Sen. Jay Rockefeller (D-WV) has long argued that the Baucus health care bill does not do enough to improve affordability and protect Americans from predatory insurance practices. The Senator voted the bill out of committee with grave reservations - reservations he has spelled out in a 13 page document now posted on the Committee's website.
The document, which does not does not include objections to the low penalties for the individual mandate, excise taxes on so-called "Cadillac plans," the so-called young invincibles program or the low creditable coverage standards offered in the bill, offers the most comprehensive progressive critique of the Baucus legislation. Specifically, Rockefeller is concerned about the lack of a public option and the lax enforcement and accountability measures, limited regulation of self-insured plans, the free rider provision, ineffective co-operatives, benefit standards for newly enrolled Medicaid patients, employer wellness programs, the Medicare Commission, and the failsafe proposal. (Be sure to hit "More" to use the above hyperlinks.)
Below is a summary of Rockefeller's concerns:
CONCERN: The Baucus bill showers private insurers with $461 billion of taxpayer- funded subsidies but does not force insurers to compete with a public option or hold the industry accountable:
Quote:
- Rockefeller debunks the industry argument that a public option that reimburses at or slightly above Medicare rates would shift costs to Americans with private insurance. As MedPAC explained in its March 2009 report to Congress, "while insurers appear to be unable or unwilling to push back' and restrain payments to providers, they have been able to pass costs on to the purchasers of insurance and maintain their profit margins." The CBO has indicated that many hospitals negotiate higher payments with private insurers as a form of price discrimination to maximize profits. They demand higher reimbursements from health insurers because they can, not because they are shifting costs.
- Therefore, "the real issue is not whether private plans pay doctors and hospitals more than government programs, but what is a fair rate based on the actual cost of providing quality care. "One of the major disappointments of the Committee mark is the lack of leverage over private health insurance industry prices….The Committee mark spends nearly one-half trillion dollars in federal premium subsidies to supplement high private health insurance costs, rather than to bring those high costs down for consumers," Rockefeller notes. "If an average family premium is $13,375, a family wishing to enroll in the public health insurance option could save $1,338 - $2,676."
- "The Committee mark does not include any new federal resources or infrastructure to regulate private health insurance companies and make certain they are actually abiding by the new insurance market rules. Without a new, robust federal regulatory role, I remain extremely concerned that private health insurance companies will continue their long-standing practice of exploiting loopholes in the law and skimming on coverage for beneficiaries to increase profits."
CONCERN: The insurance reforms in the Baucus Bill do not apply to the 50% of Americans who purchase coverage from employers that self-insure and may prove inadequate:
Quote:
- "The Committee mark only includes two new reforms of self-insured plans - they must provide coverage that is at least equal to 65 percent of the actuarial value of the Blue Cross Blue Shield standard plan offered through the Federal Employees Health Benefits Plan (FEHBP), and they must provide first dollar coverage for preventive health benefits."
- "The Committee mark eliminates pre-existing condition exclusions in the individual and small group markets. However, these provisions are not phased-in until July 1, 2013….The prohibition on pre-existing condition exclusions is phased-in for large group plans over five years beginning in 2017, and the prohibition does not apply to the self-insured market."
- "The bill also prohibits large-employer plans (including self-insured plans) from implementing "unreasonable" annual or lifetime limits, although the term "unreasonable" is undefined. I remain concerned that the mark does not implement a complete prohibition on annual and lifetime limits for large employer plans, including those in the self-insured market."
- "While reporting of medical loss ratios is an important first step, I remain concerned that the Committee mark does not require private health insurance companies, particularly those offering federally subsidized coverage through the state exchanges, to spend the majority of the nearly one-half trillion dollars in federal premium subsidies on actual medical care."
CONCERN: The 'free rider provision' could jeopardize the employment of lower-income Americans:
Quote:
- "I remain concerned that this provision provides a disincentive for employers to hire or maintain employment for low-wage workers. It would be particularly burdensome for states, like West Virginia, with a higher percentage of low-wage workers."
CONCERN: Co-operatives won't have any impact on health insurance markets:
Quote:
- "In its preliminary score of the Committee mark, CBO states that "the proposed co-ops had very little effect on the estimates of total enrollment in the exchanges or federal costs because, as they are described in the specifications, they seem unlikely to establish a significant market presence in many areas of the country or to noticeably affect federal subsidy payments."
- "As I have asserted throughout this debate, health insurance cooperatives are not a substitute for a strong public health insurance option. Additionally, I remain seriously concerned about the viability of consumer health cooperatives in the health insurance marketplace at all."
CONCERN: Newly enrolled Medicaid populations would receive inferior care:
Quote:
- "As part of the Medicaid expansion, all newly-eligible, non-pregnant adults would receive a benchmark benefit package consistent with section 1937 of the Social Security Act, which was passed as part of the Deficit Reduction Act of 2005….Specifically, the DRA allows states to offer more limited benefits for some groups and to offer different benefits to different groups of enrollees."
- "While the DRA gave states the option of implementing so-called "flexible" benefit, packages, the language included in the Committee mark makes DRA benefit reductions mandatory for newly-eligible populations, which effectively undermines the Medicaid entitlement."
- "Beginning in 2014, non-elderly, non-pregnant adults between 100 percent ($22,050 for a family of four) and 133 percent of poverty ($29,327 for a family of four) would be able to choose between Medicaid and coverage through their state exchange. This provision is estimated to cost $20 billion over the budget window, largely because private insurance is much more costly - approximately 25 percent more costly - than Medicaid, which is more efficient and provides better coverage. This $20 billion is in addition to the $461 billion that we are giving private insurers in federal tax subsidies."
CONCERN: Allowing employers to "reward" employees who meet certain "wellness" benchmarks could lead to discrimination against sicker workers.
Quote:
- "The Committee mark would codify the existing HIPPA non-discrimination regulation relating to workplace wellness programs. This rule allows employers or issuing plans to provide "rewards" for employees' participation in a wellness program or for meeting certain health status targets associated with that program. Employers, under the regulation, can provide a reward (or penalty for those who do not participate or do not meet certain health status targets) to participants of up to 20 percent of the total cost of the plan."
- "I am very concerned that these provisions are discriminatory and have not been shown to be effective. In addition to posing problems for people with less-than-perfect health, the premium "incentives" would unfairly penalize people who have other barriers to participation in such programs, like working mothers or people who work two or more jobs."
CONCERN: The Medicare Commission excludes certain provider groups from payment cuts and does not go far enough in implementing delivery system reforms:
Quote:
- "The providers protected from the Commission's recommendations constitute half, if not more, of total Medicare spending. By including a carve-out of any kind to protect a subset of providers, I am concerned that Commission is fundamentally unsound because it is barred from looking at Medicare from a comprehensive perspective….I am particularly concerned about CBO's assumption that limiting the Commission's options for exploring greater efficiencies in Medicare means that the Commission is likely to decrease premium subsidies for Medicare beneficiaries enrolled in the prescription drug program."
- "I also remain concerned that the trigger for the Commission to issue recommendations is tied to excess cost growth in the Medicare program as it relates to growth in the gross domestic product, instead of being tied to the solvency of the Medicare program. The original intent of the MedPAC Reform Act was to create an independent commission to drive Medicare quality improvement and increase the efficiency of the program, so that it continues to exist for seniors and individuals with disabilities ten, twenty, and fifty years down the line. It was never meant to cut costs just for the sake of cutting costs."
CONCERN: The failsafe provision would automatically decrease premium subsidies for families:
Quote:
- "This so-called 'failsafe' provision has the potential to undermine critical affordability of health insurance. The failsafe provision would automatically decrease premium subsidies for low- and middle-income families who would be relying on them to purchase insurance. I am also concerned that the annual nature of the review realistically means that it will make subsidized coverage unstable for consumers because the subsidies will fluctuate based on the budget."
Login
FAQ
Search
sooz06
