Finally, a clear reason to support Congressional health care reform:
LIMBAUGH: ...I'll just tell you this, if this passes and it's five years from now and all that stuff gets implemented - I am leaving the country. I'll go to Costa Rica.
Good news on the health reform front, where the President announced on Super Bowl Sunday that he plans an open meeting at the White House with Congressional leaders from both parties and cameras from C-SPAN for a conversation about improving and passing the health care bill.
If they want to take a pass on being able to provide input, let them pass. Hold the summit, ask for their ideas, let the President outmatch them once again, and pass the Senate bill and a corrective bill through both chambers, on party lines if need be.
Fresh in my inbox is a statement from Jon Tester following his vote in favor of creating a deficit reduction commission:
"For a decade, both parties have swept America's debt problem under the carpet. And like most Montanans, I'm fed up with the mess.
"The only way to get our fiscal house in order is to put politics aside and work together to create good-paying jobs, making Wall Street work for Main Street."
"That's why I crossed party lines to vote against the bailouts of Wall Street and the U.S. auto industry. And that's why I voted today to create a bipartisan panel to recommend spending cuts."
I know Jon well enough to know that this stuff is heartfelt from him. He really isn't a fan of the massive deficit we've racked up. And I don't even really have a problem with this commission, except that I don't really see how it works.
The basic idea is that most of the real solutions for dealing with the deficit -- bending the health care curve, raising taxes, or seriously rethinking the defense budget -- are politically difficult votes. That's why a health care bill that does two of those three is currently stuck in Congress with some small chance left to pass. On the third issue -- the defense budget -- it means actually building some sort of willingness to stand up to military contractors, their significant lobbies, and the "weak on security" storylines that they and their Congressional lackeys will spin if you seriously evaluate their spending.
How does any of this get easier with a bipartisan commission whose recommendations require a super-duper-pooper majority? It doesn't.
Reality is that fixing America's fiscal outlook isn't at this point a policy problem. We have a bill in Congress that will seriously reduce the long-term deficit. We can write additional bills tomorrow to do the same. The problem is that Judd Gregg, for all his hemming and hawing about budget deficits won't do anything about it. The problem is that Evan Bayh and Blanche Lincoln crow about deficits but continue to vote for massive tax cuts that will worsen the long-term deficit picture (Jon has cast some of these votes, as well).
Governing is occasionally about making hard choices. Those hard choices are compounded by a press corps whose understanding of the federal budget often seems downright abysmal. But there's no reason to believe that a blue ribbon panel will convince a single GOP member of Congress to vote for a tax cut or meaningful health care cost controls or the kinds of defense cuts that don't really threaten national security.
For now, anyone seriously interested in long-term deficit reduction should be acting to get the health care bill moving again. If that means reaching across the rotunda and pledging to work with House members on sidecar provisions to move through budget reconciliation or publicly or privately stepping up pressure to get something passed, that's what it will take to get this deficit reduced.
Virtually everything else is basically a game of kick the can.
Ezra Klein comments on a legislative compromise with unions over the excise tax, defending the compromises to appease opponents of the tax.
But here's the paragraph I want to talk about:
But if you think that the administration will simply give up on the excise tax -- which does them virtually no good in the first 10 years anyway -- why is it in there at all? It's unpopular with their allies and wins them no friends among their enemies. Indeed, it's easy to see why so few presidents attempt cost control: You get hammered by the people who usually like you and dismissed by the people who usually like cost controls but don't fundamentally trust you. That leaves you with, well, virtually no one.
First, the excise tax has nothing to do with cost control. It will not cut costs. Causing consumers to ditch good insurance plans will have two effects: One, they will pay more out-of-pocket for health care. Two, they will avoid seeking medical care when possible and in the long run, as a direct result, will consume more health care and more expensive health care than otherwise.
Second...it does beg the question, why is the administration so devoted to the excise tax?
Maybe they do believe, like Ezra, who's apparently here internalized private insurers' profiteering logic, that it will control costs. (Although, from experience, we know it doesn't.) More likely, IMHO, they need a funding mechanism for the bill they're passing, and are justifying it as a cost-control measure. And it's aimed at unions because they're easier to disappoint than deep-pocketed private insurers.
"As I look back it was a waste of time dealing with [Snowe]," [Sen. Harry] Reid is quoted as saying about the White House in a forthcoming New York Times Magazine piece, "because she had no intention of ever working anything out."
You know, Reid sounds genuinely surprised by this. I mean...he's been in the Senate, hasn't he noticed the record-setting filibuster pace the Republicans have set? Doesn't he understand the GOP would rather savage the country by blocking crucial legislation than stay out of power?
There was a lot of talk this election of ending the partisan rancor in Washington. People dug it. Obama ran a campaign on it. Only thing is, the GOP realized by upping partisanship a notch, they won't be the ones who catch h*ll.
The answer is, and always was, to go progressive and steamroll the GOP into obsolescence.
I read Bob Herbert's column in the NYTimes this morning and thought to myself that it made an excellent opportunity to talk about taxing "Cadillac" health insurance benefits, something I've written in opposition already. But as soon as I poked around the 'Tubes a little, I saw the column had already received plenty of attention. Glenn Greenwald, for example, cites the column as proof there are real reasons to oppose the bill.
Still, in the commentary I've read about the bill, I think most miss the central, and seriously flawed, premise of the tax, something that Herbert only touches on.
Herbert's against the tax because, as health care costs continue to rise (especially without any discernible cost controls present in the health care legislation), more and more health care policies will become taxable:
The tax would kick in on plans exceeding $23,000 annually for family coverage and $8,500 for individuals, starting in 2013. In the first year it would affect relatively few people in the middle class. But because of the steadily rising costs of health care in the U.S., more and more plans would reach the taxation threshold each year.
Within three years of its implementation, according to the Congressional Budget Office, the tax would apply to nearly 20 percent of all workers with employer-provided health coverage in the country, affecting some 31 million people. Within six years, according to Congress's Joint Committee on Taxation, the tax would reach a fifth of all households earning between $50,000 and $75,000 annually. Those families can hardly be considered very wealthy.
But, as Herbert notes, and as we say in the software biz, that's not bug, it's a feature.
The Senate assessment on high-cost insurance plans has much to recommend it, which is why it is almost universally favored by health policy experts. It would reduce the incentives for employers to provide excessively generous insurance, leading to more cost-conscious use of health care and, ultimately, lower spending. In other words, it "bends the curve."
I've been swamped with polling closures and some administrative/fundraising work, but a friend emailed asking me to post something on health care and the rather unfortunate news of the past few days. I still don't have a ton of time to go into details about why I still support the bill, but for whatever it is worth, I do.
You should read Nate Silver's and John Podesta's and Ezra Klein's and Jon Cohn's and others on why this bill is still a good idea. Paul Starr, in particular, deserves a close read. He's a smart dude.
But to a large extent, none of these folks are in the thick of it. Sen. Sherrod Brown of Ohio is almost certainly the most reliable economic liberal who has been in the thick of Senate negotiations. And while he's disappointed, he isn't backing off his support for the bill.
Sherrod Brown's actions are worth monitoring as this debate continues. Bernie Sanders as well, although he's less in the thick of the conversation as far as I can tell.
Bottom-line, it will actually be easier for a bunch of reasons to make progress off of this bill as a platform than off the status quo. With subsidies, insurance regulations, and exchanges in place, other policies like stronger cost containment and a meaningful public option will be able to pass through reconciliation.
Blowing up the process on the other hand gives us two options: pursuing a reconciliation strategy that would force us to omit insurance market reforms or trying from the beginning with the same set of players. Realistically, starting over would mean giving up and seeing a Congress where Ben Nelson and Olympia Snowe are no longer the key votes. Instead, Judd Gregg or someone similar would be.
Social security was strengthened over the years. Civil rights law was strengthened over the years. Victory rarely (never?) comes down to a single bill in a single year. Even slavery's ending was a mish-mash of legislative compromises over decades compounded by open warfare between the states.
Changing the fundamental polity of a nation of 300 million is hard. It probably should be.
But this bill is progress. And it lays the groundwork for more progress. That's a win. And I still support it.
There's a few different comments. Someone calls me an idiot or a sellout or something. Actually, a few people do that. But someone else points out that if this bill dies, private insurance is still the only route to coverage for most Americans, but without subsidies, without regulations, and without an understandable marketplace. That's a damn good point.
That's one reason why what Annie Bukacek is doing is so, so wrong. Bukacek is an uber-right, would-be abortion banner who is giving other Kalispell crazies a run for their money after criminal investigators rolled in to investigate her for Medicaid fraud. Bukacek not only harmed the patients she is alleged to have scammed--she's ripped-off every single one of us who have ever paid taxes in this state. Medicaid fraud puts an extra hurt on Montana taxpayers because unlike Medicare, the federally funded health care benefit program for seniors, Medicaid is a joint state-federal funded program for low-income people.
Fun fact: that sum is enough to pay for one third of U.S. defense spending for fiscal year 2010. It could cover the entire defense spending this year for Iraq and Afghanistan combined--and leave the U.S. with $100 million dollars to spare.
This year, New York state doubled their Medicaid fraud crackdown efforts and recovered an additional $114 million. I wonder how much money Montana could recover if all the Bukaceks out there were stopped.
If the rash of absurd self-fellating letters to the editor and blog comments pretending that this is about praying with patients means anything, Bukacek and her minions just don't get it. Here's an idea Bukacek: instead of rabble-rousing, how about reading the Bible now and again. There's this part about not stealing...
It's no fun to watch this unfold. And yet this is the exactly the sort of drama you should expect for the next few weeks, as the Senate deliberations play out.
The bill Majority Leader Harry Reid introduced last week is not everything it could be--not by a long shot. And progressives will try their best to improve it. But the real battle will be an ongoing rearguard action, to fend off changes from the right--amendments that, in many cases, Republicans will support even though they have no intention of voting for the final bill. Abortion. Immigration. The mandates, for individuals and employers. You name it.
For progressives, victories are more likely to come in the form of ground not conceded than ground gained. Every day that legislation doesn't get worse is a day to cherish.
I continue to see people screaming bloody murder over the health care legislation moving through Congress. I don't have the numbers handy, but a poll (CNN, I think) recently found a narrow plurality opposing the House legislation, with a notable portion of those opposing it for being too conservative (worth noting, of course, most opposition was actually from the right or was self-described non-ideological).
The Senate bill, by most accounts, is a more conservative bill. It is financed primarily not by an explicitly progressive tax, but by an excise tax on health plans that will hit Goldman Sachs executives for sure, but will also hit a lot of working class union members who have negotiated health benefits for years.
The subsidies for purchasing coverage in the Senate bill are lower than I would like, meaning near-term affordability isn't what I would hope (of course, it also means less of a public transfer to private insurance companies, which I suppose is OK).
With all that in mind, people have been asking me a lot lately why I'm still supportive of the bill. For me, it really cuts to a few things:
The underlying structure of the bill -- subsidies, insurance exchanges, insurance market regulations, etc. -- are the right underlying reforms to make a public/private system work. They also may take us a bit closer to single-payer and certainly do not move us further away (e.g. single-payer supporters may not get what they want in this bill, but it does not foreclose victory down the road, which is important).
There are some very smart political incentives built in. For example, members of Congress get thrown into the exchanges with a lot of the rest of us, helping guarantee that the incentive down the line is for them to maintain high quality and affordability (relatively speaking on the affordability, a lot of members of Congress happen to be very rich and all are higher income than the majority of Americans).
The biggest point of all is that the Senate bill is extremely serious about costs over the long-term. What should worry just about everyone in the healthcare debate is how completely unsustainable the current system is. It isn't just that it is expensive or that administrative costs run too high. Those administrative costs don't even begin to explain the wild inflation that occurs in America's healthcare sector. You simply cannot have costs in 17% of your economy rise at rates 5-10% faster than the economy as a whole in perpetuity.
My friend Jay Stevens wrote a while ago that his problem with the excise tax was that it penalized spending on healthcare and that we should be happy to encourage people to spend more on healthcare. If healthcare actually improved health, I'd be inclined to agree that it is worth subsidizing. But the correlations are relatively weak (and the odds that hospitalization can hurt or kill you are unfortunately high). Under these circumstances, reducing healthcare spending and allowing ourselves to spend more money on other things (perhaps sporting equipment or healthy local food, both of which can be expensive but would do more in general to improve health than more heart surgeons) would be a good thing.
Does the Senate bill do this? We don't know. But it does everything it can to "bend the curve." Is that good for progressives? Depends on what you mean by progressive, but anyone concerned that health insurance is too expensive for low-income people and tthe middle class should hope that the low- and middle-income people of 20 years in the future have better choices. That requires bending the curve. And by all accounts, the Senate bill works harder to bend the curve than the House bill.
The Senate bill isn't just deficit neutral. Over the next twenty years, by CBO's (rough) estimates, it will reduce the deficit by three-quarters of a trillion dollars. That, as they say, is real money. It does that by long-term holding federal spending on healthcare steady even as massively expanding federal assistance to help low-income and middle-class Americans purchase insurance.
Even better news: CBO has at times been known for being woefully pessimistic. They overestimated the cost and underestimated the impact of tradeable permits for reducing SO2 pollution (which helped clean the air in my (and Dennis Rehberg's) hometown of Billings -- maybe "cap and trade" ain't such a bad idea, Mr. Rehberg). They overestimated the cost of Medicare's prescription drug benefit. And they routinely admit that they can't "score" the cost of key provisions of health care bills that may further reduce spending because these are experiments and folks like CBO approach experiments conservatively.
A couple months ago, a "meme" flew around Facebook as millions of social networkers changed their status to read "No one should die because they cannot afford health care, and no one should go broke because they get sick." Both the Senate and the House legislation accomplish these goals. If we want to establish additional corollaries, such as "No insurance executive should make money" or "No brain surgeon should make more than $250,000 per year," we could have done that. But those goals aren't really as important, either policy-wise or politically.
Soon, we'll pass a bill that should effectively end medical bankruptcy in America and guarantee baseline health care access for all citizens (too low a bar, I agree, for a variety of reasons). Over the long-term, this bill will likely ensure that we need not ever turn back on that promise and that we may even expand on it, just as we did over time with the promises of the civil rights acts and Social Security.
The U.S. Senate made history Wednesday night with the release of the Patient Protection and Affordability Act.
The act will give a lift to Montana's small businesses and working families by providing stable, quality health care. It will strengthen Medicare and control runaway costs while meeting the particular needs of the state's wide open spaces.
"We're encouraged that the Senate is moving quickly," said Jim Fleischmann, Montana director for Change That Works, a nonprofit grassroots organization with employees in a dozen states. "Real health care reform will bring accessible, affordable health care to Montana. And it can help small business owners who want to provide medical insurance for their employees."
He added that he's pleased that the Senate bill, like the Affordable Health Care for America Act passed by the U.S. House of Representatives 11 days ago, includes a public health insurance option.
"A public option will help guarantee choice and accountability and help break the stranglehold that Big Insurance has on our health care system," he said.
How it will help:
The Patient Protection and Affordable Care Act will:
Increase health care choices, resulting in more competition and choices than are currently available.
Prohibit any rationing of health care.
Provide accessible and affordable coverage for the uninsured with pre-existing conditions.
Provide re-insurance for retiree health benefit plans. The Act will create immediate access to re-insurance for employer health plans providing coverage for early retirees. It will help protect coverage while reducing premiums for employers and retirees.
Close the coverage gap in the Medicare (Part D) drug benefit. The Act will reduce the size of the "donut hole" by raising the ceiling on the initial coverage period by $500 in 2010. It will guarantee 50 percent price discounts on brand-name drugs purchased by low and middle-income beneficiaries in the coverage gap.
Award small business tax credits. The Act will offer tax credits to small business to make employee coverage more affordable. Tax credits of up to 50 percent of premiums will be available.
Prohibit discrimination based on salary. The Act will prohibit group health plans from establishing eligibility rules for health care coverage that has the effect of discriminating in favor of higher wage employees.
Spur the state economy and generate state tax revenues. Investments in primary care clinics and community health centers included in the Act will create jobs for health care providers and staff, generating local economic activity.
Reduce drug prices. States spent $15 million providing prescription drugs to Medicaid beneficiaries in 2007. The Act will increase the Medicaid drug rebates, benefiting states and the federal government.
Source: Democratic Policy Committee
http://dpc.senate.gov/dpcdoc-s...
Why we need reform:
In Montana:
• 30 people lose their health insurance everyday.
• 16 percent of residents are uninsured.
• A total of 22,920 residents will have lost coverage from January 2008 to December 2010 unless there's health care reform.
• A typical Montana family will pay $21,822 for health coverage in 2019, unless there's health care reform.
Mike Dennison has a good and informative story out this past weekend with the short version of what health reform will do for most Montanans in difficult situations: make their lives better even if it is hard to know precisely what will improve until 2013.
For some folks, this is another major black eye for an already deeply flawed bill. For many of us, though, this is simply another foreseen frustration inevitable with major system changes in a huge sector of the economy.
The health care bill will have a handful of immediate changes. Although the structure of the national high-risk pool is currently unclear, it should provide some near-term help for the currently uninsurable. In the slightly longer term, the exchanges and the subsidies and insurance regulations should make coverage affordable for basically everybody and near-universal coverage will be the standard in the U.S. And we'll also put some key systems in place to actually bend the cost curve on health care -- which eventually will mean fewer procedures, devices, and drugs that aren't improving our health.
What marked me most about the Dennison piece wasn't the sadness of the young woman at the end when she hears that no help is coming for three or four years, it is that based on these five (representative?) stories, help is actually on the way. It's been a long time since anyone could say that on the health care front.
Interesting commentary on a provision in the House health care legislation. If this analysis is right corporate insurance companies can only charge a maximum 15% overhead instead of on average the 30% they charge now. Still not as low as Medicare or the VA at 4% but a substantial decrease in cost.
Translation: Once the bill is enacted, all health insurance plans would be required to spend at least 85 cents of every dollar paid in premiums each year to providing actual health care. If, in a given year, an insurer doesn't spend that amount on health care, they would have to give their extra profit back to their customers in the form of rebates. Only 15 percent of premiums max could be used for marketing, administration, underwriting and profit. And the HHS Secretary could up the ratio from 85-15 if she saw fit.
Also, note worthy column by Mike Dennison in his own pragmatic view of proposed health care legislation. It appears his son in BC has the simplest, best plan of anyone in the family. To bad he didn't point out that it is more likely that someone in Canada will be struck by lighting that go to America for health care.
I asked the British Columbia Health Services Ministry in Victoria what would happen if my son was seriously injured, or if he was diagnosed in Canada with a serious disease, like cancer or meningitis or diabetes. The answer: He's covered, at no cost to him or us, like any British Columbian citizen. They seemed almost amused at my questions, as though they were thinking, why would it be any other way?
Hey Mike, maybe it because they aren't corporations and worried about making a profit for Wall Street? Your stock value not growing by 59% is a big incentive to continue the misinformation campaign and block any legislation from passing.
A Goldman Sachs analysis of health care legislation has concluded that, as far as the bottom line for insurance companies is concerned, the best thing to do is nothing. A close second would be passing a watered-down version of the Senate Finance Committee's bill.
The study's authors advise that if no reform is passed, earnings per share would grow an estimated ten percent from 2010 through 2019, and the value of the stock would rise an estimated 59 percent during that time period.
Pogie is on a tear today, noting the media's love for Dennis ReTweet, the first time a prominent politician in Montana has gotten such kind treatment for so clearly mimicking his party's line through a new technology.
But the bigger problem here isn't that Rehberg is simply using the right-wing playbook out there to kill health reform. We've known that for months.
The good news remains that health care reform is largely on track. We've passed the low point that any bill is likely to hit in terms of the public option and some other key progressive priorities and we're in the process of improving the bill.
But people have no doubt seen the commentary in the last 48 hours regarding the fact that we don't have 60 votes for cloture in the Senate yet. As I have been before, I'm fundamentally optimistic about this. I think the CBO scoring of the merged bill will come back favorable. I think scores on amendments to remove the public option will put the deficit burden on opponents of the public option. I think choice is fundamentally popular and that Republicans and the sell-out Democrats are facing an uphill battle against polling.
All that being said, the fact that we can't move to a consensus point yet on the public option means that progressives have less leverage on three other important points: financing mechanisms, subsidies for affordability, and the strength of the employer mandate. That may be the reason for the foot dragging. Who knows?
But a few other thoughts:
I don't know if Max Baucus has been trying to gut this bill like a fish or busting ass to strengthen it back to his white paper while making sure he has the votes to move forward. I do know that the general momentum in this fight right now is with reformers and specifically with public option advocates and that is both a result of progressive pressure, progressive insiders, and the slow and steady work of Max and his staff and others like him in Congress.
The last 48 hours should have proven that while the problem in DC is with 40 given bad votes that require a bill that "runs the table" with Dems and the two Independents, that still means that putting together a bill that can pass is a damn tough thing to do. Both the Senate and the House will be moving toward floor consideration of their respective bills soon. That is historic. It is amazing. But we don't have the votes for cloture yet.
The Senate is a uniquely messed up institution. If you've been in the weeds, you've read that Joe Lieberman has agreed to let the health care bill be considered...because the world's greatest deliberative body requires sixty votes for debatee to even begin if a single Senator objects. This same body requires 60 votes to end debate in such a manner that the most unpopular political party in the history of the country or something can literally find one grandstanding member of the majority and lock down the chamber. Why no one has launched a full-frontal assault on the chamber's structure and existence in American political life is, frankly, beyond me.
Anyways, I know I keep getting described as a fool in comments. Maybe I am for having the policy stances that I do. But so far this game is playing out close to how I imagined it...and I think we're on the path for an OK bill.
Here's some heartening news for Montanans: Max Baucus, who had voted against two public option amendments in committee for fear that they would induce a filibuster, is back on board coming out of the negotiations he participated in with Senators Reid and Dodd and the White House:
I included a public option in the health reform blueprint I released nearly one year ago, and continue to support any provision, including a public option, that will ensure choice and competition and get the 60 votes needed to pass the Senate. Success should be our threshold and I am going to fight hard for the 60 votes we need to meet that goal this year.
As Talking Points Memo notes, this statement leaves Max some wiggle room. But Max has always been the negotiator creating wiggle room on this stuff. That's been his job -- to make sure the bill passes.
Right now, we're on track to get a bill passed with a public option while overcoming a filibuster. I know there are still naysayers in comments (and as I wrote below, I still want improvements on the employer provisions and the affordability) because the Eeyore wing of the progressive movement is alive and well, but this is a victory.
What's more, it is a victory that would not have been possible without this whole insane hand-holding process. How do we know that the White House and Max bent over backward far enough seeking GOP support? Newsweek's Howard Fineman is calling it pointless. When the conventional wisdom becomes that Republicans obstructionism is worthy of being dismissed, we're in good shape.
We're closer now than we've ever been to passing systemic health care reform. It's a massive down payment on fixing this system. I, like many others, have gotten frustrated during this process, but damn if we don't keep getting the ball down the field at the crucial moments.
Interesting story this morning as negotiations have apparently wrapped up in the Senate. Multiple outlets are now reporting that the Senate bill moving to the floor will have a national public option with a state opt-out clause. Interestingly, this is happening despite apparent reservations from...the White House.
So Harry Reid and Nancy Pelosi appear to be showing some decent spine in the last couple weeks.
On a worse front, the bill appears set to feature an employer pay or play provision that penalizes the hiring of low-income individuals by small businesses. It also isn't clear what subsidy levels will be like.
But still, we've got some progress.
Update - Two other thoughts:
I'd prefer no opt-out clause. with what is happening in the House, we may get a straight national public option -- that'd be good.
Still, worth keeping in mind that Medicaid is actually an opt-in program -- and all 50 states have Medicaid.
I just got this email from Congressman Rehberg's office forwarded to me outlining his concerns about a public option:
He has concerns about a new "public option" because he's worried that employers will stop offering health benefits, which would force too many people into a public system, which the government will not be able to pay for, so instead of making the system better for those who it isn't working for, we've made it worse for everyone.
Reality check: employers already are increasingly dropping health benefits as costs skyrocket. That's all the more reason to fix the individual market -- and also to have a meaningful employer mandate that reduces the number of individuals dropped from current coverage.
But there isn't a single proposal for a public option where people would be forced into it. Once again, for the folks at home, the public option would be one of many options housed inside a health insurance exchange. The exchange would be the likely stopping place for individuals buying insurance on the individual or small group market. By imposing guaranteed issue, community rating, and a reinsurance to reweight the risk pools, the idea is to create a pretty competitive marketplace and reduce administrative overhead of offering individual plans.
Within that exchange, one of those plans would be publicly administered and publicly accountable. Under the (likely) House plan, it would also leverage Medicare's network to be established and pay rates slightly higher than Medicare. Under the (likely) Senate plan, it would simply be a government run health plan, may be national (good) or a set of state-based (not as good), may be an option everywhere (best), everywhere that hasn't opted out (OK), or everywhere that has opted in (bad), or it might be triggered by the lack of affordable insurance (bad). Or it might not exist at all (booooooooooooooo).
But there simply isn't a proposal out there that would do what Rehberg's office is claiming.
Beyond that, Rehberg continues to say he wants insurance companies to be able to compete across state lines. Max's bill actually allows for that, just not in the willy nilly manner that credit card companies currently compete. It would just give states the authority to approve insurance companies based in another state to enter their market (Montana could say they think Washington State's regulations are sufficient for Washington insurance companies to sell their product here). The national public option proposal is based in large part on the advantage of pooling across state lines. Rehberg says he supports tax credits. That's a backbone of the major Democratic proposals. He calls for HSAs but then says he wants resources for prevention. HSAs really don't incentivize prevention. The Democratic bills actually make prevention a reality.
Beyond that, Rehberg is really worried about the cost. Fine, get out there and champion comparative effectiveness research and make it clear that the government will only subsidize proven cost-effective medicine and paying for the rest will be up to the individuals paying out-of-pocket for insurance or care. I'm all for being hard-minded in how we cover people.
The problem is that the entire Republican Party is either ignorant as dirt on these actual policy questions or more dishonest than Pinocchio. Either way, these answers are utter bullshit and Montanans deserve a hell of a lot better.
Families USA summarizes the amendments that the Finance Committee made to the Chairman's Mark. There's a mix of good (basic health plans for under 200% of poverty, enrollment simplification, only one exchange per state) and bad (lower subsidy levels) and some other stuff.
Families USA does good work, though, and their reputation as health wonks is well deserved. The full thing is an easy-to-read four pages.
