Thanks to the successful efforts by the Blue Dog caucus, the bill will not contain the “robust” public option, one that pays Medicare rates plus 5%. The bill will still contain a national public option run by the HHS, but will pay rates negotiated by region instead. This move will increase the cost of the bill by roughly $85 billion.
To make up some of the reduced saving by going with the less robust public option, the bill will expand Medicaid to cover people making below 150% of the federal poverty level (FPL) instead of 133%. It is much cheaper to cover individuals with government insurance programs (Medicare or Medicaid) than through private insurance.
The bill will not contain the excise tax on employer provided health insurance found in the Senate Finance Committee bill. Most of the money to pay for the bill will come from savings from Medicare and Medicaid and a new “millionaire’s tax.” It will be a surtax on individuals making over $500,000 and couples making over a million a year. This should create a real showdown during the conference committee. A large number of House Democrats are strongly against the tax on health insurance benefits while many senators are against the new “millionaire’s tax.”
UPDATE: Full text of the bill now available (PDF).
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Dylan Rattigan:
And the progressives have not yet said they will not vote for this? They must be looking for a bullhorn and a podium now, don’t you think?
Expanded Coverage ? Yes. Reform ? No.
In poker terms, did Nancy just fold while holding a straight flush?
somewhere in the last few hours, I read something about CPC’s design’s on the ‘Managers Amendment’ will do a little digging
here are Grijalva and Woolsey’s statements from yesterday:
The Hill
This sound like a bill that I can’t support. I want my rep to vote NO! I want a ROBUST PUBLIC OPTION open to everyone on day one, not any watered down version that will do nothing for all citizens.
I was gonna say I feel sick, but I guess I’d better not get sick considering where I live.
150 percent of poverty level is like a trigger with hollow points.
The enemy is within.
As a family practice manager who prefers single payer, I have to admit I am not upset about the negotiated Medicare rate. Currently in NC a family practice doc earns $58.89 from Medicare for the average established patient visit. If all we saw were Medicare patients, we could not afford to stay in business.
Every time that they make a compromise and that compromise is exposed to public scrutiny, the foolishness of industry give aways becomes apparent and public pressure makes them back off.
I’d imagine that with public attention focusing in closer as the details are nailed down, combined with good messaging from congressional progressives, the best I’ve seen on any issue, that we’ll see more good than bad added to the bill as it moves forward.
As the numbers roll out, it is going to be very difficult for Members of Congress to buy into the deficit hawk argument that we cannot do Medicare+5 because it would save too much money and provide an option attractive enough that people will like it and switch from private insurers.
The messaging needs to turn to the notion of the individual mandate and how that requirement on the purchase side is going to need to balance out protections for the insurers on the sales side, especially convolutions that would end up needlessly supporting higher insurance premiums.
Fortunately, the slow walk of this legislation and the presence of the internet has allowed an unprecedented amount of scrutiny, discussion and organization which has worked to file off the worst sharp edges of what they had in mind. Now is no time to stop.
Progressives need to say right now they won’t vote for that.
If they don’t it means we’ve already lost. Obama’s not gonna wave a magic wand and make it all better in conference. If that passes we’ve lost.
Is this a great system or what where 40% of the Senate representing 20% of the people is able to dictate a half-assed health care “reform” legislation that will affect every American? Does it make sense that Wyoming has as much power in the Senate as does California? I do have a suggestion that Senators be made to wear toga’s while in the Senate or being interviewed on television.
A large number of House Democrats are strongly against the tax on health insurance benefits while many senators are against the new “millionaire’s tax.”
Aw, po’ lil millionaires’ club.
I know the term P.O. means many things to many people, but now more than ever it should be clear… the term P.O. is dead.
It’s not an “option” available to the entire “public”… not even close. If we keep it alive it should be hammered into these idiots day and night. What does Public mean. What does option mean?
The Rove speak worked on Dems this year as well as it did on the idiot GOPers under Bushco.
Nancy Impeachment Is Off the Table Pelosi does it again.
Sure am glad there are huge D majorities in the House and Senate and one in the White House so we can get some progressive change!/s
“Thank you, insurance companies of America,” Pelosi said.
Dear Nancy, that’s pretty feeble snark when you’ve given them everything they wanted.
Even if patient visits doubled.. largely for check up and preventative visits? And all the billing and denial of insurance claims dramatically reduced or disappeared?
Yeah…and what does healthcare mean and what does reform mean?
Blue Dog, Conservadems must be the target in 2010.
DFA is asking the following:
I would add the following:
It’s also important to contribute if you can to FDL Action’s effort to Fund Organizers in Arkansas: Dare Blanche Lincoln to Filibuster the Public Option.
As of now, FDL Action is over half way to raising the target amount!
JUST SAY NO!
So…does anyone know if Vaseline is included in the Flashy New Plan? I’m guessing…um…nope.
Budget legerdemain: Adding people to the Medicaid program hides the costs that states will have to pay, and states are having budget problems that are cutting benefits. And some states have lowballed Medicaid ever since the program was created, denying people when the program “runs out of funds.”
Would somebody in the Congress start naming names of the obstructionists? So we can be clear who has betrayed us and who is just an unreconstructed Blue Dog corporatist?
But 60 Progressive Caucus members signed a letter on July 30 explicitly saying that they would not vote for health care bill with a public option based on negotiated rates.
Their stand on this matter drew initial exultation on FDL, followed by a derisive but somewhat confusing post by Jane, implying that the CPC was caving on the pledge.
CPC members in the Energy and Commerce Committee did cave to ObRahma’s demand that they vote the E&C version of HR 3200 (with negotiated rather than Medicare-based rates) out of committee, but that’s not the same as the entire list of signatories backing down from voting against a negotiated-rates bill if it reached the floor. Now Pelosi is bringing just such a weakened bill to the floor. So only now will we know if the 60 signatories are going to back down on their pledge.
If anyone has any information indicating CPC plans to abandon the signed pledge, please update/enlighten me.
Everyone’s annual 10-15 percent increase in health insurance premiums should be coming along any day now, but at least we’re fixing Afghanistan.
Hi,
I am an outreach coordinator for the health videos website.
I wanted to add to the discussion by offering up some videos for those of you looking for more information on health care reform. We have three topics pages about health care, one is specifically about policy, one is about the current reform efforts and finally, one features videos discussing the politics of it all.
http://www.icyou.com/topics/politics-policy/healthcare-policy
http://www.icyou.com/topics/politics-policy/healthcare-politics
http://www.icyou.com/topics/politics-policy/healthcare-reform
Check out these videos for answers to your questions, and check back daily for updates and new information!
Thanks,
Laura
We’re fixing Afghanistan?
Nancy Pelosi wouldn’t drop Medicare + Five unless she needed to in order to get Blue Dog votes, despite their ill-earned reputation as deficit hawks. Which means, also, that she must have the progressive caucus votes for negotiated rates. Which means the progressive caucus, once pledged to vote against anything that wasn’t a robust public option, has backed down.
We have been betrayed.
Lucy and her football, for the win.
Everyone who gave money should get it back from those who abandon their pledge.
I’m pretty sure we get a pony, though.
What? We don’t? I stand corrected.
the choice of a robust public option was the compromise to a single payer, medicare for all bill; however, this is a good bill. it takes into consideration of regional-based, negotiated medicare based rates which those like conrad had wanted, it closes the medicare part d doughnut hole and it taxes those who have profited from the bush tax cuts to the wealthy to pay for it, not the middle class.
i can only hope, those senators who profit from the health insurance monopolies – i’m speaking to you conrad, nelson, byah, lieberman, and lincoln – will, at the very least, vote for cloture, out of shame if nothing else.
We get just what the pony leaves behind.
Is there any way the robust option could be amended back in?
however, this is a good bill.
For the bloated insurance predators.
Stimulus package? Bust. Healthcare? Bust. Afghanistan? Quagmire bust. Bank bailout? Gazillion bust. Etc? Bust.
2012? Plenty of Wingnut Ammo?
Thanks BO and Rahm. (etal)
Pony poop! Woo hoo!
Its not ideal, its not even good and what have I been saying? It has the faint smell of shit. The Progressives have been told yet again, we don’t have the means (votes) to get a widely progressive agenda done.
Here’s what you have to do. Kucinich’s add-on isn’t including in the merged house bill. He admitted that on Ed’s show yesterday. So what you need to do it find out if there’s a Single Payer Group in your State or even City as Gavin Newsom has done in S.F
For Californians I strongly suggest you jump on the SB810 bandwagon, we’ll get this done. Not with the Governator but the person that follows, his term is almost UP.
150 percent of poverty level means the likes of Wal Mart and McDonalds just got a huge bonus. Watch the number of people who cannot break the 150 percent of poverty level in income soar! And on the other end Wellpoint, Blue Cross etc… just gained a few million new customers… all customers have to pay privateers under rule of law.
If you have ever been to court (with long lines) for not being able to buy auto insurance…. things just got much worse.
Yes, just about the same time that elephants and rhinos start flying.
Pt visits really can’t double – there are only so many patients that can be seen in the course of a day. As far as denials and billing Medicare, it is rarely an issue, Medicare is the easiest payer to deal with. Honestly, a practice could not remain open at $58.89 per visit.
Agreed re Medicare billing… sorry if I wasn’t clear. Just seemed like that certainty and potential efficiency would help a great deal… since that is the type of patient which would be on the rise.
Off the top of your head, in general how much in actual avg. payment received does private insurance really pay per visit?
Can someone help me understand how the so-called “fiscally conservative” Blue Dogs rationalize insisting on the plan that will “increase the cost of the bill by roughly $85 billion.”
Perhaps because they get a nice cut through increased bribes I mean campaign contributions?
FYI, I just posed that same question to my Blue Dog’s staff.
Well I think we all know the reason WHY they did it, I’m just wondering how they’re trying to spin it to make it look like they aren’t a bunch of corrupt, bribed scumbags.
Here is a letter I got yesterday from Lynne Woolsey, Co-Chair of the CPC (emphasis mine):
Any suggestions about what I should write back in response to this crappy capitulation?
And then there’s my Senator Bayh (D – Wellpoint) who said he’d happily join a Republican filibuster along with fellow traitor Joe Lie.
Let the Republicans vote for it if they must…. for you must not.
So…does anyone know if Vaseline is included in the Flashy New Plan?
yeah – but it’ll be by prescription only, and cost $125 for a small jar.
*passing on the possible pre-existing condition joke*
And tell me why a filibuster wouldn’t be a good thing?
Well, depending on the copay or coinsurance model (fixed amount of copay $25 or coinsurance which is usually 20% of total allowed amount). [Sentence deleted by moderator at request of commenter] So, a patient may pay 20% of that or a fixed amount of copay.
Most private insurance payers base their negotiated rates on a cost plus percent of the Medicare allowable.
sounds like they’re gonna vote for it
OK, PLEASE, PLEASE, PLEASE, can we all stop equating Medicare + 5% with “robust”? That’s a talk point generated by the Democratic consulterati weeks ago, and it’s just plain dishonest.
A robust public option would be one with negotiating clout. That requires, at minimum, a large participating population. But all public options in all bills, regardless of rate structure, are limited to just a tiny slice of the population (with a theoretical possibility of expansion starting in 2015).
In June, the Congressional Progressive Caucus defined a series of criteria for a robust public option. Medicare-based rates were part of that package, but even more important was the criterion that the PO be available to all individuals and employers without limitation. That’s what Ron Wyden is fighting for right now on the Senate side.
There are other important components to the CPC robustness criteria, and those criteria themselves have shortcomings compared with the even more muscular public option as originally conceived by Jacob Hacker and pitched (in 2008) by HCAN.
The important point is that the PO in HR 3200, even with Medicare-based rates, can in no honest sense of the word be labeled “robust.” Please stop saying otherwise. Genuine robustness is just as “off the table” as single payer and has been for many months.
Medicare + 5% is important. By all means, try to revive and preserve it. But stop using the term as if it’s synonymous with “robust.” You’re just parroting Democratic doubletalk if you do.
Please. Just. Stop.
egggggs–zactly. the progressive caucus statement was lame
(A kewpie doll to the first person to respond, “Yes, Ralph, but how do you feel about it?”)
Talking to Pelosi’s office, it seems that the tradeoff was that the PO would be open to all if the financing was a gift to the insurers.
Robustness can be measured on several dimensions. Access is one. Level of competition with private insurers another.
Medicare +5% here in NC for an established average visit would equal a payment to the doc of $61.83 – just some perspective on this issue.
Doesn’t even fit the term Public Option.. much less robust.
At this point, I almost hope it just dies. But some naive part of me still hopes that in the end we get something that’s not too miserable.
i’ve been trying to follow this shit — from before the lunatic town hall summer and i think it goes something like the robust p.o was a compromise of single payer; focus moved to the senate gang of assholes and tiggers were a huge compromise of the robust p.o. and progressives got really pissed so they might be gone; the opt-out was the replacement compromise for triggers; opt-in replaced opt-out; the house is now not opting or triggering but ditched medicare plus five and came up with shit and this will get merged with a senate bill during conference which will have opt in or out triggers or something and we’ll get a compromise of everybody go buy insurance and if you’re dirt poor we’ll throw you a bone.
can’t let the perfect be the enemy now i guess, huh? yay!!! healthcare reform!!!
So roughly 16.00 less than the privateers pay… and the cost of doing billing with privateers alone would reduce the difference further. I know as a former owner of several small businesses that every penny counts… but that is not a lot of difference, imo. Especially for a pain free billing life… and the greater benefit to society.
primary care doctor rates really need to be raised
Obviously, we must let constituents know on no uncertain terms which Senators and Congressmen/women are wholly owned subsidiaries of which corrupt corporate interests. And that includes all of the ones that are creating waves and making it impossible to get what the American people deserve in regard to healthcare, whether we like them or not. If Dodd causes an obstruction, then he needs to be on the list as well. No more pussyfooting; no more Mr. and Mrs. Niceguys and Girls. Time for them to take their lumps.
Diane, How much time do you spend with that average patient in that average office visit?
I just wrote a nice little message on Evan Bayh’s wall to make sure his other Facebook friends know what he’s up to on health care.
Funny – the Republicans would never have had the chutzpa to pass this so-called reform that mandates all Americans purchase an overpriced product from companies with monopoly power and exemption from the anti-trust laws. This is why we voted in a Democratic majority?
The cost of billing private ins is no different – most clearinghouses charge a flat rate for electronic filing no matter who the payer may be. The bigger issue is the staff time involved in obtaining authorizations for certain procedures – MRI’s and CT’s. In November NC Medicaid will begin an authorization process for those procedures. This will probably become standard practice with healthcare reform if we are to reduce the amount of waste – but believe me, it is costly to the practice.
What is the criteria to allow access to the PO under the House bill (as in, who can use it)?
15-20 minutes
Just a touch of further clarity on what the CPC has pledged.
On June 12, the leaders of the CPC published a statement, signed only by its two co-chairs, saying in part
The July 30 letter, with 60 signatures, pledged to vote against a bill in which the PO was not based on Medicare rates. It did not pledge a vote against a bill failing to live up to the CPC’s robustness criteria.
How will this help me? Is it going to reign in costs on my employer-based Anthem coverage?
How does any of that help me?
Moderator, will you delete the BC amount I quoted in my comment on #49 – probably shouldn’t have done that.
Good day everyone. I’m in the minority by saying this, yet….Short of getting the ideal piece of legislation, our goal was to get something with ‘teeth’, and I believe today’s announcement does that. It’s something we can build upon in the next few years.
Hasn’t it been said here and on similar blogs that liberals would not have voted for the original Social Secuity bill? Or the original Medicare bill? Those started less-than-perfect, too.
With the majority in Congress, what we’re going through is disappointing to say the least. Maybe it’s because I’m a lifelong Cubs fan, yet I’m optimistic and realistic that this is a good starting point for our country. Perfect ? No way! Can we work with it? I think so.
ES – Wal-Mart and McDonald’s Offers Health Care Insurance. Wal-Mart’s is weak, but if we can take that out of the final law and allow anybody to buy it, then yes for Wal-Mart is a positive for the Government to pick up the tab on its employees which it largely does anyway, what else is new?
Came late but just wanted to say that I was shocked when Pelosi backed Medicare + 5%. Her dumping it is much more her style. The White House and the leadership in both Houses of Congress have never had any interest in a public option and, as we see with Pelosi, no intention to fight for one. The public option on the table was already weak with its limited availability and start up date of 2013. Now it is crap pure and simple. Way to go, Nancy.
Good point, Ann. No matter WHO it is who obstructs, (Dodd, et al), we must support others who are more in line with the majority of Americans. After all, how many times have we all heard something at the workplace like: “Bob, you’re terrific, a hard worker and everyone likes you. It’s just that you’re not the best fit here…”
Same goes–especially–for our elected leaders.
David Dayen has a fresh cross-post already in progress: “Contrasting GDP Growth With Job Loss”
No we needed radial change, this country is in the toilet and sooner or later somebody is going to flush us down the drain.
Washington DC is a slow moving ship because it wants to maintain the Status Que while doing just enough to appear like they are doing something.
I would actually support the Progressive Caucus in both Houses to just vote the thing DOWN if the Wiener or Sanders amendments aren’t both added to final bill.
We need radical change and if the 20% or so of America wants to drag us down into the abyss, I say let them do it. Most Dems would be protected by the DNC if not the WH anyway, this is complete utter nonsense.
You betcha – which is why I was really disappointed Reid didn’t get the doc pay fix bill passed. This has had to be done on a yearly basis.
Looks to me like under 150 percent of poverty level.
Progressives punked once more.Pelosi protestations of a “robust PO” were empty words all along.
When will we learn.
OK, lets get this bill printed up and signed by Obama.
This is exactly as Rahmabama wanted.
I’ve been trying to tell you people Nancy is a big zero.
See “The Progressive Power of “No”.”
“So…does anyone know if Vaseline is included in the Flashy New Plan? I’m guessing…um…nope.”
Steny Hoyer couldn’t find enough liberals, this time. Only the Blue Dogs took it. Ha Ha..
But as usual, he saves the big jar for the conference/orgy with the Senate. That’s where everyone reeealy gets fu****.
So stay tuned..it ain’t over.
Kucinich on New Health Care Bill: ‘Is This the Best We Can Do?’
Congressman Kucinich 111th
Washington, Oct 29 -
Following a statement on the Floor of the House of Representative, Congressman Dennis Kucinich (D-OH) today made the following statement about the latest House health care plan:
“Is this the best we can do? Forcing people to buy private health insurance, guaranteeing at least $50 billion in new business for the insurance companies?
“Is this the best we can do? Government negotiates rates which will drive up insurance costs, but the government won’t negotiate with the pharmaceutical companies which will drive up pharmaceutical costs.
“Is this the best we can do? Only 3% of Americans will go to a new public plan, while currently 33% of Americans are either uninsured or underinsured?
“Is this the best we can do? Eliminating the state single payer option, while forcing most people to buy private insurance.
“If this is the best we can do, then our best isn’t good enough and we have to ask some hard questions about our political system: such as Health Care or Insurance Care? Government of the people or a government of the corporations.”
Any public option that can attract enough votes for passage, in either the House or the Senate, will be too weak to be effective in controlling costs or expanding coverage. Only a single payer system (or a system of private insurance with strict regulation — an oxymoron in American politics and law) can achieve those goals. I agree that progressives should oppose the public option — as currently proposed by Reid and as included in the House Bill announced this morning — and re-direct the effort toward the Weiner Amendment and floor votes on HR 676 and S 703. For those inclined toward public protest or civil disobedience, you can make the point by joining the nationwide protest being organized by Mobilization for Health Care for All (http://www.mobilizeforhealthcare.org).
In a health care round table this morning on Democracy Now! Dr Oliver Fein, president of Physicians for a National Heath Program , made an observation regarding the public option that the Democrats should ponder very seriously. He said:
We are headed toward not only a massive corporate welfare program for the private health insurers, but one that will necessitate the adoption of the “consumer-driven healthcare” paradigm. The low-cost plans offered under this scheme will be useless to those with low and moderate income for just the reason Dr Fein cites — the high barriers to entry into the system. Those premiums will end up subsidizing higher income plan participants, or will go straight to the bottom lines of the insurance companies.
If progressives don’t push for real solutions to our miserable, broken non-system, we’ll end up being forced, under penalty of law, to purchase those defective products. It’s a recipe for a cure that’s worse than the disease. Maybe then we’ll see the sort of passion that leads to non-compliance, civil disobedience, and a real revolt against the centrism of the Democratic Party leadership.
I am saddened beyond words. The first woman speaker, the first Black president, and they are what they always were. Hypocrites. Just like their corporate masters. Not one more red cent. Not one. As their actions say, and loudly, to hell with the people, well, I say,
to hell with them.
Jesus B. Ochoa
El Paso, Texas
What gets me is that this congress said yes to bankers, who are little more than vultures, and yet they balk at paying doctors what they’re worth! There are no doctors that aren’t worth six figure salaries, and I think it should be no lower than $200,000 or at least close to that. Yet the bankers happily smile all the way to the bank with 7 and 8 figures for lying, cheating and stealing. What’s wrong with this picture?
Shocking info and commentary: http://www.70news.com/2009/10/29/house-unveils-healthcare-reform-bill/
What’s wrong is that most of the so called progressive orgs went along with the scam on Average Americans.The average american is virtually naked,not many politicians or so called librul orgs standing up for us.Where is MoveOn on this farce ?
Why are we not in the streets ?
I tend to agree, Teddy, but what if we howl at the caucus really loudly over the next few weeks? Can we get those 41 votes to kill the bill? Or failing that can we keep howling and get the 41 votes to kill the later conference version, assuming that it, too has a terrible PO?
Trying to raise money from us for the wonderful job they’ve been doing?
How about teachers/ Why don’t they make more? I think the rule is. If you work for the Government or are subject to an actual free market you earn less. If you’re lucky enough to work for an organization that has fixed its market, you can get paid very well indeed.
Sorry if i sound like an idiot, but i don’t understand what real diffrence Medicare +5% rates vs. negotiated payments makes. Does it mean that less Doctor’s will take the goverment plan? With the public plan cost the people who choose to go on it more in premiums? Please enlighten me=)