You do realize we already have a public plan, right?

Insuring Resources Commentary:

The House health care reform bill includes a public plan option, meaning its a plan that would compete against insurers. This story is about the public plan that is the last available option, Medicaid, for many folks.

The attached story below is about the huge expansion nationwide of state Medicaid programs in the wake of the recession. During these tough times, Wisconsin has expanded its Medicaid program while most others have seen their enrollment expand without trying. But Wisconsin has expanded Medicaid through its BadgerCare program to cover more low-income uninsured persons... many of whom ARE employed. Wisconsin now covers uninsured persons with and WITHOUT kids up to 200% of fpl if they don't have employer coverage. For a family of four that's about $37,000 annually. The expanded group do pay a subsidized premium. Do you know a family on BadgerCare? I bet you know several. I'd bet several of my son's elementary school classmates are covered by it.

So for those who talk and warn about the "government takeover of health insurance", please get your head out of the sand. Its been happening for awhile.

By most estimates in 2009 we had between 45-47 million uninsured in the US. So now we have a roughly equal amount, according to Kaiser 46.9 million, on Medicaid programs.

Guess what folks, fewer and fewer of us have employer-based coverage- the last number I saw, for 2008, was 59%. You know that's lower now, right? By the way, in 2000 69% of us had employer-based coverage.

Isn't it time for an overhaul?

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Kaiser Analysis Finds Record Medicaid Enrollment Growth in 2009

Largest Ever One-Year Increase Illustrates Medicaid's Role In Covering People During Economic Downturns But Further Strains Tight State Budgets

WASHINGTON, Feb. 18 /PRNewswire-USNewswire/ --
With the country mired in a deep recession, nearly 3.3 million more people were enrolled in state Medicaid programs in June 2009 compared to the previous June, according to a new analysis by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. It was the biggest ever one-year increase in terms of absolute numbers, and boosted the June monthly Medicaid enrollment by 7.5 percent to 46.9 million people nationally.

It was the first time in decades that every state experienced an increase in Medicaid enrollment, and in 32 states enrollment grew at least twice as fast as the year before, according to the analysis, which includes data breakouts by state.

"State Medicaid programs have been able to help millions of Americans who have nowhere else to turn in a recession," said Diane Rowland, Executive Vice President of the Foundation and Executive Director of KCMU. "But the states obviously face significant fiscal pressures as increases in enrollment push up costs at a time when state budgets are already severely constrained."

The increase in enrollment reflects the role that Medicaid plays in reducing the numbers of people who become uninsured when the economy falters, with many people turning to the program for help after being laid off and losing their employer-based health insurance. Millions more who were not eligible for Medicaid likely joined the ranks of the nation's uninsured.

A new Kaiser survey of state Medicaid directors finds that 44 states and the District of Columbia are experiencing higher than expected program enrollment, resulting in increased spending for fiscal year 2010. At least 29 states say they are considering additional mid-year cuts in provider rates and program benefits.

Enhanced federal matching money for Medicaid provided through the American Recovery and Reinvestment Act of 2009 has proved critical in helping states maintain coverage. But that money is scheduled to expire on Dec. 31, 2010, which will increase the strain on state fiscal year 2011 budgets, Medicaid directors reported.

Although Medicaid enrollment is on the rise, costs of the program as measured on a per-person basis are not climbing at a faster rate than health costs more generally. (See "An Actuarial Rorschach Test" [link to http://www.kff.org/pullingittogether/021610_altman.cfm]). Moreover, in past recessions, after the economy has improved, Medicaid enrollment growth has slowed and sometimes contracted, suggesting that the record rate of enrollment growth seen in 2009 will eventually subside.

UA-10096920-2

State of the (Health Care Reform) Union

Insuring Resources Commentary:

There is no clear path forward, especially since our President displayed an astounding lack of leadership, saying only "I will not quit", and Congress needs to pass health care reform, but providing no actual direction. The next steps Thursday and Friday of this week will be very telling.

In particular I want readers to pay special attention to the health care reform comments by Gov. McConnell in the Republican response after the President's speech.
Please see below and I'll analyze his 3 main points here:

1)Most (Americans) "do not want to turn over the best medical care system in the world to the federal government."
The Democrats proposals do not even come close to "turning the best (actually its #33 in the world) health care system over to the federal gov't." 'Gov't takeover'- its amazing they're still getting way with that rhetoric.

The House plan does include a public plan option.... for about 10% of the market!

2) McConnell- "Republicans in Congress have offered legislation to reform health care, without shifting Medicaid costs to the states, without cutting Medicare, and without raising your taxes."
Yes he's right, it does those things, BUT it would change access to health insurance through tax credits and the plans are high deductible health plans with HSAs. Eventually most Americans would have $5,000 deductibles and pay for most of their care themselves with little if any help from their employers purchasing power reducing risk.

3) "let families and businesses buy health insurance policies across state lines".

The reason why we have state regulated insurance plans is because the public demanded and WANTED mandates like mammograms, birth control coverage, 48-hour minimum hospital stay after giving birth, chiropractic care, and others.

If we allow interstate purchase its going to be a race to the bottom with pared down coverage competing to be the cheapest. That's what's good for business owners, not consumers. Plans sold and barely regulated by the likes of Alabama will pervade the market. Alabama doesn't regulate insurance, they rubber stamp the weakest coverage possible. Where do you want your employer to buy YOUR health insurance.... Alabama... or Wisconsin?


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Here's what the President had to say on health care reform earlier tonight in the State of the Union address: Video link: http://www.cnn.com/video/#/video/politics/2010/01/27/sotu.sot.obama.healthcare.cnn?hpt=C2


Here's what he had to say on Health Care Reform: Obama apologized for not making the case clearer to the public for health care reform and noted that the back room deals involved tarnished the public's view but he concluded by saying, "I will not walk away."

Yesterday the New York Times reported the following:

With no clear path forward on major health care legislation, Democratic leaders in Congress effectively slammed the brakes on President Obama’s top domestic priority on Tuesday, saying they no longer felt pressure to move quickly on a health bill after eight months of setting deadlines and missing them. The Senate majority leader, Harry Reid, Democrat of Nevada, deflected questions about health care. “We’re not on health care now,” Mr. Reid said. “We’ve talked a lot about it in the past.”


And now for the Republican response to Obama's address on health care reform from Gov. McConnell of Virginia:
"While Americans agree that an affordable, high-quality health care system is needed, most of them "do not want to turn over the best medical care system in the world to the federal government."

"Republicans in Congress have offered legislation to reform health care, without shifting Medicaid costs to the states, without cutting Medicare, and without raising your taxes," he said. "We will do that by implementing common-sense reforms, like letting families and businesses buy health insurance policies across state lines, and ending frivolous lawsuits against doctors and hospitals that drive up the cost of your health care."

Senate Dems Compromise- public plan is out

Insuring Resources Commentary

The Senate Dems reached a compromise today (the details of which I predicted three months ago on this blog). I said back then that the final bill would not have a gov't run public plan but instead would use private plans heavily regulated by the Feds much like Medicare Advantage.

In addition the Senate Bill now includes a Medicare buy-in program for persons age 55 and up to buy in to Medicare early. This particularly helps early retirees.

The bill also requires insurance companies to spend at least 90 percent of their premium income providing benefits. By the way, according to the Wisconsin Association of Health Plans (WAHP) their 16 member health plans pay out 91% of premium in benefits. I've long touted those companies (Dean, GHC, Gunderson and others) as models on which to build the foundation of health care reform. Perhaps this is the stick that incents plans to base reimbursement on quality outcomes and efficiency.

From WAHP's website: "In 2007, the Association-member health plans participating in the commercial health insurance market in Wisconsin paid out approximately 91 cents in health care services for every $1 of insurance premium taken in. They spent less than 10 cents on administration, and profits remained among the lowest in health care: less than 2 cents for every $1 in premium."
http://www.wihealthplans.org/inner.iml?mdl=about_us.mdl


So what does Sen. Feingold think about this compromise (copied from below). "I do not support proposals that would replace the public option in the bill with a purely private approach. We need to have some competition for the insurance industry to keep rates down and save taxpayer dollars," Feingold said.

Competition may reduce premiums 1-2% while waste reduction, payment reform and quality incentives could have ten times the impact.


Time for my FIFTH phone call to his office staff.


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Dems reach deal to drop gov't-run plan
Dec. 8, 2009

After days of secret talks, Senate Democrats tentatively agreed Tuesday night to drop a full-blown government-run insurance option from sweeping health care legislation, several officials said, a concession to party moderates whose votes are critical to passage of President Barack Obama's top domestic priority.

In its place, officials said Democrats had tentatively settled on a private insurance arrangement to be supervised by the federal agency that oversees the system through which lawmakers purchase coverage, with the possibility of greater government involvement if needed to ensure consumers of sufficient choices in coverage.

Additionally, the emerging agreement calls for Medicare to be opened to uninsured Americans beginning at age 55, a significant expansion of the large government health care program that currently serves the 65-and-over population.

At a hastily called evening news conference in the Capitol, Majority Leader Harry Reid, D-Nev., declined to provide details of what he described as a "broad agreement" between liberals and moderates on an issue that has plagued Democrats' efforts to pass health care legislation from the outset.

With it, he added with a smile, the end is in sight for passage of the legislation that Congress has labored over for months.

The officials who described the details of the closed-door negotiations did so on condition of anonymity, saying they were not authorized to discuss them publicly. Several officials stressed that so far, Democrats had technically agreed only on submitting proposals to the Congressional Budget Office for their impact on the bill's cost and other analysis.

At its core, the legislation would expand health care to millions who lack it, ban insurance companies from denying coverage on the basis of pre-existing medical conditions and rein in the rise of health care spending nationally.

The developments followed a vote on the Senate floor earlier in the day in which abortion opponents failed to inject tougher restrictions into sweeping health care bill, and Democratic leaders labored to make sure fallout from the issue didn't hamper the drive to enact legislation. The vote was 54-45.

Taken together, the day's developments underscored the complexity that confronts the administration and Reid as they seek the 60 votes needed to overcome Republican opposition and pass a bill by Christmas. Despite their reluctance, some senators had talked openly and in detail earlier in the day about the progress of the negotiations.

The provision in the legislation to be dropped under the emerging agreement provides for a government-run insurance option to be available to consumers, with individual states permitted to drop out. Liberals have long sought such as arrangement, as a means of forcing competition on insurance companies.

One participant in the talks, Sen. Tom Harkin, D-Iowa, referring to a deal among the negotiators, told reporters he didn't like it, but added, "I'm going to support it to the hilt" in hopes of securing passage of the health care bill.

Another senator involved, Sen. Russ Feingold, D-Wis., issued a statement saying, "I do not support proposals that would replace the public option in the bill with a purely private approach. We need to have some competition for the insurance industry to keep rates down and save taxpayer dollars." But he did not rule out voting for the measure.

The White House quickly applauded the developments. "Senators are making great progress and we're pleased that they're working together to find common ground toward options that increase choice and competition," said a spokesman, Reid Cherlin.

In his comments to reporters, Reid said the emerging compromise "includes a public option and will help ensure the American people win in two ways: one, insurance companies will face more competition, and two, the American people will have more choices."

It wasn't clear what he meant by a "public option," the Medicare expansion or a fallback in case private insurance companies declined to participate in the nationwide plan envisioned to be overseen by the Office of Personnel Management. One possibility was for the agency to set up a government-run plan, either national in scope or on a state-by-state basis.

Under the tentative agreement, liberals lost their bid to expand Medicaid, the federal-state program that provides health care for the poor, elderly and disabled. But they prevailed on the Medicare expansion, and the negotiators appeared ready to maintain a separate health care program for children until 2013, two years longer than the bill currently calls for, according to officials familiar with the details.

Additionally, there was consensus support for a requirement long backed by Sen. Jay Rockefeller, D-W.Va., and other liberals for insurance companies to spend at least 90 percent of their premium income providing benefits, a step that supporters argue effectively limits their spending on advertising, salaries, promotional efforts and profits.

Senate, House Democratic Health Bills Compared

Stay tuned for Insuring Resources Commentary soon.

.... in the meantime see an analysis below courtesy of the Associated Press


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Senate, House Democratic Health Bills ComparedAssociated Press
November 19, 2009
A comparison of the health care bills before Congress:
The Senate Democratic bill (Patient Protection and Affordable Care Act):

WHO'S COVERED: About 94 percent of legal residents under age 65 -- compared with 83 percent now. Government subsidies to help buy coverage start in 2014. Illegal immigrants would not receive assistance.

COST: Coverage provisions cost $849 billion over 10 years.

HOW IT'S PAID FOR: Fees on insurance companies, drugmakers, medical device manufacturers. Medicare payroll tax increased to 1.95 percent on income over $200,000a year for individuals; $250,000 for couples. New 5 percent tax on elective cosmetic surgery. Cuts to Medicare and Medicaid. Excise tax on insurance companies, keyed to premiums paid on health care plans costing more than $8,500 annually for individuals and $23,000 for families. Fees on employers whose workers receive government subsidies to help them pay premiums. Fines on people who fail to purchase coverage.

REQUIREMENTS FOR INDIVIDUALS: Almost everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. Those who are obligated to buy coverage and refuse to do so would pay a fine starting at $95 in 2014 and rising to $750.

REQUIREMENTS FOR EMPLOYERS: Not required to offer coverage, but medium and large companies would pay a fee if the government ends up subsidizing employees' coverage.
SUBSIDIES: Tax credits for individuals and families likely making up to 400 percent of the federal poverty level, which computes to $88,200 for a family of four. Tax credits for small employers.

BENEFITS PACKAGE: All plans sold to individuals and small businesses would have to cover basic benefits. The government would set four levels of coverage: The least generous would pay an estimated 60 percent of health care costs per year; the most generous would cover an estimated 90 percent.

INSURANCE INDUSTRY RESTRICTIONS: Starting in 2014: no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age and family size. Starting upon enactment of legislation: children up to age 26 can stay on parents insurance; no lifetime limits on coverage.

GOVERNMENT-RUN PLAN: A new federal insurance plan would be offered to compete against private carriers. The government would negotiate -- not dictate -- payment rates for medical providers. Unlike the House bill, states could opt out of the plan. It's not clear the proposal commands enough votes to survive, and it could be replaced by a standby system pushed by moderates that would not go into effect until it was clear individual states were experiencing a lack of competition among private companies.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Self-employed people, uninsured individuals and small businesses could pick a plan offered through new state-based purchasing pools. Employees would be generally encouraged to keep their work-provided coverage.

DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Drug companies contribute $80 billion over 10 years with the majority of the money used to limit the prescription coverage gap in Medicare.

CHANGES TO MEDICAID: Income eligibility levels likely to be standardized to 133 percent of poverty, which is $29,327 a year for a family of four, for all parents, children and pregnant women. Federal government would pick up the full cost of the expansion during the first three years. States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid.

LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.

ANTITRUST: Amendment expected to be offered on the Senate floor to strip the health insurance industry of its antitrust exemption.
____
The House bill (Affordable Health Care for America Act):

WHO'S COVERED: About 96 percent of legal residents under age 65 -- compared with 83 percent now. Government subsidies to help buy coverage start in 2013. About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants.

COST: The Congressional Budget Office says the bill's cost of expanding insurance coverage over 10 years is $1.055 trillion. The net cost is $894 billion, factoring in penalties on individuals and employers who don't comply with new requirements. That's under President Barack Obama's $900 billion goal. However, those figures leave out a variety of new costs in the bill, including increased prescription drug coverage for seniors under Medicare, so the measure may be around $1.2 trillion.

HOW IT'S PAID FOR: $460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making more than $1 million. The original House bill taxed individuals making $280,000 a year and couples making more than $350,000, but the threshold was increased in response to lawmakers' concerns that the taxes would hit too many people and small businesses.
There are also more than $400 billion in cuts to Medicare and Medicaid; a new $20 billion fee on medical device makers; $13 billion from limiting contributions to flexible spending accounts; sizable penalties paid by individuals and employers who don't obtain coverage; and a mix of other corporate taxes and fees.

REQUIREMENTS FOR INDIVIDUALS: Individuals must have insurance, enforced through a tax penalty of 2.5 percent of income. People can apply for hardship waivers if coverage is unaffordable.

REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 annually are exempt -- a change from the original $250,000 level to accommodate concerns of moderate Democrats -- and the penalty is phased in for companies with
payrolls between $500,000 and $750,000.

Small businesses -- those with 10 or fewer workers -- get tax credits to help them provide coverage.

SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level, or $88,000 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Beginning in 2013 through a new Health Insurance Exchange open to individuals and, initially, small employers. It could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules.

BENEFITS PACKAGE: A committee would recommend a so-called essential benefits package including preventive services. Out-of pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange.

INSURANCE INDUSTRY RESTRICTIONS: Starting in 2013, no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age.

GOVERNMENT-RUN PLAN: A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services. Democrats originally designed the plan to pay Medicare rates plus 5 percent to doctors. But the final version -- preferred by moderate lawmakers -- would let the HHS secretary negotiate rates with providers.

CHANGES TO MEDICAID: The federal-state insurance program for the poor would be expanded to cover all individuals under age 65 with incomes up to 150 percent of the federal poverty level, which is $33,075 per year for a family of four. The federal government would pick up the full cost of the expansion in 2013 and 2014; thereafter the federal government would pay 91 percent and states would pay 9 percent.

DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Phases out the gap in Medicare prescription drug coverage by 2019. Requires the HHS secretary to negotiate drug prices on behalf of Medicare beneficiaries.

LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.

ANTITRUST: Would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price-fixing and bid rigging. The bill also would give the Federal Trade Commission authority to look into the health insurance industry at its own initiative.

WI Firms Pay 22% More for Health Insurance- with Soultions Offered by Insuring Resources

Insuring Resources Commentary:

Wisconsin business is at a huge disadvantage in the national marketplace because we pay so much more for health insurance, according to new research by Mercer. Part of the reason, I believe, is because Wisconsin health care providers get paid less on average for treating people on Medicare so the costs are shifted on to the private sector side.

Now if health care reform includes a public plan option that covers small businesses and uses Medicare reimbursement rates the situation will get much worse for Wisconsin businesses.

Solution:
Health care reform must
1. level the Medicare reimbursement to bring Wisconsin up where it should be. Wisconsin providers are paid much less by Medicare than the national average.

2.if we have a public plan option that includes coverage for small businesses it must not use Medicare reimbursement rates UNLESS, Medicare can finally start to negotiate rates with providers. Right now, Medicare reimbursement rates are set by the feds, NOT negotiated in the marketplace. With the purchasing power of the federal government insuring tens of millions of people on Medicare this should be a no-brainer.

3. In addition, as I've said all along, providers need reimbursement incentives to make their care more efficient and reduce the waste. The Senate bill includes pilots for this but that doesn't go far enough, we need these efficiency incentives to be standard across the entire system.

4. And finally, Wisconsin cannot be penalized for having a higher rate of insured persons. There are incentives in the House bill that gives grant money to states with higher uninsured pct.s to help them along. This actually hurts states like Wisconsin that have been proactive. For instance- Wisconsin covers childless adults through BadgerCare up to 200% of FPL. Louisiana covers them up to 26% of FPL!!! If the House reform language passes Lousiana gets extra money to bring their insured numbers up to 150% while Wisconsin already surpasses that. By the way-- thanks to Wisconsin DHS Secretary Karen Timberlake for providing the Louisiana stat at a health care forum I attended in Madison yesterday.


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State firms pay 22% more for health insurance than U.S., survey shows By Rick Romell of the Journal Sentinel

Posted: Nov. 18, 2009 10:14 a.m.

Wisconsinites continue to pay more for health insurance than Americans generally, and the costs here have increased more rapidly, a new survey by benefits consulting firm Mercer shows.

Wisconsin companies and their employees paid an average of $10,888 per worker for health insurance in 2009 - nearly 22% above the national average of $8,945, Mercer found.

And the cost gap between Wisconsin and the rest of the country widened. Nationally, the cost of health benefits for active employees rose 5.5% for the year, the smallest annual increase in a decade. In Wisconsin, costs increased by 6.8%.

Mercer's findings are based on a late-summer survey of more than 2,900 employers with at least 10 employees each. Eighty-eight Wisconsin employers were surveyed.

So this is a Gov't Takeover- 2% of the Market

Insuring Resources Commentary:

So after all the debate about the public plan option and all the skewed debate the actual numbers are in. The public plan will likely cover about TWO PERCENT.

Don't get me wrong the public plan will do wonders for those relegated to discriminatory coverage in the independent market and those abandoned and uninsured in our 35th best health care system.

Drew Altman from the Kaiser Family Foundation has it mostly correct. See below in italics. He says we need more discussion on "affordable coverage" , but even that doesn't get at the biggest issue of reducing HEALTH CARE costs.

While nearly the entire debate (as I've said all along) has focused attention on the public plan issue, we've all missed the boat. What about cost, waste elimination and PAYMENT REFORM?????

Debate on the public plan option has been the focus of 90% of the national discussion, yet in the end it will cover 2% of the population? Health Care reform should be about re-prioritizing our health care system.... shouldn't it?

Shouldn't we be focusing on the real issues, health CARE reform... not insurance reform? Maybe now we can set aside the issue of the 2% public plan and focus on cost and quality- i.e. the real issues that affect the vast majority of Americans. But I'm too cynical to believe that we'll actually start having a real discussion, afterall the GOP finally gave us their proposal. Tune in tomorrow for a gallow's analaysis of what that would do to our health care system. At this very late hour, we must refocus on eliminating waste, and emhasizing quality--- the most important issues we face. The public plan will help, but there are other important issues that will play a much bigger role in reforming the system that are being completely ignored.


--------------------------- From the Associated Press

After all the fuss, public health plan covers few

By RICARDO ALONSO-ZALDIVAR
The Associated Press
Sunday, November 1, 2009 7:35 AM

WASHINGTON -- What's all the fuss about? After all the noise over Democrats' push for a government insurance plan to compete with private carriers, coverage numbers are finally in: Two percent.

That's the estimated share of Americans younger than 65 who'd sign up for the public option plan under the health care bill that Speaker Nancy Pelosi, D-Calif., is steering toward House approval.

The underwhelming statistic is raising questions about whether the government plan will be the iron-fisted competitor that private insurers warn will shut them down or a niche operator that becomes a haven for patients with health insurance horror stories.

Some experts are wondering if lawmakers have wasted too much time arguing about the public plan, giving short shrift to basics such as ensuring that new coverage will be affordable.

"The public option is a significant issue, but its place in the debate is completely out of proportion to its actual importance to consumers," said Drew Altman, president of the nonpartisan Kaiser Family Foundation. "It has sucked all the oxygen out of the room and diverted attention from bread-and-butter consumer issues, such as affordable coverage and comprehensive benefits."

The Democratic health care bills would extend coverage to the uninsured by providing government help with premiums and prohibiting insurers from excluding people in poor health or charging them more. But to keep from piling more on the federal deficit, most of the uninsured will have to wait until 2013 for help. Even then, many will have to pay a significant share of their own health care costs.

The latest look at the public option comes from the Congressional Budget Office, the nonpartisan economic analysts for lawmakers.

It found that the scaled back government plan in the House bill wouldn't overtake private health insurance. To the contrary, it might help the insurers a little.
The budget office estimated that about 6 million people would sign up for the public option in 2019, when the House bill is fully phased in. That represents about 2 percent of a total of 282 million Americans under age 65. (Older people are covered through Medicare.)

The overwhelming majority of the population would remain in private health insurance plans sponsored by employers. Others, mainly low-income people, would be covered through an expanded Medicaid program.

To be fair, most people would not have access to the new public plan. Under the House bill, it would be offered through new insurance exchanges open only to those who buy coverage on their own or work for small companies. Yet even within that pool of 30 million people, only 1-in-5 would take the public option.

Who's likely to sign up?

The budget office said "a less healthy pool of enrollees" would probably be attracted to the public option, drawn by the prospect of looser rules on access to specialists and medical services.

As a result, premiums in the public plan would be higher than the average for private plans. That could nudge healthy middle-class workers and their families to sign up for private plans.

"The concern was that the public option would destabilize the bulk of private insurance, but in fact what Congress has fashioned is very targeted," said economist Karen Davis, president of the Commonwealth Fund. "It's not going to be taking away the insurance industry's core business."

It's unclear whether there are enough votes in the Senate for a public plan. The version that Majority Leader Harry Reid, D-Nev., has offered would let states opt out, probably leaving a smaller plan that the House would want.

Insurers aren't buying the budget office analysis. Asked if it might soften that opposition, industry spokesman Robert Zirkelbach of America's Health Insurance Plans responded with a curt "No."

While a government plan might start out modestly, insurers fear that Congress could change the rules later, opening it up to all people and setting take-it-or-leave payments for hospitals and medical providers, instead of negotiating, as the House bill calls for.

For the same reason, employer groups also remain wary. Big companies don't want to lose control of their health care budgets and instead have the government send them a tax bill.

"That cost is going to come back to you one way or another ... and it's coming back in the way of taxes and liabilities," said Eastman Kodak's chief executive, Antonio M. Perez, speaking for the Business Roundtable. "We just don't believe that there are miracles out there."

If Congress passes a public plan that's not much of a sensation, Democrats might have reason to regret all the time and energy they invested in it.

The House Health Care Reform Bill

We now have health care reform bill sfrom both the House and the Senate. They will be debated over the next few weeks and then come to a final vote in each House. Then a conference committee will negotiate a final bill to be voted on by each House of congress. Its projected that the final bill could be signed by President Obama in time for Christmas.

Coverage Highlights-**Provides coverage for 96% of legally residing Americans.

** Subidizes coverage for the poorest Americans

** Caps annual out-of-pocket costs

** Eliminates Pre-x condition exclusions

Fiscal and Cost Issues
** Cuts federal deficit by $30 mill over ten years according to the CBO

** Individuals with annual incomes over $500,000, as well as families earning more than $1 million, would face a 5.4 percent income tax surcharge.

** Cuts Medicare expenditures by 1.3% annually

** The House bill imposes a fine of up to 2.5 percent of an individual's income. Both versions include a hardship exemption for poorer Americans.

** Requires larger companies to provide employee insurance for everyone or pay a penalty of up to 8 percent of total revenue.

CNN, conforming with the rest of our wonderful media, ignores the question of whether true cost controls and waste reduction strategies exist within this bill.

I'll get a copy of the bill and research those questions.


--------------------------------- ----------------------------
From CNN, October 31, 2009

The battle over health care reform reached another milestone Thursday as top House Democrats unveiled sweeping legislation that includes a highly controversial public health insurance option.

The nearly 2,000-page bill -- a combination of three versions passed by House committees -- would cost $894 billion over 10 years to extend insurance coverage to 36 million uncovered Americans, according to House Speaker Nancy Pelosi.

However, the bill's total cost, including Medicare changes, is expected to be higher and could push the price tag over $1 trillion, according to an initial CNN analysis.

The bill guarantees that 96 percent of Americans have coverage, Pelosi stated. The claim is based on an analysis by the non-partisan Congressional Budget Office.

Among other things, the bill would subsidize insurance for poorer Americans and create health insurance exchanges to make it easier for small groups and individuals to purchase coverage. It would also cap annual out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.

Pelosi's office said the bill would cut the federal deficit by roughly $30 billion over the next decade. The measure is financed through a combination of a tax surcharge on wealthy Americans and spending constraints in Medicare and Medicaid.

Specifically, individuals with annual incomes over $500,000, as well as families earning more than $1 million, would face a 5.4 percent income tax surcharge. Medicare expenditures would be cut by 1.3 percent annually.

"Today, we are ... laying the foundation for a brighter future for generations to come," Pelosi said on Capitol Hill.

"For Americans struggling with the cost of health care, this is an urgently needed bill," said House Majority Leader Steny Hoyer, D-Maryland. "This is an idea whose time has come."

President Obama praised House Democrats for forging "a strong consensus that represents a historic step forward."

Republicans tore into the bill, characterizing it as a series of tax increases and new regulations that would destroy jobs while doing little to stop spiraling health care costs.

"This really is a government takeover of health care in America," said Rep. Mike Pence, R-Indiana. "It appears for all of the world like a massive government-run insurance plan paid for with a freight train of mandates and taxes and bureaucracy."

Critics argue that the Democrats' $894 billion price tag excludes the cost associated with closing the Medicare "donut hole" prescription drug coverage gap.

The donut hole refers to some drug costs left uncovered by Medicare before catastrophic coverage kicks in. Pelosi highlighted plans to close the gap while discussing the bill Thursday.

Under the public option in the House plan, health care providers would be allowed to negotiate reimbursement rates with the federal government, according to Democratic leadership aides.

Pelosi and other liberal Democrats had argued for a more "robust" public option that ties reimbursement rates for providers and hospitals to Medicare rates plus a 5 percent increase. Several Democrats representing rural areas, however, complained that doctors and hospitals in their districts would be shortchanged under such a formula.

The Democratic leadership "pushed as hard as they could" for the robust option but couldn't win majority support for it, said liberal New York Rep. Jerrold Nadler. "There is no point crying over spilt milk."

The House bill differs from legislation now being considered by the Senate in a number of critical ways. Senate Majority Leader Harry Reid, D-Nevada, also favors a public option but would allow individual states to opt out of the plan. Reid would allow for the creation of nonprofit health care cooperatives; the House bill does not include such a measure.

A bill recently passed by the Senate Finance Committee does not include a tax surcharge on the wealthy but would instead impose a new tax on high-end health care policies, dubbed "Cadillac plans" by critics. A large number of House Democrats are adamantly opposed to taxing such policies, arguing that such a move would hurt union members who traded higher salaries for more generous benefits.

Individuals under the $829 billion Senate Finance Committee plan would be required to purchase health insurance coverage or face a fine of up to $750. The House bill imposes a more stringent fine of up to 2.5 percent of an individual's income. Both versions include a hardship exemption for poorer Americans.

The Senate Finance Committee bill would require large companies to contribute to the health care costs of lower income workers if those workers receive a government subsidy for insurance. The House legislation would require larger companies to provide employee insurance for everyone or pay a penalty of up to 8 percent of total revenue.

Democratic leaders in both chambers agree on establishing nonprofit health care cooperatives and stripping insurance companies of an antitrust exemption that has been in place since the end of World War II.

Moderate House Democrats, whose votes are needed to pass the bill, appeared to be cautiously optimistic. They didn't, however, offer any definitive judgments.

"I'm not leaning one way or the other right now, but I just have to get into the bill and read it for myself," said Rep. Baron Hill, D-Indiana. "I'm hoping to be able to vote for it."

The House Democratic leadership posted the bill online Thursday and agreed to give members at least 72 hours to read it before a vote. Under that timetable, the full House could begin debating the bill next week.

Any bill passed by the House of Representatives will eventually have to be merged with legislation passed by the Senate. Both chambers would then have to pass a revised measure before sending it to Obama to be signed into law.

One thorny issue remaining to be resolved among House Democrats is the final abortion language in the bill. Rep. Bart Stupak, D-Michigan, has been pushing leaders to add stronger language prohibiting the use of federal money to pay for abortions under new health care reforms.

Stupak has vowed that if he isn't allowed a vote on the issue, a group of 40 anti-abortion Democrats will work to block the bill from getting to the House floor.

Leadership aides admit that they need to find compromise wording on abortion but say they are confident the issue will be resolved by the time the bill gets to the floor.

Senate Bill Now Includes Public Option

Senate Majority Leader Harry Reid thinks he has 60 votes to pass a health care reform bill that includes a public option. There are 58 Democrats and 2 independents. The bill includes the allowance that states can "opt out" if they choose within a specified timeframe.

Its important to remember we're still a long way off from a final bill to be voted on by the Senate. It could be mid to late November before a final vote on the Senate bill is taken. It still needs to be reconciled with the House's final version.

It looks very likely that the House will approve a bill that includes a public option. Even if two dozen "blue dogs" vote against it, the house bill with a public option will still pass.

Reaction from key Senators
The reaction from moderate Democrats - they fear a public plan could drive insurers out of business and take over the marketplace - ranged from muted to skeptical.

Snowe
The one Republican who has so far lent her support to Democratic health overhaul proposals, Sen. Olympia Snowe of Maine, said she was "deeply disappointed" by Reid's decision. Snowe had supported allowing government insurance in individual states only if the private market wasn't providing sufficient choice and competition. Its likely that "deeply disappointed" signals a NO VOTE from Snowe.

Among the moderates whose support is in question are Democratic Sens. Ben Nelson of Nebraska, Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana.

Landrieu said in a statement that she's still "very skeptical" about a government plan run from Washington but would keep working with Reid to find a "principled compromise."

Nelson "is not committing how we will vote regarding any proposal Sen. Reid is advancing," said spokesman Jake Thompson.

Lincoln, who's up for re-election in 2010, said through a spokesman she intends to study the details and decide how to vote based on the impact on her home state.

Lieberman
Connecticut Sen. Joseph Lieberman (Ind.) said Tuesday that while he won't vote to block Majority Leader Harry Reid's plan from going to the Senate floor for debate, he would ultimately oppose the measure because it includes a public option. Lieberman's vote is often counted within the 60 votes needed to pass a Senate bill.

Collins
Meanwhile, Maine Republican Susan Collins, who had earlier indicated interest in trying to pass a bipartisan bill this year, issued a statement underscoring her opposition to "a taxpayer-subsidized, government-run health insurance company."

This information is from the Associated Press.

A Doc from Neenah Weighs in at the White House

You've heard or read this from me numerous times at this point but a Dr from Neenah was recently invited to the White House with 149 others to discuss health care reform with President Obama.

Two comments he made are what I'm most interested in pointing out.... here they are:

1) From Sarnecki’s viewpoint, it is a system fraught with inequity and "enormous waste." He said poor patients often are charged more than affluent people for the same procedures, and many doctors prescribe tests and procedures "that provide no value to the patient."

2)"I personally think a public option would be an important part of the bill," he said, "but it’s better to have a bill than no bill" if it means giving up the public option.


One poll I recently saw and posted a few weeks ago said that 60% plus of doctors favor the inclusion of a public plan. Docs are used to dealing with Medicare and Medicaid so its really telling that they are willing to add another government program and low reimbursement.

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Neenah orthopedist joins White House push for health care reform

By LARRY BIVINS • Gannett Washington Bureau • October 6, 2009
Published in the Oshkosh Northwestern


President Barack Obama’s campaign for health care reform has found a solid ally in Dr. Jan Sarnecki, a semi-retired orthopedic surgeon from Neenah.

Sarnecki was among the 150 doctors from around the country recruited to talk about health care reform Monday with Obama at the White House. Obama wants to revamp the nation’s expensive health care system to provide coverage for millions of uninsured Americans, strengthen the plans of those who are covered and prohibit insurers from denying coverage to people because of existing medical conditions.

Obama’s latest push with physicians comes as the Senate Finance Committee is trying to wrap up its version of a health care bill. So far, three House committees and one Senate committee have passed their own versions of a bill. Obama wants a bill to sign by year’s end.

"At this point, we’ve heard all the arguments on both sides of the aisle," Obama told the white-coat-clad doctors gathered in the Rose Garden. "But when you cut through the noise and all the distractions out there, I think what’s most telling is that some of the people who are most supportive of reform are the very medical professionals who know the system best."

From Sarnecki’s viewpoint, it is a system fraught with inequity and "enormous waste." He said poor patients often are charged more than affluent people for the same procedures, and many doctors prescribe tests and procedures "that provide no value to the patient."

Sarnecki recalled the case of one employee who was forced to file for bankruptcy after being notified he had taken his pregnant wife to the "wrong hospital" for emergency care. Sarnecki said the insurance company told the employee that the hospital was not on the company’s list of approved hospitals.

That is part of the experience Sarnecki said is at the heart of his support for a government-run "public option" insurance plan.

"I personally think a public option would be an important part of the bill," he said, "but it’s better to have a bill than no bill" if it means giving up the public option.

Sarnecki, who works at Fox Cities Community Clinic in Menasha, also participated in a teleconference last week with Rep. Steve Kagen, D-Appleton, that was organized by the Wisconsin arm of Organizing for America, Obama’s campaign operation.

"The idea is simply to try to get some momentum toward health care reform," Sarnecki said Monday. "The system we have is just not working well for a large number of people."

Sarnecki’s trip to Washington was coordinated by Doctors for America, a national group of more than 15,000 doctors. Among them is Sarnecki’s daughter, Meg Sarnecki, a family physician in Missoula, Mont.

Other groups that participated include the American Medical Association, the National Medical Association and the American College of Physicians.

Republicans have doctors who oppose Obama’s health care proposals. House Republican Leader John Boehner of Ohio said, "Members of the medical community - who deal with red tape day in and day out - rightly recognize that the Democrats’ government takeover would weaken the doctor-patient relationship that is so critical to making the right health care decisions."

Meanwhile, former Wisconsin Gov. Tommy Thompson, a Republican and secretary of Health and Human Services during the George W. Bush administration, issued a joint statement with former Rep. Dick Gephardt, a Missouri Democrat, pointing to the urgency of passing health care reform.

"Failure to reach an agreement on health reform this year is not an acceptable option," said the statement posted on Politico’s Web site. "Inaction will only increase the burden of rapidly rising health care costs and care denied for millions of American families."

Informational website from Humana Insurance

Here's the link- www.myhealthreform.org

To view a very informative, straightforward video go to:

https://www.myhealthreform.org/health_reform_video.php

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This video is very straightforward and provides the basics on the issues involved in health care reform. It discusses reducing the waste currently in the health care system which would help everyone, not just insurers. It does discuss the public plan option but doesn't dis it, and does talk about taxes to pay for subsidies for low-income persons to make insurance more affordable.

When I first heard about the website I thought it would be insurer propaganda and simply be an advertisement for universal, market-based coverage, but its not. It even talks about one potential option being a government plan covering everyone even though that's really not an option currently on the table.

The website also offers a way to contact legislators and give them ideas and your opnion on what health care reform should include.

Dems and GOP Agree- Baucus bill appears to be DOA

I guess Sen. Baucus has achieved what few others have. He's gotten Democrats and Republicans to agree... this is a horrible healthcare bill... except for widely different reasons.

Republicans are against tax increases (even though there is no employer mandate) and subsidizing "socialist" care for the poor. On the second point, I guess they still don't understand Medicare and Medicaid. On the first point, Baucus caves to their whims and still they're unhappy.

Many Democrats don't like that he didn't incorporate a true public plan, among numerous other issues which are far too lengthy to list.

Disabilities
In my own read of the 223 page bill I was dumbfounded to see no discussion or improvements on health care for people with disabilities. Apparently reform is discrminatory just like health care itself, and we're suppose to keep disabled folks in a separate health care program (Medicaid) that for the most part doesn't provide integrated care or care about quality with no serious ideas for improvement. Apparently Sen. Baucus doesn't want to improve health outcomes since he included yet another pilot Medical Home project. We've had enough of small-time pilots, medical homes work, they should be the essence of the program, not an underfunded, low enrollment step-sister.

By the way, Baucus decides to cut Medicare and Medicaid by $500 billion ovet the next 10 years to help pay for the expanded uninsured coverage. That's what I mean about discrimination.

The only substantial (I hesitate to even call it that) disability item is continued funding of a great idea- Aging and Disability Resource Centers- in the amount of $10 million for an additional five years.

Waste? Baucus says let's Demonstrate and Pilot, Not Fix it On the subject of reducing waste and cutting costs, there is virtually nothing substantial. For in depth analysis of those proposals go to this blog at the Center for Health Care Value- http://www.createhealthcarevalue.com/blog/post/?bid=104

Baucus proposes Medicare demonstrations and volunteer provider programs with incentives to "study" the potential of waste reduction. discussion around incentivizing providers to eliminate waste and practice efficiently. On this point I actually agree with Republican Sen. Enzi, not that he's proposed an alternative to achive cost efficiency. Again, on this point Baucus provides pilots.

On Co-ops- Sen. Rockefeller (D-W.V.) says thay are "untested and unsubstantiated." He's wrong. Wisconsin alone has three very successful coops in existence and there are dozens of others in the U.S. Its amazing how many components of this our legislators (on both sides) simply do not understand. The Co-ops proposed by Baucus must be integrated models so at least he got that right. What he gest wrong though is that integrated models should be used nation-wide with incentives given for providers and health plans to implement them.

If enacted, this bill in present form will make the system more costly than what we have today.

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From today's Milwaukee Journal Sentinel

Washington — Senate Finance Committee Chairman Max Baucus' $856 billion plan to overhaul the nation's health care system - a package that lacks the public option that President Barack Obama favors - was greeted Wednesday largely with skepticism and sometimes disdain, even among fellow Democrats.

His package, which would create health care co-ops, raise taxes on insurers and require companies to offer coverage to nearly everyone, is the latest effort to find bipartisan agreement on Obama's top domestic priority.

For months, the Democratic senator from Montana and five other committee members, three from each party, struggled to craft bipartisan legislation. They finally gave up, and Baucus went his own way.

He still worked Wednesday to woo Republican support, but only Sen. Olympia Snowe (R-Maine) seemed hopeful. "The bill is a work in progress," she said.

More typical was the view of Sen. Michael Enzi of Wyoming, the top Republican on the Senate Health Committee, who said he was "deeply disappointed" that the group of six, of which he was one, couldn't agree.

"The proposal released today still spends too much and it does too little to cut health care costs for those with health insurance," he said.

Four other committees - three in the House and the Senate health panel - have written health care bills. All were authored almost entirely by Democrats, and all back a "public option."

Baucus thinks that such a plan can't pass the Senate. He stressed Wednesday that he made compromises aimed at winning passage.

The biggest change from the other bills is the co-op idea, which veers away from Obama's plea to include a public option.

Instead, Baucus proposed a system of co-ops that can operate at the state, regional or national level as nonprofit, member-run health plans. He proposed spending $6 billion in federal money to get them started.

Supporters of co-ops maintain that negotiating rates with hospitals, doctors and other providers collectively would reduce health care costs, "without putting the government in charge of health care," as Sen. Kent Conrad (D-N.D.), another one of the group of six, put it. He estimated that Baucus' plan would cover about 94% of Americans.

Many not happy
Many other Democrats and their supporters weren't pleased, however, and some were downright angry.

AFL-CIO President John Sweeney said the Baucus plan "absolutely fails to meet the most basic health care needs of working families."

Sen. Russ Feingold (D-Wis.) said, "My goals for health care reform include a strong public option, long-term care reform and reform of the Medicare reimbursement system that has disadvantaged Wisconsin for far too long. I am disappointed that the Finance Committee bill, as written, comes up short on all three fronts.

Sen. Jay Rockefeller of West Virginia, the second-ranking Democrat on the Finance Committee, branded co-ops "untested and unsubstantiated and should not be considered as a national model for health insurance."

House Speaker Nancy Pelosi (D-Calif.), issued a tersely worded statement. "The House bill clearly does more to make coverage affordable for more Americans and provides more competition to drive insurance companies to charge lower premiums and improve coverage," she said, adding that she looked forward to "modifications."

Pelosi made it clear what she wants: "I believe the public option is the best way to achieve that goal."

Others were more circumspect. At the White House, spokesman Robert Gibbs called the Baucus plan "an important building block," while Senate Majority Leader Harry Reid (D-Nev.) said, "Everyone should understand it's a beginning, a good beginning."

More reviews on tap
The Senate Finance Committee, which has 13 Democrats and 10 Republicans, is expected to finish writing its bill by the end of the month. It then would be combined with the Senate health committee measure and be considered by the full Senate.

At roughly the same time, the House is expected to vote on a consolidated bill melded from the three committee drafts. Then comes the hardest part: finding common ground between the House and Senate bills and producing one piece of legislation.

Baucus' proposal got one important boost Wednesday from the nonpartisan Congressional Budget Office and the bipartisan Joint Committee on Taxation.

Their preliminary analysis found that Baucus' plan would mean a net reduction in the deficit of $49 billion over the next 10 years, as new spending is offset by a combination of cuts in federal health programs, notably Medicare, as well as new taxes and fees.

Baucus proposes a nondeductible excise tax, starting in 2013, of 35% on insurance companies and plan administrators for any health insurance plan that charges more than $8,000 for individuals and $21,000 for families. The Joint Taxation Committee estimates that it would raise about $214.9 billion over 10 years.

The plan faces two instant hurdles: House Democratic leaders prefer an income tax surcharge on wealthy taxpayers, which would raise an estimated $544 billion over 10 years, and the House legislation has considerably less in Medicare savings.

And Republicans will oppose almost any tax increase. Senate Republican leader Mitch McConnell of Kentucky set the tone, saying the Baucus bill would "put massive new tax burdens on families and individuals."

Negotiations heating up, Closing in on a deal

The latest compromises and my analysis

- Elimination of pre-x- not mentioned in the article
- Payment reform- not mentioned
- Quality incentives- not mentioned
- Elimination of waste- not mentioned

= The AP and other members of the media continue their E News! style reporting and are failing to address key issues. They remain fixated on the fluff issues like the public plan option, immigrants and abortion. When most media outlets have the attention span of a fruit fly it doesn't help the American people to get informed.

Because of our sound-bite oriented news we now get three days of coverage of "You lie!" versus real reporting on what the various proposals will cover and reform.


Stay tuned as I'll dig for better details when the Baucus plan is released Wednesday.


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WASHINGTON (AP) -- Senate health care negotiators said Monday they've narrowed their differences on a host of difficult issues with just a day or so left to seal an elusive bipartisan deal that could change the course of the contentious debate.

After months of closed-door negotiations, Finance Committee Chairman Max Baucus said, "We're getting very close." But it remained unclear if the Montana Democrat could strike a bargain to close the deal.

Negotiators pared the cost of their 10-year coverage plan to under $880 billion, and also reported progress on several issues, including health insurance for the poor, restrictions on federal funding for abortions, a verification system to prevent illegal immigrants from getting benefits, and ways to encourage alternatives to malpractice lawsuits.

With or without Republican support, Baucus said he'll have a formal proposal on Wednesday to meet a deadline for moving ahead.

At the same time, he said the bipartisan talks could continue even as his Finance panel begins its formal bill-drafting session next week.

"It's not just tomorrow or the next day," said Baucus. "We're going to keep working."

The three Republicans - Mike Enzi of Wyoming, Chuck Grassley of Iowa and Olympia Snowe of Maine - are under intense pressure from leaders of their own party, some of whom have publicly dismissed Baucus' framework as a Democrat's plan. Baucus may not be able to get any of them to agree. But all three have invested much time and energy in the talks, and Baucus seems to have a chance of persuading at least Snowe.

Sen. Kent Conrad, D-N.D., said the negotiators are close on a verification system to prevent illegal immigrants from getting government subsidies to buy health coverage - a big issue for Republicans.

Negotiators also said they've found ways to reduce the cost of a planned expansion of Medicaid to cover more people near the federal poverty line. The issue is critical to winning support from governors, since the states share in the cos.

On medical malpractice, Conrad said the negotiators agreed that the federal government should provide funding for states to experiment with a range of alternatives to lawsuits.

On abortion, the negotiators are trying to come up with language that would extend current restrictions that prohibit federal funding for the procedure, except in cases of rape, incest, or to save the life of the mother.

Baucus' plan would mandate all Americans to get health insurance, either through an employer, a government program, or on their own. New consumer protections would prohibit onerous insurance companies practices, such as denying coverage because of a prior health problem, or charging more to those who are sick.

Even if Baucus can't get Republican support, the plan already reflects some major GOP priorities. For example, Baucus opted not to include a government insurance plan to compete with private carriers.

"I am very optimistic that we are going to be able to pass a bill that will get us to 60 votes," said Sen. Bill Nelson, D-Fla., a Finance member. "I didn't feel it a week-and-a-half ago, but I'm very optimistic now." Obama's speech last week "hit it head on," said Nelson.

63% of Physicians Support Inclusion of Public Plan Option

Source- Robert Wood Johnson Foundation survey

Survey: 63% of Physicians Support Inclusion of Public Option Robert Wood Johnson Foundation Survey Shows Physicians Support Reform Plan that Includes Both Public and Private Options

A Robert Wood Johnson Foundation survey summarized in today’s New England Journal of Medicine shows that 62.9 percent of physicians nationwide support proposals to expand health care coverage that include both public and private insurance options—where people under the age of 65 would have the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans. The survey shows that just 27.3 percent of physicians support a new program that does not include a public option and instead provides subsidies for low-income people to purchase private insurance. Only 9.6 percent of doctors nationwide support a system where a Medicare-like public program is created in lieu of any private insurance. A majority of physicians (58%) also support expanding Medicare eligibility to those between the ages of 55 and 64.

In every region of the country, a majority of physicians supported a combination of public and private options, as did physicians who identified themselves as primary care providers, surgeons, or other medical subspecialists. Among those who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options.

The survey was conducted between June 25 and September 3, 2009 by Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H., of the Mount Sinai School of Medicine in New York City. While the survey was conducted in several “waves” over a tumultuous summer for the health reform debate, no statistically significant differences were identified in physician responses throughout the summer.

Post Obama Speech Poll Numbers

Source- Washington Post/ ABC News

According to a Washington Post/ ABC News Poll President Obama continues to face some public resistance to his drive to initiate far-reaching changes to the country's health-care system, with widespread skepticism about central tenets of his plan, according to a new Washington Post-ABC News poll.

Earlier, Sen. Olympia J. Snowe (R-Maine), who has been seeking a bipartisan compromise, urged the president to abandon the so-called public option. "It's universally opposed by all Republicans in the Senate," she said on CBS's "Face the Nation." "And therefore, there's no (bi-partisan) way to pass a plan that includes the public option."

Here are some numbers in polling done immediately after the President's speech.

The idea of reform:
Americans remain almost deadlocked in their opinion of the Democrats' health-care initiative, with 46 percent in favor of the proposed changes and 48 percent opposed.

Individual Mandate: The public also divides about evenly -- 51 percent in favor, 47 percent against -- on the question of whether people should be required to have health insurance, a central element of the plans under consideration.

The public option: This is the major point of contention
55 percent say they like the idea, but the notion continues to attract intense objection: If that single provision were removed, opposition to the overall package drops by six percentage points, according to the poll.

Without the public option, 50 percent back the rest of the proposed changes; a still sizable 42 percent are opposed. Independents divide 45-45 on a package without the government-sponsored insurance option, while they are largely negative on the entire set of proposals (40 percent support and 52 percent oppose). Republican opposition also fades 20 points under this scenario.

The politics of the idea would also probably change dramatically depending on its scope: If it were limited to only those unable to get private insurance, support would rise to 76 percent.


More than seven in 10 Americans, including majorities across party lines, say they think Obama and congressional Democrats should adjust the health-care legislation to appeal to some Republican lawmakers. Half credit the Democrats with making a good-faith effort to do so already, while most, 62 percent, say the GOP is not returning the favor.

There is, however, less backing for the idea of a new tax on insurance companies that offer high-cost, big benefit health plans; 45 percent of Americans favor such a levy, and support plummets if it is suggested that companies would have to raise fees for those policies as a result.

Cut to the Chase: Above it all, Fifty-three percent now call government action essential, while 44 percent see it as doing more harm than good.

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.

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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.

Health Compromise Floated Before Obama Speech

Below are excerpts from a NY times article on Sen. Baucus' health care reform compromise. I've edited the article to highlight what Baucus' plan would do, what it wouldn't and what it will cost.

The article as usual does not get into the essential issues- I'll list them again as I see them:
1) payment reform based on quality and episodes of care (rather than fee reimbursement)
2) elimination of individual underwriting and pre-existing conditions
3) requirement to institute LEAN manufacturing techniques to eliminate waste


The article does however layout the essentials of Baucus' compromise-
- no public option, instead using state-based non-profit co-ops
- expansion of Medicaid for low-income uninsured individuals
- lower benefit coverage for those under age 25 without coverage
- fees and additional reporting requirements for insurers

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Health Compromise Floated Before Obama Speech

By JACKIE CALMES and ROBERT PEAR
The New York Times
Published: September 7, 2009
WASHINGTON —
As President Obama and top advisers drafted his eagerly awaited health care speech to Congress, new details emerged Monday about fees and coverage limits under a proposal being floated by the chairman of a crucial Senate committee.
The proposal from the lawmaker, Senator Max Baucus, who heads the Finance Committee, would impose new fees on some sectors of the health care industry, but none on individuals, to help offset initial costs estimated at $880 billion over 10 years, according to officials familiar with the outline.
The plan would:
offer the option of lower-cost insurance, with protection only against the costs of catastrophic illnesses, to those 25 and younger.
provide basic Medicaid coverage to millions of low-income people who are currently ineligible for the program, but the benefits would be less comprehensive than standard Medicaid.
The plan will not be a government-run insurance plan, or include a “public option,” to compete against private insurers.
Solution: Instead, his committee’s group of negotiators has coalesced around the idea of forming nonprofit, member-owned insurance cooperatives in the states.
Republicans oppose the public option, calling it an invitation to a health care system run entirely by the government, and some moderate-to-conservative Democrats are leery as well.

To help pay for his plan:Mr. Baucus would impose fees of $6 billion a year on insurance companies, $4 billion a year on manufacturers of medical devices and $750 million a year on clinical laboratories.
Mr. Baucus has apparently dropped the idea of requiring Medicare beneficiaries to pay 20 percent of the amounts charged for laboratory tests. That will allow him to say his plan does not directly increase costs to beneficiaries.
Mr. Baucus’s proposal would offer low-cost catastrophic insurance as an option for people 25 and younger. Policy experts say many people in this age group cannot afford comprehensive coverage or see no need for it.

“Mr. Baucus’s plan would also expand Medicaid, starting in 2014, to cover millions of low-income people, including many childless adults who never qualified before. Benefits offered to such newly eligible adults would generally be less generous than the comprehensive benefits available to other Medicaid recipients.
For years, governors have wanted more discretion to tailor Medicaid benefits to the needs of different population groups. But Jocelyn A. Guyer, co-executive director of the Center for Children and Families at Georgetown University, expressed concern. “Low-income people without children tend to have extensive health care needs — higher rates of mental illness, physical disability and chronic conditions,” she said.

Mr. Baucus’s proposal would also require health insurance companies to report the proportion of premium dollars spent on things other than medical care. Hospitals would be required to list standard charges for all services.
The information could be useful to consumers. But insurance companies say the data on their expenses can be misleading because the costs of some activities that benefit patients, like “disease management” and the use of health information technology, may be classified as administrative rather than medical.

We've been here before- Will Obama be more like Truman and Clinton or more like Johnson?

From the New York Times-
Changing Health Care by Steps
By DAVID LEONHARDT

Sept 1, 2009

After Harry Truman repeatedly failed to persuade Congress to pass universal health insurance, some Truman administration officials came up with a less ambitious idea. They suggested covering only 8 percent of the population, and an especially sympathetic 8 percent at that: everybody 65 and older.

Truman never really pushed the plan, however. John F. Kennedy later did, yet was stymied by Congress and the American Medical Association, which equated it with Soviet-like socialism. So it fell to Lyndon Johnson. Even after he won a 23-point landslide in 1964, he had to agree to some unseemly deal-making, as Jonathan Cohn of The New Republic has noted, that handed a big payday to hospitals and doctors.

Only then, in the summer of 1965, was Medicare born.

Next week, Congress will return to session, and health care, of course, will be at the top of its agenda. Passing a bill, it’s clear, will be no easier than in previous decades. President Obama’s poll numbers have fallen, while untruths about death panels have made the rounds and members of Congress have been subjected to town hall harangues.

But the job facing Mr. Obama hasn’t really changed: he will have to figure out how to end up more like Johnson than like Truman or, more recently, Bill Clinton. He and Congress will have to figure out how to make some progress toward fixing the country’s troubled health care system.

Any bill they pass will inevitably be flawed. It will not do enough to reduce wasteful spending. It probably will not result in universal coverage. Special interests — like drug companies and, once again, hospitals — will get off too lightly.

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So is this what our politics have become? Has everything gotten so political that we are doomed to implement poor policy and half-baked reforms?

In today's climate bold politicians run the risk of being removed from office before we find out how effective their policies are.

Hypothetical: Let's say the House (240-195) and Senate (51-48) (through Reconciliation) both pass a bold health care initiative with the controversial public plan as a cornerstone but also includes massive payment reform such as "episodes of care" based payment, mandates for individual and small business coverage, tort reform, elimination of individual underwriting and mandates LEAN health care practices by hospitals and doc's by 2015. Let's say all businesses under 10 employees are pooled in the Health Insurance Exchange where the public option is available to them in addition to private plans. Let's further say that most of the reforms including the individual and employer mandates for businesses above 10 employees are effective Jan 1, 2013. That's a realistic timeframe but its after 67% of the Senate has gone through a re-election and 2 x for the House of Reps.

It will be well into 2014 before we have a good sense of how those changes are working. If you were a member of Congress would you vote yes given our current political climate?

Sen. Grassley (R- Iowa) : No public option in health reform

It appears the Public option is out as any compromise between the House and senate versions would seem to eliminate the public option. Its not clear if co-ops remain in play as a pseudo public option to compete against private plans.

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Sen. Grassley weighs in on health reform
By MIKE GLOVER (Associated Press


DES MOINES, Iowa — Iowa Republican Sen. Charles Grassley said Monday he remains hopeful a limited health care reform measure can be negotiated, but that a small bipartisan group of senators working on the issue agrees a government-run public option won't be part of the package.

Senate Finance Chairman Max Baucus, D-Mont., meanwhile, said an overhaul measure will be presented this year with or without bipartisan support — though he said a compromise would be far better than any bill pushed through solely by Democrats.

The senators are among a group of three Democrats and three Republicans on the pivotal Finance Committee who are negotiating a proposal to overhaul the nation's health care system. Both said Monday they were hopeful a bipartisan deal could be reached.

"I think the chances are still good," Baucus told The Associated Press. "I talked to (the Republicans) and they all want to do health care reform. But the sad part is a lot of politics have crept in."

Grassley, the GOP's key negotiator, expressed similar determination, but made clear he doesn't expect a public health care option sought by President Barack Obama to be in a final deal.

"I'm still hopeful, but I'm hopeful based on I think you're talking about something a little less sweeping than what we talked about before," Grassley told the AP in a telephone interview.

Grassley in the past has roundly criticized the public option, but went a step further Monday in saying the core group of senators agreed such a provision would not be in a bill.

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.

Baldwin's efforts on health care reform

Baldwin’s efforts to advance health care- some good, but I'm not sure she understands the public plan option.

The Good…

U.S. Rep. Tammy Baldwin has recently made an impact on some provisions in the health reform bill that will come up for a vote by the full House of Representatives in September. Baldwin won a late-minute approval for one of her amendments: to start a pilot program within Medicaid known as "accountable care" that would pay more for health results rather than individual services.

but…
Unfortunately the amendment only allows a pilot and not all out payment reform based on accountable care. Frankly there’s enough research and evidence already on this to simply start enacting this reform broadly. I presume that this is all she could get passed by the committee.


… and the misunderstood
(http://www.madison.com/archives/read.php?ref=/tct/2009/07/31/0907310169.php)
On another note, in the above linked Capital Times Op-ed piece Baldwin made the case for the public plan option currently being hotly debated. Sad to say her case fell way short in her comparison of Wisconsin’s SeniorCare program to the public plan option proposed in the health care reform bill working its way through the House.

Baldwin wrote, “since 2003, Wisconsin has been offering a public option for seniors in need of prescription drug coverage who do not select the private plans in Medicare Part D. While SeniorCare is both wildly popular and hugely effective, private prescription drug insurance plans continue to flourish in Wisconsin, with a large number of available plans and fair premium rates.” What Baldwin doesn’t say however is that SeniorCare is only for low-income seniors with incomes up to $35,000 annually for a couple. There is no premium. Instead they pay a $30 annual enrollment fee and have copays and an $850 deductible.

So in reality SeniorCare is for low-income seniors and the private Medicare Part D plans are for everyone else. They don't actually compete at all and opens up the question of her understanding of the public plan option.