Senate HELP 'public option' will be multiple 'options' run by insurance companies

[IndianaGreen]

The Senate HELP Committee “public option” will be multiple “options,” and these will be run by insurance companies

Posted by Andrew Coates MD on Friday, Aug 14, 2009

By Kip Sullivan, JD

When the Senate Health, Education, Labor and Pensions (HELP) Committee passed a bill on July 15 creating an anemic “public option” program, Health Care for America Now (HCAN) and other “public option” proponents were ecstatic. They welcomed the “public option” in the HELP committee bill, proclaiming it “strong” or “robust.” But the actual provisions in the HELP Committee bill call for numerous “community health insurance options,” not the single “Medicare-like” plan promised by “public option” advocates. That means the individual “options” will probably be as small and weak as the co-ops now under discussion in the Senate Finance Committee. More importantly, these “community options” will almost certainly be run by insurance companies.

Finding the HELP Committee bill

To determine what the HELP Committee “public option” proposal is, one must first find a final version of the legislation that came out of the committee. Ordinarily, that is not a difficult process. But for some reason, the HELP Committee bill still has no bill number and, three weeks after it was voted out of the HELP committee, still is not available for the public to read. That might sound like a sloppy way to run a Senate committee, but I have confirmed with two sources that there is no final bill available. An aide in the Washington office of Senator Al Franken (D-MN), with whom I spoke on August 7, referred me to the draft bill posted at the HELP Committee’s Website. At this Website, the draft bill appears in two pieces, one labeled “the Affordable Health Choices Act” and the other labeled “the additional Chairman’s mark on coverage.” It is in the “Chairman’s mark” segment of the bill, beginning at page 77, that we find “Section 3106: Community health insurance option.”

Summary of Section 3106 in semi-plain English

Section 3106 is difficult to read. It fails to offer clear definitions of critical terms, it uses different terms to describe the same thing, and it contains unnecessarily abstract language. Because it is poorly written, it requires at least two readings to understand it. I will tell you first what I derive from it in the plainest language possible, and then discuss some of its provisions so you can judge for yourself whether I got it right.

Section 3106 requires the Secretary of the Department of Health and Human Services (DHHS, the federal agency within which Medicare and Medicaid are housed) to create multiple health insurance companies that, together, will make “public” health insurance available for sale to the non-elderly in every state in the country. The Secretary will not be using federal employees to make this happen. The Secretary is required, rather, to contract with nonprofit insurance companies to create health insurance policies that will qualify as “community health insurance options.” (Some of the bill’s language seems to be confusing by design. What meaning is conveyed by adding “community” and “options” to “health insurance”?)

http://pnhp.org/blog/

On edit, thanks to slipslidingaway, a better link:

http://pnhp.org/blog/2009/08/14/the-senate-help-committee-%e2%80%9cpublic-option%e2%80%9d-will-be-multiple-%e2%80%9coptions%e2%80%9d-and-these-will-be-run-by-insurance-companies/

[slipslidingaway]

1. knr - maybe edit the OP to include the permanent link, see below...

http://pnhp.org/blog/2009/08/14/the-senate-help-committee-%e2%80%9cpublic-option%e2%80%9d-will-be-multiple-%e2%80%9coptions%e2%80%9d-and-these-will-be-run-by-insurance-companies/

[IndianaGreen]

3. Thank you, slipslidingaway, I will do so

BTW, do you care to share the meaning of your screen name? It reminds me of my driving on Indiana icy roads. :-)

[slipslidingaway]

4. You're welcome...

it was during the Bush years when things were slipingaway (old song came to mind) almost changed it during the name change period, but was not convinced we had turned the corner especially after seeing the economic team.

Now health care reform...

:(


Icy Indiana roads might be better.

:)

[IndianaGreen]

7. Thanks for the info

I am a union member and we worked very hard to get people that had never voted before, or hadn't voted in a long time, to vote in this past election. They voted for hope and for real change. Indiana went blue for the first time since 1964. I fear we are failing them by not standing firm for real healthcare reform, which IMHO means Single Payer as in HR676 and S703. I doubt we will be able to get them back into the polls if they feel they were betrayed by a group of politicians beholden to the insurance industry.

[slipslidingaway]

12. And thank you, if too many people feel betrayed by this reform

they will stay home again.

:(

[slipslidingaway]

2. rec# 3 n/t

[slipslidingaway]

5. Now this thread is being unrecommended without one comment

as to why they feel the analysis is flawed.

[IndianaGreen]

9. The unrec squad doesn't care about facts

all their tiny little brains allow them to do is to keep unhappy stories from appearing in the Greatest Page. They are the DU version of the Creationists.

I just ignore the Rec column nowadays. It has become irrelevant.

[slipslidingaway]

13. It is a great tool for shutting down dissenting views, I wish this

modification on DU had been done after health care was decided... or not at all.

[ProSense]

6. Good grief

The government run option will be run by insurance companies.

Moronic.

[slipslidingaway]

10. And your interpretation of Section 3106 is ??? ...

Snips from the article...

"Section 3106 requires the Secretary of the Department of Health and Human Services (DHHS, the federal agency within which Medicare and Medicaid are housed) to create multiple health insurance companies that, together, will make “public” health insurance available for sale to the non-elderly in every state in the country. The Secretary will not be using federal employees to make this happen. The Secretary is required, rather, to contract with nonprofit insurance companies to create health insurance policies that will qualify as “community health insurance options.” (Some of the bill’s language seems to be confusing by design. What meaning is conveyed by adding “community” and “options” to “health insurance”?)

The corporations that contract with the Secretary to create these “community” health insurance companies will be required to meet the same standards insurance companies currently must meet in order to serve as “Medicare Administrative Contractors” (MACs) to administer Medicare’s traditional program. These corporations must, in other words, be insurance companies.

To get some idea of which insurance companies meet current MAC standards, and are therefore the ones likely to get contracts with the Secretary under the HELP Committee bill, consider this list of the companies that now have MAC contracts with the Centers for Medicare and Medicaid Services (CMS, the agency that runs Medicare):

http://www.cms.hhs.gov/MedicareContractingReform/07_PartAandPartBMedicareAdministrativeContractor.asp#TopOfPage

• Cahaba Government Benefit Administrators, a subsidiary of Blue Cross and Blue Shield of Alabama;
• First Coast Service Options, a subsidiary of Blue Cross and Blue Shield of Florida;
• Highmark Medical Services, a division of Highmark Blue Cross Blue Shield of Pennsylvania;
• National Government Services, a subsidiary of WellPoint, the nation’s largest health insurance company measured by enrollment (as opposed to revenues);
• National Heritage Insurance Corporation, which is a subsidiary of Electronic Data Systems (the firm Ross Perot founded) which is now a subsidiary of Hewlett Packard;
• Noridian Administrative Services;
• Palmetto GBA, a subsidiary of Blue Cross Blue Shield of South Carolina;
• Pinnacle Business Solutions, a subsidiary of Blue Cross Blue Shield of Arkansas;
• Trailblazer Health Enterprises, a subsidiary of Blue Cross Blue Shield of South Carolina;
• Wisconsin Physicians Services Health Insurance Corporation.

Most of the large health insurance companies, such as United HealthCare and Cigna, have also held similar contracts in the past.


...The requirement that the contracting insurers be able to “promote high quality clinical care” is a tip-off that the HELP Committee wants the insurance companies that will run the “community options” to use managed care cost-control tactics. A second tip-off is that Section 3106 does not guarantee patients the right to choose their own clinic and hospital. Instead the bill only requires that a ”community” insurer will be one that “offers a wide choice of providers.” In short, an entity that meets the MAC standards plus the additional criteria in Section 3106 amounts to your basic, non-profit managed care insurance company. The big ones these days include many Blue Cross Blue Shield companies and the nonprofit HMOs such as Kaiser Permanente, Group Heath of Puget Sound, and HealthPartners.

The only conceivable development that could keep existing non-profit insurance companies from winning the contracts to develop and run the “community options” would be the birth of dozens of non-profit companies with the expertise of insurance companies between the time Section 3106 becomes law and the time the law takes effect. In theory, that could happen. But it is extremely unlikely. It is unlikely because of the short time period between the date Section 3106 is enacted and the time it takes effect, and because of the difficulty of creating corporations with the expertise to create health insurance companies..."

[IndianaGreen]

15. She doesn't want to talk about it

as shown in another thread.

[slipslidingaway]

17. Oh well, better just repeat that the public option is robust and strong. n/t

[ProSense]

23. The public option is strong. Pnhp is confused. n/t

[slipslidingaway]

24. The current public option is a mere shell of the original proposal...

this is what Dr. McCanne of PNHP had to say about the original "public option" back in January of 2007.


page 10
http://www.ourfuture.org/files/documents/evolution-of-the-healthcare-debate.pdf

"Also, Dr. Don McCanne of Physicians for a National Health Program offers sincere praise, concluding: “Jacob Hacker’s proposal is a very welcome addition at a time that all options should be on the table. It is such a compelling model that it may shove all others off of the table - except single payer - then we can get down to a serious discussion about reform that really works.”


Original estimate - 130 million people in public option, save 1 Trillion in next decade
Edited on Sun Aug-16-09 10:55 PM by slipslidingaway
the current estimates of the public option would have 10 million people and Cost 1 Trillion over the next decade.

That is quite a shift!

Links here...
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8590393&mesg_id=8592392

[ipaint]

27. The public option is weak, you are confused. nt.

[ProSense]

22. Pnhp: "Because it is poorly written, it requires at least two readings to understand it."

I understood on the first reading.

[slipslidingaway]

25. Obviously you are much smarter because you support the current

plan which bears no resemblance to the original proposal.

[ipaint]

26. No you didn't.

[demwing]

29. My interpretation of this editorial is that it was written by a man with an agenda

A lawyer who admits that his interpretation may be wrong, who has never seen the final bill, and who believes that the only real reform must be based on single payer system.

Perhaps he's not happy with the public option in any form?

[slipslidingaway]

31. What other interpretations have you read, many people are

promoting this "public option" but most of what we hear is general praise for a "not so final bill."

Dean said the bill is great, so I guess he supports the "community health insurance options" and considers them to be the same as the a “Medicare-like” plan that has been promoted? Maybe Kip Sullivan has missed the Medicare-like option in the proposed bill, if so where is it?


PNHP did compliment the original public option as outlined by Hacker back in early 2007, but what is being offered now is a far cry from the original proposal.


page 10
http://www.ourfuture.org/files/documents/evolution-of-the-healthcare-debate.pdf

"Also, Dr. Don McCanne of Physicians for a National Health Program offers sincere praise, concluding: “Jacob Hacker’s proposal is a very welcome addition at a time that all options should be on the table. It is such a compelling model that it may shove all others off of the table - except single payer - then we can get down to a serious discussion about reform that really works.”


http://pnhp.org/blog/2009/08/14/the-senate-help-committee-%e2%80%9cpublic-option%e2%80%9d-will-be-multiple-%e2%80%9coptions%e2%80%9d-and-these-will-be-run-by-insurance-companies/

"Finding the HELP Committee bill

To determine what the HELP Committee “public option” proposal is, one must first find a final version of the legislation that came out of the committee. Ordinarily, that is not a difficult process. But for some reason, the HELP Committee bill still has no bill number and, three weeks after it was voted out of the HELP committee, still is not available for the public to read. That might sound like a sloppy way to run a Senate committee, but I have confirmed with two sources that there is no final bill available. An aide in the Washington office of Senator Al Franken (D-MN), with whom I spoke on August 7, referred me to the draft bill posted at the HELP Committee’s Website. At this Website, the draft bill appears in two pieces, one labeled “the Affordable Health Choices Act” and the other labeled “the additional Chairman’s mark on coverage.” It is in the “Chairman’s mark” segment of the bill, beginning at page 77, that we find “Section 3106: Community health insurance option.”

[nightrain]

18. Medicare Advantage programs are run by? Oh yeah, private insurance corporations.

In my state Medicaid mental health services are run by? Oh yeah... private insurance corporations.

The precedent has been set previously.

[quantass]

8. You know, single-payer would simopify things and be significantly cheaper

I find it funny that everyone keeps avoiding the simplest and best solution that has worked EVERYWHERE in the world. Interesting.

[IndianaGreen]

11. A real public option would be giving people the right to opt for Medicare

But not only we are denied Medicare for all, the Single Payer in HR676, but we are also being denied to have the option to go under Medicare.

[nightrain]

14. knr. Let's keep this kicked!

[slipslidingaway]

16. kick n/t

[billyoc]

19. K&R

[Sebastian Doyle]

20. The public option needs to be exactly THAT. The PUBLIC option.

Insurance companies running a public option is like vegans running a butcher shop. Or butchers running a vegan shop, for that matter.

[S_E_Fudd]

21. Without the public option the entire thing should just be scrapped...

Otherwise Congress will just be giving the insurance companies more and interesting ways to fuck over the public. The way it is now people at least have some idea of when to reach for the KY...

[demwing]

28. This post died as a subthread, so you promoted it, eh?

Here's the original post: http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8590887&mesg_id=8590887

The author wrote:

"Section 3106 is difficult to read. It fails to offer clear definitions of critical terms, it uses different terms to describe the same thing, and it contains unnecessarily abstract language. Because it is poorly written, it requires at least two readings to understand it. I will tell you first what I derive from it in the plainest language possible, and then discuss some of its provisions so you can judge for yourself whether I got it right."

In other words, he's unclear as to the ultimate meaning, and so, offers his interpretation.

Also, regarding the source data he uses for this interpretation, the author writes:

"... I have confirmed with two sources that there is no final bill available. An aide in the Washington office of Senator Al Franken (D-MN), with whom I spoke on August 7, referred me to the draft bill posted at the HELP Committee’s Website. At this Website, the draft bill appears in two pieces, one labeled “the Affordable Health Choices Act” and the other labeled “the additional Chairman’s mark on coverage.” It is in the “Chairman’s mark” segment of the bill, beginning at page 77, that we find “Section 3106: Community health insurance option.”

Let's look at the facts for a moment:

1. Dr. Dean supports the HELP bill
2. Dr. Dean and has a different interpretation than Kip Sullivan, the lawyer who wrote the piece.
3. Sullivan's interpretation is based on a draft bill, and no one knows whether the draft made it through the committee intact
4. Sullivan the lawyer isn't even sure if he's intrepreting correctly.

So why are we STILL talking about this?

[slipslidingaway]

30. The post did not die as a subthread, check the times on the

original posts.

I see that John Q anwered your post in the other thread.
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8590887&mesg_id=8592593


"3. Sullivan's interpretation is based on a draft bill, and no one knows whether the draft made it through the committee intact"


July 15, 2009

http://politicalticker.blogs.cnn.com/2009/07/15/obama-praises-first-health-care-passage/

"Obama praises first health care bill passage

Posted: July 15th, 2009 11:18 AM ET

(CNN) – President Obama released a statement Wednesday on a congressional committee's passing of legislation to overhaul health care.

Statement by the President on the Health Care Reform Legislation Passed Today by the Senate HELP Committee..."

[demwing]

34. Yes, we know it passed, but did it pass wirthout changes?

Sullivan's analysis was based on a draft, and it is unknown whether that draft passed without change. His analysis could be on old material, no longer relevant. And even if it did pass without major rewrite, Sullivan's interpretation is open to error, which he admits, and he he has an admitted, and not unwarranted bias against anything less than single payer. Not a problem, just a fact that needs to be weighed.

Dr Dean supports the HELP bill, and I am confident Dean is not in the pocket of the Insurance companies. He is a seasoned politician, so he is familiar with legislative language, and he is a doctor, so he is familiar with insurance companies, terminology, and processes.

I'll trust Dean. Thank you.

[slipslidingaway]

35. He is analyzing the only HELP bill there is to analyze! Does Dean have

the final HELP bill that is not available to the public?

Here is what Dean said back in February when he promoted the "public plan"...please point to section in the draft HELP bill that states everyone will be allowed to chose Medicare?


Howard Dean: Real Health Reform ‘Rises And Falls On Whether The Public Is Allowed To Choose Medicare’

http://wonkroom.thinkprogress.org/2009/02/24/dean-public-option/

"Today, during an appearance on MSNBC’s Hardball, former Gov. Howard Dean (D-VT) said that a public insurance option is essential to any health reform effort:

If Barack Obama’s bill gets changed to exclude the public entities, it is not health insurance reform…it rises and falls on whether the public is allowed to choose Medicare if they’re under 65 or not. If they are allowed to choose Medicare as an option, this bill will be real health care reform. If they’re not, we will be back fighting about it for another 20 years before somebody tries again.

Watch it:..."

Please point to the section in the draft bill that states that everyone will be allowed to chose Medicare? Kip Sullivan has pointed to section that sets up the entities for the "public plan" and believes this will not result in a choice as previously promoted.


Also you might want to read the article Dean wrote on the data exclusivity amendment, Harkin's comments on the amendment and Dean's role as adviser to the law firm he signed on with back in March.

Olbermann mentions the firm here...

http://www.youtube.com/watch?v=y5-Ai5sBFjI

[leftstreet]

32. K&R

[TheKentuckian]

33. Private companies administer much, maybe even most of government plans

I think it is important to understand the scope of what you call for. you certainly shouldn't back down but you need to understand that what you are really asking for is daunting politically. You need to acknowledge that there are substantial obstacles. You shouldn't ignore that the trickle down anti government mythos is deeply engrained in at least a near majority of the country.

It would be nice to be some approximation of honest in your arguments on any area other than your plan it's self. The bargaining position one is is maybe the dumbest ever, I hate the naive pretense that these big player have a less clear idea of the vote count than you do. That's just blind, deaf, and dumb. You can't bluff when they see your cards! You can only bluff when it is plausible that you have a better hand than you do. The single payer is supported by 70% or whatever being pushed as gospel when you ignore a similar but better number indicating how many people like the coverage they have. It may not be a lie because the numbers are real but they have been looked at in a vacuum without being looked at for any fault lines like support for government putting an industry to pasture.

You guys have absolutely fooled yourselves on the feasibility of passing a single payer plan which has further lead to the point of view that getting a public option through would be a slam dunk on 3 foot goal. When in reality it is and has always been a tough uphill battle with not guarantee of success under even perfect execution.


Your vision is distorted or you want Obama to crash and burn his Presidency not to pass single payer but simply to promote it.