...it doesn't adequately address cost of care concerns, the single number one issue preventing millions of American families from accessing the health care they need, regardless of whether or not their premiums for insurance they can't afford to use are lower.
...it doesn't provide sufficient subsidies for low-income families
...it contains no regulation to control rising costs of care, above and beyond rising premium costs
...it leaves most of the critical regulator questions unanswered, punted to states so that the quality of someone's health care can be determined by whether they live in a red or blue state.
...it does nothing to deal with denials of care
...it does nothing to deal with termination of insurance to do exploitation of claims of "fraud"
...it does nothing to break up monopolies or ensure better competition.
...it is chalked full of corporate loopholes and giveaways.
In fact, I'm going to stop explaining, and instead just point you to the National Nurses United's statement in opposition to the bill.
NNU cited ten significant problems in the legislation, noting many of the same flaws also exist in the House version and are likely to remain in the bill that emerges from the House-Senate reconciliation process:
1. The individual mandate forcing all those without coverage to buy private insurance, with insufficient cost controls on skyrocketing premiums and other insurance costs.
2. No challenge to insurance company monopolies, especially in the top 94 metropolitan areas where one or two companies dominate, severely limiting choice and competition.
3. An affordability mirage. Congressional Budget Office estimates say a family of four with a household income of $54,000 would be expected to pay 17 percent of their income, $9,000, on healthcare exposing too many families to grave financial risk.*
4. The excise tax on comprehensive insurance plans which will encourage employers to reduce benefits, shift more costs to employees, promote proliferation of high-deductible plans, and lead to more self-rationing of care and medical bankruptcies, especially as more plans are subject to the tax every year due to the lack of adequate price controls. A Towers-Perrin survey in September found 30 percent of employers said they would reduce employment if their health costs go up, 86 percent said they’d pass the higher costs to their employees.
5. Major loopholes in the insurance reforms that promise bans on exclusion for pre-existing conditions, and no cancellations for sickness. The loopholes include:
--Provisions permitting insurers and companies to more than double charges to employees who fail “wellness” programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.
--Insurers are permitted to sell policies “across state lines”, exempting patient protections passed in other states. Insurers will thus set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states.
--Insurers can charge four times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees.
--Insurers may continue to rescind policies for “fraud or intentional misrepresentation” – the main pretext insurance companies now use to cancel coverage.
6. Minimal oversight on insurance denials of care; a report by the California Nurses Association/NNOC in September found that six of California’s largest insurers have rejected more than one-fifth of all claims since 2002.
7. Inadequate limits on drug prices, especially after Senate rejection of an amendment, to protect a White House deal with pharmaceutical giants, allowing pharmacies and wholesalers to import lower-cost drugs.
8. New burdens for our public safety net. With a shortage of primary care physicians and a continuing fiscal crisis at the state and local level, public hospitals and clinics will be a dumping ground for those the private system doesn’t want.
9. Reduced reproductive rights for women.
10. No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay. Nothing changes in basic structure of the system; healthcare remains a privilege, not a right.
* This does not include federal subsidies in the form of tax credits, however those subsidies are horrible insufficient and still leave poor families crippled with costs. For documentation of that fact, you'll have to see the Center on Budget and Policy Priorities website.
http://cbpp.org
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