Sunday, December 20, 2009

Health Care Editorial– The Manager’s Amendment

Leg Hound Harry finally released his Amendment, and Bitch McConnell insisted that it be read on the Senate floor in it’s entirety.  That took all day, giving me time to do a little research.  Here’s a summary of the changes:

  • Insurance greed 2 Stronger medical loss ratios. Health insurers will be required to spend more of their premium revenues on clinical services and quality activities, with less going to administrative costs and profits - or else pay rebates to policyholders. These stricter limits will continue even after the Exchanges begin in 2011, and apply to all plans, including grandfathered plans. (Ed note: Reportedly, these require group insurance plans to pay 85% of premiums to health care, and individual plans to pay 80%. These would go into effect in 2011. In 2012, the ratios would be based on the average medical loss ratio in the Exchange.)
  • Accountability for excessive rate increases. A health insurer's participation in the Exchanges will depend on its performance. Insurers that jack up their premiums before the Exchanges begin will be excluded - a powerful incentive to keep premiums affordable.
  • Immediate ban on pre-existing condition exclusions for children. Health insurers will be immediately prohibited from excluding coverage of pre-existing conditions for children.
  • Patient protections. Health insurers will have to abide by a set of patient protections that, for example, protect choice of doctors and ensure access to emergency care.
  • Ensuring access to needed care. The use of annual limits on benefits will be tightly restricted to ensure access to needed care immediately, and will be prohibited completely beginning in 2014.
  • Guaranteed opportunity to appeal coverage denials. All health insurers will be required to implement an internal appeals process for coverage denials, and states will ensure the availability of an external appeals process that is independent and holds insurance companies accountable.
  • Multi-state option. Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees health plans for Members of Congress. At least one plan must be non-profit, and the plans will be available nationwide. This will promote competition and choice. (Ed note: At least two plans will have to be offered, one of which must be non-profit. OPM can negotiate medical loss ratio, profits, premiums and other terms.)
  • Free choice vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan.
  • Children's health. Support will be extended for the Children's Health Insurance Program and the adoption tax credit. Foster care children aging out of Medicaid will be able to retain its comprehensive coverage.
  • Rural and underserved communities. Access will be expanded through funding for rural health care providers and training programs for physician and other types of health care providers.
  • Revised abortion language, including state opt-out of abortion coverage…

Inserted from <Health Care For America Now>

Some of the provisions are not too bad.  Mandated medical loss ratios are a good thing, but the level is too low.  Companies should be required to pay out 90%-95%.  I like the idea that companies that jack up their rates will be excluded from the exchange, but I want to know how much is too much and who makes that decision.  I favor the immediate ban on pre-existing conditions, but for everyone, not just for children.  Until I know what patient protections are guaranteed, I can’t comment on that provision.  Annual limits should be prohibited immediately.  Nationwide plans have more bargaining power than state plans.  I also like the free choice vouchers.  I favor extending CHIP support.  Funding rural health care is a bribe.  I’ll cover that later.

The most controversial aspect of the Reid Amendment is the abortion sell-out.

…Under the new abortion provisions, states can opt out of allowing plans to cover abortion in the insurance exchanges the bill would set up. The exchanges are designed to serve individuals who lack coverage through their jobs, with most receiving federal subsidies to buy insurance. Enrollees in plans that cover abortion procedures would pay with separate checks -- one for abortion, one for any other health-care services… [emphasis added]

Inserted from <Washington Post>

I find this provision inacceptable.  It amounts to a coat hanger mandate in Red States, and a violation of privacy everywhere, that is so extreme that I doubt it will pass  muster when it receives judicial scrutiny.  It’s shameful!

And ironically, it’s not strong enough for that C-Street DINO, Stupak.

An aide to Rep. Bart Stupak (D. Mich.) coordinated opposition to a Senate compromise on the place of abortion in health care legislation this morning with the Republican Senate leadership, the Conference Catholic Bishops, and other anti-abortion groups, according to a chain of frantic emails obtained this morning by POLITICO.

The emails show that Stupak - who has so far remained silent on language accepted by Senator Ben Nelson (D. Neb.) and faces intense pressure from the White House to accept it - is already working behind the scenes to oppose the compromise.

They also demonstrate a previously unseen degree of coordination between Stupak and the office of Republican leader Mitch McConnell… [emphasis added]

Inserted from <Common Dreams>

That’s right.  The rat is working with Bitch McConnell.

Needless to say, there is opposition from pro-choice Reps.

…But Reps. Diana DeGette (D-CO) and Louise Slaughter (D-NY)--co-chairs of the Congressional Pro-Choice Caucuse--say they're not sold. They say the new compromise is possibly unconstitutional, and that they and other pro-choice House members could still reject it.

As the Co-Chairs of the Congressional Pro-Choice Caucus, we have serious reservations about the abortion provision included in the U.S. Senate's health care bill. This provision is not only offensive to people who believe in choice, but it is also possibly unconstitutional. As we have maintained throughout this process, health care reform should not be misused to take away access to health care. The more than 190-member Caucus will review this language carefully as we move forward on health care reform.

The Nelson compromise may ultimately allow health care reform to pass in the Senate--but with strong opposition from both pro-life and pro-choice members and constituent groups, the language still an open question in the House. Onward to conference!

Inserted from <TPM>

We can only hope that the Conference committee will return the bill to the Capps standard.

Several states are getting special deals under this amendment.

…Ben Nelson’s “Cornhusker Kickback,” as the GOP is calling it, got all the attention Saturday, but other senators lined up for deals as Majority Leader Harry Reid corralled the last few votes for a health reform package.

Nelson’s might be the most blatant – a deal carved out for a single state, a permanent exemption from the state share of Medicaid expansion for Nebraska, meaning federal taxpayers have to kick in an additional $45 million in the first decade.

But another Democratic holdout, Sen. Bernie Sanders (I-Vt.), took credit for $10 billion in new funding for community health centers, while denying it was a “sweetheart deal.” He was clearly more enthusiastic about a bill he said he couldn’t support just three days ago.

Nelson and Sen. Carl Levin (D-Mich.) carved out an exemption for non-profit insurers in their states from a hefty excise tax. Similar insurers in the other 48 states will pay the tax.

Vermont and Massachusetts were given additional Medicaid funding, another plus for Sanders and Sen. Patrick Leahy (D-Vt.) Three states – Pennsylvania, New York and Florida – all won protections for their Medicare Advantage beneficiaries at a time when the program is facing cuts nationwide.

All of this came on top of a $300 million increase for Medicaid in Louisiana, designed to win the vote of Democratic Sen. Mary Landrieu…

Inserted from <Politico>

With one exception, all of this is grossly unfair.  Bernie Sanders deal for community health centers will benefit such programs nationwide, so it’s quite different from these other provisions that are nothing but bribes.

Here’s an excerpt from Joe Biden’s Op-Ed.

IF I were still a United States senator, I would not only vote yes on the current health care reform bill, I would do so with the sure knowledge that I was casting one of the most historic votes of my 36 years in the Senate. I would vote yes knowing that the bill represents the culmination of a struggle begun by Theodore Roosevelt nearly a century ago to make health care reform a reality. And while it does not contain every measure President Obama and I wanted, I would vote yes for this bill certain that it includes the fundamental, essential change that opponents of reform have resisted for generations.

We have been here before. In the past, as the moment of decision drew nearer, criticism from both the left and the right grew louder. Compromises were derided. The perfect became the enemy of the good.

Most recently, in 1993, Democrats had a chance to forge a compromise with Senator John Chafee, Republican of Rhode Island, on a health care reform bill. Congress’s failure to pass health care reform that year led to 16 years of inaction — and 16 years of exploding health care costs and rising numbers of uninsured Americans.

We can’t let that happen again. While it is not perfect, the bill pending in the Senate today is not just good enough — it is very good. Insurance companies will no longer be able to deny coverage to those with pre-existing conditions or drop coverage when people get sick. Charging exorbitant premiums based on sex, age or health status will be outlawed. Annual and lifetime caps on benefits will be history. Those who already have insurance will be able to keep it, and will gain peace of mind knowing they won’t be priced out of the market by skyrocketing premiums. And more than 30 million uninsured Americans will gain access to affordable health care coverage.

That is not all. President Obama and I know we have to put our fiscal house in order. This is why those who claim they oppose reform because they fear for our country’s fiscal stability should finally acknowledge what the nonpartisan Congressional Budget Office makes crystal clear: not only is the Senate bill paid for, it is this country’s single largest deficit-reduction measure in a dozen years…

Inserted from <NY Times>

If you want my honest opinion, this bill stinks compared to what it could have been, had it been properly shepherded and had there protecting the giant corporations not been a priority.  Nevertheless it is not completely devoid of good qualities.

Whether we like it or not, barring some last minute grandstanding by Traitor Joe, this bill is going to pass the Senate.  Because the administration is so desperate to pass a bill and proclaim victory, they will exert intense pressure on the House to keep changes in conference to a minimum.  Nancy Pelosi will, after exacting some unknown future consideration from the White House, will play ball.  She will succeed in getting it through conference with few changes if any.  What we see now is essentially what we’re going to get.  I’m not saying we shouldn’t keep fighting to make it better.  We should.  But our voices will appear to be falling on deaf ears.  The party has too much political capital invested into passing a bill now.

We have two choices after we finish bitching and ranting about how lousy this is.  I’m sure I will do my share.  We say we don’t matter, abandon the Democrats, talk third parties and become completely ineffective politically, or we can work to build public support for passing more legislation next year to fix what’s wrong with this bill.  I’ll be making the latter choice, and I strongly hope you will too.


the walking man said...

There is a huge difference between standing on a precipice and falling into one.

No this bill is not good enough for me because it continues the most abhorrent industry practice. the American citizen for decades has been the main if not only profit stream for the medical industry.

The reason that pharmaceuticals are so inexpensive overseas is because those governments cap the amount that can be charged. What do we do...we offer them taxpayer money as profit instead of forcing them to charge us an average cost of what is charged in other countries.

If R&D within the medical industry is to be profited from then why must it be the American citizen which only pays for the science but the rest of the world reaps the benefit of it at little or no cost beyond what their government allows?

I see nothing here, I heard nothing in the past weeks that reduce our roll as little more than a herd to provide profit. I kept hearing 1/6th of the economy, 1/6th of the economy.

That's what they were saying with their mouth but by this bill they are saying that 1/6th of our economy is based on human misery and health care and that there is no will to change that.

I have vast experiences with many doctors as a patient. MANY. and I can now distinguish between them who went into practice for profit and them who went in medicine because they wanted to help a suffering person.

The former can leave the industry as far as I am concerned, their knowledge practiced without compassion is a violation of their oath. The latter will stay even if they have to live what was once called a middle class life style.

This does nothing in the present to stop the profit stream. It may slow it down some but the director of HHS in the future gains the power, unfettered, to change the cost to profit ratio without review or over sight.

So now the medical industry will follow the financial industry and work to buy themselves a president or a couple of legislators and get their person into that regulatory slot.

Tom everyone wants to believe that this is a century long waited for wedge into cracking the code that has profited so few for so long but as soon as another Reagan gets into the WH the push will be on for deregulation all over again.

And they, the industry, can wait. They know they may make only 2 or 3 hundred billion in the short term but they also know that they have what we don't money, power and a voice.

The only thing that would make this even somewhat palatable is not there and that is removing the industry from anti-trust exempt status. Beyond that it is no Christmas present it is only a temporary regression, which in the long term will in my opinion enslave us even further to provide not only now tax dollar profits but also more out of wallet profits to these dogs.

Lisa G. said...

What walking man said. I'm much too pissed off to comment. I would start with the f word, and it would just go downhill from there.

If we can get Scalia to croak in the next couple of years (I'd volunteer for the task for that fat f***), the coat hanger provision won't pass SCOTUS. It may not still pass SCOTUS even with the fat f*** on there, since they seem to let existing law be. But I wouldn't take that chance - they could reverse Roe and then we'd really be fucked.

This bill bites, and it can bite me, and Quincy (the bunny) says it bites too. And he totally stayed up all night and read the whole stinky mess. He does that for me, because well, I spoil him. But he does still occasionally bite me - no one else - just me. And I'm the one who feeds him.

And what the hell is wrong with you people getting up at the ass crack of dawn to research and post - yeah, I'm talking to you TC and Walkingman. It's 8am here in the midwest, so it's 6am there and you posted this at 3:14am your time. DO YOU SLEEP? Because I've heard that's good for you. My lazy ass is up this early only to feed the teenagers before they eat ME. (Because I'm sure as hell not going to church - because the walls would cave in and that's just not fair to the other people there. It's all for their safety.) And they have to go to their father's with the most f'ed up Christmas vacation schedule I've ever seen. Seriously, he couldn't have made this worse if he tried - and he did - the boys won't know if they are coming or going for the next 2 weeks.

Mauigirl said...

TomCat, I agree with what you said:

"We say we don’t matter, abandon the Democrats, talk third parties and become completely ineffective politically, or we can work to build public support for passing more legislation next year to fix what’s wrong with this bill. I’ll be making the latter choice, and I strongly hope you will too."

There is no other way to look at this. Not passing the bill will result in no change in our current health care system for decades to come. It is an imperfect solution, to be sure. But to your point, it can be fixed. And it must be. But it does do some good and we can't throw the baby out with the bathwater as the old saying goes.

As to all the perks that were given to individual states to get their Senators' votes - I'm sure LBJ had to do that and more to get the votes he needed for Medicare.

Jack Jodell said...

This version of the bill is pretty anemic, and who knows WHAT the final bill will look like at this point? This has been a dizzying back and forth, then back, then forth again process, after all, and it's not quite finished yet. But I agree with you and Mauigirl that third parties are not an option at this point. If we got 15% of what we need passed now, we can always add more incrementally later. And if SOMETHING is passed this year, it should boost Obama's and the Dems' popularity enough to help us stave off a GOP resurgence next year. Let the teabaggers further marginalize the GOP as they did in New York, and, with added congressional majorities, we will FINALLY get a decent comprehensive bill passed! Let McConnell, Boehner, and Bachmann ride themselves on backward chariots right out of Congress!

Distributorcap said...

i dont know what to think - i think this bill sucks and in the end will make things even worse. with no public choice and a mandate to buy - watch how fast premiums go up after an initial "be good" period

plus there is a possibility the mandate is unconstitutional - since the insurance industry has the anti-trust provision, and you are forced to buy from them (you cant go out of state) - congress cannot regulate intra state commerce - only inter state. confuisng and vague, but a chance is not const.

also - if anyone believes congress will go back and fix it later - keep dreaming. never ever going to happen. if this is past they will all shake hands and pose for the camera and congratulate themselves and say never again.

there are a few good things = but the long term damage it will do (that is what bad politics, bad goverment and bad compromising does) - will ultimately make this worse

Oso said...

What Walking Man and Lisa G. said.

I guess the thinking is,we'll do a really crappy job on something then come back in a few years and fix it.

But who's to say these assholes won't come back in a few years and gut it even further?

Dems have the house and the executive and this POS gift to the health insurance industry's lobby is the best they could do?

No.No.Screw this thing,screw Obama and his owners on Wall St.Screw his legacy.

TomCat said...

Mark, it's not good enough for me either for all the reasons you mention and more. And I said we should fight to make it better. I did not advocate the passage of this bill. I said that, unless Traitor Joe pulls a fast one, this bill in near present form is a virtual fait accompli. Their anti trust-status should be a high ranking target for future activism.

Lisa, see my reply to Mark. I usually go to bed around 6 PM and get up around 11 PM. I do my final research for the day's posts and write the blog, usually getting it up before 4 AM. I return to bed and sleep another two or three hours.

Maui, I'm not advocating this bill. It's just reached the point that fighting to change it will do no good. I will not support a bill with a mandate and no public option, and I will not support a bill with a coat-hanger provision, even if it's only in red states, where the abortion rates are highest. The perques are business as usual as you say, but I remember voting for change I can believe in, not business as usual.

Jack, I have to agree that staving off the GOP is an important. We can't drain the Democratic Swamp as long as it's fill of GOP alligators.

DC, I fully agree that this is a bad bill. My purpose here is to remind myself and others that we will still be activists when it passes and to keep that activism going.

Oso, the time to begin the fight to fix this mess is not in a few years, it's before the ink dries.

Jerilyn said...

I'm so disgusted with the whole Republican party and the Republican wannabes using women as pawns to keep the status quo. I wish I could just throw-up all over them.

-Punky Penny

TomCat said...

PP, how would you like to be called now?

Congrats on being visitor number 23,000 here.

Sadly, Nelson and Stupak are both Democrats.