The Healthcare Bill Looks Like a Winner

[berni_mccoy]

You can read more about it here in summarized format: http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BILLSUMMARY-071409.pdf

(the full bill is here (don't read it unless you have a ton of time, it's 1018 pages long): http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf

Key points

If you make less than 4x the poverty level (that's 88k / year), then you pay very little for healthcare.
If you make more than that, you will pay 5000 / year as an individual, 10k per year as a family. You pay nothing else. I currently own my own business and pay for my own healthcare coverage to the tune of 18k / year for my family. That will be 8k more in my pocket (or less, if I choose additional services on top of the basic plan).
You can't be denied coverage. Period.

97% of America will be covered by this (I'm interested to know who won't be, but I believe it will be people currently on Medicare)

Mandatory benefits are listed here: http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BENEFITS-071409.pdf

And include:
 Inpatient hospital services
 Outpatient hospital services
 Physician services
 Equipment and supplies incident to physician services
 Preventive services
 Maternity services
 Prescription drugs
 Rehabilitative and habilitative services
 Well baby and well child visits and oral health, vision, and hearing services for children
 Mental health and substance abuse services

Cost
100 billion / year (for the entire country) (Government accounting office projects 1 trillion over 10 years). That's very cost-efficient!

How it's paid for
It's paid for with two programs:
1. Through the savings the Obama administration recently got by striking a Medicare rate deal with Hospitals across the nation.
2. By increased taxes on the top 1% incomes.

I have to say, this is about as good a bill as we could have hoped for going from a completely backwards system toward a national healthcare program. Tens of thousands of American lives will be saved each year because of this bill. We were on a freight-train heading fast toward a cliff. With this bill, we put the breaks on and start to turn the train around in the right direction.

Obama and the Democrats have done a good job. But the jobs not done yet. Now they have to get this thing passed.

[guitar man]

1. I think you mean

$100 billion a year :hi:

[berni_mccoy]

6. Thanks for catching that typo!

[lindisfarne]

108. OP is wrong - he's conflating premiums with cost-sharing expenses.

See
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=222x64708

[Saturday]

2. That all sounds good BUT...

I heard it didn't kick in until 2013. Don't remember where I heard that but do you have any idea if it is true? I read the summary quickly and didn't see any dates. I'll have to look closer.

[scheming daemons]

7. If we really get all that, then I'm willing to wait until 2013

You can't get a bill that has EVERYTHING you want.

four years to kick in isn't really too much to ask for something this big.

[bvar22]

126. How many will have to die or be denied Health Care until 2013?

?

[scheming daemons]

145. How many will die or be denied health care if the whole bill collapses?

Because if we let the "perfect" be the enemy of "good", and let this plan die... then say bye-bye to Health Care reform for a generation.

[bvar22]

195. The Good is the enemy of The Bad.

I see your point.
Americans should just settle for LESS than the rest of the civilized World where Health Care is a RIGHT. It is just too hard for America to do what the rest of the World has already done.

As long as there are people who "think" like you, Americans WILL be forced to settle for LESS.

If America is scammed into buying another Pig in a Poke, then we can also "say bye-bye to Health Care reform for a generation."

I'll stick with the People who have a proven track record of protecting the American Working Class, The Progressive Caucus.

One of the things that screams "Be Fucking Careful" to me is that the ink isn't even dry on this bill, and yet there is a contingent of people at DU trumpeting support and labeling this a "Good Plan" when no one has had the time to study all the fine print. Smells like "astro-turf" to me.

Sorry, but I'm not joining your parade until ALL the details have been fleshed out.
The Democratic Party does NOT have a good record of protecting Working Americans over the last 25 years, so caution at this point is a wise choice.


"There are forces within the Democratic Party who want us to sound like kinder, gentler Republicans. I want us to compete for that great mass of voters that want a party that will stand up for working Americans, family farmers, and people who haven't felt the benefits of the economic upturn."---Paul Wellstone

[Davis_X_Machina]

9. Some parts would take...

...nearly immediate effect, others not until later. It's not an all-or-nothing.

The 2013 date, incidentally, was required to get a CBO ten-year budget score of under $1 trillion, to keep the cost below President Nelson's and President Baucus' and President Landrieu'a and The Other President Lincoln's and President Bayh's favorite arbitrary round number.

Start it up full-strength earlier, and the ten-year cost goes up.

[guitar man]

18. if that's true

If that's true, what are we supposed to do until then? If the premium on my insurance from work goes up at the same rate it did last year, my family will be uninsured. Simply cannot afford it...really can't afford it now, but have managed to suffer and sacrifice thus far to keep it.

[shadowknows69]

61. Some of us won't make it until 2013 without health care soon

But they rest of y'all enjoy it in my absence.

[lumberjack_jeff]

144. It's not true.

It is open to enrollment on day one.

The confusion stems from the language that says the public plan won't participate in the Health Insurance Exchange until 2013. Until then, they'll charge base their reimbursements to doctors on Medicare plus 5%.

[madfloridian]

3. You think current Medicare folks won't be covered? Why do you think that?

Or did I misunderstand your phrasing?

[berni_mccoy]

10. I don't know, I'm just guessing as Medicare does not appear to go away with this bill.

[lindisfarne]

12. It's not Medicare. 46 million (15% of population) are on Medicare. n/t

[watrwefitinfor]

33. And most of us 15 % are way under the poverty level.

Will we still be required to pay the Medicare premium, plus some insurance company like Blue Cross about an equal amount for "medigap" insurance for what Medicare doesn't cover? Plus even more if we want their half-assed prescription coverage?

Many of us old folks are the poorest of the poor. Many of us live on well under $1000 a month. I currently pay $200 of my monthly pittance for the privilege of Medicare and medigap with NO prescription coverage. (To say nothing of no dental and no vision, which Medicare does no cover.) Leaves me with less than $800 a month to live on.

Do they intend to make us keep paying these exhorbitant amounts, while people up to $88,000 annually pay nothing?

Stinks, if so.

Wat

[lindisfarne]

51. Your questions are unrelated to the thread I was replying to. Good questions,but I won't answer them

Google's a good place to start, as is the bill itself, which is posted somewhere online (I saw the link in one of today's threads if you want to search).

[Xenotime]

93. This is healtcare for everyone in america.

[Laelth]

121. Looks like an order to buy insurance to me.

Not sure what this bill says about health care. You might be able to get that, I suppose, if you can afford the insurance and if the treatment is approved.

:shrug:

:dem:

-Laelth

[dflprincess]

125. You got it. (eom)

[Raineyb]

199. No it's health insurance for everyone. That's not the same as health care.

Individual responsibility. Except in cases of hardship, once market reforms and affordability credits are in effect, individuals will be responsible for obtaining and maintaining health insurance coverage. Those who choose to not obtain coverage will pay a penalty of 2.5 percent of modified adjusted gross income above a specified level.

This sounds like mandatory purchasing of health insurance to me and if you can't afford it you'll end up on the receiving end of a penalty. $43,000 a year and forced to buy health insurance as an individual is not a good deal. Where I live $43,000 a year doesn't buy you a hell of a lot. You can't even buy a place to live making that kind of money.

[lumberjack_jeff]

34. Medicare will be expanded to cover everyone up to 133% FPL

[stevietheman]

179. I think the OP meant Medicaid. Medicare is separate from this plan. n/t

n/t

[Abq_Sarah]

4. By the time the Senate is finished

I'm pretty sure it will bear very little resemblance to the current form.

[kjackson227]

5. and...

if this isn't passed, healthcare will cost us $4 trillion ten years from now.

[TexasObserver]

8. Recommend

[Myrina]

11. ... and what's the definition of "basic plan" ?

... if all it covers is preventative and immunizations etc ... well that's ok but if it doesn't cover major things like surgery/heart attack/cancer etc ... then we're still going to have lots of people going bankrupt or dying because they can't afford care.

[Davis_X_Machina]

13. Basic plan...

...is what the local private insurers are offering as their basic group coverage, IIRC.

[berni_mccoy]

16. Here is the link to what must be covered:

http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BENEFITS-071409.pdf

 Inpatient hospital services
 Outpatient hospital services
 Physician services
 Equipment and supplies incident to physician services
 Preventive services
 Maternity services
 Prescription drugs
 Rehabilitative and habilitative services
 Well baby and well child visits and oral health, vision, and hearing services for children
 Mental health and substance abuse services

I'll add to the original post, thanks.

[wildflower]

45. It looks like in the basic plan, vision and dental are covered for children only

But the "Premium Plus" plan will cover them for adults.

Thanks so much for posting the summary and key info on this.

[bobbolink]

89. Children are the only ones with vision and dental issues.

That's the same thing with medicaid.

Who needs teeth anyway?

Who needs to see if you're one of those lousy poor people?

Maybe if the rest of the nation get this "plan", some will wake up.

[Raineyb]

196. Why the hell is oral health, vision, and hearing only covered for children?

Is this to say that they consider these things luxuries that only those who can afford them should get? That should be covered for everyone!

[dmosh42]

14. Won't pass the scumbag Senate!! Insurance bribes are enormous! n/t

[harun]

23. We can put tremendous, TREMENDOUS pressure on the Senate.

But, yes, it will still be tough. They will want to jack this up to 12k a year per person if they have their way.

[warren pease]

85. Not only that, but the poor bastards just don't have the votes...

plus, you can't fight with wet powder. And Pox Nous would talk bad about them on the TEEEE VEEEEEEE... Give those strongly worded letters time to work.

Oh, and money talks while honor, decency and compassion walk, which I think is the point of the exercise.


sf

[Stinky The Clown]

15. I read the summary. I'll wait and see before jumping up and down

I don't see what the drug benefit is. What is the copay?

How much are the premiums for "above standard" coverage?

[berni_mccoy]

17. Prescriptions are include, no copay

I updated the OP to show the minimum benefits.

[Stinky The Clown]

105. Thanks for the update ..... here's another question

Are those benefits which each insurer **must** provide to each insured?

Will all providers be required to accept patients from **all** insurers?

When I had my heart attack, I was transported from the hospital where I was taken by 911 to a hospital where a doc who takes my insurance practices As it happened, no harn came out of that, but it sure does seem sucky and stupid to make the transfer.

[Laelth]

123. No doctor and no hospital will be required to take people with public insurance.

I saw that here:

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6075298

:dem:

-Laelth

[Raineyb]

198. Then what's the point of having a public option?

It'll end up like Medicare where doctors won't accept it and while you're technically covered you can't actually get treated.

[Laelth]

203. Exactly. It stinks. n/t

:dem:

-Laelth

[rollingrock]

19. This might be a good first step

only problem is, the way this seems to work is the government pays the insurance companies to cover you, which I think is a bad idea in the long run. you might get covered under this system, but the insurance companies and their bureaucrats are still there to stand between you and your doctors, dreaming up excuses to deny you care when you need it. there is really no need for these kind of middle men. the only purpose of insurance companies is to deny you care and suck money out of the system, they really don't add anything of value to the process.

[berni_mccoy]

20. The public option will not flow through an insurance company.

The government will not be paying insurance companies to cover anyone.

From the summary:

"A public health insurance option. One of the many choices of health insurance within the health
insurance Exchange is a public health insurance option. It will be a new choice in many areas of our
country dominated by just one or two private insurers today. The public option will operate on a
level playing field. It will be subject to the same market reforms and consumer protections as
other private plans in the Exchange and it will be self-sustaining – financed only by its premiums. "

[bluethruandthru]

205. The public option will only be a choice in areas

dominated by one or two private insurance providers??? That's stupid. Public Option should be for everyone. We need to push for Single Payer now. THis is turning into a disaster. More layers of rules, regulations, what's covered, what's not, ... I'm starting to think any "reform" will suffocate from it's own weight.

[readmoreoften]

21. I'd be very happy with this plan as a start. If individuals making less than $88K are insured

that's a good faith start in my book.

I'm skeptical about whether or not this is going to happen though, and I don't really understand the role insurers play other than keeping clerical workers employed.

[dflprincess]

22. The $88,000 is the gross income for a family of 4

the gross income limit for an individual is $43,000. I wonder how many individuals making $45,000 or families making $89,000 can afford an additions $5,000 or $10,000 in insurance expenses.

I have to disagree with you, they could have done a lot better that this crappy bill, this is an obvious effort to protect the current system and campaign contributions. Remember, what we're seeing now is the pristine version. It will get even worse as the Republicans and Blue Dogs modify it.

[berni_mccoy]

24. You obviously are challenged to see the good in anything.

[dflprincess]

26. I could see a lot of good in a single payer bill

Sadly, once a half-assed bill gets passed, it will be years before we get another chance at any real reform.

Expecting people to be able to cough up another $5 or $10 grand is unrealistic and I am not happy that it still ties access so closely to employment.

[berni_mccoy]

29. I pretty much knew you were hung up on single payer, but thanks for confirming that.

Look, you aren't going to get single payer with the current political climate. You've got DINOs who are threatening to kill even this bill. We've got to stop the train from heading over the cliff first. Once we have it turned around, the majority of the public is on the public plan, the insurance companies will start buckling. Then you can have single payer. But you are going to make a quantum leap with this.

[dflprincess]

37. Forcing us to pay into for profit companies is not a quantum leap

and charging penalties if we don't is Romney Care - it's a step backward.

There's nothing to lose by continuing to fight for single payer rather than bending over for the first lousy bill Congress (or their lobbyist friends) come up with and thanking then for screwing us.

[berni_mccoy]

40. You need to read the bill (or at least the summary). It's not forcing you to buy private insurance.

There will be a public health insurance plan run by the government.

[dflprincess]

46. The public plan will not be open to everyone until 2013 (if then)

Until then many of us will be forced to continue to pay into the private insurers.

[berni_mccoy]

54. The paying for the subsidies doesn't happen until 2013. That doesn't mean the plan

won't be available. But if that is true, and no one can benefit from it until 2013, it would be a huge political mistake for the Democrats to make. I can't see that happening.

[dflprincess]

60. From what I read in the summary and what I heard on the local progressive radio yesterday

the public option will not be open to everyone immediately. It will be limited to small business and individuals who cannot get coverage elsewhere. This will limit the pool and, possibly, limit it so much that the people in it will consist mainly of those with higher costs. If this is the case, the public option is being set up for failure.

(from the summary):
"The new Health Insurance Exchange creates a transparent and functional marketplace for individuals and small employers to comparison shop among private and public insurers. It works with state insurance departments to set and enforce insurance reforms and consumer protections, facilitates enrollment, and administers affordability credits to help low- and middle-income individuals and families purchase insurance. Over time, the Exchange will be opened to additional employers as another choice for covering their employees. States may opt to operate the Exchange in lieu of the national Exchange provided they follow the federal rules."

[berni_mccoy]

64. The exchange is just for employers

Anyone can enlist in the public plan. And during ramp up, if you can't get coverage (aka, the 50 million Americans currently without coverage because of pre-existing conditions or cost) can get it.

These are the people who need it the most.

This is a far cry from the "shitty" bill you originally framed it as.

Sheesh people, wake up. This won't happen overnight!

[dflprincess]

71. Please provide a link to where it says anybody can sign up for the public plan

I haven't found it or heard that anywhere else. And, if anyone can sign up for it, why can't employers offer it as an option (or better yet, be required to offer it as an option).

Truman first brought up national healthcare 60 years ago; Kennedy has been advocating for it more than 30 years - this is hardly happening "overnight". I'd rather wait a bit longer and get something that is truly reform rather than get something that's only called refrom and is more concerned with protecting insurance companies. Access to health insurance does not necessarily mean access to health care. if you think the companies won't get their Congressional stooges to see to it that they're protected, you're the one who needs to wake up.

[Laelth]

103. Hear, hear! n/t

:dem:

-Laelth

[berni_mccoy]

132. I've provided all the links you need.

[lumberjack_jeff]

156. Yes it is. It is open on day 1.

You're confused because it doesn't participate in the Health Insurance Exchange until it is up and running in 2013.

In the interim, reimbursements will be based on Medicaid +5%

[lumberjack_jeff]

154. Progressives have been pushing for it for 100 years.

I'm disinclined to wait another 100 years. This bill is not only "good enough", it's not only "as good as we're going to get", it is also "good".

[Sebastian Doyle]

111. Your train is going off a cliff too. It will just take longer and go backwards all the way there

This is not a quantum leap towards single payer. This is mandatory coverage for all, insuring (pardon the pun) that there is NEVER single payer, and that the existence of the insurance corporations is always protected.

The attitude inside the corporate beltway: everyone's "covered" (i.e. forced to buy)? Problem solved.

And that's not even counting the worthless pieces of shit like Baucus and Conrad who think even this weak assed idea goes "too far".

[dflprincess]

118. Exactly. If there had been any intention to move us toward single payer

then single payer would have been a serious part of the discussion. As things stand, it's barely been acknowledged.

Mandatory coverage has not worked in Massachusetts, it will not work at a federal level, but United Health Group, Aetna, Cigna, etal will be protected.

[Deja Q]

32. Forgive me, but at least she's putting effort into her comments.

Looks like YOU are the one doing the one-line attacks, please forgive me intercession...

[berni_mccoy]

43. It's clear she didn't bother to read the summary (or even my post).

She believes the bill forces you to buy private health insurance. That's not true. There will be a public plan and that's what the OP is discussing.

[mike_c]

101. me too, I'm afraid....

This bill is great news for poor folks. I'm lower middle class, and as I read it, the way it currently stands, it would significantly INCREASE my health care premiums unless my employer pays the difference.

on edit: I'm holding out my support for single payer universal health care for all.

[Davis_X_Machina]

31. I'm paying close to that now...

...if the employer's portion of premiums is included. It's 80-20 for families, and I pay ~$1300 p/a, with employer throwing in the 80%. (Family of 4, AGI ~$80,000)

If my employer stopped paying the 80%, gave it to me as salary, and I had to take their money and my money into the public option, it'd not be a big difference.

Germany's hybrid system caps premiums at 11% of income for the high end. That'd be $9700 p/a.

[Hannah Bell]

39. i think it's less than current cost of similar insurance.

[Blasphemer]

59. I find the 5k and 10k to be very high as well... nt

[cascadiance]

78. What about for us single people who *made* over $43k and are now unemployed...

Now we get a COBRA option and for a period of time it is either free or 1/3rd of the rate that it eventually has.

How are unemployed people handled under this plan? Do they have to still fork out $5k?

BTW, I still think that $5k is rather bogus. I doubt employers are going to give you much more money to make up for the savings they get if you enroll in the public option versus their private insurance plan arrangements. Or are emplolyers at a minimum required to pay whatever they pay to private insurers to the public option plan for the employee so that it is "on an even playing field" as they claim... If not you still wind up paying more for coverage than you did before if you're in these categories.

Single Payer is still the real solution! Take the insurance companies OUT of health care coverage!

[Davis_X_Machina]

87. Yeah..

Single Payer is still the real solution! Take the insurance companies OUT of health care coverage!

I know that.
You know that.
But you'll never see it in your lifetime.
Expecting to see it is a recipe for disappointment.

[cascadiance]

88. I guess we should also think of democracy as a myth too...

I guess we'll never see it here in our lifetime... Perhaps its time to move to Canada, and leave this country to just be populated by the "corporate persons" it is so fond of favoring!

[Davis_X_Machina]

92. Don't let me stop you.

The only time this country has ever, ever, changed its fundamentals in a non-incremental way is referred to as The Civil War.

Not civil rights, not rights for labor, not votes for women, not prohibition, not nothing. Every one of those battles was won piecemeal. Every one had false starts, and switchbacks and false dawns and false midnights...

[cascadiance]

96. Maybe war is what is needed then, if our government continues to not work for its people...

that is REAL people, NOT corporate people...

I hate to say it, but I think we may need to go through another Kent State or worse before those in the government see the stakes of what they are putting in place when they continue to be obstinate in staying on their corporate *greed* train that the rest of us have to pay for dearly in so many ways. At some point, the people are going to say they have nothing more to lose. We haven't crossed that threshold yet, but that day is coming unless more than these "bandaid" solutions that really don't solve problems but are just trying to get votes happens.

[Davis_X_Machina]

100. Even the best war is worse than a bad peace. n/t

[bvar22]

127. You are grossly mistaken.

See: Medicare, 1965
Also SEE: Social Security Act, 1935

There are many, many other examples of the Democratic Party producing bold "Fundamental Changes". Though I will admit that there have been no bold measures since the Party was Corporatized in the 70s.

[dysfunctional press]

129. what is the limit for a married couple with no children?

that's what i'd like to know.

[stevietheman]

180. It's not "additional", it's "instead of". n/t

n/t

[ohheckyeah]

25. Your link for the complete bill goes to the summary

as well.

[berni_mccoy]

28. Thanks. Corrected.

[ohheckyeah]

35. Thank you.

[lumberjack_jeff]

27. It is a winner, but you're mistaken.

Families making less than $88,000 per year will have a portion of their premiums subsidized. Those making $87,000 per year will have their maximum premiums capped at no more than 11% of their income. Those making $30,000 per year, approximately 1.5%.

It's not free lunch time.

Provides sliding scale affordability credits. The affordability credits will be available to low- and moderate- income individuals and families. The credits are most generous for those who are just above the proposed new Medicaid eligibility levels; the credits decline with income (and so premium and cost-sharing support is more limited as your income increases) and are completely phased out when income reaches 400 percent of the federal poverty level ($43,000 for an individual or $88,000 for a family of four). The affordability credits will not only make insurance premiums affordable, they will also reduce cost-sharing to levels that ensure access to care. The Exchange administers the affordability credits with other federal and state entities, such as local Social Security offices and state Medicaid agencies.
 Caps annual out-of-pocket spending. All new policies will cap annual out-of-pocket spending to prevent bankruptcies from medical expenses.

[berni_mccoy]

38. You are correct, I fixed it.

Thanks.

[dflprincess]

44. 11% of $87,000 is $9,750

(and the $87,000 is gross income, not net). Does anyone really think many families can afford that?

[JVS]

47. It's steep, but they can afford it because there are plenty of families that get by on under $77K

[lumberjack_jeff]

48. They're affording it now.

The difference is that coverage will be guaranteed, standardized and you can't be kicked out the moment you get sick.

AND

Absent this bill, families making $30,000 are required to pay significantly more than $9750 for vaporware coverage.

[dflprincess]

55. The employee share for family coverage where I work is less than this

(I just asked the guy across the aisle from me, I'm single so less will be coming out of my pocket). If this money is coming straight out of the family's income, not a combination of what employer/employee pay together, it will certainly cost some familes quite a bit more than what they're paying now. And, if they do not qualify for the public program right away, they will be paying it to the for profits.

More money into the pockets of the Bill McGuires of the country (though I suppose some of this will help cover the money the for profits have spent lobbying Congress to protect them).

[lumberjack_jeff]

65. A) this bill does not force you to give up your current insurance.

B) The employer share suppresses wages. An employer could afford to pay more if their insurance costs were lower.
C) the subsidy only really makes a difference to people who must buy their own insurance. Most employers will be required to offer insurance.
D) millions of Americans stay in substandard jobs because they can't afford to lose their insurance. Healthcare reform is the best possible move to spur innovation and growth.

Everyone can afford coverage under this bill. Make over 400% of FPL? Total annual out of pocket expenses are capped. Make between 133% and 400%? It's capped AND subsidized. Make less than 133% of FPL? Healthcare is free.

The only people who disagree are those who think they'll never get sick. For them, there is the option of paying a 2 1/2% tax.

It is as close to perfect as our government will allow.

[PassingTimeHere]

50. How do you think it's going to be paid for?

Even in much more progressive countries in Europe, heath care programs often operate at a loss and funding must come out of the general funds. Have you taken a look at the debt we are in?

I fully expect that a family of four making $80,000 a year is going to pay $500 a month - probably more. If they got insurance through their employer it would be twice that amount. Take out the (insurance company) profit, and you're still at over $500 a month more than likely.

The only way this is going to work is if we go single payer with a progressive health tax.

[Deja Q]

30. Cool! All I need do now is make more than $100k/yr like everyone else!

[Warren DeMontague]

36. Now, we get to work.

This is about as important as it gets.

[clu]

41. wow

do it obama! sic 'em

[Hannah Bell]

42. better than i expected, at least as outlined.

[SidneyCarton]

49. Thanks for the update Berni.

Looks interesting, let's see if it makes its way through Congress ok. I don't think the private providers will have much to squalk about, for people who make more than 88K and don't own their own business, healthcare through their employer (if they get it) may be cheaper, so life will go on. For my own small family, this may work out very well, particularly if I lose my job, or when I may have to eventually give it up to do TA'ing as a Grad Student.

[Ilsa]

52. Will it pay for speech therapy for autistic children?

I realize that is a detail, but I don't know if children's services are paid for only under this: Well baby and well child visits and oral health, vision, and hearing services for children or Rehabilitative and habilitative services. For alot of families, this adds up to thousands of dollars a year.

I just did a search for "autism" on the long document, and came up with 0. I'll try some other variations of the disorder.

Next Edit: The big PDF doc doesn't contain the words "autism", "developmental", or "speech".

[berni_mccoy]

69. I live with two children with chronic diseases. I understand your pain.

And I don't know what will/won't be covered at this detailed level.

But the savings it will mean to my family will certainly offset some of our uninsured costs, whatever those might be under the new plan.

Granted, my two boys don't have autism, but we do deal with special health issues 24/7.

[lumberjack_jeff]

146. Look into "children with special healthcare needs"

My son is on that.

[mzmolly]

53. It's emotionally overwhelming to think about the fact that we may finally

have comprehensive health care reform soon.

K and R

[Jkid]

56. What does this mean for me?

I can't afford private insurance. I'm a college student, I'm unable to get a job. But I'm concerned about getting health care. If I get into the public option do I still have to pay?

Also from what it looks like it: There's no adult dental or vision plan (HR 676 has those provisions for such care)

[lumberjack_jeff]

149. Under this bill, if you make less than 133% of FPL you'd be eligible for medicaid. n/t

When you start working, (assuming you make less than 400% of FPL) your premiums would be subsidized.

[kath]

185. but good luck trying to find a doc who will TAKE Medicaid -

the reimbursement rates are pitiful.

[lumberjack_jeff]

188. In my area this is not especially difficult. n/t

[Maru Kitteh]

57. Please, please, please please PLEASE let this be true and let it PASS!

[Laelth]

58. This stinks.

With all due respect to the party aparatchiks who want me to be happy about it, I am not. If this is the best we can do in this political climate, I would rather do nothing.

The exchange is a bureaucratic nightmare and serves little function other than to protect private insurance companies. The public option must compete on a "level playing field" with private insurance. Why? Does that improve health care? No. It protects private insurance companies. And I am going to be "forced" to buy insurance and face a fine if I don't? Why? Because the private insurance companies insisted on it. That's why, and that's not a good enough reason.
Let's wait until 2011 when we will have about 63 Dems in the Senate.

:dem:

-Laelth

[berni_mccoy]

62. You must be one of those people who thinks the unrec feature suppresses free speech.

[Laelth]

63. LOL. How could you tell? n/t

:rofl:

:dem:

-Laelth

[ipaint]

68. The key is competition with private for profit insurance

So far I have not been able to find a single country with a successful hybrid of government and private insurance choices that allows for profit health insurers to compete with government ins.
All but one country prohibits for profit ins. entirely and the one country that does allow them, the dutch, heavily regulates them and they must compete on a level playing field.

It is impossible to have a successful hybrid system with for profit, basically unregulated insurance companies participating. The cost are too high.

Forcing people to pay into this scam will be a disaster, as it has been in the states that have attempted it.

[berni_mccoy]

70. You've got it completely backwards

This bill is the first step to eliminating for-profit health insurance.

The for-profit companies are going to have to compete with a non-profit, public insurance. They won't be able to in the long run, and they will be phased out as more and more people and employers choose the public plan. Obama has as much stated this explicitly.

[dflprincess]

72. Obama has said the purpose of the public option is to "keep the companies honest"

So he admits they're crooked and can't be trusted, but he still wants to keep them in the game.

[ipaint]

74. I don't think so.

But that is because every public safety net is underfunded as I believe the public option will be. The same problem the states that have attempted this have.

Gambling with people's lives that we will be the first country in the history of government run healthcare in the world to have a public health care option that successfully competes with for profit basically unregulated health insurance corporations is pretty reckless.

I am really taken back at both the fact everyone admits corporations own the government and the majority of our representatives but in the same breath think this public option will eventually destroy those very same corporations. I really don't think they are that stupid nor will they allow it.

The real answer will be in the details, affordability and the teeth in regulations and their enforcement on for profit insurance.

[berni_mccoy]

75. "Gambling with peoples lives..." -- What do you think is happening now? People ARE dying.

Something needs to be done, and this is the first step, not the final one.

You can't get from where we are to where the best public systems are in a single step without a revolution, and that's not going to happen. This is the best alternative.

[ipaint]

80. I don't think we need a revolution

We need folks refusing to settle for less or for plans proven to be unsuccessful.

As far as people dying, I have not had healthcare for 20 years so for all I know I may be one of them.

I hope your right.

[berni_mccoy]

82. "refusing to settle for less" than single payer... yeah, good luck with that.

:eyes:

[lumberjack_jeff]

153. We've been trying that one for almost 100 years. n/t

[lumberjack_jeff]

152. Are insurance companies underfunded?

The public option is going to be self-sustaining, and since rates will be set by the exchange, the public plan will be well capitalized.

My only concern is how does the exchange set the rates? I want the exchange to exert huge downward price pressures on the insurers in the pool.

[eridani]

181. If the public option turns out to be a dumping ground for the poor and the sick--

--it will INCREASE the power of private insurance.

[lumberjack_jeff]

189. It won't, so don't worry about that. n/t

[eridani]

204. You know that how, exactly?

If private insurance continues to cherrypick, the publc option will be for poorer and sicker people.

[SidneyCarton]

99. As someone who may soon be without any healthcare...

And whose wife cannot be covered if not through my employer (preexisting conditions) you will forgive me if I would rather not do nothing.

[Laelth]

102. I certainly understand that.

I hope you can afford the insurance, and I hope some hospital or doctor will take it. They're not required to. Personally, I can't afford insurance right now, and I don't have it. I live in constant fear of getting sick. All the same, I can't afford o buy insurance, and I will be hard-pressed to comply with this law, if it passes.

:dem:

-Laelth

[lumberjack_jeff]

190. Well said. n/t

[Kingofalldems]

66. Are the blue dogs on board?

Or will they caucus with the repubs?

[berni_mccoy]

67. At least one of them (Altmier-PA) voted for it in the Committee.

[dflprincess]

73. That's probably not a good sign for anyone interested in actual reform (eom)

[berni_mccoy]

76. Why do you feel it is necessary for you to keep interjecting unfounded negativity into this thread?

:shrug:

There is only one blue dog on the committee, and the fact that he voted for the bill is a great sign, not a bad one.

[dflprincess]

84. To counter those who are wearing rose colored glasses

and are willing to settle for less. You don't start negotiations with what you might be willing to settle for and odds are this bill will only get worse before the House is done with it.

If you think a bill the Blue Dogs will back is a good thing for anyone but the corporations who own them, go right ahead. Given their track records, I have serious doubts that they're willing to put the general welfare ahead of their campaign "contributions" and lucrative lobbying jobs they can get when they leave Congress.

[Laelth]

128. The Progressive Caucus is NOT on board.

Saw that here:

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6076998

:dem:

-Laelth

[kenfrequed]

77. If it passes...

I will have another reason to be happy with Obama. And I am not even remotely a cheerleader.

[warren pease]

86. Just curious... what are you happy with thus far in his presidency...

... besides getting fairly close to the strike zone with last night's ceremonial first pitch?

sf

[kenfrequed]

171. Well...

I am fairly progressive so I have a good deal to be annoyed with.

However he has moved more towards using diplomacy abroad.

There are a few other decisions made with regards to provision for family planning funds usage and stem cell research, but it hasn't been a really happy time.

His cabinet and Chief of Staff appointments were god-awful.

But I am still tyring to stay a little hopeful

[warren pease]

182. Thanks... That's kinda my list as well, but it's way too short given the expectations HE set. n/t

[kenfrequed]

184. I think there are a few other things...

And obviously he is better than Palin/McSame but I was really hoping for a bit more.


Of course there is substantial blame to be directed at the blue dog/DLC crowd, but really did he have to put so many of these jerks into appointed positions?

[closeupready]

79. Wait - this makes no sense - for individuals, poverty is less than 10.4k. therefore,

if you make over $42,000 per year, you will be socked with a $5,000 bill for health insurance? That's no good.

[berni_mccoy]

81. A single person (no family or kids) making more than 42k / year can afford 5k on healthcare

that's less than 12% of their income.

[closeupready]

83. I suppose. It's a lot, though.

Let me do the calculation on it -

In New York, this is probably someone pushing papers from 9-5 as a temp or uncovered by health insurance, so you've got a salary of 42,000, which is $23 per hour - local, state and federal taxes take out about 1/3, so taking home $600 per week. Doing a traditional calculation that rent should be no more than 1/52nd of your annual gross, that's about $800/month for rent.

$5,000 per year is $96/week - I presume this is paid after taxes are taken out?

It's affordable, I suppose, but expensive.

[mamaleah]

90. Depends on where they live.

$42K as a single might be fine in Kansas. But try living in San Francisco, NYC, or Los Angeles on that. You can get by, in a tiny studio apartment or a slightly larger 1 bedroom in a not so great neighborhood.

Also factor in what an urban dweller has to spend on food....its usually more than those in rural areas.

[lumberjack_jeff]

94. Sam Kinnison was right.

Some people don't need public help, they need u-haul trucks.

I hear Detroit is much cheaper.

[superduperfarleft]

95. That attitude, telling people what they can afford, is exactly why I oppose mandated coverage.

$5000 a year is $416 a month. If someone is struggling with rent/mortgage, credit card bills, car payments, car insurance, student loans, etc. etc. etc., you think it's good PR to tell them, "Oh don't worry, you can cough up another $416 a month, and if you don't, we penalize you."

[lumberjack_jeff]

109. Health care costs $5800 per person in this country.

I understand that some people feel that someone else should pay this bill. That would, admittedly, be nice.

The alternative is what we have now, where those who truly can't afford insurance, seek treatment at emergency rooms and leave those of us who purchase insurance with the bill.

All along, I've been arguing that people don't lack coverage because they choose not to, but that they truly can't afford it. Frankly, I don't consider a car payment a good excuse to saddle others with their medical risks.

The house bill;
a) gives free medical coverage to everyone under 133% of FPL ($33k-ish for a family)
b) gives big subsidies to anyone under 400% of FPL ($88k for a family) who doesn't get insurance from their employer
c) allows those who are happy with their current insurer to keep it.
d) guarantees that you won't lose your coverage if you get sick, and allows you to keep continuous coverage if you change jobs.
e) caps your total risk at $10,000 - eliminating medical bankruptcies.

It is 100% win.

In twenty years, I want to be fighting to turn this program into single payer, not fighting this battle again.

[berni_mccoy]

133. Well said. So many here are missing the point.

[warren pease]

200. It's much worse than that...

Here's numbers from the WHO's 2000 landmark study comparing the medical systems of 190 countries, updated for 2005. (It's alphabetical, so you need to scroll to the "U's.")

So four years ago, according to that update, it was $6,350 per capita. Latest WHO numbers I've seen put that figure at $6,719 per capita for 2006.

Here's more from the Organization for Economic Co-operation and Development (OECD).

They cite $6,401 per capita in 2005, a little higher than the WHO numbers, but you'll notice that per capita expenditures on public health are nearly half that total, or about $2,900.

So the US spends more per capita on public health than more than half (18, to be exact) the other OCED countries spend as total health care costs.

This funds health care for federal, state and local government employees. That includes programs such as the Federal Employees Health Plan and those for state and local employees as well; the Cadillac single-payer coverage our fine Representatives and Senators enjoy (and which they say we can't have); the cost of covering ER expenses for those without insurance; Medicare; and the costs of various state-run Medicaid programs.

So we're already paying for national health care; we're just not getting it.

This just in... Health and Human Services puts the 2007 per capita buy-in at $7,421.


sf



On edit: Added HHS numbers for 2007.

[mamaleah]

112. Thank you

$416/month in this economic climate is way more than most think.

[Jakes Progress]

106. You're saying that $5K

gets 100% coverage - no copay - drugs - hospital - labs. The whole thing?

[lumberjack_jeff]

91. My insurance, for just me, is $550/month.

Luckily for us, my wife's employer pays it.

At our current income, my family's healthcare would be free under the house bill.

If our income doubled, the family coverage would be something like $300/month, which would probably be paid by an employer.

If this passes, it will be a huge win for americans, for innovation, for business and for democrats.

I would no longer have to worry about keeping coverage, and crazy ideas like self-employment make sense.

[superduperfarleft]

97. And when the right and the DINOs refuse to fund this public option properly

and doctors start refusing to accept patients because reimbursement rates are drastically lower than what they could get accepting private insurance, the right will then use the ensuing disaster as proof that government-sponsored health insurance doesn't work, and single-payer will be doomed for generations in this country. And that's assuming the bill doesn't end up hopelessly watered down that it doesn't take chronic underfunding to make it a disaster.

I truly hope I'm wrong, but I doubt it.

[Xenotime]

98. This should be re-evaluated every year and tax more of the wealthy if needed.

[brentspeak]

104. A $5,000 co-pay on top of basic coverage is what you call "a winner"?

A vaguely-defined public option that won't kick in until at least 2013 is "a winner"?

[SpartanDem]

107. Both cost sharing and premiums are subsidized

[lumberjack_jeff]

110. You're misinformed.

the public health plan is available day one, as "medicare +5". It begins to participate in the insurance exhange within 36 months.
for a single person, $5000 is the annual cap... their costs won't exceed this. $10,000 for a family. Medical costs will no longer be a bankruptcy cause.

Yes. It's a winner.

[ipaint]

113. Only to those who are allowed in

"Under the main Democratic health bills being debated in Congress, many people with job-based insurance could find it difficult to impossible to switch to health plans on a new insurance exchange, even if those plans were cheaper or offered better coverage. The restrictions would extend to any government-run plan.

The provisions could change, and there are a few exceptions: Workers would be allowed to buy insurance through the exchange if their job-based coverage gobbled up too much of their incomes or was too skimpy. Also, under the proposal by Democrats in the House of Representatives, people could get insurance through the exchange if they paid their entire premiums, a cost that would be prohibitive for many.

Democratic lawmakers and administration officials say the restrictions are crucial to maintaining a strong employer-based insurance system, which covers 158 million Americans.
Critics argue, however, that the rules run counter to suggestions that a health care overhaul could provide people with a broader choice of insurance options. The restrictions, they say, could be especially unfair to some lower-income workers who are enrolled in costly job-based insurance. Also, they warn that the rules could hurt the proposed public plan by limiting enrollment.

Jonathan Oberlander, an associate professor at the University of North Carolina at Chapel Hill, said, “The rhetoric is that Americans will gain new alternatives, but the reality is that they are putting up firewalls that are going to restrict the access of people with employer-sponsored insurance to the exchange.”

http://www.freep.com/article/20090715/NEWS15/90715069

[lumberjack_jeff]

114. Which is it?

If your current employer-based coverage is cheap and you'll continue using it, what's the problem?

If your current employer-based coverage is expensive, then why is there a problem now that government will subsidize it?

If your current employer-based coverage sucks because it is too limited, what's the problem now that government will begin enforcing minimum standards?

If you risk losing your job because you become ill and cost-prohibitive for your employer to insure, then what's the problem with prohibiting that and guaranteeing that you can continue your care/coverage?

It's the best we can do, but that misses the point; it's also good.

It is eminently reasonable to provide a mechanism to meter entrance into the public system, starting with those who are currently uninsured.

[dflprincess]

119. I was listening to an interview with Steny Hoyer on NPR this evening

according to Steny we all need access to health insurance (apparently the idiot, with his taxpayer subsidized insurnace, hasn't figured out that what we need is access to heath care)

Steny could not give any opinion as to what the monthly premiums might be for the public option because premiums will be "market driven" (his words) and vary across the country. He did say that they will not be cheaper than private plans because that would "undercut" having a real choice between the public and private plans (no shit, that's what he said).

He also could not say what the maxium out of pocket expenses (in addition to premiums) would be - but there will be one so that no one will be driven to bankruptcy by medical bills. Of course, the fact that Steny has no idea where the tipping point for bankruptcy might be doesn't leave a lot of hope that that maxium will be realistic. I imagine it would take a more expenses to drive Steny to bankruptcy than it would most of us.

[SpartanDem]

120. The reason he didn't have numbers is the premium limit is based on income

from 1.5 to 11 percent. The cost-sharing is hard limited to 5,000 individuals and 10,000 for families

[dflprincess]

122. He specifically said premiums would be market driven

which probably means anyone who doesn't qualify for a subsidy will wind up paying the maximum of 5 or 10K because the for profits will make sure that's the market price. According to our pal Steny there will also be other out of pocket expenses over and above the premium. Those will be capped, but he can't say what the cap will be or if it will be tied to income. There was no indication as to whether or not expenses not covered (i.e. adult dental and eye care) would count toward the cap.

He also made it clear that the public program is not being set up to truly compete with the private insurers but only as an alternative with pretty much the same costs.

Even with a $5,000 maximum premium we'll still be paying more for health insurance than people in civilized countries pay through taxes for access to health care.

Really, nothing much will change with this plan except that a person will be forced to buy coverage whether they can afford it or not.

[berni_mccoy]

130. You are mistaken. Please stop spouting false info. Thanks.

[dflprincess]

136. You'd better call Steny and let him know he's wrong

this is what he said in the interview.

[Fire_Medic_Dave]

115. So if you have private insurance you don't have to pay right?

[lumberjack_jeff]

116. That's correct. n/t

[Fire_Medic_Dave]

117. That's good otherwise my taxes would be going up $8,800 a year.

[Juche]

124. 43k for an individual, but 88k for a family

Those are the cutoffs for those of us who are single and childless.

However I don't know how the sliding scale works and what they charge for a single person making 14k vs 40k. If the premiums are only 200 or so a month, that isn't bad. But if they go up to 400 or more a month for a single person and you aren't getting any credits, that might be hard. Not impossible, but hard to pay.

I hope that $5000 a person and $10000 limitation for individuals and families includes the premiums. If you need to pay the premiums plus a 5k a year out of pocket limit, that could be hard on an individual making 45k a year.

[bvar22]

131. I'm sticking with these guys.

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6076998

Why should Americans be forced to settle for LESS than the rest of the civilized World?

Especially troublesome:
The Public Option will compete on a "level playing field" with the For Profit Insurers.

WTF?

The Public Plan should be allowed to use every single advantage of Public Ownership and Government administration.
Why should it be forced onto a "level playing field"?
I mean, thats the point of a Public Plan...isn't it?

[earth mom]

135. Very interesting...hadn't seen that yet. nt

[earth mom]

134. Why are you selling this so hard?

I read the entire thread and there are damn good reservations about this plan.

Our family has rock solid union health care. We already pay monthly for it. Now it sounds like we will have to pay even more regardless of our income.

Why should we have to pay one dime into this new plan?


This bill sounds like mandatory insurance to cover the insurance companies asses.

And everyone already knows what huge blood sucking heartless bastards they are.

This is not about us, it's about THEM.


I'm not convinced, and find it interesting that you are "selling" it so hard.

So who do you work for?

[SpartanDem]

137. You already have insurance nothing would change for you

depending on income you may pay less

[earth mom]

138. That's good to know, but the insurance companies really need to be kicked to the curb.

They are evil and should NOT be able to profit off of peoples misery.

[ContinentalOp]

157. OK, great. So that's missing the ENTIRE POINT OF REFORM!

So I can keep my current cheaper insurance until they decide that I'm too expensive to insure anymore and then I can buy into the way more expensive public plan? How the hell does that fix anything?

[lumberjack_jeff]

142. Because there is so much complete ignorance on display.

If you have insurance, good for you. Stop reading. The only relevant things for you are;
a) if the bill passes, you now have the option of changing jobs, or divorcing without fear of going without insurance.
b) if you get sick, new safeguards on the industry will prevent insurers from dropping you.
c) because it essentially eliminates the uninsured, healthcare inflation will be brought under control.

This stuff doesn't pertain to you, but is relevant to the rest of us.
d) everyone under 133% of FPL who isn't covered at work will be eligible for medicaid. Everyone under 400% of FPL who isn't covered at work will get a subsidy, paid for by a tax on rich people.
e) because there's a cap, medical bankruptcies will be a thing of the past.

This is 100% win. I'm more interested in securing healthcare for the 50 million at risk than I am about punishing the insurance companies. That'll come soon enough.

Unless you make more than $250k/year, this doesn't cost you anything. I've been pushing for healthcare reform for 30 years, and it frustrates me a great deal to find so much ignorance *here* of all places about the benefits of this Democratic plan.

[earth mom]

148. Why is Kucinich against it? Why are 50 dems against it?

Sorry, I'm sure you've worked hard, but it's sounding more and more like a scam to me.

I might have no worries about health care, but that doesn't mean I don't care about this issue.

My dad went through hell before he died because of the crappy health insurance system this country has.


FYI:
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6077877

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6076998

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6078401

[SpartanDem]

160. They don't oppose this bill

they're saying that they'd oppose any bill without a public option. There is nothing that says they're against this particular bill

Progressive Democrats are taking a hard stand on health care reform, with a majority committing to oppose any health care reform package that doesn't include a robust public option. On Wednesday, they got an inadvertent assist by an anonymous leak of their "whip list."

It names fifty members of the Congressional Progressive Caucus (CPC) who have firmly pledged to oppose any bill that doesn't meet the group's standard

[Laelth]

202. They should oppose it, and I intend to tell them so.

How in the world can imposing a new, regressive tax equal to 12% of gross income on the uninsured be a good idea?

:shrug:

:dem:

-Laelth

[scheming daemons]

161. Kucinich is a nutcase, and those 50 dems are going to kill a GOOD plan because it's not PERFECT

...and as a result, we'll end up with *NO* plan.

[bvar22]

164. The Dems who are against a "weak Public Option"....

...are the ones I trust.

The Progressive Caucus has been on the right side of almost every issue for over 20 years while the "Centrists" have been selling us out to the Big Corporations.

I will reserve judgment until I have a chance to read all the Fine Print, and hear what the Progressive Caucus has to say before putting on my Party Hat.

This is what a REAL Public Option MUST include according to the Progressive Caucus:

The Congressional Progressive Caucus calls for a robust public option that must:

Enact concurrently with other significant expansions of coverage and must not be conditioned on private industry actions.

Consist of one entity, operated by the federal government, which sets policies and bears the risk for paying medical claims to keep administrative costs low and provide a higher standard of care.

Be available to all individuals and employers across the nation without limitation

Allow patients to have access to their choice of doctors and other providers that meet defined participation standards, similar to the traditional Medicare model, promote the medical home model, and eliminate lifetime caps on benefits.

Have the ability to structure the provider rates to promote quality care, primary care, prevention, chronic care management, and good public health.

Utilize the existing infrastructure of successful public programs like Medicare in order to maintain transparency and consumer protections for administering processes including payment systems, claims and appeals.

Establish or negotiate rates with pharmaceutical companies, durable medical equipment providers, and other providers to achieve the lowest prices for consumers.

Receive a level of subsidy and support that is no less than that received by private plans.
Ensure premiums must be priced at the lowest levels possible, not tied to the rates of private insurance plans.

In conclusion, the public plan, like all other qualified plans, must redress historical disparities in underrepresented communities. It must provide a standard package of comprehensive benefits including dental, vision, mental health and prescription drug coverage with no pre-existing condition exclusions. It must limit cost-sharing so that there are no barriers to care, and incorporate up-to-date best practice models to improve quality and lower costs. All plans, including the public plan, must include coverage for evidence-based preventive health services at minimal or no co-pay. All plans, including the public plan, should be at least as transparent as traditional Medicare.

[lumberjack_jeff]

168. Kucinich, like most of us, prefers single payer

He has not said that he would vote against it. The other 50 is just rumormongering. The progressive caucus has been on record for quite some time against any plan which lacks a strong public option. This bill has a strong public option.

[ContinentalOp]

158. Bullshit. If you have insurance already you may be screwed.

Sure, I don't have to fear going without insurance, but if for some reason I'm forced onto the public plan my healthcare costs are going to more than DOUBLE!

[lumberjack_jeff]

167. If "for some reason" you lose your insurance NOW, what happens?

*crickets*

You don't understand "screwed", if you think the current system is preferable.

[ContinentalOp]

170. I don't think the current system is preferable.

I just don't see how this new system amounts to anything other than cheap private insurance for the young healthy folks and an expensive public plan for everyone else.

Sure it's better than what we have. I'm not arguing this or nothing, I'm saying that maybe there's something better.

[lumberjack_jeff]

172. I get confused. Is "level playing field" a good thing or bad?

The house bill sets up the public plan to compete with private insurers within the health care exchange. The exchange "works with state insurance departments to set and enforce insurance reforms and consumer protections, facilitates enrollment, and administers affordability credits to help low and middle-income individuals and families purchase insurance."

The exchange sets premiums for all of the competing plans. Personally, I think the likelihood is that the public plan will find that the minimum premiums that the private insurers require to do business will allow the public plan to offer a wider range of services than the competition.

The private plans will be prohibited from cherry-picking, can't deny applicants based on preexisting conditions and can't cancel policies for reasons other than nonpayment.

Applicants will choose a plan based primarily on service offering, not price, and certainly not based on "the public plan is the only one who will take me".

In the short term, this probably means that premiums will be higher than the taxes in a single payer system would be. Maybe 10-15%. In the longer term, insurance companies will innovate or die. If they die, the premiums will drop to the level at which the surviving insurer - the public option - can operate.

[SpartanDem]

175. It means

that the public option must be revenue neutral it's co pays/premiums not government funds must cover operating cost and that public and private plans must follow the same regulations

[lumberjack_jeff]

176. This is how the public option summary pdf describes "level playing field"

LEVEL PLAYING FIELD
 Require public option to meet the same benefit requirements and comply with the same insurance market reforms as private plans.
 Establish the public option’s premiums for the local market areas that are designated by the Exchange, just as other insurers do.
 Individuals with affordability credits can choose among the private carriers and the public option.

It also means that the plan administrators be functionally independent of government.

Although I'm confused by the second bullet. Do the administrators of the public plan set their premiums for the areas established by the exchange, or does the exchange set premiums for both the private insurers and the public plan within each market area? I'd read that it was the latter, but now I'm not so sure.

[ContinentalOp]

177. It's good that they can't drop me or deny me.

The key is, can they raise my premiums? This is the part I don't understand. Are our rates locked in permanently? Or does the federal government mandate the rates? Or are the private insurers still free to set rates as they please?

If it's the latter I would imagine private insurers will simply continue to raise rates as soon as people start using their insurance, thus forcing people onto the cheaper public option. In other words, the public option will only be cheaper for those that the private industry doesn't want to bother insuring. And it will still be more expensive than it would be if it were a universal system, because the public plan will be a dumping ground for the sickest and most expensive to insure.

[ibegurpard]

178. And what's setting the cost for medical services?

Lord knows what's doing it now.

[lumberjack_jeff]

194. Insurers negotiate with providers.

If the federal government coordinates their negotiating efforts, they could bring prices down.

Additionally, since there would be few uninsured, providers couldn't use "charity care" as an excuse to raise prices on everyone else.

[lumberjack_jeff]

187. The rates are set by the government-run exchange, independent of the public plan.

The insurance companies, the pertinent state insurance regulator and the public plan administrators will come to the exchange, lay out their costs for the previous years and negotiate with the exchange for a premium schedule.

Since the public plan pays no profits, they should be a good (i.e. cheap) baseline.

I read conflicting info on this point; are the rates for the various plans set at the same price for every insurer within the geographic exchange, or does the exchange set each plan premium independently? In other words, do the plans compete on the basis of service offering or on price given the same set of offerings?

Either way it's good, but I'd prefer the latter, because I want to see the public plan eventually drive the private insurers into fringe, supplementary offerings.

As to your questions, yes. Your premiums will change over time. No, they are not locked in permanently. Yes, the federal government mandates the rates within each state exchange. No, the private insurers are not free to set the rates as they please.

My gut feel is that they will drop slowly over the next decade, then resume climbing approximately at the rate of inflation. But there's no free lunch. We have a tremendously expensive system, for which there is no magic bullet, and a government who is incapable to pull the trigger if one could be found.

Remember, for the foreseeable future, most people will continue with their employer-based coverage. As they leave work or change jobs, they will begin to use the public plan in earnest.

[dflprincess]

151. That's an interesting question

I see it hasn't been answered.


BTW earth mom, you nailed it in this post
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6077877#6078436

[berni_mccoy]

193. Because 18k people are dying each year because they don't have health insurance.

And because a LARGE percentage of my income goes to providing healthcare for my family. I have two children with type-1 and have had to fight and fight with Insurance companies to pay the bills and provide coverage. To answer your question, I own my own business and work for myself.

And I'm not selling it as hard as people are attacking it.

[maryf]

139. Not as good as some might think...pretty bad possibly...

Notes from a doctor I know (single payer supporter!)

"The proposals under consideration by the White House and the Congress,
with and without a "public option" (which even now has yet to be
defined!) will not improve our health care predicament and may well
make things worse.

Criminalizing the uninsured ($1000 fine if you don't buy insurance),
subsidizing private health insurance premiums with tax dollars, taxing
health benefits, incentivizing employers to drop health coverage
(modest charge per employee), cutting Medicaid and Medicare
reimbursements to hospitals and providers -- these are packaged as
"reform." These will not make health care any more affordable, will
leave tens of millions uninsured, will not improve quality and will
likely worsen disparities."

Single Payer is really the only way to go, take the profit out of health care!!

[earth mom]

163. WTF?! "Taxing health benefits"

:wtf:

[maryf]

166. Yep, nt

[SpartanDem]

169. That not true it's paid largely by a 5% tax increase on people making 1 million+

[berni_mccoy]

174. That is a completely dishonest response and has nothing to do with the current proposal.

[Echo In Light]

192. Sounds like "Reform" is on the same euphemistic level as rightists favored "Deregulation"

[kath]

140. $10K per year is 8-9X what the Canadians pay -- WAY too high!

They call this "affordable"??????

[ContinentalOp]

141. Hell, it's more than double what I pay for a family of 3 with private insurance in the U.S. -nt-

[kath]

143. well, but you probably also have to pay co-pays and deductibles, and probably have to pay 20% of

big-ticket items (hospitalization, ER, CAT scans, MRIs etc.) on top of your premiums, and pay at least a co-pay for prescriptions.

Several Canadians have posted here that they pay around $100/month, but their care is generally FREE at the point of service - so around $1200 per year TOTAL.

[ContinentalOp]

162. Yeah, copays are about $10 or something.

Haven't had any big ticket items and nobody in my family has any prescriptions at the moment. We pay about $500 a month (two adults in our 30s & a 5 year old child) out of pocket as we're both self employed.

So Canadians are paying $1200 a year.
My private insurance is about $6000 a year for a family of 3.
This new public plan is $10,000 a year!? :wtf:

[SpartanDem]

147. That's the cost sharing limit for a family of four making 89,000 or more

[kath]

183. My point was that Canadians' "cost-sharing limit" is only around $1200 per year for a family.

$10K is ridiculous.
Gotta get the blood-sucking insurance companies out of the picture.

[Lorien]

155. Canadians aren't paying middlemen-i.e. insurance companies-correct?

we won't have anything truly affordable until we cut out the profiteers. Insurance companies shouldn't stand between a doctor and the patient they care for. Perhaps everyone will be "covered" under the new plan, but when do insurance companies ever willingly pay for "covered" procedures?

[Laelth]

159. That would not be "affordable" for me. n/t

:dem:

-Laelth

[Maru Kitteh]

150. I will have a bottle of very wonderful, locally grown wine ready to celebrate if this passes.

[lonestarnot]

165. Likie!

[mp9200]

173. Sounds good

Now if Obama would actually put it into place.

[berni_mccoy]

186. UPDATE: This bill IS created by and approved by the Progressives

See: http://journals.democraticunderground.com/berni_mccoy/702

[lumberjack_jeff]

191. ^-------- Must read. Thanks Berni! n/t

[bvar22]

197. Thanks, Bernie.

This is the endorsement I have been looking for.
I trust the Progressive Caucus to protect the interests of Working Americans.
They have a very good record of doing so over the last 25 years.


"There are forces within the Democratic Party who want us to sound like kinder, gentler Republicans. I want us to compete for that great mass of voters that want a party that will stand up for working Americans, family farmers, and people who haven't felt the benefits of the economic upturn."---Paul Wellstone

[Mass]

201. This is the House healthcare bill, not yet voted out of committee. It is different from the HELP

bill, and definitively different from the not yet defined Finance Committee Bill in the Senate, which will certainly will be a lot worse.

The final bill will be a compromise between those bills, therefore worse than the one you posted.

It is also expected that the public option will not be opened to all. According to Sebelius yesterday on the Today Show, it would only be offered to those whose companies do not offer healthcare. Now, she does not define the law, but I am sure she has some idea where it is going to look like.