Tag Archives: Medicaid

Baucus Bill: No Public Option

As expected, Senator Max Baucus released the full text of a health reform bill that was noteworthy primarily for what wasn’t there: the bill is minus a public option. As long predicted here, the legislation includes “co-ops” and “exchanges,” which are similar to the federal health employees health care plan. And Medicare Advantage stays, albeit at lesser rates.

And in return for this sellout on the most meaningful planks of health care reform, the Baucus plan has gotten…so far, not one single, solitary Republican vote.

Kaiser Health News provides a concise summary:

Senate Finance Committee Chairman Max Baucus today unveiled a health care bill that would require most individuals to have health insurance. Insurance companies could not deny health coverage based on a pre-exisiting medical conditions or place yearly or lifetime limits on coverage.

People who earn as much as 133 percent of the federal poverty level ($14,440 for an individual, $29,400 for a family of four) would be eligible for Medicaid, the government insurance program for the poor. The measure includes a health insurance ‘exchange’ where people could buy insurance and a system of health care “co-ops” rather than a government-run health insurance plan. Subsidies would help low-income workers purchase health insurance and small businesses would receive tax credits to help offset the cost of providing coverage.

The bill is projected to cost $856 over 10 years. It would be paid for with an excise tax on high-end health insurance policies, lower payments to the Medicare Advantage program and with fees on medical device manufacturers, clinical labs, drug makers and health insurance companies. Baucus negotiated the plan with five other finance committee members – including three Republicans – but no one in the GOP has endorsed the package.

Baucus Releases His Plan

Senator Max Baucus has released his health care plan one day ahead of President Obama’s speech to a joint session of Congress. His version of a $900 billion plan will include a series of cooperatives in place of a public option. It also features “exchanges” where people can purchase insurance policies, rather like the existing federal employees health plan. Kaiser Health News reports:

The so-called “framework” would establish health insurance exchanges in 2010, require health plans to report the amount of money they spend on items other than health care and require insurers to cover pre-existing medical conditions, according to documents obtained today by Kaiser Health News.

Baucus is proposing tax credits to help individuals who earn up to 300 percent of the federal poverty level, or $66,000 for a family of four, to purchase health care coverage. In addition, individuals who earn between 300 percent and 400 percent of the federal poverty level would be eligible for a premium credit as a flat percent of income.

Dr. Dean’s Health Care Prescription: “The Free Market Just Doesn’t Work in Medicine”

On a book tour in southern California recently, Howard Dean–the ex-governor of Vermont, 2004 presidential candidate, and former DNC chair, who is himself a medical doctor–makes a few points about health care that are worth keeping in mind through the bitter partisan debate (if you can still call it a debate). His book from Chelsea Green is called Howard Dean’s Prescription for Real Healthcare Refom.

Remember that it was Dean who, as governor of Vermont, got through a provision guaranteeing health care covering to all of the state’s children. He was ridiculed on the stump in 2004 as an out of control lefty–which is about as true as the accusations that Obama is a socialist. Dean is a moderate-to-conservative New Englander who has never proposed anything faintly resembling socialized medicine. 

But Dean does believe, as he pointed out at one book tour appearance: “The free market just doesn’t work in medicine. You can’t be an informed consumer. I never saw someone with severe chest pain jump off the table and say, ‘Doctor, I’m going to the cheaper guy down the street.'” And he doesn’t favor compromising on a public option, because “the public option is the compromise.”

The above quote was supplied by Miriam Raftery, editor of the East County Magazine, who  provides a fine precis of Dean’s book and the talk he gave last month at a San Diego bookstore: 

Dean noted that public healthcare in Europe was established not by liberals, but was in fact championed by conservative statesman Winston Churchill. “Disease must be attacked, whether it occurs in the poorest or the richest man or woman simply on the ground that it is the enemy; and it must be attacked just in the same way as the fire brigade will give its full assistance to the humblest cottage as readily as to the most important mansion,” Churchill once stated.” Our policy is to create a national health service in order to ensure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Cost savings would occur by moving to a wellness-based medical model that emphasizes prevention, lowering current costs for treating patients who wait and go to the emergency room in a crisis. Eliminating administrative overhead would also save money in a public option. . .

“To fix the economy, we need to begin by fixing our healthcare system,” his book states, noting that General Motors spends more on healthcare insurance for workers than on steel to build automobiles. He cites a Kaiser Family Foundation survey which found that 58% of all small businesses have difficulty keeping up with healthcare costs. “If you want to help small businesses,” he argues, “let them pay lower health insurance premiums.”

Dean has practiced what he preaches. As Governor of Vermont, he led the state’s expansion of Medicaid eligibility to children under 18 in families earning under $65,000. “Basically we made Medicaid a middle class entitlement for children,” he says, adding that the shift saved businesses money and increased profit margins for those that opted to have employees’ children covered by the public plan. Vermont also increased Medicaid reimbursements to assure that doctors would not opt out of the system.

Dean now advocates what is basically a public option, achieved by opening up Medicare to people under 65, while allowing anyone who chooses to keep their private insurance. 

“Americans ought to be able to decide for themselves: Is private health insurance really health insurance? Or is it simply an extension of the things that have been happening on Wall Street over the past five to ten years, in which private corporations find yet new and ingenious ways of taking money from ordinary citizens without giving them the services they’ve paid for?”

Dean dispells myths promoted by the healthcare industry. “There is no country in the world with a public option that doesn’t also have private insurance,” he noted. “A public option allows you to sign up for Medicaid [Medicare] before 65. All the Republicans who’ve been whining and complaining all have a public system,” said Dean, former head of the Democratic National Committee, citing the high-quality government healthcare program that Congress has given its own members. Moreover, satisfaction ratings are high for two other government healthcare programs: Medicaid and Veterans Administration healthcare, Dean noted.

He believes true healthcare reform must include five core principles. Everyone must have the option of coverage. No one should be forced to declare bankruptcy because of medical bills. Health insurance should be portable, meaning you can’t lose your health insurance even if you change jobs, move, retire or have a pre-existing condition. Plus the quality and efficiency of care must be improved. . .

“My bottom line is not single-payer,” he said, noting that most Americans like to have choices. But he added that supporters of single payer should continue to lobby their legislators to prevent healthcare reform in Congress from being watered down to remove a public option. “Public option is the compromise,” he noted.

Dean noted that all countries in Europe now have a public option, except Switzerland and Netherland, where insurance companies are tightly regulated similar to public utilities. Americans spend more on healthcare per capita than any other nation, yet the U.S. ranks dead last in ratings of healthcare quality, access and affordability…

William Greider on “Looting Social Security”

Veteran progressive journalist and radical geezer Bill Greider has written an essential article in the current issue of The Nation, on the strategic attack now underway against Social Security and Medicare.

Governing elites in Washington and Wall Street have devised a fiendishly clever “grand bargain” they want President Obama to embrace in the name of “fiscal responsibility.” The government, they argue, having spent billions on bailing out the banks, can recover its costs by looting the Social Security system. They are also targeting Medicare and Medicaid. The pitch sounds preposterous to millions of ordinary working people anxious about their economic security and worried about their retirement years. But an impressive armada is lined up to push the idea–Washington’s leading think tanks, the prestige media, tax-exempt foundations, skillful propagandists posing as economic experts and a self-righteous billionaire spending his fortune to save the nation from the elderly.

These players are promoting a tricky way to whack Social Security benefits, but to do it behind closed doors so the public cannot see what’s happening or figure out which politicians to blame. The essential transaction would amount to misappropriating the trillions in Social Security taxes that workers have paid to finance their retirement benefits. This swindle is portrayed as “fiscal reform.” In fact, it’s the political equivalent of bait-and-switch fraud.

I addressed this subject last month in a series of posts on the coming “entitlement wars“–but Greider does a better job than I ever could, laying out the history, the players, and the tactics employed in this long-brewing struggle. He documents how conservatives are working to exploit the recession, along with public fears and misapprehensions, to manufacture intergenerational conflict, and thereby achieve their cherished goal of rolling back the entitlement programs responsible for rescuing millions of elders from desperate poverty. He also explains why this fight “could become a defining test for ‘new politics’ in the Obama era.”

Defending Social Security sounds like yesterday’s issue–the fight people won when they defeated George W. Bush’s attempt to privatize the system in 2005. But the financial establishment has pushed it back on the table, claiming that the current crisis requires “responsible” leaders to take action. Will Obama take the bait? Surely not. The new president has been clear and consistent about Social Security, as a candidate and since his election. The program’s financing is basically sound, he has explained, and can be assured far into the future by making only modest adjustments.

But Obama is also playing footsie with the conservative advocates of “entitlement reform” (their euphemism for cutting benefits). The president wants the corporate establishment’s support on many other important matters, and he recently promised to hold a “fiscal responsibility summit” to examine the long-term costs of entitlements. That forum could set the trap for a “bipartisan compromise” that may become difficult for Obama to resist, given the burgeoning deficit. If he resists, he will be denounced as an old-fashioned free-spending liberal. The advocates are urging both parties to hold hands and take the leap together, authorizing big benefits cuts in a circuitous way that allows them to dodge the public’s blame. In my new book, Come Home, America, I make the point: “When official America talks of ‘bipartisan compromise,’ it usually means the people are about to get screwed.”

The Social Security fight could become a defining test for “new politics” in the Obama era. Will Americans at large step up and make themselves heard, not to attack Obama but to protect his presidency from the political forces aligned with Wall Street interests? This fight can be won if people everywhere raise a mighty din–hands off our Social Security money!–and do it now, before the deal gains momentum. Popular outrage can overwhelm the insiders and put members of Congress on notice: a vote to gut Social Security will kill your career. By organizing and agitating, people blocked Bush’s attempt to privatize Social Security. Imagine if he had succeeded–their retirement money would have disappeared in the collapsing stock market.

Old folks–and anyone who plans on becoming old some day–need to gear up for this one. A good start is to read Greider’s long article in its entirety.

Brother, Can You Spare a Tax Cut? Latest Version of Recovery Bill Cuts Help for Poor and Jobless

“If there’s anyone out there who still doesn’t believe this constitutes a full-blown crisis,” Barack Obama said last night in his first prime-time news conference, “I suggest speaking to one of the millions of Americans whose lives have been turned upside down because they don’t know where their next paycheck is coming from.” Yet it is precisely those Americans who’ve lost out in the Senate’s compromise version of the economic stimulus package, which is scheduled for a vote today. For the sake of securing three Republican votes and a filibuster-proof majority, Senate Democrats have agreed to jettison some of the most vital and most progressive elements of the Recovery and Reinvestment Act–and with them, the lifeline it offered to millions of poor and unemployed Americans.

Obama last night was clearly exasperated, taking some oblique shots at Republican resistance to the plan. Yet the president appears resigned to the Senate compromise, saying over the weekend, “We can’t afford to make perfect the enemy of the absolutely necessary.” Only in the next few days, as the Senate, the House, and the administration hammer out final legislation, will we learn to what extent expediency and lingering fantasies of bipartisanship trump any vision of the federal government as a place its most vulnerable citizens can once again turn to for help.

A bottom-line issue in this economic crisis is whether the government will help provide the unemployed with the most basic necessities of life: food, shelter, and health care. The ranks of jobless Americans have swelled by more than 50 percent in the last year, to 11.6 million. The official rate of 7.6 percent accounts only for the recently unemployed; by a broader measure that includes people who have stopped looking for work or can’t find full-time jobs, it jumps to a sobering 13.9 percent.  Job losses have plunged millions of families into economic insecurity–where they join the working poor and the elderly and disabled poor, whose incomes are already lower than the unemployment benefits of many middle-class people. Beyond these essential stop-gap measures, of course, what these people really need are jobs.

Obama’s original proposal dealt with many of these needs head-on, with a bigger food stamp program, voucher programs and direct government refinancing to prevent foreclosures, and federal funding for COBRA and an expanded Medicaid program, to keep the unemployed from slipping into the widening pool of the uninsured: food, shelter, and health care. Key to all this was increased funding to state governments, whose budgets are now on the verge of catastrophic collapse. More money to the states means social service programs can continue to function, even expand to meet the strains of the crisis. Two weeks ago, I was even inspired to write: “With this package, Obama begins the process of reversing cutbacks initiated by Reagan and carried forward by the two Bushes, with some help from Clinton’s welfare ‘reform.'” On January 28, the House passed the legislation with its most important components intact. But as the Senate has now shown, reports of the death of trickle-down economics seem to have been greatly exaggerated.

The Senate version of the stimulus plan reduces monies already approved in the House for the states, by a crushing $40 billion. Both plans extend unemployment benefits, but the expansion of Medicaid to the unemployed-which could have been a lifesaver for millions of families–is absent from the Senate bill. The subsidies for COBRA have been cut back, as have the increases in food stamps,  and funds for school construction, early education, and environmental cleanup. And according to the Center for American Progress, the compromise would create between 430,000 and 538,000 fewer jobs than the House-passed bill.”

The Senate bill preserves and elevates the revered conservative approach to economic stimulus: tax cuts and more tax cuts, which aren’t much use to the destitute. Obama had already offered up an excess of tax cuts in pursuit of the elusive bipartisanship, but the Senate added more cuts (the AMT “patch,” a homebuyer’s credit, and business write-offs) destined to benefit only those with higher incomes.

In addition to leaving the needy to fend for themselves, the Senate package is considerably less likely to be effective. Washington has long known that the swiftest way out of an economic stagnation like this one is to put money immediately into the hands of people who will spend it on goods and services. Tax cuts, by comparison, are slow to take effect, if they work at all–especially if they benefit the well-off, who are just as likely to keep the money in their pockets.

If Obama supports this compromised Senate version of the Recovery and Reinvestment Act, rather than rallying his progressive base and exposing the Republicans as obstructionists, he will lose moral and political authority. He could also begin to look not only like the cautious centrist Democrat that he is, but like just another triangulator in the fashion of the Democratic Leadership Council–a particular form of slime that I hoped was at long last being sluiced out of the Washington swamp.

Obama’s Lifeline: For a Change, Government Spending That Actually Helps the People Who Need It Most

Republicans took to the Sunday morning news shows to express their “concern” about parts of the stimulus package presented by the Obama administration last week. House Minority Leader John Boehner declared that he would vote no “if it’s the plan I see today”–a pretty idle threat, since even if he takes his entire party with him, the Democrats still have nearly an 80-vote margin. In the Senate, however, two Republican votes are needed to create a filibuster-proof majority, which might at least slow the package down and could force some compromises.

There’s good reason for the Republican resistance. While it makes numerous concessions to favored conservative approaches–lots of public-private partnerships that will allow the private sector to cash in, tax cuts for businesses and the middle class, and no immediate end to the Bush tax cuts (which will expire on their own in 2010)-the $820 billion stimulus package also includes some dramatic increases in support for the nation’s social welfare programs.

With this package, Obama begins the process of reversing cutbacks initiated by Reagan and carried forward by the two Bushes, with some help from Clinton’s welfare “reform.” There may still be plenty of holes, but with this plan, the new government confirms that has some responsibility for providing a safety net for its poor and disabled, its children and elderly. To see the magnitude of the shift, it is only necessary to glance at the last budget drawn up by President Bush, for fiscal year 2009: In the midst of the growing recession, it had yet more cuts to the social welfare system, reducing already inadequate health and feeding programs for the most vulnerable Americans.

Here are some of Obama’s initiatives–not quite the New Deal, but quite a new deal compared to what we’ve grown used to over the past 30 years:

  • As unemployment grows, more and more people lose their health insurance and turn to Medicaid. State budgets already are in desperate straits, and can’t possibly shoulder this added burden. Obama would pump federal money into state Medicaid budgets as well into the program providing for health insurance for children.
  • In addition, Obama wants to shore up existing health insurance coverage for people losing jobs by extending COBRA and underwriting part of its cost through tax rebates. COBRA is a program that enables people losing their jobs to continue their health insurance if they pay for it. Obama wants the federal government to partially subsidize these payments, and also gives some low-income unemployed people access to Medicaid.
  • The president’s plan proposes to extend unemployment benefits through December 2009 and increase weekly unemployment insurance benefits by $25.
  • The stimulus package would incresasing food stamp benefits for the 30 million people now in the program, and provide support for food banks, school lunch programs, and the WIC program that provides for mothers and infants.
  • Obama’s plan would give 7.5 million blind, disabled, and aged Americans an immediate $450 by increasing-on a temporary basis–Supplemental Security Income (SSI) benefits.

Expanding Medicaid: A Positive Move on Entitlements

There has been much speculation that Obama’s promise to make substantive change to entitlements could presages the further erosion of the already tattered safety net’s coverage. (I’ve engaged in some of this speculation myself). But while the term “entitlement reform” has long been misused by Conservatives to mean “let the poor people and the geezers make it on their own,” there’s ample room to change things for the better, as well. 

On this front, a report in Saturday’s Washington Post is encouraging. The article reports that the Democratic Congress and Obama administrtation are pondering two big changes:

The first would allow the state to sign up literally all unemployed people on Medicaid with the federal government picking up the total cost. The second would provide subsidies so that people could be covered under COBRA, the law which allows people who have been laid off the right to buy health benefits they once got through their jobs.

A major reason for proposing such regulations is that the 7.2 percent unemployment rate has added 2.6 million people to the 45 million already uninsured.

These expansions would follow the health insurance legislation now going through Congress that provides health insurance for poor and working class children. The House voted for this program and the key Senate committee has also approved it. Bush steadily opposes the plan–but that obstruction will happily soon be gone.

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