For starters, the Medicaid expansion has completely been dropped, even though it would have been a big money saver for the government:
This afternoon, Jay Rockefeller said that the new proposal to expand Medicaid coverage for those who are 133% to 150% above the federal poverty line was dropped during a meeting of key legislators this morning. “I was sad this morning,” Rockefeller told me and a few other reporters. “We walked in, and it was 133[%] to 140[%], then it’s staying at 133... So we didn’t get anything.”
Now we are getting reports that the Medicare buy-in is not really a buy-in. . . or really Medicare. Senators are looking at restricting the Medicare buy-in so completely that it will be an option for almost no one. It will likely only be for a very tiny segment of poor and very unhealthy 55-64 year-olds:
Negotiators are considering limiting consumers to those who would qualify for high-risk insurance pools already set up under the Senate's health care legislation. This would mean primarily those who have been uninsured for a certain amount of time, have a history of poor health or are unable to get insurance because of a preexisting condition.
Adding insult to injury, the "Medicare" this tiny fraction of people could buy in to might end up not even really being Medicare:
[Kent] Conrad said that he’d propose having the Medicare buy-in be treated as “a separate pool” that could have negotiated rates, rather than those set by the existing Medicare program.
Thanks Conrad! You just radically increased the federal cost of the program, reduced the quality of coverage, and sent the premiums this small group of older Americans would need to pay through the roof.
But wait, it gets worse. This very expensive non-Medicare that almost no one could buy in to might only be a temporary stopgap for just three years if a handful of conservatives get their way:
The Medicare "buy-in" for people 55 to 64 would be available until government subsidies start flowing in 2014 to new health insurance markets designed for people who now have trouble getting and keeping affordable coverage.
This is in no way a "Medicare buy-in." As I feared, this has become—in only two days—a Medicare buy-in in name only. If the program is saddled with this massive set of restrictions detailed here, then it would, at most, help barely a few thousands Americans--that is if the program can even manage to function after being so crippled, which should be a serious concern.
Of course, negotiations are still on going, and the details are very much in flux. It is, in theory, possible that the eventual result will not be something so terrible. But the way it looks now, if this new, new “grand compromise” even resembles the current rumors, it will be a great big nothing. Everyday, it gets more and more clear that the only way to pass real health care reform is with reconciliation or the nuclear option. There simply are not 60 senators who would rather help regular Americans instead of bailing out the health insurance industry.