Debate has largely centered on developing agovernment-run insurance plan, known as the public option, and expandingMedicare, two measures strongly supported by progressives that were droppedfrom the bill last week after independent Connecticut Sen. Joseph Liebermandemanded their removal.
Republicans and conservatives have united to opposeany reform that doesn’t benefit for-profit insurance companies.
While progressives may be disappointed thatLieberman’s demands appear to be successfulat least until the Senate bill isreconciled with the House of Representatives’ bill, which includes a publicoptionhealth care expert Robert Kraig, executive director of Citizen Action ofWisconsin, says there are significant provisions in the Senate bill that willhelp Wisconsin families.
“Frankly, there is a lot in this bill that could notbe achieved absent a comprehensive health care bill that would make things betterfor a lot of people,” Kraig said.
Progressives may not be enthusiastic about thepublic-option-lacking Senate bill, but the nonpartisan research group FamiliesUSA found that the bill would extend health care coverage to an additional332,000 Wisconsinites by 2019. In contrast, an additional 86,000 people in Wisconsin would losetheir health care coverage by 2019 if health care reform is not enacted at thenational level. That is a difference of 418,000 Wisconsinites.
While the Senate’s version of the bill may bealteredand even strengthenedas the legislative process grinds on, here arethe highlights of the plan as of this writing:
- Extends coverage to 30 million people.People who do not have coverage through their employer or who cannot afford coverageon the individual health insurance market would be able to purchase insuranceon a state-based or regional health insurance exchange. In time, more peoplecould be eligible for the exchangefor example, those who work in medium-sizedbusinesses, or, ultimately, everyone, if the secretary of Health and HumanServices makes that determination.
- Includes a nonprofit insurer in the healthcare exchange. President Obama advocated for the public option to “keepinsurance companies honest” and lower costs for everyone. That provision isincluded in the House of Representatives’ bill, but was removed in the Senate.Instead, at least one nonprofit insurer would have to be included in the healthinsurance exchange. “We would rather have a public option, but it’s not a smallmatter to require a nonprofit option” along with for-profit insurance plans,Kraig said.
Kraig pointed to a Citizen Action study released onTuesday that analyzed health care costs and quality in the state. The studyfound “a strong correlation between [the] quality and [the] type of healthplan, with national for-profit insurance companies offering by far the lowestquality plans, and nonprofit provider networks offering the highest qualityplans.” That should bode well for people who purchase a nonprofit plan in theexchange.
The establishment of the insurance exchange alsomeans that the expensive and highly unregulated individual policy market wouldfade away. After all, if people who aren’t insured through their employers canpurchase affordable, quality insurance on the exchange, why settle for anexpensive policy that covers little?
- Expands Medicaid coverage to more people.Under the Senate bill, folks with incomes less than 133% of the poverty level($29,327 for a family of four) would be eligible for Medicaidabout 14 millionpeople nationwide. This includes the people who are eligible for Wisconsin’s BadgerCare,BadgerCare Plus and BadgerCare Plus Core Plan.
Kraig said Medicaid expansion is critical topreserving these state programs in the long run, which he said were “stop-gap”measures intended to last until reform was enacted nationally. “If nationalreform falls through now, then we’re going to have catastrophic effects,” Kraigsaid. “We’d like to keep [these programs], but it’s going to be very difficultto keep those benefits in the medium- and long-term given the state’s financesif Congress fails to pass health care reform.”
- Subsidizeshealth insurance policies. While some have blasted government-subsidizedpremiums as a “bailout for the insurance industry,” the inclusion of anonprofit plan in the health insurance exchange doesn’t necessarily mean thatprivate insurers will be getting fistfuls of taxpayer money. Kraig called thesubsidiesto be paid on a sliding-scale basis for those who can’t afford healthinsurance on their own but aren’t eligible for Medicaidan extremelyprogressive element of the reform bill that should help working families. Taxcredits would also be granted to small businesses and charities so they cancover their employees.
- Reformsinsurance practices. Individuals would have to purchase health insurance;the tradeoff is that insurers would have to end some if not all of theirdiscriminatory practices. Policies within the health insurance exchange wouldhave the strongest protections for consumers, Kraig said. To gain access tothese potential policyholders, insurers would not be able to discriminate basedon gender, age or pre-existing conditions; they’d also have to stop puttinglifetime limits on policies, which would end medical-bill-related bankruptcies;and end the practice called “rescission”otherwise known as canceling coveragewhen a consumer needs to make a claim. Outside of the exchange, insurers wouldhave to end most of their discriminatory practices. Insurance companies wouldalso have to spend at least 80% of their revenues on medical carenotadministration or profit.
- Abortion.Not surprisingly, some pro-life legislators made comprehensive health carereform hinge on women’s access to affordable (and legal) abortion. In theSenate’s version of the bill, people who purchase plans with federal subsidiescould opt for one that covers abortion. The hitch is that they’d have to writetwo checks: one for the policy without abortion coverage, and another for theadditional abortion coverage.
- Costand payment. According to the Congressional Budget Office, the Senate’sversion of reform would cost $871 billion over the next decade, but overallwould reduce the federal budget deficit by $132 billion over those 10 years.(The House version costs moreabout $1 trillionbut still reduces the deficitand covers 5 million more people.) The programs would be paid for by raisingtaxes on policies with high premiums; pharmaceutical companies, manufacturersof medical devices and insurance companies; those who earn more than $200,000;and indoor tanning services. About $483 billion would be cut out of Medicareand other programs.
