"Public Option" Would Only Be Available To The Otherwise Uninsured

[Better Believe It]

"Public Option" Would Only Be Available To The Otherwise Uninsured
TPM Cafe
July 16, 2009

I'm not sure that people really understand how the "public option" would work, given the rhetoric of the adminstration that people could "keep" their current insurance if they want to or choose a public option.

Last night on The Daily Show, Secretary Sebelius, in response to a question, made things a bit clearer regarding just how the public option would work. She was asked "who would choose" whether or not to use the public option: the employee or the employer? The Secretary said essentially it would be the choice of the employer because if the employer provides health insurance then that is the insurance the employee would have to use. Only if the employer chose not to provide health insurance would the employee be able to enroll in the public option.

Most of the people I know that have employer provided health insurance are glad they have insurance as opposed to not having it, but they hate the plans they have because the expense is totally unreasonable and with each passing year, less and less coverage is provided while costs go up. So, leaving the choice to employers is not the same as providing choice to citizens at all.

http://tpmcafe.talkingpointsmemo.com/talk/blogs/oleeb/2009/07/public-option-would-only-be-av.php?ref=reccafe

-------------------------------------

It appears that the "public plan" may not kick in for employers with more than 20 employees unless "the Commissioner" permits larger employers to join the public plan in 2015!

And congressional aides say only about 9 million will be insured by public plan by 2019! 21 million will be insured by private companies in the exchange by 2019. Another 164 million would be insured with private insurance through their employers.


----------------------------------

The Health Insurance Exchange: It's run nationally, though states can opt out of the national structure and go it alone if they choose, and if they follow federal rules. In the first year, it accepts those without health insurance, those who are buying health insurance on their own, and small businesses with fewer than 10 people. In the second year, it accepts small businesses with fewer than 20 people. After that, "larger employers as permitted by the Commissioner." In other words, expansion is discretionary, not mandated. The only people able to access the public plan in the early years will be on the exchange, and the exchange will be, relative to the population, pretty limited. So the public plan will be limited, and so too will any anticipated savings.


http://voices.washingtonpost.com/ezra-klein/2009/07/the_house_releases_its_health-.html?hpid=news-col-blog

http://www.reuters.com/article/reutersComService_2_MOLT/idUSTRE56D7JX20090714

[RBInMaine]

1. In any case, make no mistake, it will shock may private co.'s into reducing costs.

[Better Believe It]

2. Only 9 million people will be covered by the public option in 2019

That sure doesn't seem like a whole lot of pressure on private insurance.

[RBInMaine]

5. You are working off just one estimate. And tell me, then why are R's and Ins. co's fighting public

option tooth and nail???

[Better Believe It]

9. Because they don't want any healthcare that involves the gov't and that might tax the rich.

I thought everyone understood that.

They will oppose any legislation, no matter how weak it might be, that raises taxes or increases government involvement in the economy. It's a "free market" principal!

[RBInMaine]

46. Yes, it was a rhetorical question. Fact is, public option scares the shit out of the corporate

right wing, and the fact also remains that single payer will not happen now. Just ain't happening. So rather than making the better the enemy of the ideal, let's at least do this, strike a blow against the right wing and R's, have an advance, and get something done for Americans. Stink as it might, single payer isn't happening now. I wish it could happen too, but it isn't. Period. So take the next best thing. That's politics. That's reality. Holding out for single payer right now at the expense of public option, frankly, would be a stupid move for progressives. Even Howard Dean agrees with my point.

[Oregone]

42. LOL. Yeah, they sure will be shocked and awed

We will smoke them insurance companies out




Look, I don't know how true this all is (seems like everyone still has their head spinning), but if it has to build up a premium reserve AND cover the previously uninsured (high payout group) AND not be able to deny treatment, it may not be competing so well. Time will tell. Who knows

[valerief]

3. So if our employer pays for a portion of our health insurance, the insurance

companies can continue to deny our claims.

I really want a single payer system run by the govt. I really want to see medical insurance GONE.

[Still Sensible]

4. If that interpretation is correct, it is not really a public option

IMO... the real "robust" public option takes off and works when those employers decide it is better for them to insure their employees through the public plan than to pay the ridiculous overhead they have been feeding to private insurers. That will get the program to critical mass, and therefore effectiveness, faster.

One thing that has been exasperating to me is that our side hasn't campaigned hard to gain the support of small business interests for whom a strong public option would be a financial life raft.

[uponit7771]

11. Well, right now the average is 12k per employee...that's the avg. If they're talking about

...5000 per employee then I think they'll kick the public option to the curb

[kath]

6. Then this bill is non-reform "reform", which will likely be worse than

nothing at all - it will then be decades and decades before we get anything approaching WHAT EVERY OTHER DEVELOPED DEMOCRACY HAS.

The "mother of all sell-outs", indeed.
Bring out the pitchforks.

[LiberalFighter]

7. What is an employer likely to do? Keep using the insurance they have with higher premiums

or go with public plan?

[Better Believe It]

12. They can't go with the public plan before 2015 and might even be excluded after 2015!

So yes, they have several major choices. They can Continue private insurance with higher premiums, require employees to pay a bigger percentage of those premium and have higher co-pays, reduce health care benefits or totally end health insurance benefits for workers.

[uponit7771]

17. Avg employer plan cost 12k, I think they might go public option...I can see 5000 being an...

...option now VS 12k and see what insurance companies are so sKeered

[damntexdem]

8. If it proves cheaper, as is likely, wouldn't private companies have incentives to offer it?

Except companies acting from RW ideological views -- and they deserve to have to pay more.

[Better Believe It]

15. Priate companies can't offer the public plan if they have over 20 employees

without government permission and they can't request such approval until 2015!

http://voices.washingtonpost.com/ezra-klein/2009/07/the_house_releases_its_health-.html?hpid=news-col-blog

[madfloridian]

10. Well, hell....tell Doctor Dean to shut up and sit down.

Silly man, all this time he thought it was going to be about "choice."

http://journals.democraticunderground.com/madfloridian/4219

[flpoljunkie]

13. She also replied, 'Not necessarily' when Stewart asked if the public plan would cost less.

[Better Believe It]

16. Of course not. That would be an unlevel playing field for private insurance!

Can't have that.

But, if public insurance doesn't provide better benefits and cost less than private insurance why in the world would anyone want it?

[WI_DEM]

14. I want to keep my insurance thru my job which is very good, but I'm glad to know that if I ever lost

my job or insurance that there is a public plan out there.

[uponit7771]

18. ..at 5000.00 per person per year MINIMUM a family of four pays 1700 a month...that stupid

[juno jones]

19. So if my employer (like one I had in the past)

Has the world's crappiest cheap insurance, ie: high deductable, high co-pays and a riduculous ceiling of less than thirty grand or so on each illness, I would STILL have to have that insurance rather than a public plan?

What kind of choice is that? :wtf:

[Better Believe It]

21. That appears to be correct.

However, if you lose your job and are unemployed you might qualify for the public plan in 2013. Before 2013 you can wait in line at the emergency room.

Now, the public plan offered in 2013 may not be cheaper and/or offer better benefits than private insurance, however, you still get to decide what you want! And you'll probably get some help from the government to pay for part of your private or public health insurance premium if you're poor.

[juno jones]

57. I can wait in emergency now.

I'm uninsured. My current job doesn't offer it. I just want to make sure I can get the public plan regardless of my employer's status.

I also want a mandate that requires docs and hospitals to take the 'public option' and medicare. We have two public clinics in our city (county seat for basically big rural county). We have people driving hours to get here. We have waiting lists that are months long. The public option has to be accessable, which means that either local docs must be compelled to take the policys or some kind of service has to be put in place to service these areas.

Medicare is a great program, but it is already stressed and hard to obtain. The public option needs teeth and powers of enforcement.

[lumberjack_jeff]

24. Employers' insurance must comply with the new guidelines. n/t

[juno jones]

58. I hope so.

but I would rather have a public option no matter my employer. In my profession, the employers do not always have their employees best interest at heart.

Which is ironic because the employer who offered the crappy insurance was actually a big sweetie progressive who wanted his employees to have a chance at insurance. Crap scam insurance was all HE could afford.

Most of my other employers either have not bothered or only had insurance for salaried workers.

[NYC_SKP]

20. I LOVE it, it's PERFECT for me and millions of others.

I get a $200 monthly "allowance" to pay for whatever I can find, so I'm in heaven over this.

And if I'm ever between jobs, I'll have it.

Anyone looking for sweeping, mandatory, wholesale, everyone-gets-the-package-all-at-once healthcare will die before it ever happens.

It will never happen in one action, there aren't enough like-minded Democrats for it to even be possible.

This is good.

People without a plan through work will get a plan.

Perfect.

[harun]

22. I think that is misleading. I can't see them not allowing businesses

to choose to have the Public Option along side their current choices for employees to choose from. I don't think all would do it but certainly some would choose to.

I don't think that was clear. If they actually put in to this bill some bullsh*t about employers not being able to have this as a selection for their employees no matter what then that is completely unacceptable.

[NYC_SKP]

25. Sebelius implied that businesses would likely opt for the public package.

That's the beauty of it.

Businesses are likely to "choose" it rather than be forced by big-brother government to "take it".

:evilgrin:

[Better Believe It]

27. The bill clearly states that employers with over 20 workers can't qualify for the "public option" ..

before 2015 and that employers with over 10 workers can't qualify for public insurance before 2014. After 2015, the commissioner may permit employers with more than 20 employees to buy public health insurance .... of the commissioner might not approve larger employers to sign up. There is no requirement that larger employers be allowed to obtain public insurance.

That's clearly explained beginning at page 74 of the House bill.

http://energycommerce.house.gov/Press_111/20090714/aahca.pdf

The bill confirms the following report:

The Health Insurance Exchange: It's run nationally, though states can opt out of the national structure and go it alone if they choose, and if they follow federal rules. In the first year, it accepts those without health insurance, those who are buying health insurance on their own, and small businesses with fewer than 10 people. In the second year, it accepts small businesses with fewer than 20 people. After that, "larger employers as permitted by the Commissioner." In other words, expansion is discretionary, not mandated. The only people able to access the public plan in the early years will be on the exchange, and the exchange will be, relative to the population, pretty limited. So the public plan will be limited, and so too will any anticipated savings.

http://voices.washingtonpost.com/ezra-klein/2009/07/the_house_releases_its_health-.html?hpid=news-col-blog

[harun]

32. They should change that. The big employers are where they could

get big pay-ins to the plan. My employer spends a huge amount of money to insure me. I would rather that money go in to the Public Plan.

[lumberjack_jeff]

23. It's true that members of a group plan through an employer...

... can't force their employer to contract with the public plan instead. Is that really what everyone was expecting?

That's one of the downsides of our system of employment-based insurance.

[Better Believe It]

28. Many employers can't contract with the public plan if they want to!

Those with over 20 employees might be permitted to subscribe to the public plan if approved by "the commissioner", but, they have no legal right to the public option under the House legislation.

Read the bill starting at page 74.

[lumberjack_jeff]

30. In the short run, this is true.

I find it useful when trying to solve a problem, to define it really well
1) costs are skyrocketing
2) 50 million lack insurance
3) insurance companies are free to kick people off because they get sick.
4) insurance companies cherrypick their subscribers, leaving those who most need coverage without it.
5) most bankruptcy is caused by illness
6) the public is served best by public solutions
7) leaving a job means leaving your insurance
8) insurance companies have limited oversight and don't operate transparently
9) costs are high because the uninsured still get care, but through the most expensive avenues.
...
99) people who work for companies of over 20 people, although they are already insured, and now have the security of knowing they won't lose coverage in event of being laid off, might want to join a hypothetical public plan, if the price was better, before 2013. Maybe.

This is way down the list of immediate problems.

[Better Believe It]

34. A lot of maybe's!

"people who work for companies of over 20 people, although they are already insured, and now have the security of knowing they won't lose coverage in event of being laid off, might want to join a hypothetical public plan, if the price was better, before 2013. Maybe."

None of the people you cite will be able to join a public plan before 2013. None of them.

The fact is millions of more people will be uninsured and in worse financial shape during the 2010 and 2012 elections.

We need a true universal health plan before those elections take place.

And if we don't have it, what do you think will happen in the 2010 and 2012 elections, not to even mention the terrible conditions tens of millions of people will confront in their daily lives.

[lumberjack_jeff]

36. No. Bullshit. Stop the misinformation.

With the exception of some people who would rather pay the penalty than get insuance, this bill will essentially eliminate the uninsured.

The public plan is available to every uninsured american on day one, 70% of whom can get the coverage either free or at a big discount.

The large companies who would like to shift over to the new cheaper plans within the exchange will have to wait until the exchange is ready for them. In the meantime, those people are insured, and not an emergent problem.

The bigger electoral problem are those who are uninsured by choice, and who resent being forced to accept any responsiblity for their own wellbeing.

[Better Believe It]

44. I wiil now prove you are 100% wrong. Haven't read the legislation?

You should read the bill if you'd like to know what's happening.

You wrote:

"The public plan is available to every uninsured american on day one, 70% of whom can get the coverage either free or at a big discount."

That's total bull shit!

The House "Public Option" won't kick in until sometime in 2013.

Here's the credible link .... the text of the House healthcare bill.

Read pages 117 and 14 of the House healthcare bill at:

http://energycommerce.house.gov/Press_111/20090714/aahc...

Now let's see your link indicating the public option kicks in on day one when it's signed by the President.

Or by day one did you really mean in some unspecified date in about 4 fricken years .... in 2013?

Are you just trying to be cute by playing some sort of word game in order to confuse DU'ers?

Sorry.

You can't get away with that.

We know how to read.

[lumberjack_jeff]

48. You are right. I am wrong.

I read "Y1" in the bill, combined with commentary pulled from elsewhere led me to understand that the ramp in began this year and was completed in 2013. In fact, the ramp in begins in 2013 and runs into 2016.

I was wrong, and I was an asshole about it.

:hurts:

[Better Believe It]

53. No problem. We all make honest mistakes. Even me!

Really.

I do.

I know that's hard to believe.

:)

[BattyDem]

26. What would stop employers from simply dropping their health insurance plan?

Even if they are fined for not offering health insurance, wouldn't those fines still be considerably less than the insurance premiums they're currently paying?

Some people have great insurance from their employers and I can understand why that company would continue to offer it - they don't want to lose their top employees. However, some companies take money out of their employee's paychecks to subsidize the premiums for a crappy insurance plan with high-deductibles and copays. Why would that company continue to pay outrageous premiums if they don't have to? Why would the employees want to continue with that plan? :shrug:


edited: typo :blush:

[lumberjack_jeff]

29. What prevents them from dropping their health insurance plan now?

:shrug:

[CTyankee]

31. I don't think employers want unhealthy employees working for them.

What I have noticed since being on Medicare is that the nonprofit sector attracts people in this category who are too young and able really to retire but don't require health insurance. Either that or they have people who have coverage from a spouse. These nonprofits are usually small and cannot afford to offer health insurance. This situation helps employ older workers who have been shut out of the for profit workplace...

[Better Believe It]

33. Nothing. In fact, employers have been doing that or cutting benefits.

And that means more people will be uninsured over the next few years.

[lumberjack_jeff]

37. which makes getting something in place this year more urgent, right? n/t

[Better Believe It]

39. Right. But that won't happen under the bill.

[BattyDem]

40. To be honest, I can't believe employers haven't done that.

Why the hell do they all keep paying ridiculous amounts of money without question? :shrug:

Most individuals and families can't afford a decent health insurance plan on their own. The majority of "good" plans come from employers. It seems to me that only way we'll get single-payer in this country is if all the companies say, "F*ck it! We're not paying these prices anymore! They're ripping us off!" With the vast majority of Americans without insurance, something would have to be done ... right?

[lumberjack_jeff]

41. Yeah, I suppose the survivors might do that. n/t

[BattyDem]

50. I don't understand your comment.

Is it snark or sorrow ... or both? :-) Sorry ... perhaps I'm a little dense today. :hi:

People are already dying because of no insurance and/or crappy insurance that refuses to pay for treatment. Obviously, I don't want more people to lose their insurance, I'm simply trying to figure out why employers, who foot the bill for the crappy system, haven't done anything up until now. For the most part, THEY are the consumers, not individual people, so why haven't they used their power? Why haven't they demanded reform? It doesn't make sense. :shrug:

[lumberjack_jeff]

55. If the vast majority of people became uninsured...

... those that survived the experience would be motivated to do something. Sorry for being cryptic.

[BattyDem]

56. Oh ok ... thanks for clearing that up. I wasn't sure what you meant. :-)

That was my thinking, too. It would be very unfortunate for all of us if the crisis had to get that bad before something was done (it's already bad enough right now), but sometimes, that's what it takes. :-(

[vaberella]

35. I don't like Op-eds of what someone says. Give me the direct quote from Sebelius or it's crap. n/t

[Better Believe It]

38. Does it need to be notarized by Sebelius to meet your requirements?

:)

[flpoljunkie]

43. Private insurers will be competing for those eligible for subsidies in the health insurance exchange

[quidam56]

45. YES WE CAN !!!

As a former health care giver, I am shocked and saddened to see what has become of health care in America. $ 1. 4 million is being spent per day in DC by the health care lobbyists so your elected representative is getting taken care of and has quality health care we pay for and can't afford ourselves for our families, I know what is deemed, defended and supported in Tennessee and Virginia as quality health care and clearly profit care comes ahead of patient care. http://www.wisecountyissues.com/?p=62 MRSA ( methicillin resistant staphylococcus aureas ) is infesting our communities because filthy, uncaring hospitals and emergency rooms are breeding them and spreading them into our schools, homes, restaurants. How many more Americans' will be diseased or die while 74 % of Americans' are begging for health care reform ? More people died in America last year from MRSA complications than AIDS. When MRSA and a flu bug start mixing, it won't be pretty and we are being infected by the very health care system we depend on and trust to keep us safe and healthy. If we had "the best health care" in the world then why does RAM ( Remote Area Medical ) come to Wise County, Virginia year after year so people can go to the fairgrounds and stand in a line like cattle in the hot July sun just to see a health care provider ??? America's health care system is a disgraceful sham !

[madville]

47. Well we know whatever passes the Senate will be worse than the House

So they will compromise in committee. What are the most likely parts that the House will have to concede on? It will be weaker than what the House is proposing so we'll have to wait and see what the Senate produces, I'm saving most of my outrage for that :)

[ipaint]

49. Also keep in mind the insurance ind. needs us, we don't need them

The customer base for private insurance has slipped since 2000, when soaring premiums began driving people out. The recession has accelerated the problem. But even after the economy recovers, the downward spiral is expected to continue for years as baby boomers become eligible for Medicare -- and stop buying private insurance.

Insurers do not embrace all of the healthcare restructuring proposals. But they are fighting hard for a purchase requirement, sweetened with taxpayer-funded subsidies for customers who can't afford to buy it on their own, and enforced with fines.

Such a so-called individual mandate amounts to a huge booster shot for health insurers, serving up millions of new customers almost overnight.

..."They are interested in 45 million new customers," he said, "but the first thing in everybody's mind is preserving their right to do business in a way that can be profitable and meet shareholder needs."

http://articles.latimes.com/2009/jun/07/business/fi-healthcare7?pg=2

They know if they can't get a mandate for coverage through their co's and a weakened public option (1.4 mil a day in washington will buy that) their businesses are facing a bleak economic future.

[Sebastian Doyle]

51. I saw Sebelius on the Daily Show last night

Two things jumped out at me.... First was her admission that the US spends twice as much on health care as any other country (I'm assuming that's proportional to population) Second was her mention that the current bills circulating around are over 1000 pages long.

I wanted to scream at my television..... Geezus Kathleen, what does that tell you? Stop doing this WRONG and trying fix an entirely corrupt system, rather than moving to a system that is proven to fucking WORK for the rest of the goddamn planet.

Why is that so goddamn hard to understand?

[xchrom]

52. so we're supposed to consider any health care 'reform' -- no matter how convoluted and

tied up and weighted down -- to be a 'win'?

pathetic -- and extremely disheartening.

[Better Believe It]

54. House & Senate bills restrict access to public option through a process called "firewalling".

New Wyden health care proposal could be crucial
by snaxattack
Daily Kos
July 16, 2009


I mentioned in a previous diary the importance of the insurance exchange as a tool for enacting real health care reform. Without access to the health insurance exchange, there is no access to the public option and no access to portable health insurance. The House and Senate approaches both restrict access to the insurance exchange through a process called "firewalling", forcing everyone who has employer-based health insurance to keep that insurance. Firewalling is an impediment to real reform and must be stopped!

Jonathan Cohn and Ezra Klein are now reporting that Ron Wyden has come out with a "Free Choice Proposal" that would not only eliminate firewalls; it would force employers to contribute to the cost of health care on the insurance exchange. Wyden, who sits on the Senate Finance Committee, seems to have drawn major ideas from his Healthy Americans Act in order to achieve a happy medium that balances letting people keep what they have with reorganizing the health care system.

The Senate committees are making it hard to even enter the exchange as an individual. In order to prevent insurance companies from seeing real competition and make it more difficult to receive government subsidies, they are creating a "firewall" that puts a barrier between the insurance exchange and employees of companies that offer their own group insurance plan.

We need to start lobbying our congressional representatives for a STRONG insurance exchange, with no firewall to prevent employees of large companies from accessing high quality, portable insurance through the insurance exchange. We need to ask our congresspeople to implement a plan that allows large employers to contract with the insurance exchange, just as small businesses will be able to do.

http://www.dailykos.com/storyonly/2009/7/16/754237/-New-Wyden-health-care-proposal-could-be-crucial

http://www.dailykos.com/storyonly/2009/7/9/751637/-The-future-of-health-insurance-portability