The long debate over health care reform has now reached the end game, but there are still some obstacles to overcome before they can get a bill to President Obama’s desk. The question now becomes how the two houses of Congress can reconcile their differences.

The House and Senate versions of reform have many things in common, most important that both are projected to result in more than 30 million more Americans getting some kind of health coverage. The Senate and House bills both set up exchanges in which individuals without employer-sponsored health insurance and small businesses can shop for coverage. Both bills also include major reforms for the insurance industry that would prohibit insurers from excluding people from coverage for pre-existing conditions. Insurers also no longer would be able to base premiums on gender or occupation.

However, there are still some major areas of differences that both chambers must resolve. Here are the most important differences:

1. PUBLIC OPTION (and the health insurance exchange)

2. METHODS OF PAYING

  • Taxes
  • Coverage Mandates
  • Employer Mandates

3. ABORTION

4. MEDICARE

5. MEDICAID

1. THE PUBLIC OPTION

“I would let this bill go to conference committee and see if we can fix this bill more … Let’s see what they add to this bill and make it work. If they can make it work without a public option, I’m all ears.” -Dr. Howard Dean

Senate

No public option. In order to get the filibuster-proof 60 votes for the bill, Majority Leader Harry Reid scrapped the creation of a new government-run health insurance plan. It had been so weakened by the time it made it into Reid’s bill that it was expected to enroll only several million people, but it was still a deal breaker for conservatives like Democrat Ben Nelson of Nebraska and Independent Joe Lieberman of Connecticut.

House

Contains a public option. The House bill would create a new government health insurance plan to compete with private insurers.  But even though they kept a public option in its bill, it would be financed solely by premiums without any government subsidization and is a far cry from the versions that liberals had pushed, which would have pegged reimbursements to lower Medicare rates. This “public option” would have to meet the same coverage requirements as private insurers.

The Negotiations

Although some House members have signaled that they may be willing to drop the public option in order to get a final bill that could get 60 votes in the Senate, they will insist on getting something in return. Probably from the insurance exchange, a web-accessible, marketplace for insurance. The likeliest concession from the Senate would be more generous federal subsidies for individuals and small groups shopping in the exchange, along with possible changes to the scope of the exchange itself.

The Senate bill calls for state-based exchanges, which would have less bargaining power with providers and insurers, but which appeal to moderates in the Senate afraid of big government. The exchange would be national under the House bill. This means that those shopping in the exchange – including many of the currently uninsured – would be bundled together in large pools. If House Dems give up the public option, they may insist that the exchange be national.

The Senate bill does have two other mechanisms for providing insurance outside the standard coverage options. Like the House bill, it would allow for and initially fund creation of non-profit consumer-owned health insurance cooperatives, though most economists say such coops would not have a major impact on the insurance market. The Senate bill would also allow the federal Office of Personnel and Management to contract with private insurers to offer at least two multi-state plans in each state exchange. These OPM negotiated plans could be less expensive than standard state-based insurance offerings, but their overall impact would be far less significant than a public option

The Senate bill would direct the U.S. Office of Personnel Management, which oversees health policies for 8 million federal workers and their families, to contract with private insurance companies to offer policies on the exchanges.

2. METHODS OF PAYING

  • Taxes
  • Coverage Mandates
  • Employer Mandates

“I believe that the bill we passed in the House, though not perfect, would have been a major step forward in providing all Americans with quality, affordable health care that guarantees choice, and competition through a public option. Unless the final bill looks more like what we passed in the House, and less what we saw emerge from the Senate, I will not support it.” -Representative Anthony Weiner (D-NY)

Both the Senate and House bills would reduce the deficit by more than $100 billion over ten years, but they get there in very different ways. Both the House and Senate bills raise revenue by penalizing Americans who don’t buy health care coverage (mandates). Both bills would reduce Medicare spending, largely from cuts in the Medicare Advantage program. Both bills would also tax medical device makers, with the Senate bill also calling for massive fees on the pharmaceutical and health insurance industries. The Senate bill includes special fees on insurers, drug companies and medical device makers and would impose a 10-percent tax on indoor tanning.

Senate

  • Taxes: The Senate bill would increase the Medicare payroll tax for families earning over $250,000 and individuals earning over $200,000, but would also tax health insurance itself, applying a 40% excise tax on health plans valued above $8,500 for individuals and $23,000 for families. (Only the amount exceeding these thresholds would be taxed.) This new tax on so-called “Cadillac plans” would raise $149 billion over 10 years. Exceptions would be made for Americans over 55, those working in high-risk jobs and (initially) those living in states where health care costs are highest. But the excise tax on Cadillac plans has another purpose – by discouraging high-value insurance plans, health care economists expect overall medical spending to decrease. And, by taxing the fast-growing cost of insurance itself, the Senate plan may have a better chance of keeping up with medical costs, something a high-income tax like the House’s would not accomplish. Research also indicates that when workers get lower cost health insurance plans through their employers, wages increase.
  • Coverage mandate: The Senate mandate would phase in a $750-per-person annual penalty up to $2,250 per family or a penalty of 2 percent of taxable income, whichever is greater. The full penalty would take effect in 2016.
  • Employer Mandates: The Senate bill has no employer mandate–per se. But large firms with more than 50 workers would have to pay a fine of $750 annually per worker if any of their employees obtain federally subsidized coverage on the exchange.

House

  • Taxes: The House plan is to tax high income earners and it generates far more revenue and doesn’t affect the middle class like the tax on health insurance plans likely would. (Municipal employees and manufacturing union members are among those with high value high plans that could exceed the excise tax threshold). The House bill mandate would impose a 2.5-percent penalty tax on income up to the average cost of an insurance policy.
  • Coverage Mandates: The House bill would impose a 2.5-percent penalty tax on income up to the average cost of an insurance policy.
  • The Employer Mandates:  House bill would require employers with payrolls above $750,000 to provide health insurance to workers. Those who do not provide insurance would face a penalty of 8 percent of payroll. Employers with a payroll between $500,000 would pay fines on a sliding scale of 2 percent, 4 percent and 6 percent of payroll. Workers with employer-sponsored plans with costs deemed unaffordable — exceeding 9.8 percent of salary — may drop that coverage and purchase federally subsidized insurance on the exchange. In those cases, the employer would pay a fine up to $3,000 per worker receiving the insurance subsidy.

The Negotiations

Unions have been pushing Democrats hard to eliminate the tax on Cadillac plans or at least raise the threshold for which plans would be taxed, which could bring House Democrats on board without alienating Senate supporters of the excise tax. To make up for the lost revenue, Senate Majority Leader Reid could agree to a Medicare payroll tax higher than what’s called for in the current Senate bill.

3. ABORTION

“I will not vote for the Senate bill regardless of the abortion language,” Rep. Bart Stupak (D-MI)

Both sides in the debate generally agree on two things when it comes to health reform: federal funds should not be used to pay for abortions, and women should not lose their access to abortion services. The trick is how to keep public and private funds for abortion separate, and how far restrictions on abortion coverage can go before they effectively limit access.

Senate

The Senate bill, which was amended at the last minute to win the vote of Nebraska Senator Ben Nelson, would let states opt out of including plans with abortion coverage on the exchanges and would require anyone with abortion coverage to write two separate premium checks — one for the abortion coverage and one for the rest.

House

Also singles out abortion coverage as something patients must separately pay for, but by purchasing a rider. The House bill contains tougher language and it places stricter limits on abortion, prohibiting any insurance plans that cover abortion from participating in the public exchange and receiving subsidies.

The Negotiations

Reconciliation of the two versions is a numbers game for the Democratic leadership. Pro-choice politicians in both chambers are reluctantly willing to accept the abortion language in the Senate bill, but they have vowed to oppose health reform if the more restrictive House version wins out. At the same time, anti-abortion Democratic Congressman Bart Stupak, who authored the abortion restrictions in the House bill, is warning that he’ll bolt if the Senate version emerges from conference committee.

But the Senate version is strong enough for many of those anti-abortion Democrats, who are not insisting that Stupak’s language go untouched. And other changes in the Senate bill — including cost-saving measures, the elimination of the public option and certain family-planning measures such as increased adoption tax credits that anti-abortion Senator Bob Casey got put in — could pick up some additional Democratic votes even without Stupak’s support.

4. MEDICARE

“To those on the left, who are disappointed in what the bill does not do — and in some cases are even calling for its demise — I implore you to reconsider, to be a part of this solution even as we keep working on others, which I promise you I will do.”—Senator Jay Rockefeller (D-WV)

Much of the cost containment in both bills centers on Medicare– for two reasons. First, because the Medicare is such a big component of the federal budget, and second because it drives much of what happens in the private health insurance market as well— spending more than $450 billion a year. Both bills reduce the reimbursements that Medicare pays health care providers and Medicare Advantage plans.

Senate

The Senate bill contains an element that President Obama, and many economists, consider to be a potential game changer on health care costs. That is a 15-member independent commission, known as the Independent Payment Advisory Board. The board would have the power to bring down Medicare spending when it exceeds a certain measure of inflation. There would be limits to what the board could do though. It would not be allowed to recommend anything that would ration care or change benefits for current Medicare recipients. Congress could block the commission’s recommendations, but only if it turns them all down at once rather than picking and choosing.

House

The House bill does not contain such a commission, mostly because lawmakers wanted to retain the ability to set Medicare payments (which can be channeled to hospitals in members’ own districts), and partly because the proposal has come up against opposition by senior citizens groups.

The Negotiations

President Obama has stated that he wants the Independent Payment Advisory Board in the final bill, so some version of it probably will be. What remains to be seen is whether there will be an effort to weaken the commission’s authority, and as a result, its ability to impact health costs.

There are also a number of other differences in the two bills with regard to Medicare. The House measure, for instance, would require that the HHS Secretary negotiate pharmaceutical prices directly with the drug companies — something that the Senate is not likely to go along with. And both bills would establish a number of pilot programs to test innovative methods of coordinating medical care among providers; one major question is how much power the HHS Secretary will have to implement those programs on her own, rather than having to seek Congress’ permission to do so.

5. MEDICAID

“We need strong leadership so close to the finish line, not efforts to water down a bill to the breaking point.” – Rep. Raul M. Grijalva (D-Ariz)

The Medicaid program is jointly administered (and paid for) by the state and federal governments. Both bills would transform and vastly expand its mission. Currently, depending on each state, it is generally available to low-income people only if they are also elderly, disabled or pregnant. Both bills would make qualifying for Medicaid available on the basis of low income alone. Many health-care experts have said this is the most efficient and cost-effective way of expanding coverage to those of limited means. However, there are differences in how the two bills would expand Medicaid.

Senate

The Senate bill would put fewer people into Medicaid and set the upper limit at 133% of poverty (or $29,300 a year for a family of four).

House

The House would put more people into the program. Under this bill, those earning up to 150% (or $33,000 for a family of four) of poverty would qualify. The bill is also more generous in helping states pay for their share of the newly eligible Medicaid recipients.

The Negotiations

State governments have a huge stake in this and will watch the negotiations. States’ budgets are already nearly broke, and they say that they cannot afford the additional burden. That is one reason Ben Nelson negotiated a special deal in which the government would pay the whole tab for the expansion. There are likely to be other lawmakers clamoring for similar arrangements. Additionally, some governors have warned that their states do not have enough providers willing to accept patients under Medicaid, which in many states pays very low reimbursement. The poverty level in 2009 for an individual was $10,830 and for a family of four $22,050. Many states have eligibility requirements below that level.

HOW WILL THE BILLS BE MERGED?

Leaders of the two chambers are still working out how they will go about doing this—and momentum is important. One option may be to forego the conference committee, which would have to bring more negotiators — including Republicans — into the room, and instead have the leaders and their key committee chairmen try to hammer out an agreement that would then be submitted to the House and Senate for a final vote.

Senate and House Democratic leaders, the chairmen of the five congressional committees that wrote the legislation and top White House officials will negotiate the final bill. Most of the discussions are likely to be held behind closed doors. Republicans obstructionism makes them irrelevant, so the talks will be on settling differences among liberal and conservative Democrats to win the needed 60 votes in the Senate and at least 218 in the House.

HOW QUICKLY CAN IT BE DONE?

Since the two chambers are working with similar bills, the final negotiations likely will weeks rather than months. Democrats would like to have a final bill by the time Obama delivers his annual State of the Union address to Congress. Presidents usually give the annual address in late January, but Obama could deliver it in early February, giving more time to congressional Democrats to secure a final deal. One factor that could delay things is that they need cost estimates from the Congressional Budget Office to make sure that the price tag for the final bill remains below $900 billion over the next decade — an amount that Obama has insisted upon as the upper limit.

CAN ANYONE KILL THE BILL?

It would be hard for opponents to kill it. The bill is the top legislative priority for Obama. His fellow Democrats are motivated to give him a major victory at the start of his second year in office. Most analysts say the final healthcare bill will be signed into law within the next several weeks despite Republican opposition and efforts to slow it down.

WHAT HAPPENS AFTER THE HOUSE AND SENATE REACH AGREEMENT?

Both the House and Senate must pass the final version of the bill before it is sent to Obama for his signature.

Once it is enacted into law, some provisions would go into effect immediately, such as barring insurers from excluding coverage for children due to pre-existing conditions.

Democrats will emphasize the measure’s benefits as they try to protect their House and Senate majorities in November congressional elections. Republicans, who stand a good chance of taking some Democratic seats, are expected to stress Medicare spending cuts and tax increases in the bill.

Federal agencies will start writing regulations to implement the overhaul. A provision requiring everyone to purchase healthcare insurance might face a court challenge from people who believe the Constitution does not give Congress authority to require everyone to purchase a product from private companies.

“Nowhere has there been a bigger gap between the perceptions of compromise and the realities of compromise than in the health care bill. Every single criteria for reform I put forward is in this bill.” -President Barack Obama

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KQµårk 死神
Member

Cher another update. Like we talked about yesterday their seems to be a compromise deal with labor unions on the Cadillac taxes. It sounds like a good deal for them now. I like the common sense exemption for high cost healthcare states as well.

http://news.yahoo.com/s/ap/20100115/ap_on_bi_ge/us_health_care_overhaul

In a significant victory for unions, the 40 percent excise tax would not apply to policies covering workers in collective bargaining agreements, state and local workers and members of voluntary employee benefit associations through Dec. 31, 2017.

Rep. Joe Courtney, D-Conn., and others said the tax would apply to fewer plans than was the case in the Senate-passed bill and would exclude the value of dental and vision coverage. They added it would provide an exemption for residents of states where the cost of health care is particularly high, as well as for employees of high-risk professions.

A positive unintended affect I was thinking about is that it could be a factor in more workers seeking collective bargaining agreements in future. With all the pressure to destroy unions in this country the playing field needs to be leveled even more.

choicelady
Member

KQ – I totally agree that this could definitely increase union membership. But think of it! Hedge Fund Operators Local 101!!! Creepy Bogus Lenders Amalgamated!!! Brotherhood of United Overpaid Executives! Why – the possibilities are endless!

Seriously, thank you for this since it’s VERY GREAT NEWS. I knew they’d find a way!

KQµårk 死神
Member

😆 well they do have the sports players unions which are about the same.

choicelady
Member

Mentioned this to a labor union ally, and she said this is untrue because AFL-CIO said it was not very good.

My whole reaction, even as one who taught and loved labor people at Cornell U. over many years, is – HUH?

I am fed up with the nit-picky pesky “hates” that people seem to need to have. It is very discouraging to have people get something beneficial and have them disparage it because it’s not perfect.

I want to tell my allies: PEOPLE!!! REMEMBER 2000-2008!!! No matter what happens to almost anything, it is head and shoulders BETTER!!!! Get over yourselves! Grow up! Get a life!

I really have to learn not to hold things in so much, doncha think?

nellie
Member

We’re under a real “rewrite history” assault from the Republican Party. I just find people to be too gullible. Too ready to believe what they hear instead of their own experience. It seems to be just part of the human condition. There will always be those who follow — even if it’s over the edge of the cliff.

bito
Member

As Much as I hate chasing the hourly rumor, I am going to post this tidbit. FWIW: Charlie Rangel says they are shooting for the compromise by this Friday. Like I say, For What It’s Worth

KQµårk 死神
Member

It seems like the end game is close. How are you doing Bito?

bito
Member

OK, KQ, test days wear me out sometimes. Few more next week and then the Docs. Thanks for asking, and I’m glad your ticker is doing better. That’s great!

SueInCa
Member

Hey you take care of yourself too. We miss you when you are not here.

choicelady
Member

Hi- that would confirm what I was told yesterday save for the fact that it still has to go through some vetting in each house. I think there is still room for input during next week – still in ping pong mode, but I’m not sure how locked it it will be to prevent the delaying tactics of the conservatives. I’m good with CA state stuff. Have to admit The Hill baffles me often. There are rules and exceptions to rules that I think one has to discover from being there. Has the transparency of various Mystic Orders sometimes…NOT.

bito
Member

C’Lady, If you confirm, I believe.~~ House rules are hard to follow and they can be changed much easier than in the Senate. Just when one thinks they understand, smething new comes up. The one thing I do know, I want a size 15 foot in the door to get us to single payer, or insurance becoming controlled like a public utility.

Emerald1943
Member

Someone wrote earlier that if we had regulation of the insurance industry, we would not need the public option or single payer either. And that’s a good point. But you know as well as I do that the insurance lobby is never going to allow that. They have what seems to be an unlimited amount of money to stuff into our lawmakers’ pockets!

choicelady
Member

Hi Em – maybe not so much anymore. There are a number of things moving that would clamp a lid on them, and this is part of the deal that has to come if the pro-public option Dems are to pass whatever comes out. That was the best news I heard yesterday! I think the outrage against the insurance companies is felt all the way inside the Capitol by more and more legislators. I have some real hope that the exemption from anti-trust and the need to prove they have to have rate increases will be at least two major provisions of the bill when it’s finished. For me, hope springs eternal!

Emerald1943
Member

Wow! Choice, This is the first I have heard of this about the anti-trust. Please, please…keep us posted. You seem to have some very good contacts to get information. Also, the rate increase thing. They should have to justify those increases just as the public utilities do.

Maybe there’s light at the end of the tunnel…and it’s NOT an oncoming train! 🙂

choicelady
Member

I’m glad to convey what I know since I talk to congressional staffers, but what I know can be obsolete five minutes later! That’s the problem with the closed doors – we just do NOT know what’s going on. I understand why (so tea baggers don’t run amok)but it’s awfully frustrating!

choicelady
Member

Agreed! My size 5 1/2 (OK – small but mighty) wants the same. But I’m a realist and cannot, as a single payer ally of mine insists, advocate to scrap this plan and go back to the drawing board. There are those 18 million people. How can I say to them, “Too bad. You’ll have to wait 2-10 years to get that breast cancer treatment you need.” I just CANNOT do that to anyone who is facing chronic illness or even death. But that said, I also CANNOT say to people “Too bad. You will have to spend a fortune on your health care and have no choice other than NO insurance again.” I am hoping that Pelosi, Rangle, Waxman, Reid, Dodd, Harkin et al. are being mindful of real human beings in real peril.

Wish to hell I were a fly upon the wall. Where is Harry’s invisibility cloak when you need it?

Emerald1943
Member

Hey choice, do you mean Harry Potter’s cloak…or Harry Reid’s??? Harry Reid has not been very visible lately! LOL

choicelady
Member

LOL!!! Yes, Em – I mean Potter NOT Reid!

bito
Member

C’Lady you are singing my song. To scrap this bill is absurd IMHO. Progress is Progressive.

choicelady
Member

Indeed!!!

kesmarn
Admin

Cher, a very quick note to say how much I admire the hard work, thought and beautiful writing that is in this article. A serious mainstream publication would be crazy not to hire you away from the Planet and pay you mega-mega-bucks to do this. Don’t leave us, though!
Looks like a work day for me, so I can’t take all the time I’d like to tell you how truly wonderful this piece is. But it is.

Emerald1943
Member

Good morning, Cher!

Brilliant work! I haven’t seen anything like this comparison anywhere.

Back during the heated debate over last summer, I fought long and hard for the public option to be included in the bill. I even traveled to Washington in September to attend a march in support of it, at some considerable personal expense. Our march was scheduled for the day AFTER the Glenn Beck/teabag demonstrations.

It takes five days for a permit for any march or demonstration in the capitol. Mysteriously, our permit was canceled, with no reason given, four days prior to the march, while the teabaggers were allowed to go ahead with theirs. It was obvious that someone up there did not want us seen or heard that day. We were able to hold a small rally in the park adjacent to the Senate Office Building, out of sight and with no media…a tiny blip on the radar at best.

I came back from that trip, discouraged and disillusioned. I wish I had a buck for every petition, letter, email and phone call I made in the belief that our Congress would do what is just and right for the American people. But that is exactly what they are NOT doing. This debacle may be viewed as “progress” by some, but in my opinion, this is nothing but a gold-plated give-away to the health insurance industry! And our representatives have been well paid to provide it for them! It looks like our government is totally under the control of the lobbyists and special interests, and there is not a damned thing we can do about it. They will pass this watered-down, bastardized bill mandating coverage without a public option. Never in the history of this country has there been a federal law passed requiring the purchase of a product from a private company. How can this pass the constitutionality smell test? I suppose you could mandate away homelessness by requiring that everyone buy a house…

As the proceedings drag on, watch the insurance company stocks. You will be able to quickly tell who is winning this battle…and it ain’t the American people. It will be almost amusing to see what else they strip from the bill in committee…at least, it would be if it were not so deadly serious.

I have written it before, and no doubt, I will write it again…until we demand sweeping campaign finance reform, we will not see any legislation passed by Congress that benefits the American working people over the big corporations! We do indeed have the best government money can buy!

Sorry for the long rant, but this is a major sore spot with me! Thanks again for your hard work on this article. This is what I would call “REAL” journalism. I look forward to more from you!

KQµårk 死神
Member

I totally understand your frustration but I knew the PO was dead when it was not open to everyone. The last House version was a token PO and is not much different from a bill without the PO.

I disagree that it’s just a giveaway to private insurance unless you say it’s also a giveaway by the federal government to give tens of millions of middle class families relief from paying higher premiums as well.

Also the healthcare industry does not want this bill for good reason. It will finally reign in their worst practices and even limit their profiteering. It simply will benefit too many Americans then to summarize it in such stark terms.

choicelady
Member

Emerald – We vigorously (and pretty much alone) opposed Gov. Schwarzenegger’s plan to mandate purchase in the private market. There is not even a term in economics for that! Only precedent I can find – feudal tribute. That said, the way they seem to be moving is as Switzerland and Germany started – yes, everyone has to have insurance, but the government (national or state is still an issue) regulates their premiums and makes HUGE provision (unlike CA) for lower-income people to have major support financially AND significant limits to deductibles and out of pocket expenses. MA and CA were proposing (and MA has) deductibles of $5K with OOP at $10K per person per year, and that’s outrageous. What I have read – and who knows if this is still in the works – is real subsidies and the possibility that all preventive medicine for the maintenance of health is NOT subject to deductibles – that would come in for only hospitalization. If those provisions prevail, then this moves us WELL toward truly affordable health care coverage. If it capitulates to the insurance industry and follows the MA plan, it will not. Too many people in MA are using their insurance for only catatrophic care – that is horrible.

My organization is watching closely because what happens with the terms of the mandates does determine the degree of our support or opposition. Our principles of humane treatment of all people rests on understanding that health is a human responsibility, one to the other, and that we must share the abundance of our resources freely even as we practice good stewardship with them. My biggest problem is the bar to documented immigrants – if they have lived here and paid taxes, why the five year wait? That’s outrageous. Compassion AND good health judgements also mean it makes good sense and is a moral imperative that undocumented immigrants be permitted to purchase insurance in the national exchange. Germs and viruses don’t know boundaries. All human beings deserve to have access to some kind of coverage. That also means the House desire to expand community clinics is essential – that is where rural and urban poor as well as undocumented immigrants get the best assistance now. We need a much better network of those.

So much of this hangs on details. We would prefer single payer, but if this follows the Swiss and German models, it will be moving us in the right direction for that. One of the strongest single payer supporters in CA has said if we had absolute rate regulation, you would not NEED single payer. That then remains a way of soothing the savage breast of fear mongers AND achieving what Switzerland and Germany have done.

Getting what you want quietly and through incremental change always struck me as “the American way”!!!! We seem utterly incapable of massive alteration of the status quo, so starting well matters a very great deal. An earlier post (sorry I forgot whose) on Social Security, Medicare, et al. showed how long that took us to get right.

Hope that brings you some small optimism, Em?

KQµårk 死神
Member

The Netherlands, Singapore and many countries have private only systems and most countries have hybrid systems like Japan that are lower cost than ours and more effective. With Medicare and Medicaid our system is actually going to be a hybrid system. It is now but without the universal coverage.

Emerald1943
Member

Hey choice! Here is the quote from Cher’s article that I mentioned below:

“Once it is enacted into law, some provisions would go into effect immediately, such as barring insurers from excluding coverage for children due to pre-existing conditions.”

While this is most worthy of immediate passage, what about the rest of us? The devil is in the details.

choicelady
Member

Hi Em – I’m answering above and below – seemed easier.

I learned yesterday from Sen. Sherrod Brown’s (D-OH) staff person on health that no, it’s NOT just for children. If all goes as planned (and I cannot be definite) then everyone with a pre-existing chronic or life-threatening condition and uninsured 6 or more months will immediately go into a catastrophic care pool and be covered. I have no idea what the terms of this might be, but it is intended for those who simply cannot afford or obtain coverage. That would be 18 million men, women, and children right off the bat.

A word about the lack of transparency. Like Colbert’s The Word: tea bag (OK – TWO words). The outrage from the right (and let’s be honest with Ms. AH even the left) has forced them to do this behind closed doors so their energies don’t have to go in putting out fires based on lies (You LIe! and Death Panels!) instead of creating a decent bill. I don’t like it. I do understand it. If I were there, I’d do the same. There are only so many fools a body can entertain in a day.

Do I have hopes? Yup. The parties involved are all progressives save Baucus, whose personal problems with favoritism for his girlfriend have subdued him, and that means a great deal. The Baucus “Never Met an Insurance Donation I Did Not Like” bill is dead. Doesn’t mean we will get the public option (though I wish the WH and Reid would now melt Lieberman into the ground for the 60th vote) but we will likely get a vastly better plan than Baucus’s with a lot of what the House prefers.

Pelosi and Obama are leaning HARD on true affordability and broad access with an emphasis on fulfilling the essential democratic and humane promises of America. This information I derived from Pelosi’s health care consultant yesterday, and I believe it.

One thing I asked Brown’s consultant was whether the conservatives could use delaying tactics, and she said not much – there will be a couple of 60-vote hurdles, BUT when this bill comes forward, IT CANNOT BE AMENDED which leaves out the Reep playbook of stalls and obfuscations!

Because it cannot be amended it is essential that we all express our wants NOW. It really does matter. Write to Reid and Pelosi if no one else – they take email from everyone.

Will this be perfect? Nope. But it can be beneficial to millions if we make clear that we won’t settle for paying for something we cannot afford to use. I really believe we are being heard, and I think this will prove to be a good first step.

Hope that helps?

Emerald1943
Member

Choice, yes it helps. It has been difficult to get much detail in the past couple of weeks, I guess, due to the closed door meetings. I don’t like it either, but I can understand. It has been nice not to see Mitch McConnell or John Boehner on TV everytime there is an open mic.

Yesterday, I believe it was Chuck Todd of NBC that made the statement that the White House was “exhausted” from political battles…not his exact words but that’s the gist. I would imagine that they are! They are probably glad to take a little media break from all the hoopla on this subject.

choicelady
Member

Indeed! I respect the degree to which the President has left this to Congress and then the degree to which he is now wading in. That is a critical balancing act. He learned from the Clinton debacle that this had to be done by Congress first. He knows from history that now his presence and leadership are essential. I’m very admiring of his respect for the democratic process. Democracy is messy. No way around that.

Emerald1943
Member

I got really PO’d at how the President was being crucified for not getting into the fray earlier. I had written the same thing that he was a student of history and knew well what the Clintons went through. I just hope he will be very involved now. We need him to be!

Emerald1943
Member

Hi Choice! Good to see you here! Yes, I know that the incremental way is the way change will have to come. We don’t do too well with the pitchforks and torches in the streets like the French do! 🙂

I agree with you about the responsibility part. We all do need to participate to make sure that the least of us has decent medical care. But I fail to see how that is going to happen with this bill. Forcing people to buy expensive insurance from the same greedy bastards who have been ripping us off for years doesn’t seem like the best way. If I could see some serious cost controls or rate regulation, I might feel better about it. As I said, it will be interesting to see how much more is stripped out of the bill in committee.

I noticed one item in Cher’s article about the denial of coverage for pre-existing conditions…it mentioned only children. Perhaps I read it the wrong way.

choicelady
Member

Hi Em – you made me laugh a lot because with respect to the CA budget, I end my emails to allies: “Pitchforks! Torches! To the streets!”

You have to save that for REALLY big stuff, and Arnold’s disgusting, anti-people budget would be that big stuff.

On the other hand, I don’t see anyone behind me with more pitchforks…Sigh.

Emerald1943
Member

Choice, neither do I. 🙁

The problem, I believe, is that so many millions in this country have employer provided health care coverage and are happy with it. The public option, for instance, will not affect that many people, and many of those are the poor, the unemployed, some of which really don’t have access to let their voices be heard. They do have advocates but those advocates are drowned out by the lobbyists and the industry scare tactics. It’s hard to get the average American couch potato to get up, turn off the TV, and get involved, especially when they listen to Faux every day and believe the lies and distortions.

javaz
Member

Good morning, Em.
Was a reason given for denying or canceling your permit?
This is disturbing to learn about this, and makes me wonder about the motives of those who issue such permits for protest.
Very troublesome and my conspiracy-loving mind is kicking into overdrive.

Emerald1943
Member

Hi javaz! I never learned of any reason for the permit to be revoked. It was apparently arranged some weeks in advance by a Democratic Congressman…can’t recall his name but will find it and let you know. Apparently, his office was responsible for pulling the permit too. ???????

We were originally supposed to gather on the National Mall at noon that day. If you have been there, you know it’s HUGE, stretching from the Washington Monument to the Capitol building. We were supposed to meet and march to the Capitol. The organizers attempted to contact everyone by email to let them know NOT to meet there, but instead to go to the park next to the Senate building up on the hill. I suspect that many people did not get the message and when arriving at the Mall, did not see the rest of us. It is a rather secluded spot, surrounded by large trees and out of sight of the Mall itself. I saw one local TV cameraman there, but no other coverage. If you remember, the teabaggers got PLENTY of coverage of their event.

The circumstances were just too strange! I remember seeing a group of Jamaicans, perhaps 250 in number, demonstrating on the very steps of the Capitol Building at that same time. I guess that was more important than our little issue…snark, snark!

choicelady
Member

Hi Em – at the same time, a fair number of progressive faith leaders were given the same standards as yours – off to the side, mostly out of sight. It was their belief that the issue was safety – that even though the teabag group was quite small, it was considered potentially very dangerous. So the Capitol police moved to keep the groups very much apart. Since the teabag folks had gotten the first permit, the rest (you, clergy) were in second-class space. I don’t LIKE that, but upon reflection, that might have been a good strategy. The teabag people here in Sacramento last summer were downright scary. I’m usually pretty outspoken, but I avoided them like the plague. So it might not have been designed to silence you so much as to protect you. Can’t say that for sure, but that is what happened to the clergy group.

Emerald1943
Member

Thanks choice! That makes sense, except that the tea baggers were there the day before, not on the same day. Some of them were still in town but were mostly doing the tourist bit, visiting museums, etc. I saw some of them in the Smithsonian while I was there. They were in their charter buses all over town, but very few on foot as we were.

You’re right about them being scary though! Thanks for the info.

choicelady
Member

Gosh Em – the clergy were there with the teabag folks, so your experience is deeply troubling. I’d missed the fact it was AFTER they’d disbanded. That is NOT good. I don’t understand that. Has anyone asked the Capitol cops WHY? Sometimes it takes a direct question to get an answer (true, indifferent, or bad!) I don’t like to read this though – those are leftover Bushie tactics.

Emerald1943
Member

I was not among the organizers of the event. I sent several emails after I returned home, trying to get some answers, but I never got any reply. I really never thought of calling the Capitol police.

Another march was to be held in October, but it never took off. There was some talk of a march scheduled for tomorrow in Washington..Jan.15th,but I have heard nothing about it from MoveOn or anyone else. I don’t know if it’s still being held.

escribacat
Member

Emerald, I was wondering what happened with that. I remember getting emails and reading posts about it but then it seemed to just vanish when the time came. Very strange. And how frustrating that people like you went to all the effort to go here.

Emerald1943
Member

Hi e-cat! Good to see you! It was really strange. I am going to try to find the name of the Congressman who got the permit…and then had it revoked. I wonder if he is on the lobbyists’ payroll!

Emerald1943
Member

Hey Choice and E-cat!

I just found the Congressman’s name…Chaka Fattah, D-PA 2nd.

He was reportedly the one who obtained the permit in the first place. I was told that it was his office that requested that it be revoked.

I just looked at his campaign donations and will have to do a little more digging. The donations listed were not broken down into categories such as health care, etc. I’ll post more when I find it.

bito
Member

Em, did you go to this site and do a search on him? http://www.govtrack.us/
You may find a list of his contributors there.
Edit: govtrack uses opensecrets, so never mind.

Emerald1943
Member

I went to OpenSecrets.org and it looks like Rep. Fattah did not receive a large amount of health care lobbying money, so that blows that theory. He did have much more from Labor than other categories.

AdLib
Admin

Cher, your remarkable article is evidenced by the remarkable responses it has inspired.

Especially mine.

Seriously, excellent and thorough job!

As to the points you raise, it would be wise for Obama to back and the Senate to support a nationalized exchange. The Progressives have had the Public Option ripped away from them, this could be at least a modest salve on that wound and not be another unnecessary kowtowing to the insurance corporations.

On methods of paying, this seems like a simple one. The wealthy, who have made more money than ever off of destroying health care and our economy pay or the middle class and lower middle class pays. Obama doesn’t seem to recognize that people have to pay their taxes just two months before primary elections. They will indeed remember having to scrape up thousands of dollars to pay taxes (which the wealthy don’t have to pay their fair share of due to offshore banking and loopholes). And the reason for those taxes? They have good health insurance plans.

Huh? People should be taxed BECAUSE they have excellent health insurance? That is so messed up! This will undermine Obama if it is the case, the union folk will not donate generously as they did in 2008 since they will have to donate thousands to the IRS instead.

There is a possible wild card in passing HCR. If Coakley was to lose Teddy’s old seat in MA to a Repub, they would not have 60 votes in The Senate. Then what?

It is possible though not probable that she could lose, she has been losing her lead in polls taken on probable voters.

I just wish we had a Senate Leader with balls who would just use the Nuclear Option to get rid of the filibuster, bring democracy back to The Senate and pass the robust health care reform with a Public Option open to all, just as the public wants.

KQµårk 死神
Member

Cher’s story exemplifies the type of journalism we are missing today. First it answers all the W questions and How which is the foundation of journalism. She states the facts in a tremendously organized fashion with quotes from the key news makers. Then she intertwines her thoughtful opinion with the facts in a wonderfully written argument. Most of all she shows by omitting present day hyperbolic spin that you can have a straight opinion piece based on facts that does not have a hidden agenda.

Speaking of budget reconciliation, one thing we have not heard about at all is how this Congress is going to deal with the expiration of the Bush tax cuts.

whisperingn woods
Guest
whisperingn woods

Wow, first of all a very impressive article by Cher, very informative!
I like the house version better. A bill with taxes and no public option, what was Reid thinking?

KQµårk 死神
Member

Reid claims Lieberman stabbed him in the back on the PO.

A good article of how things went down on the NYTs.

http://www.nytimes.com/2010/01/24/magazine/24reid-t.html?ref=politics

escribacat
Member

Thanks for the post, KQ. He’s an interesting guy who has to do a lot of the dirty work that no one else wants to do.

Hopeington
Member

I’m going to have to save this til later Cher, but, from what I’ve read so far, I can tell I’ll be better informed after I do!!
I’ve got to go take care of things outside before the rain starts pouring down again!!

KQµårk 死神
Member

Cher excellent rundown of the situation and substantial differences in the two bills. Obviously the House bill is better, save for the Stupak amendment, for progressives.

I’m not totally against taxing private insurance for their highest cost plans. The biggest problem I have now is that the ceiling is too low and will affect too many middle class workers. One of the things that perpetuates private insurance is that they get a double free ride by cooking their books to maintain “non-profit” status like BCBS and no matter how high premiums go up they are tax exempt. Both these factors lead to upward pressure in premium costs and worse solidifies the employee based system we have.

I’m glad the president is supporting the House version of the national exchanges because that’s the biggest way in a private and non-profit model to put downward pressure on healthcare costs.

Time an time again I try to get this point across but it falls on deaf ears many times, just pooling the risk in a universal or near universal system lessens the increase in healthcare costs by the largest factor. I learned that from Krugman and an unaffiliated Commonwealth Fund study.

How universal healthcare lowers costs.

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Jun/Fork-in-the-Road.aspx

With no universal healthcare costs will rise 6.5%
With only private universal healthcare costs will rise 5.8%
With universal healthcare with public option costs will rise 5.6% (keep in mind this number was tabulated considering the PO would be available to all not only to the uninsured like the last House version so cost decreases would be much lower.)

The Commonweal Fund has done another study of the two bills and this biggest difference is the House bill will provide more coverage to more people faster and cheaper.

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jan/Health-Insurance-Provisions.aspx?page=1

nellie
Member

Cher, you are awesomeness.

I have to read this a few times before I comment, but wow — what a great job of reporting.