The CBO Smiles on the House Bill (HR 3200)
Published July 15, 2009 @ 05:01AM PT
Basically, Henry Waxman, Charlie Rangel and George Miller did not want me to watch the All-Star Game tonight. What other possible reason could they have for dropping a 1,018 full bill version of HR 3200 – The America’s Affordable Health Choices Act on Tuesday night?
I have not yet read the full bill, but I have perused the many of the policy materials on the Education and Labor Committee blog, did a quick spot check of specific sections, and of course read the excellent commentary by Ezra Klein, Jon Cohn and Igor Volsky – who even includes putatively “sexy facts” in his chart break down of the features from the score by the Congressional Budget Office. The best part of the bill was how little surprised I was by its features. After all, it tracks very well to the draft House bill that was released weeks ago in terms of structure and features, and its mechanisms for new revenue were already telegraphed by Rep. Rangel of Ways and Means. It also comports along the same lines as the plan that all Democratic candidates – including Barack Obama – ran on.
The question was what would the Congressional Budget Office think? The House bill was always seen as more robust than either the version coming from Senate Health, Education, Labor and Pensions or Senate Finance – meaning it was anticipated to be more expensive. What would the CBO say it cost, and how many Americans would it really cover?
There’s a reason for looking at the CBO as a looming, potential threat to the viability of getting reform enacted. During the Bill Clinton effort, the CBO made the determination that all premiums paid to the network of private HMOs that formed the backbone of that plan should count as federal income. Even though it didn’t change the reality of how much money Clinton’s plan would have cost, it changed the political perception of his program as an unprecedented expansion of the federal government. A plan that was already reeling received a knockout blow.
One need only look at the miscommunication and brouhaha that arose a month and a half ago when the CBO released preliminary numbers on 2/3 of the Senate HELP bill showing it cost over $1 trillion over 10 years but would only cover a few million more people to realize a bad score could stop reform in its tracks.
That’s why it’s so gratifying that CBO has given the House a good score – indeed, better than I anticipated. In what are admittedly preliminary numbers – the bill may still change during markup and amendment, the CBO scores the complete House package as costing $1.042 trillion over 10 years, well under the $1.5 trillion or more anticipated by many. It would also be effective, with approximately 97% of Americans receiving coverage through public programs like Medicare and Medicaid, their employer, or through the Health Exchange transparent marketplace for comprehensive benefits, with its subsidy credits to make health insurance affordable as a fraction of your income.
What’s striking is that the major controversial pieces in the bill haven’t been watered down in the face of opposition. They didn’t need to be. It still has a public health insurance option that’s more robust than the version in the Senate HELP committee, in that it would start off with Medicare rates for doctors and hospitals (although it would modify those rates upwards if the doctor took both Medicare and the public plan) before shifting over time to negotiating with providers like any health insurance plan. Far from adding to the cost of health care reform, that more robust public plan is a cost-saver, generating a surplus of $150 billion over ten years. Those who complain that the public plan will “crowd out” private insurance no longer have the numbers to back it up – the CBO projects even this robust public plan will only enroll 11 to 12 million people. That’s a frustrating low number for those of us who think the public plan will truly be a better deal. But if it helps diffuse the “fast march to socialism” meme, I’m all for it.
If covering 4% of Americans over ten years is a “Washington takeover of health care,” then me paying state sales tax is an “Albany takeover” of my personal budget.
The House has a stronger employer “pay or play” in that the fee for not giving your employees meaningful coverage would be 8% of salary for businesses with an income of over $400,000 a year, rather than the tamer $750 per full-time employee in the Senate. The combination of savings from Medicare and Medicaid – usually the obvious things that we’ve talked about again and again, like cutting overpayments to private Medicare Advantage plans – and the surtax on the wealthiest 1.2% of Americans are anticipated to easily pay for the bill’s provisions (the final word is still pending, although the House bill would wisely scale back the surtax if it turned out to generate more revenue than was required.) Anticipating a misinformation campaign from the opposition about how any tax on the wealthiest sliver of Americans would hurt small businesses, the House policy document announcing the surtax throws water on that assertion: “96% of small businesses would see no tax increases under this proposal.”
These are the very things that the opposition is likely to demonize. They’re also the very things that, according to the CBO’s calculations, make it work.
Of course, if you had read the news reports over the past week, you might have expected a severely curtailed and compromised bill, or one more susceptible to the complaints from the conservative Blue Dogs. But the House hasn’t pared down its ambitions one bit. And lo, the CBO does smile upon the results. Let’s hope that stiffens the backs of reformers in the House – they’ll need to be strong to shepherd this bill through the political mess to come.
(Photo credit: House Education and Labor Committee on Flickr.)
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Comments (41)
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Tim has been an online organizer and blogger on health care policy for the Obama for America campaign (during the primaries) and currently for the Committee of Interns and Residents/SEIU Healthcare, a labor union for intern and resident doctors. Views expressed here are Tim's, and don't represent the positions of CIR or SEIU.
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I'm hitting all the same sources you are for analysis and am about to resort to digging through the bill itself to figure out why the public health insurance plan will only cover that many people. Will membership be restricted or is the CBO figuring that people won't choose to opt in? TNR's wondrous timeline (here: http://issuu.com/thenewrepublic/docs/timelineforhealthreform?mode=embed&layout=http%3A//skin.issuu.com/v/light/layout.xml) suggests that membership will be restricted and that by 2015 the Commissioner will have the option to expand eligibility. I'm not loving the sound of that.
I'm very relieved to see the good score from the CBO. I was sweating that more than the release of the new version of the bill.
Posted by robin stelly on 07/15/2009 @ 05:59AM PT
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The short version, as near as I'm able to tell, is that because the CBO estimates that premiums for the public plan will be 10% lower than the private insurance plans, that something less than half the people in the Exchange will sign up for it. They also presume the tougher employer mandate in the House will deter more employers from dumping coverage.
As with everything to do with the public plan, we're guessing based on economic modeling. The Lewin Group guessed that 30 million or so would sign up for a weak public plan. The CBO guesses 11 to 12 million. In that, it's consistent -- it gave a similar low guess for the Senate HELP version of the public plan.
Reality, I would hope, would be much better than that. But I'm not an economist.
Posted by Timothy Foley on 07/15/2009 @ 10:45AM PT
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Also, the rules for who can enter the Exchange (and thus get the public plan) are unchanged, as far as I've read, from the draft bill. I don't see any more stringent regulations.
Posted by Timothy Foley on 07/15/2009 @ 10:48AM PT
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When I read the draft, I thought the public plan would be open to everyone in Year 3 - but I read summaries of the draft, not the draft itself. The Exchange Access Study may have been in it.
Posted by robin stelly on 07/15/2009 @ 04:01PM PT
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So we're supposed to be happy because the CBO gave a "favorable" score to a bill that leaves millions uninsured, doesn't insure undocumented workers, taxes businesses more than they would under a single-payer plan, costs over a trillion dollars, and subsidizes private insurance companies?
Obsessing over the CBO score has distracted you from the reality that this bill, which is the most progressive we'll get out of this reform effort, sucks.
Spending a trillion dollars to NOT provide universal coverage, while a single-payer plan could save up to $400 billion a year and cover everyone, is a sad mistake created by a Congress that has decided to protect private insurance rather than stand up to them.
Furthermore, compromising a good public option, to "diffuse the 'fast march to socialism' meme," is maddening. Who cares about what FOX says about health reform? Why would we write policy in hopes of not upsetting Hannity and Beck? They're the only ones spreading this baseless meme.
Posted by Jeff Muck on 07/15/2009 @ 07:33AM PT
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Well, get ready for more bad news, Jeff. It looks like the HELP bill will be out today.
Posted by robin stelly on 07/15/2009 @ 08:40AM PT
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Here's a very long summary of the HELP bill: http://help.senate.gov/Maj_press/2009_07_15_b.pdf
Posted by robin stelly on 07/15/2009 @ 09:28AM PT
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I was hoping to see something under "Controlling Costs" about limiting the exclusivity of data in the pharmaceutical industry. As I pointed out elsewhere, the hope was that exclusive research data could be made available to others after 7 years. Ths would ensure drug companies a fair return, spur innovation, and reduce the cost of drugs to consumers. The HELP committee opted only to ensure obscene profits for drug companies for fear they would leave the country.
Sen. Tom Harkin: Keep in mind what we're talking about here. We're not talking about patents. Everybody gets a 20 year patent... What we're talking about here is data, data exclusivity... How do you get that data? You get it through FDA supervised trials... Where do they do those clinical trials? Academic health centers. Who supports academic health centers? Our taxpayers... When should that data be released so that another company out there, some other entrepreneurs, can look at the data and say... I'll bet if we changed this and did this, we might come up with a new formulation that might actually help something else. They're still going to have to go through their clinical trials... At least they'll be able to look at the data. If you don't do that that means that the company can sit on that data for 12 years. Then they let the data out. Clinical trials will take another 7 years or more, so you're going to have at least a whole 20 year run in there... before anyone can ever surface with anything even comparable to what that drug or that biologic is.
Sen. Sherrod Brown: You know what we've not talked about, Mr. Chairman? We're not talking about how much these biologics are costing patients. Let me give you some numbers. (examples)... 48 thousand dollars... 20 thousand dollars ...100 thousand dollars. You know what the average wage in my state is? 46 thousand dollars... If we do this giveaway to the drug industry, this giveaway to the biologic companies, it means profits are up for them, it means executive salaries are up for them, it means we can all feel good, but let's think about the patients, let's think of the patient with breast cancer who has got to spend 1000 dollars a week... the patient with colon cancer who's got to spend 2000 dollars a week... What kind of progress is that, Mr. Chairman?
Posted by Martin Bring on 07/15/2009 @ 09:59AM PT
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I am suspicious of the "public plan" because I think it will
be far less costly than competing private plans
and will therefore NOT be made available to anyone currently
insured. This is exactly what Massachusetts did
in their mandate legislation. Can anyone dis-abuse me of this
notion? Why should any of us be interested in spending
a trillion dollars on something that will not really be made availableto us? Sorry if I sound selfish, but if the plan is
solely to subsidize the currently uninsured, where is MY
savings?
Posted by owen bowman on 07/15/2009 @ 10:36AM PT
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The trillion dollars is NOT for the public plan. It's for reforming health care in general.
For that fine price, you get:
* More primary care providers (we have too few) trained and deployed to high need areas
* Excluding discrimantion of pre-existing conditions for private insurance and out-of-pocket spending limits where none currently exists
* Investments in Health IT, prevention, wellness, research on what works and what does not, and to curb out of control costs for preventable phenomena like hospital readmissions, which we're all paying for in taxes
* And a gazillion other things that directly impact quality of health care and saves costs in the long run, but costs up-front dollars
Your question brings up a great point. Too often the public plan gets misinterpreted as being the central piece of health care. It's the focus of the political fight. But the plan doesn't just provide piece of mind for those who are currently insured against costs that are getting less and less affordable -- it provides real savings.
Posted by Timothy Foley on 07/15/2009 @ 11:53AM PT
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Owen: As I read the House bill, it feels more and more to me like a pilot program. The public plan, which would provide you with savings as far as cost of coverage goes, won't be available to you (I'm guessing) within the first three year. After that point, the Commissioner will review a study of terms, access and affordabilty (pg. 83 of the bill) to see whether eligibility expansion is warranted. So, if the private insurers play ball and offer products that make expanding access to the exchange unnecessary, then it won't expand. Making sure that that study is on the up and up will be a job for consumer advocates.
Posted by robin stelly on 07/15/2009 @ 12:18PM PT
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According to the NY Times today, "Douglas W. Elmendorf, director of the budget office, said that by 2019 the bill could reduce the number of uninsured by 37 million, leaving 17 million still uninsured." Note the "could."
Further on, the story notes: "The House bill would create a new government-run health plan, which would compete with private insurers, starting in 2013." Well, let's give the private competition a four-year lead to make SURE the public plan can't compete.
As I have commented elsewhere on this blog before, it took 11 months to cover 95 percent of eligible seniors with Medicare in 1965, and that was before computers were in widespread use.
Ten years to cover 2/3rds of the uninsured means, very conservatively, another 200,000 people dying in this country simply due to lack of coverage. This bill is an OUTRAGE.
I don't know how anyone can talk about healthcare reform the House bill in the same sentence with a straight face.
Posted by Carla Rautenberg on 07/15/2009 @ 12:42PM PT
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Tim (or anyone),
As we know, the surtax on the top 1% would have a minimal impact on only a small percentage of small businesses.
But what about the tax on employers who do not provide coverage? Has there been any analysis of the potential economic effects of this, given the proposed levels & percentages?
Posted by Paul Drake on 07/15/2009 @ 02:06PM PT
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Just answering for the House bill (since that's the topic we're on), if the business has a payroll under $250,000, the penalty is 2%. It's on a sliding scale between $250k and $400k, and at 8% for $400k and above.
But let's also not forget that microbusinesses (10 employees or fewer) get a tax credit to help them afford insurance.
So the net result for all small businesses under $400k in payroll is actually that the plan pays out more than it takes in -- to the tune of $53 billion in credits.
It makes that money back for businesses with payrolls over $400,000, which is how we can afford to do it. But it's not unfair to say the House is bending over backwards not to be harsh on small businesses. The current small business market, of course, is extremely harsh, which is why fewer and fewer businesses are able to realistically afford to offer benefits.
Posted by Timothy Foley on 07/15/2009 @ 02:23PM PT
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Are the subsidies available based on number of employees or on amount of payroll? Volsky suggests it's the latter: http://wonkroom.thinkprogress.org/2009/07/14/house-bill-comes-in-at-1-trillion-undermines-gop-talking-points/
Posted by robin stelly on 07/15/2009 @ 04:04PM PT
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The whole direction of the healthcare "debate" in Congress is making me sicker by the minute. I don't want "choices", I want care, wherever and whenever I need it. Everyone deserves the best care and we, as a nation, not simply as individuals, deserve it at the lowest cost to this nation that we can manage.
What I really want to see is direct answers from our reps to direct and simple questions that concern US. e.g. What if I lose my job, have only income from unemployment and can't pay for health insurance? Am I covered? Will I be covered right away? If I find a job and the employer makes me wait 90 days to start coverage, will I be covered in the meantime? At what cost? Will doctors and hospitals be able to chose which coverage to accept? Can my insurer still restrict availability of doctors and hospitals and make me travel farther to a pre-approved provider? Can I tell my employer to enroll me in a better plan? a public plan?
Think I can get straight answers from my representative? He'll be voting agaisnt the bill, that's a foregone conclusion. I've written and cannot get a personal response. Just his FOX-quoting lies.
There's too much thought about healthcare affordability and not what it is we're trying to afford. There's too much thought about preserving the insurance system and no one in Congress is asking why. There's too much choice being given to providers as to what they want to offer.
Everyone deserves, by right, to be healed when sick, have chronic conditions handled by pharmaceutical or other appropriate therapies, receive screenings and preventive care, and receive the best of all available services with or without insurance, with or without means. It isn't about profit, employment, liberties, or choices - it's about our right to life and our duties toward one another.
Funny thing is, the strongest opposition to this is the pro-life party of faith. I'm getting tired of seeing my faith invoked, waived around, and used to frighten the opposition instead of being put to work.
Posted by Harold Lewis on 07/15/2009 @ 02:54PM PT
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Not everyone in Congress is happy with the trend. Bernie Sanders, Dennis Kucinich, John Conyers and many others support Single Payer and have made their complaints known to Obama and their colleagues.
Senate HELP Committee
July 14, 2009
Sen. Bernie Sanders just offered an amendment to the Senate HELP health care reform bill that would allow a limited number of state experiments with single payer systems. The proposal would have provided waivers from federal regulations such as ERISA, and would have authorized current federal spending on programs such as Medicare and Medicaid to be transferred to the state to be used in the single payer program.
Those voting for the amendment:
Bernie Sanders
Tom Harkin
Sherrod Brown
Jeff Merkley
All HELP Republicans and all other HELP Democrats voted against it.
Posted by Martin Bring on 07/15/2009 @ 03:42PM PT
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Harold,
You say everything I want to say, and you say it better. THANK YOU for your thoughts, your knowledge, your passion, and your heart.
Posted by Carla Rautenberg on 07/15/2009 @ 08:22PM PT
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It looks to me as though the House is bending over backwards to save the health insurance industry from itself... I don't see a public plan that will keep insurance companies honest. What I see is a plan designed for limited membership so as not to disrupt the status quo .... or as Tim put it, "diffuse the “fast march to socialism” meme."
We'll have to wait and see how Wall Street reacts.. If funds start loading up on private health insurance stocks, we'll know they expect a captive base of customers with government subsidies, courtesy of tax payers, to guarantee profits. If funds start running for the door, we can have a reasonable expectation that the Administrations plans for health care reform are effective.
Again, the goal is to reduce the rate at which the cost of health care goes up to 2% a year or less.. That would be a tragedy for Wall Street but a success for Main Street.
Another gauge is Larry Kudlow.. The more that twisted man whines, the more we can presume we're moving in the right direction.
http://www.youtube.com/watch?v=Lkqb1pQrCcg&feature=related
Posted by Martin Bring on 07/15/2009 @ 03:31PM PT
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Hang on. Did I read right that individuals who are at 400% above the poverty line ($44,000+ per year) will be obligated to pay a 2.5% (so $1100 for $44,000) penalty if they opt out of the mandate?
And these individuals will not receive subsidies for the public option, correct?
Do we know how much the public option will cost per year for an individual?
Posted by Paul Drake on 07/15/2009 @ 09:57PM PT
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Last question first: we haven't even set the benefits yet, so we can't know precisely. The CBO thinks that the public option will be about 10% cheaper than an equivalent private plan in the Exchange. Their estimates are, by nature, conservative.
Individuals at 400% of the poverty line and below receive a subsidy so that any plan is 11% of their income or less. So you can buy a comprehensive plan for $4,000 or, as you say, you can opt out of the whole system for a measly $1,100. That's one of the reason that 3% of legal citizens are likely to still not have coverage -- they may decide to take their chances and just pay the fine.
The other reason is once you get to 96, 97, 98%, it becomes infinitely harder to get to 100, even if the program is free. New York State has a very generous CHIP program for free, but it's still a challenge to get that 95-100th percentile to sign up. I've been to hospitals where they're literally offering free iTunes cards for each signup to try to get closer and closer to 100.
Posted by Timothy Foley on 07/15/2009 @ 10:07PM PT
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OK, thanks for the clarification, Tim.
(Sorry, but I have some more questions):
Do those under the 400% mark also have to pay the 2.5% penalty if they do not buy insurance?
I guess I'm concerned that those folks and/or people just above that 400% cutoff who may still, for whatever reason, struggle to afford even the public insurance. Wouldn't the mandate just mean that they now have to pay an extra 2.5% tax but still have no insurance to show for it?
In short, could the individual mandate end up hurting low to middle income folks who couldn't afford the public option? (Or is it generally understood most would be able to afford it?)
Posted by Paul Drake on 07/15/2009 @ 11:28PM PT
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Proof will have to be in the pudding for people under 400% of poverty. Those up to 133% will now be eligible for Medicare, so affordability won't be a problem. Those from 133%-400% will have comprehensive plans with subsidies tied to a percentage of income. At the low end, it's 1%. At the high end, it's 10-11%.
Here's some back-of-the-envelope math: If you're a family of 4 at 150% of poverty, your premium would be around $330. That's *less* than the penalty would cost. If you're at 300% of poverty, your premium would be around $6,000 (penalty would be $1,650).
The one other data point is what an average family of 4 health insurance plan costs TODAY. It's currently $12,000 and rising. So no matter what, this is a vastly improved situation.
It's entirely possible a family making $66,000 may still not be able to afford a $500 monthly premium. Most health care wonks think 5-8% is the ideal affordability range, so 10% is certainly high. There is room for a hardship deferment on the penalty, as there is in Massachusetts. But most of the economic modeling suggests you'd get health insurance within reach of nearly everyone under 400% of poverty.
Posted by Timothy Foley on 07/15/2009 @ 11:40PM PT
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Europeans with private insurace pay in premiums for a year what we pay for a month.
Can't say that the EU isn't staunchly capitalist. With regard to the insurance companies they sort of trust in God but keep their powder dry.
All we need is the backbone to stand up and reject the current system of funding.
Posted by Harold Lewis on 07/16/2009 @ 05:47AM PT
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Tim, you say "Those up to 133% will now be eligible for Medicare, so affordability won't be a problem." I think you mean Medicaid, the program for the poor, which is substantially different than Medicare, the program for the elderly.
HR3200 is a federal version of the Massachusetts plan, and the Massachusetts plan is in financial free-fall after only 3 years of existence.
Moreover, everybody please note: the so-called "public option" will not be available to anyone before 2013.
It is very likely we will be operating with a very different Congress and possible that we will have a different President by then.
This is a boondoggle for the American people and a give-away to the insurance industry. As Martin Bring so wisely says, watch Wall Street. Online financial sites have been salivating over the prospects for health insurance stocks following this Change We Can't Believe In.
Posted by Carla Rautenberg on 07/16/2009 @ 04:23AM PT
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Thanks for the catch, Carla -- yes, I meant Medicaid, not Medicare. No more posting comments after 2 am for me...
Posted by Timothy Foley on 07/16/2009 @ 07:19AM PT
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As I see it, regional variations in cost of living, everything from rents to groceries, make federal poverty guidelines useless. Further, not tapering off the subsidies upward more gradually is going to trap a lot of families in between.
I think the notion of a highly progressive tax on top incomes that is being considered to fund part of the public plan is a start but Congress (and many middle-class Americans) is still deluded into believing that truly progressive taxation amounts to a free-ride for middle and lower incomes and a penalty for the wealthy. We could surtax the fortunes of the top 15% of earners to have single payer for the 85% of us who produce their fortunes.
So, I find it a great irony that individuals will be forced to spend, either through penalties or mandated premiums and that they will be forced to spend in a decidedly regressive fashion. It's a twisted sense of fair play not to mention a direct contradiction of fundamental economics.
Further, with all the talk of choice - where we WANT to put our healthcare coverage dollars - I don't see a provision in the bill requiring emloyers who offer plans to pay out as salary the amount of the premiums they subsidize to an employee who opts to obtain coverage elsewhere. This is a critical issue as many corporations have job classifications sorted often by function and title. The wages within a classification are comparable over a range. Someone opting out because a spouse has coverage saves the employee contribution but does not get the addtional pay. As evidence of the situation, employers often have waiting periods from 30 - 90 days for a new employee to be eligible for coverage. During that span, there is no contribution from the employee toward the plan. However, the base salary is no higher for the period prior to the emloyee being enrolled.
At least, this how things have been structured in Northern Jersey for over 20 years. Which brings me back to federal poverty guidelines. If you're an individual at 400% of poverty level in Northern Jersey and you're not still living with your parents, then you're paying about $1200/ month to compete with roaches for living space - less if you can handle more crime and rats. I can promise that even another 5% of your gross would be a huge burden.
Posted by Harold Lewis on 07/16/2009 @ 05:43AM PT
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Wow, those who beleive it is a good thing to pay Medicare rates need to their research.
http://www.healthcarefinancenews.com/press-release/new-plan-imposes-financial-hardship-california-hospitals
An excerpt
"Government programs, such as Medicare and Medicaid, currently underpay providers for services. In California, Medicare reimbursements only cover approximately 83 percent of hospital costs, and Medi-Cal only covers 81 percent. Those shortfalls get passed through the health care system, and consumers and employers end up paying higher premiums as a result. According to a study by Milliman, Inc., an average family of four is paying $1,500 -- or an additional 10 percent -- on their premiums to offset the under-reimbursements from government programs. As more people move to a government-run plan, there would be fewer people with private coverage to offset these costs, causing premiums to increase even further. This would ultimately lead to a "death spiral", resulting in everyone moving to the new government-run plan."
Posted by zeus charles on 08/08/2009 @ 01:26AM PT
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That report has already been debunked in a previous post. Gosh, let me think, what's been going on in California's budget situation that might possibly be a contributing factor...
Posted by Timothy Foley on 08/08/2009 @ 01:40PM PT
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According to the text of the bill;
"To enable the real-time (or near real time) determination of an individuals financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card"
So we will all have to carry a card that has access to ones financial information. Furthermore to determine ones "individual Financial Responsibility" ones financial information would be tacked on and if I understand the text of the bill correctly the government would have access to your bank information to deduct what your "fair share" would be. This means that we would all be carrying a card that identifies us, ties us to a number that relays tax and full access to ones banking information. I am not ok with that and refuse to believe that most Americans are ok with the government having that much information on them either. After all even though the Obama administration has conveniently forgotten about it the patriot act is not the most popular legislation.
As I have said before I am all for reform, but this is just another set of bad, hurried legislation that will inject more government controll into our lives. One other interesting observaton, everyone is so eager to compair this legislation to legislation in countries like France and Canada. In those countries you simply sign your name, here we add red tape.
Posted by Seth Piepgrass on 08/08/2009 @ 09:03PM PT
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Seth, you used the phase, "if I understand the text of the bill correctly"
Based on the above, the answer is no.
The clause you cite above uses the word "may." Guess what, I have a smart card with my private insurer right now. Swipe it, and it determines what my co-pay (or "financial responsibility at the point of service") is at the time of the tranaction. This includes whether my doctor is in network or I have to be charged an out-of-network fee on the spot or through paper billing.
Everything about your financial status, your banking system, your whatever, your privacy being compromised -- you totally just added that into the discussion yourself. You guys have some pretty vivid imaginations, I'll give you that.
Posted by Timothy Foley on 08/08/2009 @ 09:13PM PT
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For those of you so inclined to see for yourself, this section is "‘SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE TRANSACTIONS." and basically talks about setting up a cross-industry standard for paperwork and a process for approving and adjusting claims, making sure your doctor is in-network, etc.
Currently, there is no standard, which contributes to the administrative overhead, particularly for private insurance -- everyone has their own forms, their own standards, their own pre-approval process, etc. This makes it tough for doctors in private practice, who now must hire their own administrative staff to jump through the hoops of each insurer. A few private insurers are using smart cards with providers who use electronic medical records to determine co-pays and cost-sharing, as well as sending up a flag when a treatment or prescription drug a doctor wants to provide is not covered by the plan. It turns the old FAX and telephone system into a simple swipe that takes seconds. The VA system has also been using smart cards for years, although that's a closed system and so a bit of an apples &oranges comparison.
Ironically, it is an attempt to clear away red tape, despite being branded as a bureaucratic nuisance by enemies of reform.
Posted by Timothy Foley on 08/08/2009 @ 09:25PM PT
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The reason you can't simply sign your name and red tape is added is because the system reforms being proposed prefer to support costs+profit and subsidy to the insurance companies rather than direct disbursement to healthcare costs only.
So long as obligations vary by participant and chosen plan, some form of tracking is required.
Beyond that, unless we create the most open and merciful system the world has ever seen and offer care to anyone without regard to citizenship, some form of identification would be required. Believe me, if I could sell the idea, I'd cover anyone from anywhere who is in need and wouldn't even ask them for information they don't wish to volunteer.
Posted by Harold Lewis on 08/10/2009 @ 06:45AM PT
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That part I "added" as you say was from page 58 paragraph D of the bill legislation (I unlike our legislators actually read the bill going through). Lets use some simple logic shall we? Why feel the need to specify "real-time" to determine financial responsibility if there was not a tie-in to ones financial information? Oh and why do I say this? because I have read on from what I posted earlier. The legislation goes on to say;
(Continued from above quote)
(E) ...and enable, where feasible, near real-time
adjudication of claims;
(F) provide for timely acknowledgment,
response, and status reporting applicable to any
electronic transaction deemed appropriate by
the Secretary
Translated:
The bill grants rights to the government to directly pull funds, to do so access to ones financial information would be required.
Posted by Seth Piepgrass on 08/08/2009 @ 09:33PM PT
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Seth, your translation skills are intriguing to say the least:
There is no authorization to pull funds from anywhere. "Real-time adjudication of claims" = resolving a disputed claim with your insurance company.
Right now, disputing claims takes a significant amount of time during which either the provider's payment is held up, or you need to call back to your insurance company between the hours of 9 am and 5 pm and provide ample documentation. Real-time is important because if the podiatrist wants to do an in-office repair of my in-grown toenail and the claim is disupted by my insurance company (something that happened to me just last year), the adjudication takes months.
I would much rather have that be an electronic transaction, akin to canceling and rescheduling a flight on jetblue.com, rather than go through the laborious process it is now.
Again, you're totally putting any talk of a person's financial information in there yourself. Reading the bill is insufficient if you're just going to make stuff up about it all the same. Frankly, you should have saved yourself the trouble of reading it and gone right to the make believe. Would have probably been a little more fun for all of us.
Posted by Timothy Foley on 08/08/2009 @ 09:57PM PT
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Pg 195-196
"Health Choices Act of 2009, shall disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit described in subtitle C of title II of the America's Affordable Health Choices Act of 2009. Such return information shall be limited to-
‘‘(i) taxpayer identity information
with respect to such taxpayer,
‘‘(ii) the filing status of such tax13
payer,
‘‘(iii) the modified adjusted gross in15
come of such taxpayer (as defined in sec16
tion 59B(e)(5)),
‘‘(iv) the number of dependents of the
taxpayer,‘‘(v) such other information as is pre20
scribed by the Secretary by regulation as
might indicate whether the taxpayer is eli22
gible for such affordability credits (and the
amount thereof), and
‘‘(vi) the taxable year with respect to
which the preceding information relates or,if applicable, the fact that such information is not available."
A persons income tax information is certainly ones private financial information, and that is just what is expressly written in the bill. There is a lot of leeway given to the Secretary as to what is "deemed appropriate", so even things that are not expressly transcribed in the bill may at a later time be added.
Again if you would read posts rather than lashing out at those who have a differing opinion from your own maybe we would see progress in politics. Sadly you would rather belittle others than engage in actual dialogue. I find this to be a sad trend on this site. The group-think gets to a such a level that anyone who has a differing opinion is openly attacked.
Posted by Seth Piepgrass on 08/08/2009 @ 10:33PM PT
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I don't mean to play so rough, but honestly, you come here claiming to have found something in a bill that isn't there. I'm going to point that out every time, because you are putting your opinion out there as objective fact, and subsituting your translation of a clause for its true meaning.
If you do that and it turns out your translation is correct, I'll leave it be.
In this case, you just juxtaposed two completely different clauses to make the case that we'll have an identifying card with our tax information on it.
pg 57 allows for standard administration and claims processing. A card there is a good idea, particularly if it turns up a dispute that can be resolved immediately.
pg 195-196 allows for how to determine if your income qualifies for a subsidy ("affordability credit"). A swipe card to determine eligibility would be a poor idea, which is why it isn't mentioned. There is no connection between this clause and the clause above except that, yes, they happen to be contained in the same document.
You should continue to section B which restricts any use of this information explicitly "only for the purposes of, and to the extent necessary in, establishing and verifying the appropriate amount of any affordability credit".
Look, Seth, if you came in here saying it is your opinion that this puts us down the path to an invasion of privacy, I wouldn't be jumping in because that's your opinion. I don't agree, but I can't disprove it. If you come in here with bill citations that, to your mind, prove an apple when the bill language sets up an orange, I'm going to correct you every time. If it's easy to disprove, I'm going to do so.
Posted by Timothy Foley on 08/08/2009 @ 10:48PM PT
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I understand that you have an interpretation of the legislation based on your understanding of the language used in it. I have pointed out parts of this legislation that point to language that gives a lot of latitude to the government in determining ones responsibility. While I thought I implied it I probably should have spelled out that yes having a card that ties one to a number should be disconcerting to every citizen. If you think someone getting your social security number is a nightmare...Privacy rights are among several concern I have with this legislation. Social engineering, mandatory end of life counseling, Government home visitation... I think the whole privacy thing went out the window a long time ago. I am still going through a lot of that part of the bill so I will wait to comment on it, suffice to say I think it will take us in a directions a little too 1984 for most Americans liking...
In any case I am reading the bill like most Americans are. It's a complex piece of legislation that leaves more loose ends up to the Secretary than I am comfortable with. Maybe you are comfortable with your tax information being accessed by several federal entities but I am not. Additionally in reading the bill allows talk between branches of the government (pg 503) to communicate your information. Point blank I don't trust them to not abuse the power this legislation gives them. I have friends with whom the IRS has made their lives hell (even if the culpret did deserve it it affected employees) and the IRS has acess to bank information. This institution has the power to get data from other state agencies (the IRS being one that they would regularly get tax information from). I don't like it, especailly since the administration isn't about limiting the power of government.
Posted by Seth Piepgrass on 08/08/2009 @ 11:46PM PT
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We can all discuss the fine points of HR 3200 for endless hours, this is NOT the reform I want and certainly not what I expected from Obama. It's like putting a band-aid over a severed head! I agree with people that say we need to get a backbone and stand up to the lobbyists, stand up to the corporate health insurance giants, stand up to the opponents of true reform and say THIS IS UNACCEPTABLE!
First, I have a BIG objection to being forced to pay an outrageous amount of money for a health plan premium or being forced to pay a fine. How can they FORCE people to pay a fine and still not be able to offer medical care to every citizen??!!! Who in this country wants to choose between paying too much or paying a fine and STILL not have a health insurance plan? That's the most absurd idea I've ever heard in all this mess! SO much for choices and freedom!
What we need is HR 676! I support a single-payer national health care plan. And it is NOT socialist. It's in the same category as the public school system and the public water system. Health care should NOT be a for-profit corporate industry, it is a basic necessity to life and a fundamental right in any free, democratic industrialized nation (except the United States). When you look at the facts and the statistics, a single-payer public health care option really is the best choice.
Posted by Danielle Kelly on 08/09/2009 @ 04:37AM PT
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If we boil down the proposal to the basic method being proposed to deliver better healthcare to more people we have: direct taxpayer subsidy to costs + corporate OH&P as a preferred mechanism over direct funding of actual costs.
You couldn't pull this off in any other country. Only Americans are so wary of their ability to govern and so trusting of profit-driven interests.
Even more shameful is that the press in most other nations would have boiled this down already for their audience. Ours is just another tool of obfuscation throwing the details out as a smoke screen to cover up the central flaws.
The bill is too big and tires to do too much all at once. It avoids the needed universal coverage inspite of looming long-term unemployment even after recovery.
It maintains a separation based solely on age as entitlement to single-payer coverage despite the fact that Medicare is not earned, it is a pay-as-you-go program funding current benefit costs with current tax revenues. Mind you, I do not object to Medicare. I object to the mobilization of these single-payer benficiaries as voices against extending those benefits to the workers who are paying for Medicare. Here, too, such divide and conquer strategies find traction in this country where they would not in others.
The bill proposes directions, rather than concrete strategies, to shift away from disease-centered to prevention-centered care. It largely relegates high-cost services like dental and orthodonture to premium status for adult patients. It doesn't actually spell out what fundamental care ought to be offered to all Americans. It leaves it as a to-be-determined-by-process issue which, like Medicare, can vary State to State. This should have been among the first orders of business, provide universal coverage to everyone and here's what the coverage shall be...
What we're being offered is a windy, timid bill with a weak public option, tons of corporate welfare, uncertain cost controls, and even less certain delivery reforms.
HR676 is the solution but no one is getting the real message.
Posted by Harold Lewis on 08/10/2009 @ 07:32AM PT
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I prefer a health care Reform bill that reforms our current healthcare systems instead of creating a whole new systems that brings with it new problems. Our present system as good as it is fails in several ways. One coverage for people who are laid off or loose employment, no coverage for low income employees (even though state plans will pay for the poor and unemployed) Illegal or undocumented workers (this one gets to me, I travel all over the world and not one country will cover my medial care abroad) Americans should not pay for people who are here Illegally. Interstate Insurance competition (check out the McCarran-Ferguson Act) Insurance industry needs more regulatory oversight . Tort reform . I believe these are some of the steps that will bring us closer to real healthcare reform.
Posted by Scott Wieduwilt on 08/15/2009 @ 08:51PM PT
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