What Does Ted Kennedy Have Up His Sleeve?
Published May 28, 2009 @ 10:08PM PT
He’s a liberal and progressive icon for whom health care has been a lifelong passion. But we have not heard an awful lot from Ted Kennedy lately. We know he’s been having regular closed-door meetings with shareholders across the health care system. Because of that many have been nervous about what type of reform proposals would surface in the Senate Health, Education, Labor and Pensions Committee. For the first time today, we’ve begun to see hints about what Ted Kennedy has up his sleeve. It looks very good, both for health care advocates and the country.
In an Op-Ed in the Boston Globe, Kennedy begins to lay out what reform will look like when his bill begins mark-up. Because I always give short shift to these aspects of anyone’s plan – largely because almost everyone is in agreement on the importance of these steps, and most proposals are short on details – let me first mention Kennedy’s focus on “cost reduction,” “a new emphasis on prevention,” expanding home care, and “a 21st-century workforce” -- all essential elements for a comprehensive plan.
But the section that will get most reporters, reformers and forces of the status quo stroking their chins explains how he would extend coverage to the uninsured. After such a dramatic silence, it turns out his rhetoric contains few dramatic surprises. It sounds like the Obama campaign plan, the public musings of Baucus’ Senate Finance Committee, and the leaked elements of the House plan: the by-now traditional promise of “If you like the coverage you have now, you keep it”; “new gateways” – basically the health exchange model – that allows you to easily compare benefits and costs for participating plans; subsidies to “help you with your premiums if you can't afford them”; new regulation of the insurance industry, including a prohibition on cherry-picking; and finally, the ever-controversial but much-needed “health insurance program backed by the government for the public good, not private profit.”
So far, no surprises. It was at best a longshot that Kennedy would duck the Congressional trend and propose a single-payer or other left-field option. But some of the private details that are leaking not only support the public rhetoric – they have the potential for Kennedy’s version to be the most progressive of all. As reported by Igor Volsky [and with my notes in brackets], these include:
“a public plan option that would pay providers — who would be required to participate — 10 percent more than Medicare rates." [A public plan proposal far more robust than we’re likely to get out of the Finance Committee.]
- An individual and employer mandate for coverage
- The legislation would expand the Medicaid program to cover individuals earning up to 150 percent of poverty [Baucus and Obama also propose expanding the federal share of Medicaid, but only to 100% of poverty]
- It would subsidize people earning up to 500% FPL to purchase insurance through state-based insurance exchanges [This is a big surprise. Massachusetts subsidizes to 300%, which is far too low. Most people had guessed 400% as a likely number. If Kennedy really has 500%, his subsidies are equal to the generous eligibility of the Healthy San Francisco plan, and would still give a partial subsidy to a family of 4 making around $100,000. Also, the state-based exchanges differ from Baucus and Obama, who have a federal one. But it’s similar to the approach taken by Sen. Wyden or John Edwards in his campaign plan.]
- Expands the Children’s Health Insurance Program (CHIP) to people up to age 26 [Wow! Given that those 0-26 are much more likely to be uninsured, this is a huge deal It’s also an idea no one else seems to have had yet.]
- Establishing a “federal health reserve” type entity called a Medical Advisory Council that would assist in designing minimum standard benefits [This is a very good idea to de-politicize the benefits package for the exchanges. The Council itself, however, is almost guaranteed to be divisive politics at its worst, as it will be accused of rationing care, slashing your tires, eating the last of the Crackin’ Oat Bran and punching your grandmother in the face.]
We still haven’t seen the bill, and a Kennedy spokesperson was quick to say “there is no final policy” and everything is still under negotiation, this is an impressive shake-up that tilts the emergency health care Congressional consensus away from a watered-down center and decidedly to the left.
Ted – it’s good to have you back, man.
(Photo credit: johnmcnab on Flickr.)
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Comments (10)
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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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Even 500% of poverty for a subsidy is too low to cut off subsidies if the plan doesn't include preventing higher rates, denial of insurance or pre-existing exclusionary periods for people with known conditions or "risk factors" or who simply are female. The insurance plans would also have to be required to provide certain types of coverage at certain minimum rates - like not just providing mental health coverage but providing parity of coverage to the "physical" coverage. Otherwise, many who've been disabled largely by our dysfunctional system will continue to be disabled by lack of access to care because we won't be able to get the care we need if we try to leave disability.
My husband has heart problems, diabetes, neuropathy and vision issues from his diabetes. I'm VERY nearsighted, have mental health issues, diabetes, PCOS, and at the time we did the figuring we had NO idea that I had neurological conditions beyond migraines (nor that the migraines warranted seeing a neurologist), that my joint pain wasn't "all in my head" or that my "IBS" really wasn't IBS (it's turned out to be idiopathic gastroparesis). As best as we could estimate - and this was about 3 years ago - for us to cover our THEN costs of health care and keep our THEN poverty lifestyle, we'd have needed to go directly from my SSDI, food stamps and the medical assistance we had at the time to no medical assistance, no food stamps and an income of approximately $90K/year AT LEAST until we had insurance that no longer had pre-existing condition exclusions. Now even with IT certifications and a college degree, just what are my chances of making even HALF that right off the bat with several years of time to explain due to disability? And why so much? Between us, we take over $3000/mo in medications - $1000 of that is just insulins. So most of that $90K would be to cover out of pocket medical costs - and do you honestly think even the IRS would believe us WITH receipts? I can hear the laughing already. Plus, that $90 presumes that neither of us would need anything more than very minimal maintenance care until we had insurance again - a risky bet all things considered...
Posted by Danetta Amschler on 05/28/2009 @ 10:41PM PT
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We'll have to see -- denial of pre-existing conditions is something Kennedy would explicitly forbid. A minimum of standard benefits, "similar to members of Congress" but determined by the Council is also part of the plan that has leaked.
It's likely he would take an aggressive stance on community rating and risk factors, but we'll know when we have the bill in front of us...
Posted by Timothy Foley on 05/29/2009 @ 12:07AM PT
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If it can get through as is being hinted at - and it IS what's being hinted at without being watered down or twisted to favor insurance companies (something I'm snottily starting to suspect after how Baucus is running his fiasco of "hearings"), then I *may* prove optimistic.
As to the quality of care bit mentioned in a way below, I'd like to see that myself. It shouldn't take a malpractice attorney to weed out the bad doctors and the not-bad to good doctors shouldn't be doing dozens of extra tests or procedures just to prove they're not bad doctors. Clearly the system needs a better way of doing quality control - and from the inside first. That research works to prove which treatments are usually most effective isn't unreasonable either, that's relatively standard to develop an if/then type thing - like if the patient has this, then you start with ___, if that doesn't work, then ___ is next... On a related note, could we ban direct or at least restrict medication marketing? New simply for the sake of new doesn't necessarily mean better and particularly not when the medications aren't being well researched to prove safety or long term safety.
Posted by Danetta Amschler on 05/29/2009 @ 07:09AM PT
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"As experience has shown, it's better - and cheaper - to get it right the first time rather than have patients go in and out of the hospital. So we'll start paying for the overall quality of care, not the quantity of procedures. We'll make certain that doctors and patients will have better information so they can decide which treatment is best based on real evidence. Runaway healthcare costs threaten the economic survival of this nation. Bringing them under control will not be easy, and all of us - business, labor, providers, and government - will have to make real sacrifices if this is to work."
It doesn't sound like a lot of cost control- it sounds like the Medicare readmittance to hospitals plan is in, but not much else - some discussion about moving away from fee for service, but "quality of care, not quantity of procedures" raises as many questions as it answers. He's suggesting that Comparative Effectiveness will drive a lot of cost controlling... but that data is far away and can't be as comprehensive a fix as he's suggesting. Also, notice that "all of us" does not include the health consumer - he has nothing, basically, in the way of moving patients and families into thinking differently about healthcare, just that Businesses, government, providers and "labor" have to change (and really, what "change" is Kennedy suggesting for organized labor?). I know conservatives who could have a field day with that sentence alone, as it sums up a lifetime of Kennedy-esque faith in government managed, big group solutions; it's reasonable, I think, to point out that individuals will have a role in controlling costs by doing things differently... or we can't make real progress at all. Mostly, I think the problematic element in all of this remain excessive vagueness and a lack of detail - in theory, who can argue with what Kennedy's offering here? - but until he spells out the specifics (and with those ideas of subsidies of up to 500% of poverty for insurance, and Medicaid covering up to 150%, I think "how to pay for it" just became enormously more difficult), we still have very little substance, and mostly air. Some of this is great, yes. Some of it, I think, is a lot less clear in how it will actually play out.
Posted by NYC Weboy on 05/29/2009 @ 04:13AM PT
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The difference is that Kennedy cannot be bought. He is ill and he is concerned with legacy. Then, there is the family name and its reputation. Then there is his moral standing with the Senators.
So there is hope here. The symbolism is there.
Good news.
Bohdan A. Oryshkevich, MD, MPH
Posted by Bohdan Oryshkevich on 05/29/2009 @ 10:40AM PT
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It's not Ted Kennedy I'm worried about, it's what happens after the rest of the Senate gets hold of his ideas and suggestions. Because of Baucus' shenanigans, the very ideas of what may happen gives me the willies.
Posted by Danetta Amschler on 05/29/2009 @ 11:29AM PT
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What do you think will happen with the Hyde Amendment? Could we see a public plan that doesn't cover the full range of women's reproductive health care?
Posted by Steve Perez on 05/29/2009 @ 11:48AM PT
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Bohdan, although Sir Ted could not get Me to vote for him on a bet, You can bet he is a man of His word. You do not have to agree with His politics to know he is going to do what He thinks is right. He has always been one of the hardest working politicians in office. (much to My chagrin)
Posted by Charlie Reed on 05/29/2009 @ 05:26PM PT
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It's a lose-lose situation here for the health industry imbeciles, I'm telling you. There's two possible outcomes whether or not anyone gets paid off.
1. Health reform happens. People can survive, the nation flourishes again.
2. The poor and middle class leave the country and they have nobody here to play in their health casino, forcing the industry to collapse as well as america.
Real simple: Choose one.
Can you imagine an emtpy nation filled with bimbo exec's trying to keep things running without the skill of the middle class? They'd finally find out what real work is all about...
L-M-F-A-O
Posted by Bruce Allen on 05/30/2009 @ 09:44PM PT
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Bruce, I like your way of thinking. I hope you are visiting "poverty" and other sites, They need your input.
Posted by Charlie Reed on 05/31/2009 @ 03:46PM PT
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