I wrote yesterday about the good points and the BAD points of the public option in the Tri-Committee House draft bill. Let me summarize the weak points for you.
- The public option and the National Exchange won't be available on day 1. They both get started in 2013. That's too long. We should ask for it to be pushed back sooner.
- The public option will be tied to Medicare plus rates at first, but over time, it has to find new payment mechanisms, which makes it weaker. Why hobble a strong public option over time? We have to insist on its continuing to be tied to Medicare plus rates at first.
- The public option has to be completely self-sustaining by premiums alone, with no revenue whatsoever from the government. This is of concern, because it has to have a large start-up fund, and it needs a partial revenue from the government to stay stable, so I would encourage the use of the Value-added tax, which is a national sales tax, and a tax raise on the wealthy to help pay for the public option.
- The administrative functions of the public option will be contracted out to private insurance companies. That's the best way to hobble the public option. We have to INSIST that the administrative control of the public option stay within the government alone.
- People in employer group plans won't be able to take advantage of the public option. Only the uninsured and individual policy holders will be able to take advantage of the public option. Thus it's not OPEN to ALL Americans, and we have to pressure the Committee on Education and Labor Committee to make it open to all Americans.
Here's what Wonk Room had to say about the House bill below as I wrote about yesterday:
Unlike the HELP bill and the draft (leaked) language of the Senate Finance Committee, the Tri-Committee proposal seems to contain a fairly robust public insurance option. While details are still being worked out, the proposal establishes a public plan in 2013 that will compete with private insurers, within the Exchange, on a level playing field. The public option will be required to abide by all marketing, operations, and rating rules and would initially be allowed to use Medicare plus rates. After some time, the plan would have to independently negotiate fees with providers.
On the whole, the bill’s affordability measures are impressive. Full details are after the jump but the plan offers subsidies on a sliding scale (up to 400 percent of poverty) and opens up Medicaid to Americans at or below 133% of the federal poverty level. While I haven’t seen the cost-sharing details, the robust public plan that could use Medicare plus rates would be able to force private insurers to aggressively negotiate with providers and pass on savings to consumers.
And there it seems that it might be wrong about the public option in the Tri-Committee proposal being available everywhere on day one. How can it be available on day one if it's supposed to be available in 2013 and the National Exchange that's proposed to cut down on costs is established in 2013 as well? This is one of the sticking points for us to push back on. It does need plenty of administrative time to start up, since Social Security took about five years to get started. We can always push for this to be started earlier, but this isn't a major point.We'll have to ask the House Education and Labor Committee if the private insurers will have to be regulated immediately after the passage of the legislation or if the regulation starts in 2013.
Always remember, the devil is in the details.
Another sticking point for us to push back on is that the public option will have to stop using Medicare plus rates at a certain point in time. Here's more from Karen Tumulty at Time Magazine on what that means:
In the early stage, the public plan would reimburse health care providers at rates that are "similar to those used in Medicare"--that is, significantly lower than most private insurers pay them. This is something that the insurance industry, doctors and hospitals will all hate. “A government-run plan that pays based on Medicare rates – for any period of time – is a recipe for disaster," Scott P. Serota, president and Chief Executive Officer of the Blue Cross and Blue Shield Association, said in a statement issued by the association. "Already in some parts of the country nearly 30 percent of Medicare enrollees report that they cannot find doctors willing to accept new patients, due to below market rates. Rural hospitals, in particular, are struggling to keep their doors open. These low payment rates would threaten the quality of healthcare and undermine the improvements that we believe reform can bring to communities across the country."
Advocates would argue, on the other hand, that those lower rates could be a powerful engine to bring down health costs. Which is why they won't be happy with what happens next. According to the summary, this tie to Medicare rates would be "severed over time as more flexible payment systems are developed." In other words, this public plan would eventually evolve into something that looks--and competes--more like a private insurance company, albeit one that happens to be run by the government. At the news conference, I asked the committee chairmen precisely what that means--When would that happen? And under what circumstances? They couldn't tell me, and demurred that this is the kind of thing that still needs to be worked out. Waxman said it would take "a period of time" for the public plan to get started, but that "they will at some point compete."
The House committee chairmen are trying to have it both ways on the public plan. That might work--or might just end up satisfying no one.
This is the biggest sticking point for us to push back on along with the one about the public option having to be self-sustaining only on premiums, and we'll need to ask the Congressional Progressive Caucus to push back on this as well. Basically, we'll have a strong public option at first, but over time, it'll be weakened. I don't think this is right.
- CALL Senator Dodd at (202) 224-2823 and ask him to put in OPTION A, which is the strong, robust Medicare-like public option, NOT OPTION B, which is the Conrad co-op proposal, in the markup on Monday.
- EMAIL the Senate HELP Committee at help_comments@help.senate.gov to ask them to put in OPTION A, which is the strong, robust Medicare-like public option, NOT OPTION B, which is the Conrad co-op proposal, in the markup TODAY.
- CALL the phone numbers of ALL the Senators on the HELP Committee with these talking points below and tell them to support OPTION A, not OPTION B, in the mark-up:
Tell Senator [Name] that you DO NOT want the 7-year trigger for the public option and take it off the table, and that you want him to support an affordable strong, robust Medicare-like public option. We NEED a strong, robust Medicare-like public option NOW OPEN TO ALL AMERICANS AND AFFORDABLE, not more of the SAME broken system that's given us unaffordable premiums, little private insurance coverage, and rising co-pays. Also, DON'T TAX OUR EMPLOYER HEALTH BENEFITS. Instead, follow the proposal by President Obama to tax the wealthy above $250,000, eliminate the overpayments in Medicare Advantage, and put tax capital gains to help fund health care reform. TELL YOUR SENATOR NO ON THE SCHUMER COMPROMISE AND NO ON THE CONRAD CO-OP COMPROMISE.
These are the members of the HELP Committee to CALL today since they're having their markup today.
Tom Harkin (IA): (202) 224-3254
Barbara A. Mikulski (MD): (202) 224-4654
Jeff Bingaman (NM): (202) 224-5521
Patty Murray (WA: (202) 224-2621
Jack Reed (RI): (202) 224-4642
Bernard Sanders (I) (VT): (202) 224-5141
Sherrod Brown (OH): (202) 224-2315
Robert P. Casey, Jr. (PA): (202) 224-6324
Kay Hagan (NC): (202) 224-6342
Jeff Merkley (OR): (202) 224-3753
Then PLEASE CALL the rest of the Democratic Senators to urge them to support a strong, robust Medicare-like public option in health care reform!
Please CALL Senator Max Baucus at (202) 224-2651
Please CALL Senator Olympia Snowe at (202) 224-5344
Please CALL Senator Charles Schumer at 202-224-6542
Please CALL Senator Edward Kennedy at (202) 224-4543
Please CALL Senator John Rockefeller at (202) 224-6472
Please CALL Senator Ron Wyden at (202) 224-5244
Please CALL Senator Kent Conrad at (202) 224-2043
Please CALL Senator Jeff Bingaman at (202) 224-5521
Please CALL Senator John Kerry at (202) 224-2742
Please CALL Senator Blanche Lincoln at 202-224-4843
Please CALL Senator Debbie Stabenow at (202) 224-4822
Please CALL Senator Maria Cantwell at 202-224-3441
Please CALL Senator Bill Nelson at 202-224-5274
Please CALL Senator Robert Menendez at 202-224-4744
Please CALL Senator Thomas Carper at (202) 224-2441
- CALL ALL of the members on the House Education and Labor Committee to ask them to support a STRONGER public option than what is currently proposed in the Tri-Committee draft with these talking points below:
Tell Representative [Name] that we want them to consider starting the National Exchange and the public option earlier than 2013 because we desperately need affordable health care RIGHT NOW. Also, tell him or her that YOU DON'T WANT the public option's tie to Medicare rates to "severed over time as more flexible payment systems are developed." You want the public option to be based on Medicare plus rates, and that you don't want the public option to end up as a Fannie Mae or Freddie Mac. You want it to be administered by the government and NOT by any private insurance companies, and to be like Medicare based on its ability to negotiate rates with providers and pharmaceutical companies. Also, that you want employer group plans to have ACCESS to the public option, and not be locked out of that access. Say that you don't want your health benefits to be taxed, but that you support a raise in taxes for the wealthy to help pay for the public option. You don't want the public option to be self-sustained only by premiums because that will help hobble its viability, and that you NEED for it to have some financing from the government.
Please USE these toll-free congressional numbers to CALL these Education and Labor Committee members below! Just say the name of the committee member, and you'll be connected to that person.
800-828-0498
1-800-828-0498
1-866-338-1015
1-866-220-0044
1-877-851-6437
George Miller, Chairman (CA-07)
Dale E. Kildee (MI-05)
Donald M. Payne (NJ-10)
Robert E. Andrews (NJ-01)
Robert C. Scott (VA-03)
Lynn C. Woolsey (CA-06)
Rubén Hinojosa (TX-15)
Carolyn McCarthy (NY-04)
John F. Tierney (MA-06)
Dennis J. Kucinich (OH-10)
David Wu (OR-01)
Rush D. Holt (NJ-12)
Susan A. Davis (CA-53)
Raúl M. Grijalva (AZ-07)
Timothy H. Bishop (NY-01)
Joe Sestak (PA-07)
Dave Loebsack (IA-02)
Mazie Hirono (HI-02)
Jason Altmire (PA-04)
Phil Hare (IL-17)
Yvette Clarke (NY-11)
Joe Courtney (CT-02)
Carol Shea-Porter (NH-01)
Marcia Fudge (OH-11)
Jared Polis (CO-2)
Paul Tonko (NY-21)
Pedro Pierluisi (PR)
Gregorio Kilili Camacho Sablan (Northern Mariana Islands)
Dina Titus (NV-3)
Vacancy
CALL the White House at: 202-456-1111 and E-MAIL them as well!
Also, can you please CALL these THREE chairmen in the House of Representatives, especially Rep. Waxman who's leading the charge on health care reform below with your concerns about the five weak points of the public option in their house bill?
Ways and Means Committee Chair Charlie Rangel (202) 225-3625)
Energy and Commerce Committee Chair Henry Waxman (202) 225-2927)
Education and Labor Committee Chair George Miller (202) 225-3725)
Whew. I've got one last thing for you guys to do. President Obama is going to have a televised town hall on ABCNEWS on Wednesday. I really NEED for you to go and PLEASE DIGG UP THIS QUESTION to ask President Obama in his town hall on ABC News!
Please feel free to REC up this diary so it can be on the rec list for others to see the phone numbers and call today.
UPDATE: Please RECOMMEND this diary by askew asking for our help to PUSH BACK on the co-op plan being favored by the White House and some Senators!