industry. But his aides suggested on the weekend that he could sign legislation even if it does not include a public option.
In the Senate, the public plan is not part of Baucus' proposal. He's calling for nonprofit co-ops to compete in the marketplace instead.
An 18-page summary of the Baucus proposal was obtained by The Associated Press. The complex plan would make dozens of changes in the health care system, many of them contentious. For example, it includes new fees on insurers, drug companies, medical device manufacturers and clinical labs.
It would require insurers to take all applicants, regardless of age or health. But smokers could be charged higher premiums. And 60-year-olds could be charged five times as much for a policy as 20-year-olds.
People working for major employers would probably not see big changes. The plan is geared to helping those who now have the hardest time getting and keeping coverage: the self-employed and small business owners. New purchasing pools would be set up in each state, allowing them to band together and get some of the advantages big companies now have.
Thursday, August 27, 2009
So What do Health Care Co-ops Look Like?
If you look around Wisconsin, they’re everywhere
On Sunday, August 23 there was a very informative article in the Wisconsin State Journal on heath care coops and their prevalence in society today. Link-http://www.madison.com/wsj/arch_local/462964
For instance in Wisconsin we have several examples-
Group Health Cooperative (Madison)- provides health care for 62,000 members, owns five clinics. Doctors do not bill by procedure, are paid by salary, and emphasize preventive medicine and alternative therapies. U.S. News and World Report named GHC the 8th best health plan in the country the last 3 years. Their slogan you may have heard is: “Better, Together.”
Group Health Cooperative (Eau Claire)- Similar model as GHC in Madison but they are independent of each other.
The Alliance- is a health care purchasing cooperative made up of 160 employers. It negotiates contracts directly with providers instead of through an insurer. Most of the employer members self-fund their health care.
Rural Wisconsin Health Cooperative- This coop, based in Sauk City, is composed of 35 rural hospitals that share services such as technology and quality improvement to maximize rural resources.
The Farmer’s Health Cooperative- consists of 2,700 independent farmer members that access health care through the co-op. The co-op spreads risk among a large group of farmers and contracts with Aetna to offer 6 different benefit plans.
These are all not-for-profit coops that enhance Wisconsin residents access to affordable, quality health care. Building on these models would be a great start.
On Sunday, August 23 there was a very informative article in the Wisconsin State Journal on heath care coops and their prevalence in society today. Link-http://www.madison.com/wsj/arch_local/462964
For instance in Wisconsin we have several examples-
Group Health Cooperative (Madison)- provides health care for 62,000 members, owns five clinics. Doctors do not bill by procedure, are paid by salary, and emphasize preventive medicine and alternative therapies. U.S. News and World Report named GHC the 8th best health plan in the country the last 3 years. Their slogan you may have heard is: “Better, Together.”
Group Health Cooperative (Eau Claire)- Similar model as GHC in Madison but they are independent of each other.
The Alliance- is a health care purchasing cooperative made up of 160 employers. It negotiates contracts directly with providers instead of through an insurer. Most of the employer members self-fund their health care.
Rural Wisconsin Health Cooperative- This coop, based in Sauk City, is composed of 35 rural hospitals that share services such as technology and quality improvement to maximize rural resources.
The Farmer’s Health Cooperative- consists of 2,700 independent farmer members that access health care through the co-op. The co-op spreads risk among a large group of farmers and contracts with Aetna to offer 6 different benefit plans.
These are all not-for-profit coops that enhance Wisconsin residents access to affordable, quality health care. Building on these models would be a great start.
Tuesday, August 18, 2009
Reform without the Public Plan Option- It could look like this
What will reform look like?
I have consistently predicted that health care reform passage will not include a public plan, government run program. I don't see how it will get the votes needed. In a previous post I gave the pros and cons and more recently posted how agents might still be able to sell the public plan option which makes the cost more even with private plans.
Moving on let's look at what's possible without the public plan option.
I'll discuss two possibilities to use as the mechanism to get competition without a true public plan.
1- the Co-op model run by private, non-profit state based consumer friendly entities with strict implementation regulations by the feds with the carrot of seed money.
2- Medicare Advantage-like health plans regulated and contracts enforced by the feds BUT, not run by the feds.
Critics say you can't put cost controls in either of these above like you can if it were "government-run". And why not? States regulate the sale of health insurance. The NAIC (Nat'l Assoc of Insurance Comm.'s) sets forth model acts and rules on nearly every aspect of health insurance as guidelines for the state regulators to implement. This ain't rocket science, don't let them tell you it can't be done. It can.
Both of these models I identify can be set up with new payment structures like accountable care to reimburse providers for episodes of care, not strictly fee reimbursement. And the reimbursement does not need to mirror the reduced fee structures under Medicare or Medicaid. Don't let them tell you otherwise.
Example-
Let's look to the enactment of HIPAA in the late 90's as an example. The feds passed the law which the states were then required to pass as well with at least the same consumer protections, but the state's could also go beyond the federal minimums. The same can be done here. The "Health Care Reform Act of 2009" could mandate "episodes of care" reimbursement and penalize doctors for hospital readmissions. That will step up quality and reduce cost. Going a step further it could provide incentive payments to health plans and insurers and require providers to implement LEAN processes ( see http://www.healthcarevalueleaders.org/ for details). This can be instituted in the same way as the HIPAA privacy measures that were placed upon health care providers. It can be done on a strict timeline- say by 2015.
There's your cost savings in two distinct options and without a public plan run and operated by the feds. Both include oversight by the feds like Medicare, Medicaid and TRICARE (military). This is nothing new, we've done it for decades, its not socialism. Again, don't let them tell you otherwise.
By the way the Co-ops and the Medicare Advantage-like federal contracted plans could both be structured to set up the elimination of the individual health insurance market by letting individuals join the larger risk pool and lower costs to individuals like the self-employed. Of course it would also eliminate individual underwriting and therefore that dreaded term, "pre-existing condition." Cost savings would also include the elimination of individual state high risk pools which together insure several hundred thousand Americans.
This is the framework that's needed for true health care reform. Please comment and add to the reform discussion.
I have consistently predicted that health care reform passage will not include a public plan, government run program. I don't see how it will get the votes needed. In a previous post I gave the pros and cons and more recently posted how agents might still be able to sell the public plan option which makes the cost more even with private plans.
Moving on let's look at what's possible without the public plan option.
I'll discuss two possibilities to use as the mechanism to get competition without a true public plan.
1- the Co-op model run by private, non-profit state based consumer friendly entities with strict implementation regulations by the feds with the carrot of seed money.
2- Medicare Advantage-like health plans regulated and contracts enforced by the feds BUT, not run by the feds.
Critics say you can't put cost controls in either of these above like you can if it were "government-run". And why not? States regulate the sale of health insurance. The NAIC (Nat'l Assoc of Insurance Comm.'s) sets forth model acts and rules on nearly every aspect of health insurance as guidelines for the state regulators to implement. This ain't rocket science, don't let them tell you it can't be done. It can.
Both of these models I identify can be set up with new payment structures like accountable care to reimburse providers for episodes of care, not strictly fee reimbursement. And the reimbursement does not need to mirror the reduced fee structures under Medicare or Medicaid. Don't let them tell you otherwise.
Example-
Let's look to the enactment of HIPAA in the late 90's as an example. The feds passed the law which the states were then required to pass as well with at least the same consumer protections, but the state's could also go beyond the federal minimums. The same can be done here. The "Health Care Reform Act of 2009" could mandate "episodes of care" reimbursement and penalize doctors for hospital readmissions. That will step up quality and reduce cost. Going a step further it could provide incentive payments to health plans and insurers and require providers to implement LEAN processes ( see http://www.healthcarevalueleaders.org/ for details). This can be instituted in the same way as the HIPAA privacy measures that were placed upon health care providers. It can be done on a strict timeline- say by 2015.
There's your cost savings in two distinct options and without a public plan run and operated by the feds. Both include oversight by the feds like Medicare, Medicaid and TRICARE (military). This is nothing new, we've done it for decades, its not socialism. Again, don't let them tell you otherwise.
By the way the Co-ops and the Medicare Advantage-like federal contracted plans could both be structured to set up the elimination of the individual health insurance market by letting individuals join the larger risk pool and lower costs to individuals like the self-employed. Of course it would also eliminate individual underwriting and therefore that dreaded term, "pre-existing condition." Cost savings would also include the elimination of individual state high risk pools which together insure several hundred thousand Americans.
This is the framework that's needed for true health care reform. Please comment and add to the reform discussion.
Monday, August 17, 2009
Co-ops may be the compromise answer
Details on Co-ops
Kathy Sebelius, Secretary of the U.S. Dept of Health and Human Services, said the White House would be open to co-ops instead of a public option — a sign that Democrats want a compromise so they can declare a victory.
Under a proposal by Sen. Kent Conrad, D-N.D., consumer-owned nonprofit cooperatives would sell insurance in competition with private industry, not unlike the way electric and agriculture co-ops operate, especially in rural states such as his own.
With $3 billion to $4 billion in initial support from the government, the co-ops would operate under a national structure with state affiliates, but independent of the government. They would be required to maintain the type of financial reserves that private companies are required to keep in case of unexpectedly high claims.
"I think there will be a competitor to private insurers," Sebelius said. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing."
--------------
Co-ops may be the best compromise solution to still get the competition needed to reign in health care costs. In the end Co-ops may gain some votes from Republicans and may lose a few of the hardest line liberals. It should provide a net gain. But, we still need other elelments to achieve real reform - i.e.- payment reform based on episodes of care, quality-based incentives and incentives to implement LEAN techniques. See previous posts for details on these items.
Kathy Sebelius, Secretary of the U.S. Dept of Health and Human Services, said the White House would be open to co-ops instead of a public option — a sign that Democrats want a compromise so they can declare a victory.
Under a proposal by Sen. Kent Conrad, D-N.D., consumer-owned nonprofit cooperatives would sell insurance in competition with private industry, not unlike the way electric and agriculture co-ops operate, especially in rural states such as his own.
With $3 billion to $4 billion in initial support from the government, the co-ops would operate under a national structure with state affiliates, but independent of the government. They would be required to maintain the type of financial reserves that private companies are required to keep in case of unexpectedly high claims.
"I think there will be a competitor to private insurers," Sebelius said. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing."
--------------
Co-ops may be the best compromise solution to still get the competition needed to reign in health care costs. In the end Co-ops may gain some votes from Republicans and may lose a few of the hardest line liberals. It should provide a net gain. But, we still need other elelments to achieve real reform - i.e.- payment reform based on episodes of care, quality-based incentives and incentives to implement LEAN techniques. See previous posts for details on these items.
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