Part I
Last Saturday I published a diary, in which I argued that, while I would like to see the Senate healthcare reform bil improved through reconciliation, I believe progressives should acknowledge that the Senate bill, even if passed as is, without a fix, would represent a major progressive achievment.
In that diary I cited a number of healthcare policy experts, most prominently Prof. Paul Starr of Princeton University and The America Prospect, all making pronouncements on the bill along the lines of "greatest progressive achievment since the Great Society."
My opinion as to the correct progressive position regarding the Senate bill is essentially that the House should be encouraged to pass it without delay, that the Senate should be encouraged to pass a fix, mainly to improve affordability, create a national exchange and alleviate some of the concerns raised about the excise tax. And also that progressives should enthusiasitically support the legislation and, for that matter, the Democratic legislators who vote for it, even while they continue to push for improvements to the bill.
My main concern is that progressives are, to paraphrase Prof. Starr, vastly underrating the value of the Senate bill.
I've seen many diaries and comments on diaries that suggest that without a major fix, the Senate bill isn't worth passing and might even be a step in the wrong direction. That is just completely wrong.
The Senate healthcare bill, without a fix, already provides the following:
14 million people who are just above the poverty line and struggling to make ends meet will receive free coverage through Medicaid.
Millions of working class and lower middle class people who don't qualify for Medicaid will receive billions of dollars in subsidies to help them afford private insurance, with lower income people receiving larger subsidies.
Out-of-pocket annual medical expenses will be subject to an annual cap based upon income.
Uninsured people with chronic health problems who can't buy insurance at any price under the current system, will be able to purchase insurance for the same price a healthy person pays.
$10 billion goes to community health clinics providing services, including dental work, to communities with the greatest need.
In other words, the sicker, poorer and less insured you are, the more you benefit from this bill. Which is exactly as it should be.
Yet, many progressives are prepared to throw all of that away in a fit of piqué because there's no public optionm even though the benefits of the public option passed by the House are dubious at best, and because insurance companies will be taxed on a small percentage of high cost plans held only by people with good jobs that provide excellent benefits.
Lately the push for the Public Option has been renewed. And, frankly, for the pure PR benefits if no other reason, I'd love to see the thing get included in a Senate fix. But I'm pleading with my fellow progressives not to make the Public Option the sine qua non of healthcare reform.
Progressives cannot afford to treat anything as a deal breaker right now because if we don't at least pass the Senate bill, progressives lose and the enemies of progress win.
Of course, theoretically, the Senate could have passed a bill that progressives simply could not, in good conscience, accept. But for the reasons I've set forth above, the Senate bill is not that bill.
I can't begin to tell you how disappointed I've been that progressives have not managed to play a more constructive role in this whole healthcare reform process.
Instead of being the drivers of change, too many progressives are acting like just another obstructive special interest group.
And here's what's at stake: if a healthcare reform bill doesn't pass millions of people will needlessly suffer -- physically, financially and emotionally -- and the bad guys will have won.
Some progressives are understandably tired of being shoved around. I'm tired of being shoved around. But guess what: if we as progressives choose to be just as ornery and obstinate as the conservatives, we lose.
Obstinance is a great weapon for preventing things from getting done, but if your someone who actually cares about getting things done then what you need is not obstinance but obstinance's gentle, good natured cousin --patience.
Some people think that patience is a sign of weakness. That is wrong. Patience actually requires more strength than obstinance.
If you're obstinant all you have to do is grit your teeth, dig your heels in and refuse to move.
If you're patient you have to be able to grit your teeth, dig your heels in and refuse to move, but you also have to be able to keep a cool head in the heat of battle and you have to constantly be thinking, evaluating, moving when necessary. It means never being able to choose a comfortable spot to plant your flag and refuse to be budged.
The mission of the Republicans is simple: No Change. Our job is hard: make changes that benefit the lives of everyone with whom we share this country, even those who violently oppose us.
Accomplishing this task is going to try everyone's patience. But if we're going to get the job done we're going to have to be patient with each other and with the politicians we sent to Washington to represent us.
Part II
While last week's diary didn't chart :(, it did foster a pretty lively discussion regarding the relative merits/demerits of the Senate bill. Some commenters raised particularly good objections and/or questions, really penetrating to some core concerns and issues that I want to address in detail.
Following is my attempt to to answer, rebut and/or contextualize some of the best and most frequently asked questions and raised issues. The information, where not otherwise indicated, comes from the Senate Democratic Policy Committee's webpage on the Senate Healthcare reform bill. Often I will be quoting portions of various documents posted on that site without further attribution. I don't think there is any fair use issue because the information is provided as public service, but if anyone disagrees or and/or is offended, please let me know in comments and I'll be happy to get into a screaming match with you!
1. The Senate bill does not do nearly enough to define the minimum requirements for a basic insurance policy.
It is true that the Senate bill does not set out all of the particular requirements of a basic insurance policy. However, Sect. 1302 of the bill does provide that policies shall include essential benefits to be defined by the Secretary of Health and Human Services that at least includes the following general categories:
(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.
Effective January 1, 2014, premium assistance tax credits will limit the amount an individual spends on their health care premium for the essential benefits package from two percent at 100 percent of the Federal Poverty Level (FPL) to 9.8 percent of income at 300-400 percent of the FPL. The amount of the credit is tied to the premium of the second-lowest cost (silver) plan in each area (a silver plan is a plan that covers 70% of all medical costs, up to the out-of-pocket cut-off and 100% thereafter, there are also bronze [60%], gold [80%] and platinum [90%] plans.
In my last diary I posted this chart, showing premiums and potential out-of-pocket expenses for a family of four at various income levels of up to 400% of the Federal Poverty Line.
Here is a little more context on what the numbers in that chart mean:
A family of four with an income of $36,275 would have to pay a premium of up to $163.85 per month for a policy that covers 70% of their medical bills up to $14,000. (Meaning if they had $14,000 in medical bills in a year they would have to come up with $4,200.00 in copays. Everything over $14,000 would be covered 100%) Bear in mind that there is no copay for preventive care.
A family of four with an income of $48,367 per year would have to pay a premium of up to 302.42 per month for a policy that covers 70% of their medical bills up to $21,000. (Meaning if they had $21,000 in medical bills they would have to come up with $6,300 in copays. Everything over $21,000 would be coverd 100%.)
A family of four with an income of $60,458 per year would have to pay a premium of up to $483.08 per month for a policy that covers 70% of their medical bills up to $21,000. (Meaning if they had $21,000 in medical bills they would have to come up with $6,300 in copays. Everything over $21,000 would be coverd 100%.)
A family of four with an income of $72,550 per year would have to pay a premium of up to $705.67 per month for a policy that covers 70% of their medical bills up to $28,000. (Meaning if they had $28,000 in medical bills they would have to come up with $8,400 in copays. Everything over $28,000 would be coverd 100%.)
A family of four with an income of $84,642 per year would have to pay a premium of up to $823.25 per month for a policy that covers 70% of their medical bills up to $28,000. (Meaning if they had $28,000 in medical bills they would have to come up with $8,400 in copays. Everything over $28,000 would be coverd 100%.)
This isn't so generous that purchasing insurance won't be completely painless for families, but a family shopping on the open market in our present system absolutely cannot get the sort of rock-solid dependable coverage that will be available to them through the exchange if the Senate bill were to be passed as is.
Of course, most people expect additional measures to somewhat improve affordability will be included in the "fix" but even without a fix, the Senate bill vastly improves the insurance for working families who are currently not ensured through their employers.
2. I am over 55 and get insurance through my employer. Won't the Senate bill allow my insurance company to raise my rates?
If you're already in a group insurance plan through your employer or another organization and your state requires that group insurance plan to offer the same rates to all participants regardless of age, nothing in the Senate bill changes that.
Pursuant to Section 1312(d)(2) of the bill provides:
CONTINUED OPERATION OF STATE BENEFIT REQUIREMENTS.—Nothing in this title shall be construed to terminate, abridge, or limit the operation of any requirement under State law with respect to any policy or plan that is offered outside of an Exchange to offer benefits.
Basically, nothing in the Senate bill reduces the consumer protections that your State has created. All it does is raise the floor.
Also, there is a state innovation waiver in section 1332 of the bill that allows a State to opt out if it presents a plan that meets or exceeds the standards of the national plan and take all of the federal dollars that would have been spent on it to fund its own plan starting January 1, 2017.
3. Yeah, but won't employers just stop providing health insurance to employees and pocket the savings, forcing their employees to purchase insurance from the exchange?
Employers with more than 200 employees must automatically enroll new full-time employees in coverage with adequate notice and the opportunity for an employee to opt out.
Employers with more than 50 full-time employees that do not offer coverage and have at least one full-time employee receiving the premium assistance tax credit must make a payment of $750 per full-time employee.
Employers with more than 50 full-time employees that require a waiting period before an employee can enroll in health care coverage will pay $400 for any full-time employee in a 30-60 day waiting period and $600 for any full-time employee in a 60-90 day waiting period.
So, essentially, if an employer with at leat 50 employees doesn't want to provide health insurance, they're going to help pay for it anyway.
Further, in addtion to these regulatory sticks, small businesses are also offered tax credit carrots for providing employees with health insurance.
I realize that I've hit on some hot-button issues in this diary and have made some statements that a lot of enthusiastic healthcare reform advocates will take issue with. But I firmly believe that if more progressives only realized just how much progress the Senate bill actually represents, we could provide the energy and momentum necessary to be certain that a bill passes. However, I fear the progressives lack of enthusiasm and/or outright hostility to the bill has made the outcome uncertain.
So, I urge you to follow nyceve and slinkerwink's lead and call your senators on 2/24 and ask them to support a public option and a millionaires tax, but please also call your reprentative and tell her or him that whatever the Senate does, the House needs to Pass. The. Damn. Bill!