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Archive for December, 2009

What To Expect In The First Six Months Of Health Reform

This post is in collaboration with NPR.

As the Senate inches closer to passing its health overhaul bill, some are pointing out that many changes, including a requirement that most Americans get insurance, won’t kick in until 2014.

If health overhaul legislation passes, expect some things to shrink, and some things to expand.  But a handful of new rules and benefits kick in much earlier — six months after enactment. Here’s what you can expect sooner rather than later:

A Shrinking Medicare “Doughnut Hole”
Starting in 2010, the coverage gap for prescription drugs in seniors’ drug plans would shrink by $500 a year. Starting in July, brand-name drugs would be discounted by 50 perceny for many seniors in the coverage gap.

New Rules On Insurance Coverage
Within six months of enactment, insurers would be required to:

  • Cover preventive care and wellness benefits — which insurers wouldn’t be permitted to count toward enrollees’ deductibles. 
  • Cover children with preexisting conditions, including asthma and cancer.
  • Let young adults stay on their parents’ plans until age 26 — which is longer than the current rules in most states.

There’s one big caveat: All of the above changes only apply to new health insurance plans.

What exactly is a “new plan?” Any health insurance plan that you or your employer buys after the six months following enactment. Renewal of existing plans doesn’t count, but all plans would be subject to the new rules starting in 2014.

A New National High-Risk Pool
Currently offered in many states, these plans are meant to provide coverage for people who are uninsurable for medical reasons. Under the Senate bill, some uninsured Americans, as well as legal immigrants with preexisting conditions, would be able to buy coverage through the pools.

Limits On Limits
There’s some changes to the kinds of limits insurers can apply to your policy. “Lifetime maximum benefits” — or how much they pay out for your care as long as you’re a member — are nixed, effective six months after enactment.

At the same time, the secretary of Health and Human Services will determine acceptable annual limits on insurers’ coverage.

In addition, insurers wouldn’t be permitted to cancel, or rescind policies, unless there’s evidence of fraud or willful distortion of your medical history, effective six months after the law is enacted. But again, these requirements apply only to new plans for the first few years.

Tax Credits For Small Businesses
Some small business would be eligible for tax credits for 35 percent of their health-insurance premiums, starting in 2010. Amanda Austin, director of federal public policy at the National Federation of Independent Business, estimates the credits will apply to slightly more than 12 percent of businesses. While saying NFIB “is thankful the coverage was improved,” Austin points to a Congressional Budget Office report that found the credits won’t help reduce the overall cost of premiums for small businesses.

Information For Consumers
Finally, the Senate bill provides help to states to set up new offices for appeals and complaints against health insurers. And it calls for the creation of a new Web site that will help “facilitate informed consumer choice of insurance options.”

The most expensive — and most controversial — parts of the new law don’t start for a few years. So patients with preexisting conditions will have to wait; low-income Americans don’t get expanded Medicaid coverage just yet, and other big changes — like the doling out of billions of dollars in subsidies to people who need help buying insurance — are still to come.

Tuesday, December 22nd, 2009

Reactions To Hectic Senate Weekend

The Senate voted early this morning to file cloture, or move forward, in the final steps toward passing its health overhaul bill.  The vote was not certain when the weekend began, and only after Sen. Ben Nelson, D-Neb., announced his support did the action proceed. Reid is now saying a final vote will take place by Christmas.

Bloggers were recovering from a busy weekend, trying to make sense of the big picture as the legislation moves forward.

Wonk Room’s Igor Volsky notes, “The Senators voted from their desks — a customary practice reserved for the most significant votes. Once the presiding president read the final tally, Democrats rushed over to congratulate Majority Leader Harry Reid (D-NV).”  He posts video of the vote, below:

The Washington Post’s Ezra Klein compares the Senate’s version with President Obama’s campaign health plan.  Klein notes that the public plan was dropped and Obama didn’t initially include an individual mandate,

But whether you love the Senate bill or loathe it, whether you’re impressed by Obama’s effort or disappointed, it is very hard to argue that the bill Congress looks likely to pass is fundamentally different from the approach Obama initially advocated. “The Obama-Biden plan both builds on and improves our current insurance system,” the campaign promised, and on that, for better or for worse, they’ve delivered.

Despite Klein’s conclusion that the plan isn’t very different from Obama’s campaign promise, Heritage’s Conn Carroll says the Senate bill’s passage “is only the beginning of a much larger health care fight.”  He continues, “This bill will only make every single problem with out health care system worse: higher spending, higher deficits, and worse care. Former-Democratic National Committee Chair Howard Dean said on Meet the Press yesterday, ‘[This bill] simply sets us on a track in this country which is expensive and where we’re going to have lots more political fights.’ Dean is dead on. President Barack Obama’s signature on this health care bill settles nothing.”

Jacob Goldstein of the Wall Street Journal’s Health Blog looks at Congressional Budget Office estimates released this weekend that found certain provisions are estimated to make little difference: “During all the last-minute action this weekend, CBO put out its estimates on the latest version of the Senate bill. As it turns out, replacing the public option with private plans overseen by a government agency — a sort of “public option lite” that was a key part of the compromise — makes almost no difference to how the bill would work in the real world, according to CBO.”

Grace-Marie Turner lists 12  “constituencies that will be gored, to which senators will have to answer next time they go before the voters.”  She includes “everyone.”

Huffington Post’s Drew Westen is disappointed with Obama’s leadership, saying his actions “soured” young people to politics:

Somehow the president has managed to turn a base of new and progressive voters he himself energized like no one else could in 2008 into the likely stay-at-home voters of 2010, souring an entire generation of young people to the political process. It isn’t hard for them to see that the winners seem to be the same no matter who the voters select (Wall Street, big oil, big Pharma, the insurance industry). In fact, the president’s leadership style, combined with the Democratic Congress’s penchant for making its sausage in public and producing new and usually more tasteless recipes every day, has had a very high toll far from the left: smack in the center of the political spectrum.

The American Spectator’s Philip Klein notes that some health insurance stocks are rising this morning.

James Capretta takes a closer look at the final version and says it’s “still a budget buster.”

And from the other perspective, Health Beat Blog’s Maggie Mahar has a series of posts looking at the details, including potential affordability challenges for older Americans, Ben Nelson’s abortion compromise and the “glass half empty/glass half full” viewpoints.

Mark Trahant reports that the Indian Health Care Improvement Act is in both the Senate and House versions.

And in the wake of the coming vote, Bob Laszewski wonders, “Is there anyone left, on either side of the political spectrum, who wants the Senate health care bill to pass?”

Monday, December 21st, 2009

Stuffing Your Stockings With Videos

To celebrate the end of the week (though the Senate will keep working through the weekend!), we’re highlighting some recent multimedia  health reform battles.

MoveOn.org raised over $1 million following Sen. Joe Lieberman’s initial promise to filibuster health reform.  Then the liberal advocacy org produced this sock puppet video:

Chris Rovzar of New York Magazine’s Daily Intel writes, “they’re launching a mildly mean ad campaign. Involving unfunny sock puppets! That’ll teach him, libs. You spend that money wisely.”

A video of Sen. Al Franken denying Lieberman an extension  of time to finish a floor speech (in support of an amendment for a Medicare advisory committeee) caused Hot Air’s Allah Pundit to quip: “Lieberman says he doesn’t take it personally, but if you believe the left, his every waking moment is spent calculating revenge on his political enemies. How will he thwart Franken?”

The Heritage Foundation posts a video that includes doctors  ”talking back” to Vice President Biden on health reform:

The White House blog just posted a video of President Obama after he met with Senate leaders Tuesday, saying he thinks they are “on the verge of passing significant reform legislation.”

But Dems beware, Sen. Jim DeMint is lading a charge to have the entire bill read aloud, and turned to Twitter for more support this morning:

demint tweet

Friday, December 18th, 2009

Liberal Coalition Cracks

Several bloggers are putting in their two cents following news that some prominent liberals, including former Democratic National Committee chair Howard Dean, are calling to “kill” the Senate health bill.  Following the pronouncement, Markos Moulitsas, founder of the liberal mega-blogging community DailyKos, wants the individual mandate requirement to purchase health insurance dropped.

Later that evening, cable news host Keith Olbermann joined suit (in a post on DailyKos, coincidentally). Video below:


 

The Washington Post’s Ezra Klein responds to Kos, explaining his support for an individual mandate: “This is called an insurance death spiral. If the people who think they’re healthy now decide to wait until they need insurance to purchase it, the cost increases, which means the next healthiest group leaves, which jacks up costs again, and so forth.”

The New Republic’s Jonathan Cohn, a long-time supporter of health reform, says “The Left Is Playing With Fire.” He is particularly displeased with the new attacks on an individual mandate, writing: “there’s a fine line between being constructive and destructive. This latest gambit, I think, crosses it.”

Time’s Joe Klein gets passionate about emerging liberal opposition: “The opposition by Republicans was no surprise, nor was the chicanery of a few Democratic conservatives in the Senate, but I’m just dumbstruck by those on the left who would oppose this for whatever ideological fetishes they imagine are being traduced. It is simply amazing and absolutely disgraceful. Grow up.”  In a separate post, he says the events “calls into question the ability of the Democratic Party to govern this country.”

Nate Silver has “20 Questions for Bill Killers,” including: “1. Over the medium term, how many other opportunities will exist to provide in excess of $100 billion per year in public subsidies to poor and sick people? 3. Where is the evidence that the plan, as constructed, would substantially increase insurance industry profit margins, particularly when it is funded in part via a tax on insurers? 9. If the idea is to wait for a complete meltdown of the health care system, how likely is it that our country will respond to such a crisis in a rational fashion? How have we tended to respond to such crises in the past?”
 
Health historian Paul Starr, in a way predicting the coming fire, penned a web-only piece in the American Prospect in which he argued progressives should support the Senate’s health overhaul bill: “The moment of decision on health-care reform is arriving for progressives in Congress. Some of them have insisted they will refuse to vote for any bill without a public option, and that is now the only bill that has any chance of passing. If they hold to their position, the most significant social reform on behalf of low-income Americans in 40 years will go down to defeat.”
As the melee unfolds on the left, commentators on the right continue to be pleased with the defections.

The American Spectator’s Joseph Lawler thinks Dean’s rejection of the Senate bill as it stands is further evidence of ”alignment” between conservatives and liberals: ”It’s amazing on how many topics the administration and congressional leadership have managed to force progressives and conservatives into alignment. The Fed’s record, and to a lesser extent Afghanistan, comes to mind. The important legislative battles right now are big business Obamanomics vs. everyone else instead of right vs. left to an extent that I wouldn’t have thought possible.”

 Cato’s Michael Cannon also finds himself on a similar page with critics, and has a special request: “My question for Walker, and for Howard Dean, and for Markos Moulitsas is: will they join me in calling for the Senate to obtain a CBO cost estimate of the off-budget part of the insurance-industry bailout (i.e., the individual and employer mandates)?  Do they think Senate Majority Leader Harry Reid should at least be up front with his base about what he’s asking them to swallow?  Do they think that We, the People deserve to know the whole truth about this bill?”

Thursday, December 17th, 2009

Are Senate Democrats Out Of The Woods?

The newest issue of the conservative Weekly Standard — complete with a menancing cover – zeroes in on Senate Majority Leader Harry Reid.  The premise of Jeffrey Anderson and Andy Wickersham’s piece  is: “Voters punished Democrats for Hillarycare. (in 1994) They’ll do the same for Obamacare.” 

The New Republic’s Jonathan Cohn warns his readers, “Pssst. This isn’t over.”  Though Sen. Lieberman indicated his support for the bill after an agreement to drop the Medicare buy-in and a public option, Cohn thinks Sen. Ben Nelson, D-Neb., is the real issue:

A lot of people are treating today as the end of the debate, for better or worse, now that the Democrats have shelved the public option and Joe Lieberman appears ready to support the Senate bill. But that’s only because everybody (pro- and anti-reform) has focused too much on the public option. On Capitol Hill, operatives and staff have said all along that Nelson, not Lieberman, would be the most difficult member of the caucus to win over. And his primary focus is abortion, although he has other concerns, as well.

This morning Hot Air’s Ed Morrissey has a different angle on Nelson: “the Obama administration has targeted the last remaining Democratic holdout, at least among moderates — and they’re willing to damage national security to extort his support.  The White House has threatened Ben Nelson (D-NE) with the closure of Offutt Air Force Base in Nebraska if he opposes Reid’s latest version, despite its status as the headquarters of US Strategic Command.” 

Former Democratic National Committee Chair Howard Dean’s pronouncement on the agreement to drop the Medicare buy-in (“This is essentially the collapse of health care reform in the United States Senate. And, honestly, the best thing to do right now is kill the Senate bill and go back to the House”) got an unexpected endorsement, from Heritage’s Conn Carroll  this morning:

It has become obvious to any American following the debate that President Obama has adopted a get-a-deal-at-any-cost mentality that puts a higher priority on the political victory of passing any bill over the policy substance of what is actually in the bill and how it would effect the American people.

Finally, the Washington Post’s Ezra Klein reports: “Joe Lieberman’s successful effort to tank the public option and Medicare buy-in does not mark the end of his involvement in health-care reform, But his next major initiative is actually good: He’s partnered with Jay Rockefeller and Sheldon Whitehouse to save — and even strengthen — the Medicare Commission.”  Klein says the group of senators “are all pushing in the right direction here. Whether other senators support this amendment will say a lot about how committed they actually are to controlling costs.”

Wednesday, December 16th, 2009

Democrats Frustrated By Lieberman

LiebermanIndependent Senator Joseph Lieberman made a splash on Sunday after he announced he would not support a Medicare buy-in compromise intended to gain votes from a handful of moderate senators.  Democratic leaders have been courting Lieberman for months — but he  has not agreed to their terms.

And Democrats are angry. Huffington Post’s Sam Stein reports “More than 80 percent of Democrats say they believe Sen. Joseph Lieberman (I-Conn) should be stripped of his powerful chairmanship in the Senate if he ends up supporting a Republican filibuster of health care reform, according to a new poll.”

A frustrated Ezra Klein is definitely one of the 80 percent:

To put this in context, Lieberman was invited to participate in the process that led to the Medicare buy-in. His opposition would have killed it before liberals invested in the idea. Instead, he skipped the meetings and is forcing liberals to give up yet another compromise. Each time he does that, he increases the chances of the bill’s failure that much more. And if there’s a policy rationale here, it’s not apparent to me, or to others who’ve interviewed him. At this point, Lieberman seems primarily motivated by torturing liberals. That is to say, he seems willing to cause the deaths of hundreds of thousands of people in order to settle an old electoral score.

Andrew Sprung on Andrew Sullivan’s blog says Lieberman’s announcement means “the Gang of 10’s compromise is dead and that a bill can’t get through the Senate with either a public option or Medicare expansion. Unless Lieberman makes one more grandstanding reversal. Or all of Barack Obama’s courting of [Maine Sen. Olympia] Snowe pays off somehow.  Or Susan Collins has an epiphany. Or someone resigns abruptly and Santa is appointed to the Senate.”

The New Republic’s Jonathan Cohn picks out another reason Lieberman may oppose the compromise: “Lieberman isn’t waiting for CBO or anybody else to weigh in. He says he’s worried that the Medicare buy-in would be the first step towards a single-payer system–and that it would bust the budget. (At least, that’s his latest argument. As Steve Benen has noted, it’s changed a few times.) Ergo, it doesn’t have his support.

But Hot Air’s Ed Morrissey thinks Dems have been naive:

Why did this surprise anyone?  Last Wednesday, Lieberman warned that he couldn’t support a Medicare expansion.  A week ago, he appeared with Susan Collins for both of them to publicly oppose a government-run insurance option, reiterating the same position that he had publicly declared two days before Thanksgiving.

How can this be a “total flip-flop”?  It sounds as if Lieberman’s colleagues have wax stuck in their ears.

The American Spectator’s Philip Klein notes things have just gotten tougher for Majority Leader Reid: ”Either Reid will have to pull a new compromise out of his hat like magic or get liberals to accept all of Nelson and Lieberman’s demands, or this thing is going to spill over into next year, and the whole effort may collapse altogether. But before you get too excited, just remember that the media was declaring health care legislation ‘inevitable’ last Tuesday, so we shouldn’t assume it’s doomed today. The story keeps changing.”

Monday, December 14th, 2009

Dread and Facebook Games

 Online controversy errupted this week after The Business Insider reported that a coalition of health insurers called “Get Health Reform Right” were offering freebies on Facebook in return for users sending a letter to Congress opposing the health overhaul bills.  The offer automatically sent a message expressing “concern” after completing a survey, in order to receive virtual currency for various Facebook games.

Elsewhere, other news has The New Republic’s Jonathan Cohn shuddering.  The reason? “[O]n three separate occasions this week I heard two words I hadn’t heard before [about when a health reform bill will be finished]: ’Valentine’s Day.’  For what it’s worth, I don’t think it will take that long, for reasons I’ll soon explain. But I thought I’d share that information anyway.” Health care and politics reporters may all shudder now…

Austin Frakt takes issue with former Labor Secretary Robert Reich’s claim that health insurers are consolidated, so they have little incentive to be more efficient.  Frakt argues: “Though it is true that insurers with higher market power can charge higher premiums, they also obtain lower prices from providers. The optimal balance of power that results in the lowest premiums is not one in which insurers are weakest. In fact, insurers need a certain level of market power just to offset that of providers.”

The New York Times’ Room for Debate takes on a Medicare expansion to those ages 55-64.  The editors recruited health policy power hitters from all sides of the spectrum, including Stuart Butler, Jonathan Oberlander and David Himmelstein.

But Bob Laszewski is declaring the buy-in deal “dead,” and thinks it spells trouble for the Democratic coalition: “So it is no longer the moderate Dems who are the swing votes. It is all of those liberals in the Senate and House who said they would not vote for a health bill that did not have a public option. True, the latest version in the Reid and Pelosi bill was nothing more than the neutered variety but at least the liberals had some political cover. Now they will have none.”

Time’s Amy Sullivan reports that the Catholic bishops conference is still promising to oppose health reform if the controversial Stupak amendment is dropped from the final legislation.

Finally, The Heritage Foundation has spent time lately objecting to the individual mandate, and posts a video today of Utah Sen. Orrin Hatch speaking at their building on the issue:

Friday, December 11th, 2009

Unanswerable Questions

Many blog eyes are focused on where the action is – the Senate.

The Washington Post’s Ezra Klein gives a preview of ”worth-taking-seriously” bipartisan amendments to be offered today by Republican Susan Collins and Democrat Ron Wyden. Klein says the proposed changes are substantive, adding, “If the Senate would turn the bulk of its attention to debating what types of plans should be in the exchanges and how they should be chosen, the debate would be somewhat less interesting, but the eventual bill might be a lot better. Collins and Wyden are taking a stab a doing that, and they deserve plaudits for it.” 

Those amendments are sure to add more pages to the bill.  The 2,000+ page length has been a big complaint from right-leaning commentators since the start. But Capital Gains and Games’ Stan Collender says the length isn’t because of the bill itself — it’s the way law is written, which is far from conversational:

If you’re having trouble getting your mind around this concept, think of it as the difference between the formal way you were taught to speak in school when you were learing a foreign language and how you’re more likely to say the same thing now. In other words, instead of saying:

“Good morning.  I hope you slept well.  What are your plans for the rest of the day?”

You probably say something like:

“What’s up?”

In other words, unless you want to speak like you first Spanish or French teacher, you absolutely need to resist the urge to criticize health care reform because of the number of pages in the draft legislation.

James Capretta disagrees and says health bills are so long ”because the authors start from the premise that the federal government has the capacity to centrally plan one-sixth of the American economy from Washington, D.C. That’s the main reason the bill contains scores of new agencies, mountains of regulations, and pages and pages of taxes, mandates, and fees.”

Elsewhere, Worker’s Comp Insider hosts Health Wonk Review, your biweekly compendium of  health policy blogging.

Dana Goldman on the New York Times’ Economix says “Everyone from Michael Moore to Sarah Palin agrees that limiting access to any beneficial care, no matter how cost-ineffective, is unequivocally immoral.” He adds, In the absence of such fundamental reforms, there are worthwhile (albeit smaller) steps we can take to encourage greater consciousness of health care costs. And these steps do not require government panels making health care decisions,” and then offers fixes — including fast-tracking some FDA approvals, legal reform and removing the tax exclusion for health insurance.  Goldman offers fixes to get around the idea of “death panels” — fast-tracking some FDA approvals, legal reform and removing the tax exclusion for health insurance.

And Cato’s Tad DeHaven looks at more reports of Medicare fraud in Miami-Dade county and notes that “the defrauding isn’t sophisticated – it’s just good ole fashioned bribery.”  Apparently the defrauders bribed doctors and others with cash to write false prescriptions and referrals.

Thursday, December 10th, 2009

About That Compromise…

Senate Majority Leader Harry Reid announced a cryptic compromise last night — providing just enough detail to send the blogosphere scrambling to eek out the rest.

Today they’ve unfolded this much — there will be some sort of option for those 55-65 to buy into Medicare, coupled with new national nonprofit plans and a “triggered” public option. The problem? No one seems very happy.

TPMDC’s Brian Beutler reports: “The picture, therefore, is decidedly mixed. Which means, after all this effort, 60 votes remains uncertain. That’s probably why Reid sent an array of options to CBO, and why nobody will know the nittiest, grittiest details of the compromise until it’s unveiled.”  Beutler also rounds up Senators’ comments thus far.

There’s still a ton to figure out – The New Republic’s Jonathan Cohn made a list of 10 wonky policy questions, including who exactly will be allowed into Medicare (all workers? only uninsurable?) and what kind of plan would appear, should it be triggered?

Bob Laszewski thinks Democrats have latched onto Republican ideas in terms of the national nonprofit plan — and he says it will fail: ”an out-of-state health plan by definition isn’t going to have a local provider network and will have health care costs that are a lot more expensive than a local plan that does have discounts and managed care protocols negotiated with providers. Well, at least neither side–Democrats or Republicans–have the upper hand on this issue.”

And economist Austin Frakt sees flaws in the proposal to open Medicare to more people: “That is, Medicare for the 55-64 age range will probably only be available to those who meet certain tests of neediness, which is closer to the way it operates for disabled individuals than for the elderly. In effect, Medicare will likely be a dumping ground for bad risks, risks that the insurance industry is happy to transfer to the federal government. This version of Medicare for more will not lead to Medicare for all, it may only lead to Medicare for all bad risks. That’s also why it may pass.”

Heritage’s Conn Carroll thinks the deal “reveals how desperate Reid is” and thinks the process continues to violate Obama’s promises: “When President Barack Obama gave one of his first national health care addresses in June, he instructed Congress: ‘As we move forward on health care reform, it is not sufficient for us simply to add more people to Medicare or Medicaid.’ But after months of debate in Congress, that is all Obamacare has turned out to be.”

And Cato’s Michael Tanner says “No wonder Senator Reid wants to keep it a secret,” and gives “afew reasons to believe this is yet another truly bad idea.”

Wednesday, December 9th, 2009

Beyond the Senate Debate

Bloggers are mostly immune to the specific’s of today’s Senate debate, instead plugging away at topics of their choice, including a proposed Medicare commission, right-leaning ideas for health reform and a new CBO report.

The Washington Post’s Ezra Klein is concerned that that recent changes have “seriously weakened” the proposed new  independent Medicare commission.  ”The big problem is that the commission is now barred from submitting reform proposals when Medicare’s five-year spending growth average is lower than the health-care system’s more generally. But Medicare’s five-year average is almost always lower than the health-care system’s. Medicare is better at containing costs. But better, in this case, is not good enough.”  Klein credits The Concord Coalition’s Joshua Gordon.

John Goodman responds to criticism of right-leaning health policy ideas, noting, “there is probably no other public policy area on which there is so much diversity of right-of-center opinion than there is right now on health policy.” (emphasis his)  He lists 12 different right-leaning proposals, saying the main area of agreement is Health Savings Accounts.

Louise Norris was “struck by the negativity” of the Chamber of Commerce’s proposal: “It seems that they have devoted so much time and energy to criticizing the proposed reforms that they forgot to focus on solutions of their own.  It makes me wonder if they’re seeing the same problems as the rest of us:  problems like 62% of bankruptcies being attributed to medical debt, and the tens of millions of Americans who have no health insurance at all.”

Also in the news is a Congressional Budget Office report on “promotional spending” of pharmaceutical companies that found they spent about $20.5 billion in 2008.  Director Douglas Elmendorf says, “To place those figures in context, in 2008, promotional expenditures equaled 10.8 percent of the U.S. sales reported by the Pharmaceutical Research and Manufacturers of America, in line with most years since the early 1990s, during which time that share has remained between 10 percent and 12 percent.”

Thursday, December 3rd, 2009