For a Republican, Olympia Snowe seems to have a real disdain for states' rights when it comes to health care reform. At every turn she has been trying to take power away from the states and give it to the federal government. She has been one of the biggest supporters of the “national plans” strongly favored by the health insurance lobby. This would allow insurance companies to sell "national plans" in any state, and these plans would be exempt by federal law from needing to meet state regulations about coverage. Effectively, Snowe wants to completely gut the health insurance consumer protections put in to place by the state legislatures.
Snowe voted against Cantwell's amendment which would allow states to create a “basic health plan” for people making between 133%-200% of FPL, if the state wanted to. The state legislatures would need to pass a law to create a “basic health plan,” and the federal government would only let them if they could prove it would provide better or equal quality care. It would also need to save both the federal government and the new enrollees money to be approved for funding. Snowe voted against letting states experiment with a plan that would save the federal government serious money. Denying the states the right to pursue a different, cheaper strategy for helping to provide health insurance seems like an insane violation of states' rights, fiscal conservatism, and basic logic.
Snowe, shockingly, also opposes the public option opt-in and the state-based public option. This is really perplexing because Snowe claims to support the idea of a national trigger. The idea if the insurance companies don't meet some criteria it would then cause the public option to be available in that state.
For all practical purposes, a national public option with a state opt-in clause is the same as a trigger. Under both scenarios, the public option will not be available on “day one.” The only difference is who is setting the criteria for the trigger. With Snowe's trigger it is the federal government telling states when the conditions are meet to justify the addition of a public option. With the opt-in, individual state legislatures have the power to set their own “trigger” criteria. The states get to decide when and if the insurance companies have failed and the market now needs a public option. Snowe does not want the states to have that right.
Secondly, her opposition to the idea of state-based public options is a massive federal government encroachment into state matters. As Sen. Bingaman has pointed out states already have the power to set up public plans if they want to. There is nothing currently stopping states from creating a public plan today. To say your are against state-based public options must mean you want to strip existing rights from the states.
It is always shocking to me how Republicans talk a good game about states' rights, but are always trying to strip states of power at the behest of powerful lobbying groups, like the health insurance industry. I guess I should not be surprised that Empress Snowe wants to use the federal government to take power away from the states. If someone else had power, it would infringe on her absolute reign.
Showing posts with label Cantwell. Show all posts
Showing posts with label Cantwell. Show all posts
Good Day For Baucus, Bad Day For Real Reform
I'm sure Chairman Baucus, Senate Majority Leader Reid, and President Obama are all pleased that Republican senator Olympia Snowe voted for the Baucus bill in committee. Their goals have long been to pass anything they could slap the label “health care reform” on and declare victory. Sadly, Snowe's support could signal a bad day for real reform.
Snowe has long been opposed to some of the most important elements of reform. I'm not just referring to her opposition to a real public option and her support for a worthless trigger proposal.
Snowe opposes a real employer mandate, and instead favors a disastrously stupid “free rider” provision. It could have serious consequences for low-income workers.
She is against giving the exchanges the power to negotiate with private insurance companies. This is a provision that should help keep down the cost of health care. It would save individuals money and the government money. Snowe fears it is too much government involvement. John Kingsdale, who runs Massachusetts's exchange, called Snowe's insistence that the exchanges not have the power to negotiate price with insurance companies a recipe for disaster.
Just today, during the committee hearing, she reaffirmed her support for “national plans.” This would allow health insurance companies to sell national plans in any states. Individuals state would lose the power to regulate these insurance plans sold in their states. The national plans would be exempt from all minimum benefit requirements mandated by the state legislature. This has been for a long time one of the top goals of the for-profit health insurance industry.
These are only the few changes that I know Snowe requested. Other good ideas, like a minimum medical loss ratio for insurance sold on the exchange, a stronger regulator, and a better defined minimum benefits package, could also have been excluded at the request of Snowe. For Example, Cantwell's “basic health plan” amendment did not get Snowe's vote in committee. It may be left out of the merged bill because Snowe opposes it.
I fear all of these terrible ideas from Sen. Snowe will make their way into the final bill. Obama has signaled his desperation to win the support of Snowe, and seems willing to accept any idea she has regardless how bad. Snowe's vote may make it easier for the Democratic leadership to declare a political victory, but the cost of winning Snowe's support could be that health care reform is a policy failure. In which case, it is the American people who are the real losers.
Snowe has long been opposed to some of the most important elements of reform. I'm not just referring to her opposition to a real public option and her support for a worthless trigger proposal.
Snowe opposes a real employer mandate, and instead favors a disastrously stupid “free rider” provision. It could have serious consequences for low-income workers.
She is against giving the exchanges the power to negotiate with private insurance companies. This is a provision that should help keep down the cost of health care. It would save individuals money and the government money. Snowe fears it is too much government involvement. John Kingsdale, who runs Massachusetts's exchange, called Snowe's insistence that the exchanges not have the power to negotiate price with insurance companies a recipe for disaster.
Just today, during the committee hearing, she reaffirmed her support for “national plans.” This would allow health insurance companies to sell national plans in any states. Individuals state would lose the power to regulate these insurance plans sold in their states. The national plans would be exempt from all minimum benefit requirements mandated by the state legislature. This has been for a long time one of the top goals of the for-profit health insurance industry.
These are only the few changes that I know Snowe requested. Other good ideas, like a minimum medical loss ratio for insurance sold on the exchange, a stronger regulator, and a better defined minimum benefits package, could also have been excluded at the request of Snowe. For Example, Cantwell's “basic health plan” amendment did not get Snowe's vote in committee. It may be left out of the merged bill because Snowe opposes it.
I fear all of these terrible ideas from Sen. Snowe will make their way into the final bill. Obama has signaled his desperation to win the support of Snowe, and seems willing to accept any idea she has regardless how bad. Snowe's vote may make it easier for the Democratic leadership to declare a political victory, but the cost of winning Snowe's support could be that health care reform is a policy failure. In which case, it is the American people who are the real losers.
Media False Equates Cantwell's Amendment With Public Option
Last week, Think Progress wrote a piece about how the media was falsely equating Cantwell's “basic health plan” amendment with a public option. Since then, the problem continues to persist, so I think it needs to be addressed again.
Politico has repeatedly referred to her amendment as a public option alternative, “quasi state-based public option,” and “quasi public plan option.”
MSNBC has two videos up on the health section with Cantwell talking about her amendment labeled “small victory for public option” and “nearly public option passes Senate committee.'” MSNBC's first read also repeated the claim that it is as a public option.
The Hill claimed that Cantwell's amendment would “enable states to form their own public options.” In another article about Democrats trying to come up with a form of a public option it was called “optional state-based public plans.”
This confusion is not just limited to news organizations. The Democratic Party of Wisconsin has also claimed that Cantwell's amendment is public option.
I do not want this falsehood to continue. I don't dislike Cantwell's amendment. In fact my biggest complaint is that the amendment is far too weak. I think it should be strengthened and expanded, but that is a side issue. The important thing is that it is not a public option. It is a fact that I have repeatedly pointed out, as have others.
I know Cantwell has a responsive communications staff. I hope they contact these news organizations and ask them to stop falsely claiming that Cantwell's “basic health plan” is some type or form of a public option. It would be unfortunate if the progressive grassroots were forced to attack a decent idea because some political operatives tried to use it as an excuse for not including a real public option as part of health care reform. If the same media sources continue to equate Cantwell's amendment with a public option, I will be forced to continue speculating that Cantwell (or some members of the Democratic leadership) wants this falsehood to persist.
I honestly do hope that we can debate Cantwell's "basic health plan" idea on its own merits, completely separate from the issue of a public option. I would like to see how a much improved version could make it into the final bill.
Did Obama Ask Sen. Cantwell To Mislead You?
Since last Thursday when Sen. Cantwell started calling her “basic health plan” proposal a “public plan,” I have been very troubled. Unfortunately, several media outlets have uncritically repeated her claim that it is a public option.
I don't dislike Cantwell's basic health amendment. In fact, I think it has some merit even if it is far too limited. It allows states to use the power of a large purchasing pool to negotiate better prices from private insurance companies. It could help some low income Americans get private health insurance at a better price, but it is in no way a public option. People would still be insured by private insurance companies. Most writers who focus on health care policy agree that it is not a public option (1,2,3).
Given that the issue of a public plan has become a political flash point, it seemed very strange to me that Cantwell would call her proposal a “public plan.” Calling her “basic health plan” proposal a “public plan” should hurt its chances of becoming law. Conservatives will attack it for being a public plan, and progressives will attack it for being woefully insufficient as a public plan.
Now, thanks to a Chicago Tribune article about Obama lobbying conservative Democrats on the issue of a public option, I think I have an explanation:
When Obama spoke by phone recently with Sen. Maria Cantwell, D-Wash., he made a point of the breadth of support for the public option, the senator said in an interview. Cantwell authored a proposal to let states set up public plans that Democrats added to the Senate Finance Committee bill on Wednesday.
This is very strange. Obama does not need to tell Cantwell that Americans want a public option. Cantwell strongly supports a public option. She voted for both public option amendments in the Senate Finance Committee hearing.
I think the purpose of the call was to ask Cantwell to try to mislead American into thinking her “basic health plan” is a public option. The evidence is that Obama does not plan to fight for a real public option, but only wants some fig leaf so he can tell the base that there is a public option. It sounds like Obama wants to try to use Cantwell's proposal as the newest fig leaf.
Expect to see administration officials soon falsely claim that Cantwell's proposal is a public option. It is the kind of fake “compromise” the health insurance industry is unlikely to really fight. It is not a public health insurance alternative to the private insurance companies. It is only a mechanism to get a better price from private insurance companies. Cantwell's amendment, without a public option, still means the private health insurance companies will get millions of new consumers without competition from a public entity. The idea is completely unacceptable as an alternative to offering people the choice of a real public option.
I strongly hope Sen. Cantwell will stop calling her proposal a public plan. The American people deserve a serious debate about the public option. Actively trying to muddle a honest policy debate is unacceptable regardless of political affiliation. Don't let a decent idea be used as a way to trick the American people.
Cantwell Vs. Baucus, Battle of The Exchanges
As I get more information about Cantwell's “basic health plan” amendment the more I like it. (The modified amendment is available here.) I really wish Cantwell would stop calling it a public option. It is not a public option. I think it is an idea which should be debated on its own merits and not get drawn into the battle for a real public option.
As I have said before, what Cantwell's amendment would do is allow states to create a much better exchange for those under 200% of FPL. It is an exchange with well-defined minimum benefit package with fixed co-pays, out-of-pocket limits, and deductibles. It would allow real economies of scale to affect negotiations, and mandate a minimum medical loss ratio of 85% for participating insurers. Insurers would be required to meet “specific performance measures and standards,” and their performance would be publicly reported. The basic health program must provide a choice of at least two or more similar plans.
This is closer to a Dutch-, Belgian-, Swiss-style, well-regulated, private system. You get to choose from several similar well-defined plans, knowing all of the plans provide sufficient coverage. It is like Medicare Advantage without the option of Medicare. (It would still be dramatically improved if one of those plans was a public option. Medicare Advantage plans cost noticeably more without providing better coverage.)
The main exchanges in the Baucus bill will likely be confusing, loosely regulated marketplaces with dozens of incomprehensible choices. They will lack mechanisms that might engender the best possible bargain or drive down cost. I wish that Baucus's exchanges could be more like Cantwell's “basic health plan” exchanges.
Judging from an interview Cantwell did with Ezra Klein, I don't think I'm alone.
It sounds like Cantwell also doesn't have a very high opinion of Baucus's reform plan. I think it is clear that she sees expanding her “basic health plan” as a way to slowly replace Baucus's terrible exchanges with a much better ones.
Cantwell's amendment is a good but sadly insufficient idea. It is really at best a “foothold.” It is how all the exchanges should be run, not a small subset for some people in some states. If the current Senate Finance Committee bill was passed into law, Cantwell probably hopes progressives will fight hundreds of smaller battles using her amendment to gradually marginalize Baucus's terrible exchanges. I appreciate the effort represented by Sen. Cantwell's amendment; like Wyden's state experimentation amendment it could be a tool progressives might use to fight for real reform at the state level. But I think it is far too early to begin a strategic retreat, to prepare to fight another day. Now is not the moment to accept defeat. This is a perfect time to fight, if only elected Democrats can be forced to remember what the party stands for.
As I have said before, what Cantwell's amendment would do is allow states to create a much better exchange for those under 200% of FPL. It is an exchange with well-defined minimum benefit package with fixed co-pays, out-of-pocket limits, and deductibles. It would allow real economies of scale to affect negotiations, and mandate a minimum medical loss ratio of 85% for participating insurers. Insurers would be required to meet “specific performance measures and standards,” and their performance would be publicly reported. The basic health program must provide a choice of at least two or more similar plans.
This is closer to a Dutch-, Belgian-, Swiss-style, well-regulated, private system. You get to choose from several similar well-defined plans, knowing all of the plans provide sufficient coverage. It is like Medicare Advantage without the option of Medicare. (It would still be dramatically improved if one of those plans was a public option. Medicare Advantage plans cost noticeably more without providing better coverage.)
The main exchanges in the Baucus bill will likely be confusing, loosely regulated marketplaces with dozens of incomprehensible choices. They will lack mechanisms that might engender the best possible bargain or drive down cost. I wish that Baucus's exchanges could be more like Cantwell's “basic health plan” exchanges.
Judging from an interview Cantwell did with Ezra Klein, I don't think I'm alone.
Why only go up to 200 percent of poverty? A lot of the concern right now is for people between 200 percent and 400 percent of poverty because they don’t have as much in the way of subsidies.It sounds like Cantwell also doesn't have a very high opinion of Baucus reform plan. I think it is clear that she sees expanding her “basic health plan” as a way to slowly replace Baucus's terrible exchanges with a much better ones.
Because right now, that’s where 75 percent of the uninsured population lives. They need the health insurance. You create models within our system that are efficient. I’d be willing to do more, but that’s a different question.
What about me? I make more than 200 percent of poverty. What if I want to join your plan?
That’s for another day, Ezra. This is a big mountain to climb. We’ve got to get a foothold and this is the foothold.
It sounds like Cantwell also doesn't have a very high opinion of Baucus's reform plan. I think it is clear that she sees expanding her “basic health plan” as a way to slowly replace Baucus's terrible exchanges with a much better ones.
Cantwell's amendment is a good but sadly insufficient idea. It is really at best a “foothold.” It is how all the exchanges should be run, not a small subset for some people in some states. If the current Senate Finance Committee bill was passed into law, Cantwell probably hopes progressives will fight hundreds of smaller battles using her amendment to gradually marginalize Baucus's terrible exchanges. I appreciate the effort represented by Sen. Cantwell's amendment; like Wyden's state experimentation amendment it could be a tool progressives might use to fight for real reform at the state level. But I think it is far too early to begin a strategic retreat, to prepare to fight another day. Now is not the moment to accept defeat. This is a perfect time to fight, if only elected Democrats can be forced to remember what the party stands for.
Cantwell “Basic Health Plan” Passes, 12-11
Cantwell offered her “basic health plan” amendment (described in further detail earlier). It would be a voluntary program that states would need to choose to opt in to. If states choose to create a “basic health plan,” their population between 133%-200% of the FPL would be covered through private insurers operating under the basic health program, and not through plans selected on the new exchange. During the debate, Cantwell called the idea a public plan (a point I strongly dispute). Interestingly, the amendment had not been scored by the CBO. It is expected to save money given the history of the program in Washington state, and because of how the amendment is designed.
The amendment passed 12-11. All ten Republicans, along with Democratic Senator Blanche Lincoln, voted against the amendment. All other Democrats voted in support. Chairman Baucus described it as a “great amendment.”
Committee Republicans such as Sen. Cornyn expressed serious concerns that removing such a large population from the exchange would weaken the exchange. He is worried that it could drive up prices for individuals who would still be buying coverage on the exchange. Cantwell argued that lower income Americans tend to be the least healthy individuals. She argued that removing them from the exchange would in fact reduce premiums for those still buying coverage on the exchange. There was no CBO analysis available to support either argument.
Committee Republicans such as Sen Cornyn expressed serious concerns that removing such a large population from the exchange would weaken the exchange. He is worried that it could drive up prices for individuals who would still be buying coverage on the exchange. Cantwell argued that lower income Americans tend to be the least health individuals. She argued that removing them from the exchange would in fact reduce premiums for those still buying coverage on the exchange. There was no CBO analysis available to support either argument.
The amendment passed 12-11. All ten Republicans, along with Democratic Senator Blanche Lincoln, voted against the amendment. All other Democrats voted in support. Chairman Baucus described it as a “great amendment.”
Committee Republicans such as Sen. Cornyn expressed serious concerns that removing such a large population from the exchange would weaken the exchange. He is worried that it could drive up prices for individuals who would still be buying coverage on the exchange. Cantwell argued that lower income Americans tend to be the least healthy individuals. She argued that removing them from the exchange would in fact reduce premiums for those still buying coverage on the exchange. There was no CBO analysis available to support either argument.
Committee Republicans such as Sen Cornyn expressed serious concerns that removing such a large population from the exchange would weaken the exchange. He is worried that it could drive up prices for individuals who would still be buying coverage on the exchange. Cantwell argued that lower income Americans tend to be the least health individuals. She argued that removing them from the exchange would in fact reduce premiums for those still buying coverage on the exchange. There was no CBO analysis available to support either argument.
Cantwell's “Basic Health Plan”, A Better Exchange But Not A Public Option
Cantwell's has an amendment which would have states create a “basic health plan” from individuals making less than 200% of the FPL but more than 133% (the new cut off for Medicaid eligibility). The idea is modeled after the basic health plan in Washington state which has been around for about 20 years. While a good idea, it is in no way a public option.
In essence, what Washington state does is define a basic health plan--it sets the deductible, out of pocket limit, co-pays, drug cost sharing, and defines exactly what must be covered. Private insures bid to be able to offer basically this exact same plan. A few private insurers are qualified; there are small differences in the basic health plan depending on the insurer the individual selects. Premiums are subsidized by the state to make the plans affordable.
This is not a public option. It is not a health insurance company run by, managed by, or directly overseen by Congress. What Cantwell's “basic health plan” is is simply a better way to run an exchange. This is closer to how more market-heavy universal health insurance systems are run in other countries (Switzerland, Netherlands, Beligium). The government defines the basic health care plan which must be covered, and companies mainly compete on price of premiums and provider network. In those systems, you can buy supplemental insurance which covers what is not covered by the government-defined minimum benefits package. The idea is also similar to Medicare Advantage without the choice of Medicare.
This is a much better way of running an exchange, in contrast to vague categories of what must be covered and policies sold at different actuarial levels. (The current framework of the exchanges in the Baucus bill is just asking for confusion, bureaucratic red tape, and abuse.) However, it is still just a better exchange, and would still greatly benefit from having a public option as one of the qualified insurance providers.
I see two problems with Cantwell's amendment. The first is that the basic plan is restricted to only those people making between 133%-200% of the FPL. It should be open to everyone or the whole exchange should be run this way. This would depopulate the original state-based exchanges, reducing the market power and increasing the price for individuals making above 200% of FPL. It makes some people better off, but others considerably worse off.
The other problem is that Cantwell is trying to sell her idea as a public option--and it is not a public option . It is still not a bad idea--it would be an improvement over Baucus's plan for people making below 200% of FPL (not hard to do)--but it is not a public plan.
My message to Cantwell is simple: Don't hand progressives a daffodil and try to call it a rose. It discredits you and it discredits a reasonable idea.
In essence, what Washington state does is define a basic health plan--it sets the deductible, out of pocket limit, co-pays, drug cost sharing, and defines exactly what must be covered. Private insures bid to be able to offer basically this exact same plan. A few private insurers are qualified; there are small differences in the basic health plan depending on the insurer the individual selects. Premiums are subsidized by the state to make the plans affordable.
This is not a public option. It is not a health insurance company run by, managed by, or directly overseen by Congress. What Cantwell's “basic health plan” is is simply a better way to run an exchange. This is closer to how more market-heavy universal health insurance systems are run in other countries (Switzerland, Netherlands, Beligium). The government defines the basic health care plan which must be covered, and companies mainly compete on price of premiums and provider network. In those systems, you can buy supplemental insurance which covers what is not covered by the government-defined minimum benefits package. The idea is also similar to Medicare Advantage without the choice of Medicare.
This is a much better way of running an exchange, in contrast to vague categories of what must be covered and policies sold at different actuarial levels. (The current framework of the exchanges in the Baucus bill is just asking for confusion, bureaucratic red tape, and abuse.) However, it is still just a better exchange, and would still greatly benefit from having a public option as one of the qualified insurance providers.
I see two problems with Cantwell's amendment. The first is that the basic plan is restricted to only those people making between 133%-200% of the FPL. It should be open to everyone or the whole exchange should be run this way. This would depopulate the original state-based exchanges, reducing the market power and increasing the price for individuals making above 200% of FPL. It makes some people better off, but others considerably worse off.
The other problem is that Cantwell is trying to sell her idea as a public option--and it is not a public option . It is still not a bad idea--it would be an improvement over Baucus's plan for people making below 200% of FPL (not hard to do)--but it is not a public plan.
My message to Cantwell is simple: Don't hand progressives a daffodil and try to call it a rose. It discredits you and it discredits a reasonable idea.
Amendments To Watch For Tuesday And Beyond
When the Senate Finance Committee starts work again on Tuesday things should get heated. Here are some of the more interesting amendments to watch out for.
Free Choice Amendment – Wyden C1
What it hopes to do: It would allow employee's who do not like their current employer provided health insurance to ask for a voucher to buy insurance for themselves on the new exchange.
Background:
Wyden's Free Choice Amendments is very important to the Senator. He has gone so far as to say that it is “a prerequisite to supporting the bill.” The CBO concluded it would have very little effect on overall health insurance and only save $1 billion. Wyden has been selling his amendments to conservatives as a way to increase choice and to liberals as a way to give more people access to the public option. This amendment is a wild card with the possibility of some bipartisan support. The amendment is opposed by the Chamber of Commerce.
What to look for:
Watch to see if any Republicans (especially Snowe) decide to back Wyden's free choice amendment. Also check out how Baucus and Conrad vote. The amendment may upset the delicate balance of back room deals and compromises Baucus has tried to achieve.
Applying Regulation To Large Group and Self-Insured Market – Rockefeller C1
What it hopes to do: It would apply all new insurance regulations to self-insured and large group market
Background:
The bill as currently written would exclude insurance provide by large employers from most of the new consumer protection regulations. While big business (i.e. the Chamber of Commerce) is opposed to the amendment it should be very politically difficult vote for any Democrats to vote against it. No one wants to be on record voting against protecting everyone from some of the worst insurance practices
What to look for:
Watch to see if any Democrat besides maybe Baucus votes against the amendment. Also important is to see how Snowe votes. If she supports the amendment it should make it into the final bill.
Various Public Option Amendments - Schumer, Cantwell, Rockefeller
What it hopes to do: Add a public option to Baucus' bill.
Background:
Senators Rockefeller and Schumer have been the most vocal supporters of the public option on the Senate Finance Committee. Rockefeller is likely to introduce a robust public option tied to Medicare, while Schumer plans to introduce a “level paying field” public option which must negotiate it's rates independent from Medicare. Schumer and Rockefeller have been working closely on the issue and have not yet decided on the best political strategy. They may choose to only introduce Schumer's weaker public option in an attempt to show the idea of a public option has strong support. They might also introduce two public option amendments hoping to give conservative Democrats cover of voting against the robust public option but supporting the weaker “compromise.”
What to look for:
First watch to see how many public option amendments are debated. Pay close attention to the CBO scores each public option gets. Baucus's use of the second lowest cost plan as the benchmark for determining tax credits may prevent the CBO from scoring the public option as saving money. Finally, pay attention to how conservative Democrats (Baucus, Carper, Lincoln, Conrad, Nelson) vote on Schumer's “level playing field” public option.
“Safety Net” Trigger Amendment – Snowe C1
What it hopes to do: It would trigger a weak state base public option if a low standard of affordablity is not met in any state at some time in the future.
Background:
The new message from prominent Democrats seems to be that what ever Sen. Snowe wants is a great idea. Despite being a worthless fig leaf Peter Orszag, Harry Reid, and Bill Clinton have all talked positively about it. The idea of a trigger is opposed by all the other Republicans on the committee along with many liberals who think it is worthless.
What to look for:
It is possible liberals could join with Republicans to kill Snowe's trigger. Pay attention to how the more progressives Democrats like Schumer, Rockefeller, Stabenow, and Cantwell vote. If they vote for the amendment it is probably because they got pressure to do so from leadership. Also pay attention to how Baucus votes. A trigger will likely insure that the final bill won't get more than 1-3 Republican votes in the Senate. If he supports the trigger amendment it is a clear sign he has fully given up on any hope of broad bipartisan support.
If Snowe's trigger amendment is not brought for a vote in committee it might be a sign that enough liberals on the committee have threatened to vote against it. If it failed in committee it would be more politically difficult for Reid to insert the idea when he combines the two committee bills.
Eliminating The CO-OPS - Rockefeller C11
What it hopes to do: Remove co-ops from the bill
Background:
Conrad created the idea of the non-profit co-ops instead of a public option in an attempt to find broad compromise. The idea failed miserably. Liberals Democrats and conservative Republicans both attacked the idea. The idea seems to be losing support with even Conrad admitting they should be stronger.
What to look for:
Watch to see which progressive members of the committee vote against the co-op idea. The votes of Republicans Snowe, Grassley, and Enzi should be interesting. All three were part of the Gang of Six that negotiated the co-ops idea. With Grassley and Enzi unlikely to support the bill, it is interesting to see if they will vote against the co-ops idea they helped create.
Free Choice Amendment – Wyden C1
What it hopes to do: It would allow employee's who do not like their current employer provided health insurance to ask for a voucher to buy insurance for themselves on the new exchange.
Background:
Wyden's Free Choice Amendments is very important to the Senator. He has gone so far as to say that it is “a prerequisite to supporting the bill.” The CBO concluded it would have very little effect on overall health insurance and only save $1 billion. Wyden has been selling his amendments to conservatives as a way to increase choice and to liberals as a way to give more people access to the public option. This amendment is a wild card with the possibility of some bipartisan support. The amendment is opposed by the Chamber of Commerce.
What to look for:
Watch to see if any Republicans (especially Snowe) decide to back Wyden's free choice amendment. Also check out how Baucus and Conrad vote. The amendment may upset the delicate balance of back room deals and compromises Baucus has tried to achieve.
Applying Regulation To Large Group and Self-Insured Market – Rockefeller C1
What it hopes to do: It would apply all new insurance regulations to self-insured and large group market
Background:
The bill as currently written would exclude insurance provide by large employers from most of the new consumer protection regulations. While big business (i.e. the Chamber of Commerce) is opposed to the amendment it should be very politically difficult vote for any Democrats to vote against it. No one wants to be on record voting against protecting everyone from some of the worst insurance practices
What to look for:
Watch to see if any Democrat besides maybe Baucus votes against the amendment. Also important is to see how Snowe votes. If she supports the amendment it should make it into the final bill.
Various Public Option Amendments - Schumer, Cantwell, Rockefeller
What it hopes to do: Add a public option to Baucus' bill.
Background:
Senators Rockefeller and Schumer have been the most vocal supporters of the public option on the Senate Finance Committee. Rockefeller is likely to introduce a robust public option tied to Medicare, while Schumer plans to introduce a “level paying field” public option which must negotiate it's rates independent from Medicare. Schumer and Rockefeller have been working closely on the issue and have not yet decided on the best political strategy. They may choose to only introduce Schumer's weaker public option in an attempt to show the idea of a public option has strong support. They might also introduce two public option amendments hoping to give conservative Democrats cover of voting against the robust public option but supporting the weaker “compromise.”
What to look for:
First watch to see how many public option amendments are debated. Pay close attention to the CBO scores each public option gets. Baucus's use of the second lowest cost plan as the benchmark for determining tax credits may prevent the CBO from scoring the public option as saving money. Finally, pay attention to how conservative Democrats (Baucus, Carper, Lincoln, Conrad, Nelson) vote on Schumer's “level playing field” public option.
“Safety Net” Trigger Amendment – Snowe C1
What it hopes to do: It would trigger a weak state base public option if a low standard of affordablity is not met in any state at some time in the future.
Background:
The new message from prominent Democrats seems to be that what ever Sen. Snowe wants is a great idea. Despite being a worthless fig leaf Peter Orszag, Harry Reid, and Bill Clinton have all talked positively about it. The idea of a trigger is opposed by all the other Republicans on the committee along with many liberals who think it is worthless.
What to look for:
It is possible liberals could join with Republicans to kill Snowe's trigger. Pay attention to how the more progressives Democrats like Schumer, Rockefeller, Stabenow, and Cantwell vote. If they vote for the amendment it is probably because they got pressure to do so from leadership. Also pay attention to how Baucus votes. A trigger will likely insure that the final bill won't get more than 1-3 Republican votes in the Senate. If he supports the trigger amendment it is a clear sign he has fully given up on any hope of broad bipartisan support.
If Snowe's trigger amendment is not brought for a vote in committee it might be a sign that enough liberals on the committee have threatened to vote against it. If it failed in committee it would be more politically difficult for Reid to insert the idea when he combines the two committee bills.
Eliminating The CO-OPS - Rockefeller C11
What it hopes to do: Remove co-ops from the bill
Background:
Conrad created the idea of the non-profit co-ops instead of a public option in an attempt to find broad compromise. The idea failed miserably. Liberals Democrats and conservative Republicans both attacked the idea. The idea seems to be losing support with even Conrad admitting they should be stronger.
What to look for:
Watch to see which progressive members of the committee vote against the co-op idea. The votes of Republicans Snowe, Grassley, and Enzi should be interesting. All three were part of the Gang of Six that negotiated the co-ops idea. With Grassley and Enzi unlikely to support the bill, it is interesting to see if they will vote against the co-ops idea they helped create.
Three Public Options Amendments Submitted For Baucus' Bill
A total of three different public options have been offered as amendments to Baucus' bill. The three public option run the gambit from the robust to the weak.
The best and most robust public option is the one submitted by Senator Rockefeller. It resembles the robust public option originally proposed in the House. It would pay Medicare rates plus 5% for the first three years. Medicare providers would automatically participate in the public option unless they choose to opt out. There is no penalty for providers opting out of Rockefeller's public option.
The second public option is the one submitted by Senator Schumer and Senator Cantwell. It would add to the Senate Finance Committee's bill the same public option that passed in Senate HELP Committee. The public option in the Senate HELP Committee's bill is called the “Community Health Insurance Option.” This public option does not pay modified Medicare rates but its rates “shall not be higher than the average of all Gateway reimbursement rates.”
The final and weakest public option amendment was also submitted by Schumer. It would be his national “level playing field” public option. The government would only provide start up funds to help create a new public option that must follow all the same rules as private insurance companies. Like any private insurance company it would need to negotiate rates and create it's own provider network from scratch.
The best and most robust public option is the one submitted by Senator Rockefeller. It resembles the robust public option originally proposed in the House. It would pay Medicare rates plus 5% for the first three years. Medicare providers would automatically participate in the public option unless they choose to opt out. There is no penalty for providers opting out of Rockefeller's public option.
The second public option is the one submitted by Senator Schumer and Senator Cantwell. It would add to the Senate Finance Committee's bill the same public option that passed in Senate HELP Committee. The public option in the Senate HELP Committee's bill is called the “Community Health Insurance Option.” This public option does not pay modified Medicare rates but its rates “shall not be higher than the average of all Gateway reimbursement rates.”
The final and weakest public option amendment was also submitted by Schumer. It would be his national “level playing field” public option. The government would only provide start up funds to help create a new public option that must follow all the same rules as private insurance companies. Like any private insurance company it would need to negotiate rates and create it's own provider network from scratch.
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