Worst Aspects of the Current HCR & What Might Happen As It Moves to Conference:

[amborin]

•The excise tax, (which is not in the House bill) which the CBO itself says will affect 19% of people with employer-provided insurance in 2016. In 2019, six years after this bill takes effect, the excise tax will affect one in five taxpayers making $50-$75,000 per year, and the average tax impact on this bracket will rise to $1,100 a year in 2019.
In addition, the Centers for Medicare and Medicaid Services (CMS, another CBO-like organization) predicts that the excise tax will actually make coverage worse for very little return in savings.

In reaction to the tax, many employers would reduce the scope of their health benefits. The resulting reductions in covered services and/or increases in employee cost-sharing requirements would induce workers to use fewer services. Because plan benefit values would generally increase faster than the threshold amounts for defining high-cost plans (which are indexed by the CPI plus 1 percent), over time additional plans would become subject to the excise tax, prompting those employers to scale back coverage.

The savings?

This excise tax, which would reduce the quality of millions of Americans’ health insurance coverage, will technically "bend the cost curve" by just barely 0.3% in 2019. All that for a measly 0.3% reduction in national health expenditures. To give you a comparison, CBO projects that Dorgan’s drug re-importation would reduce spending on prescription drugs roughly $100 billion over the next decade (I think the savings could easily end up 4-5 times that amount). A $10 billion reduction in prescription drug spending compared to the total NHE spending last year, which was roughly $2.4 trillion in 2008, would be a 0.4% reduction in NHE.

•The mandate remains, with a larger fine for those who don't purchase coverage attached. Perhaps that's in response to the calculations done showing that it would be cheaper for people to pay the fine than to maintain coverage under the junk insurance plans that are still going to be allowed in the newly "reformed" system. The exemption for those who can prove they can't afford coverage is maintained.

•There is no public option of any kind in the Senate bill, no opt-out, no Medicare buy-in. Just the two national private plans, one of which would be non-profit, that would be overseen by the Office of Personnel Management. The CBO says it's questionable whether "insurers would be interested in offering such plans is unclear, and establishing a nationwide plan comprising only nonprofit insurers might be particularly difficult." Note, even should a national non-profit be set up by an insurer, it is not the equivalent of the public option.

effective they will be:

California recently dropped an attempt to enforce its anti-rescission law against a major insurer, saying that it was financially outgunned by the insurer's legal team.

The rescission law, according to the legislation, "shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage."

Insurers today routinely claim that patients engaged in "fraud" or "intentional misrepresentation" when dropping them from coverage. Much depends on who defines the terms in the bill.

It won't be the federal government. There will be no federal agency tasked with overseeing the enforcement of the bill's rules. Rather, a Senate leadership aide told reporters in a briefing Saturday, individual states will police the new system.

That's a task the California Department of Managed Health Care was unable to perform when battling Anthem Blue Cross, which has rescinded 1,770 policies since 2004.

"In each and every one of those rescissions, the right to contest each, and that could tie us up in court forever," the department's director, Cindy Ehnes, told The Associated Press. A million-dollar fine was announced in March 2007, but has not been enforced.

If the enforcement for these regulations falls on the individual states, and the individual states will have to litigate them, which could take a very long time in each case. The regulations are unlikely to be uniformly enforced state to state--some of them have extremely proactive insurance commissioners and strong regulatory structures in place, others don't. And in the states that don't, don't expect insurers to end some of these practices out of the goodness of their hearts.

Bottom line, Americans are still going to be forced to buy insurance that for too many people will be unaffordable. As long as that's the case, and until there's a true alternative public option that provides people real choice, the insurance companies shouldn't get that one thing in the legislation they want: the mandate.

from Daily Kos

snip

The Public Option: Over 60 members of the Progressive Caucus signed multiple letters saying they would vote against any bill that didn’t include a public insurance option. They already compromised back on Medicare + 5% rates, but leaders of the Progressive Caucus like Raul Grijalva and Lynn Woolsey have indicated that they would find it difficult to compromise again. I wouldn’t guess that everyone who signed the letter agrees with them, but there may be another handful.

There are obviously other pieces of reform that House members may find distasteful and want to improve; in particular, the funding mechanism (excise tax on high-end insurance plans vs. surtax on millionaires) or the employer mandate (versus the “free-rider” measure in the Senate bill). Nobody has yet made an ultimatum on these measures, but labor is fighting these two particularly hard, so I wouldn’t be surprised to see some labor liberals in the House make that claim.

There are probably 25-30 House Democrats who, for whatever reason, won’t vote for any health care bill. That leaves a very small margin of error to lose Democrats on any of the above issues. And of course, if they are satisfied, they risk losing 1 or 2 Democrats on the razor-thin margins in the Senate, which would also sink the bill.

snip

Petition to sign, for public option:

<http://www.change.org/actions/view/i_demand_the_congress_and_the_president_enact_a_strong_public_health_care_insurance_option>


all from:

<http://news.firedoglake.com/2009/12/20/potential-pitfalls-for-the-health-care-bill-as-it-moves-to-conference/#comments>