Wednesday, December 9, 2009

Health Care: Opt-out out, Trigger in, Medicare Buy-in in, Overall Deal Better Than First Feared

OK, TPM is now giving us more details on the "new new" Senate health care reform deal struck.

An aide briefed on the negotiations among the gang of 10 offers up the rundown of the most important aspects of the public option compromise being sent to CBO.

If this trade-off carries the day, the opt out public option is gone.

In its place will be many of the alternatives we've been hearing about, including a Medicare expansion and a triggered, federally-based public option, the aide said.

As has been widely reported, one of the trade-offs will be to extend a version of the Federal Employees Health Benefits Plan to consumers in the exchanges. Insurance companies will have the option of creating nationally-based non-profit insurance plans that would offered on the exchanges in every state. However, according to the aide, if insurance companies don't step up to the plate to offer such plans, that will trigger a national public option.

Beyond that, the group agreed--contingent upon CBO analysis--to a Medicare buy in.

That buy-in option would initially be made available to some uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized--people will have to pay in without federal premium assistance--and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.

It appears as if liberals lost out on a Medicaid expansion that would have opened the program up to everybody under 150 percent of the poverty line. That ceiling will likely remain at 133 percent, as is called for in the current bill.

In addition to the new insurance options, the group has tentatively agreed to new, and strengthened, insurance regulations, which the aide could not divulge at this time.

OK, so Harry Reid was NOT lying. The public option isn't dead... It's just sidelined, for now, with actually a decent possibility of being "triggered". I'm still not a major fan of the "trigger", but at least Olympia Snowe's never-to-be-actually-triggered language was rejected in favor of stronger guidelines, regulations, and mandates to the insurance industry that will require the HMOs to either offer truly affordable coverage in the exchange or let the public option come in and do so. And I guess if I have to choose from a severely weakened skeleton of a "public option" left open to few to start some time in 2013 or a stronger public option that may or may not (but at least now MORE likely) to be triggered some time within the next 5 years, I guess I'll have to hold my nose and accept the "non-Snowe" trigger.

And even not considering the better trigger possibly allowing a stronger public option, here's what else progressives get out of the deal (and hey, Chris Bowers linked to me! Yay!):

It is not the scope of victory we aimed for, but it is hard to call a significant expansion of public health insurance a total defeat for a campaign that was designed to expand public health insurance. While it was not expanded in the way we envisioned, it was expanded nonetheless. Directly as a result of the public option campaign, at least five million more Americans will receive good, public health insurance. And this is part of an overall bill where at least 16-17 million people--most of them low income and currently uninsured--will receive public health insurance.

Plus, the Franken amendment will be in the bill[...] Score! That is actually up from 85% in the House bill. This is a major improvement. [Link substituted by me.]

In summary, here are the important concessions that have been won since July in return for dumping the Medicare +5% option (that public option would have been available to everyone in the exchanges, and would have covered 10 million, but didn't even have the votes to pass the House):

- 4 million more people covered by Medicaid
- 1-2 million covered by a Medicare buy-in
- An increase in the percentage of money received by health insurance premiums that must be spent on health care from 85% to 90%

And there is a trigger too, but so friggin' what. That was never meaningful.

Now, even a Medicare +5% public option, available to everyone in the exchange, was a major concession from Medicare for all. Still, there is no way we would have gotten even the three meaningful concessions listed above without the broader campaign for the public option.

So all in all, not too bad. Again, I'm willing to give Harry Reid some credit for playing hardball to get a better deal for us. It's far from perfect, QUITE FAR FROM PERFECT, but still about 75-80% of what most progressives wanted with a triggered public option bumping that figure up to 90% if it's soon triggered. And most importantly, more Americans will get better and more affordable health care out of this deal. That's really what matters most.

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