And we just saw this past week the first step in rationing of health care in the country with this panel that they have, this preventive panel. A government panel that says women between 40 and 50 shouldn’t have mammograms. You know, my wife Bobbi is a breast cancer survivor. She was diagnosed by a mammogram, went for an operation, the cancer had already spread. The mammogram has saved her life, but yet this preventive panel that the bill says, this health care bill says, ‘oh no, they’re the ones who get to decide what preventive measures are paid for or not.’ That panel would have not allowed her to have this care.

Watch it:

Rather than mandating “what preventive measures are paid for or not,” the task force issues recommendations that help doctors decide on a course of treatment. Providers can use the recommendations as a starting point to examine a patient’s particular needs, but the task force has no authority over coverage or treatment decisions. Barrasso’s wife Bobbi Brown would have received a mammogram regardless of any recommendation. Wyoming, along with 48 other states, requires insurers to cover mammograms and if the Senate bill were to become law all insurers would be required to pay for the procedure. The Wonk Room has more.

While expanding coverage to 31 million Americans would cost $848 billion over 10 years, the cost of these coverage expansions would be more than offset by a combination of new revenue and spending changes. After the $848 billion is paid off, the bill invests the remainder — $130 billion — into deficit reduction. Doocy is double-counting the cost of the bill to taxpayers. Imagine the following scenario: you drive to the supermarket and purchase a gallon of $10 laundry detergent with a $20 bill. According to Doocy’s logic, the cost of your detergent is not $10, but rather $30!

Senator Casey has been a vocal supporter of health care reform and voted for the HELP Committee bill in July. He supports the public option to increase competition and reduce costs. And he is offering amendments to improve health care for children. Senator Casey thinks that health care reform should not be used to change longstanding policies regarding federal financing of abortion which has been in place since 1976.

He continues to work with his colleagues in the Senate and with the White House to ensure that the Senate health care reform bill protects existing federal and state conscience protections, existing state abortion laws and contains strong language to prohibit federal funds from being used to fund abortions. He voted for amendments in the HELP Committee that would maintain neutrality on abortion. Until Senate bill language is released it is premature to discuss next steps.

The existing abortion language in the Senate bill maintains the status quo by ensuring that federal dollars can only be used to pay for abortions when the pregnancy threatens life of mother or results from rape or incest. Only private premiums could be used to pay for so-called ‘elective’ abortions.

Democrats believe that pro-life advocates would not be able to muster the requisite 60 votes to pass a more restrictive amendment that would make it difficult for many private plans to provide abortion coverage. “If someone wants to offer this very radical amendment, which would really tear apart [a decades-long] compromise, then I think at that point they would need to have 60 votes to do it,” Sen. Barbara Boxer (D-CA) said during a recent interview with the Huffington Post. “And I believe in our Senate we can hold it.” On Monday, President Obama also indicated that he wanted to preserve the status quo on abortion coverage.

Casey’s statement, while promising, does not guarantee that the Senator won’t vote for a bill that includes stricter abortion restrictions. During the Health, Labor, Education and Pensions Committee’s (HELP)’s mark-up, Casey provided the only Democratic vote to at least four anti-choice amendments, all of which ultimately failed. One such amendment — offered by Sen. Orrin Hatch (R-UT) — closely resembled the Stupak provision.

If the Senate bill retains its current abortion compromise, it’s likely that the conference report will include similar language. Already, 41 House Democrats have sent a letter to Speaker Nancy Pelosi (D-CA), vowing to vote against the final conference report if it contains the Stupak amendment.

Cross-posted on The Wonk Room.

Should lawmakers further water-down the SFC bill, the industry will stand to profit, the report implies, suggesting that the “bull” case scenario is a reform package that brings in millions of new government-subsidized customers without requiring the industry to pay any new taxes. Industry revenue would grow 6.9% from “more moderation of provisions in the current SFC plan or as a result of changes prior to the major implementation in 2013,” the report states. The report therefore suggests that the insurance industry may actually prefer watered-down reform over nothing. The Wonk Room has more. (Chart courtesy of FDL)

The root difficulty is Obama’s insistence that the nation can afford a large new social program without raising taxes on anyone who earns less than $250,000 per year. Under his plan, according to a CBO analysis, the government will be spending 24.5 percent of gross domestic product — the total value of the national economy — by 2019 while raising only 19 percent in revenue: a huge, unsustainable gap.

The 24.5% of GDP isn’t a measure of government spending as a result of the House/Obama health care bill. It’s a measure of the outlays of all of the President’s policies in his 2010 budget in 2019 and does not capture the deficit-reducing effects of health care reform or the House bill. The Wonk Room has more.

At the “House Call” tea party protest on Capitol Hill this week, House Minority Whip Eric Cantor (R-VA) pledged to the right-wing activists: “Be assured not one Republican will vote for this bill.” Cao’s vote must have surprised Cantor.

Cao has previously been touted by House Minority Leader John Boehner (R-OH) once as “the future” of the GOP. The White House had reportedly “been in constant contact” with him prior to the vote. “Rahm is going all in to get him,” one aide told Roll Call, referring to White House Chief of Staff Rahm Emanuel.

The House also approved, by a vote of 240-194, an amendment introduced by Rep. Bart Stupak (D-MI), which imposed tighter restrictions on abortion coverage. A GOP substitute failed in a vote of 178-258, with a single Republican, Rep. Tim Johnson (R-IL) voting against the legislation.

FOXX: I think we should start with the premise that I have felt all along, despite being questioned on this by my colleagues, that all of us want all Americans to have health insurance and access to good health care. Again, despite accusations made against me, I think we would be all better off if we accepted that assumption. We want to go about it in different ways. But I think accusing each other of things that aren’t true isn’t a good way to start out this meeting. And so I want to say I believe everybody wants all Americans to have affordable health insurance and good quality health care. I just take that assumption.

Watch it:

But Americans shouldn’t “just take that assumption.” In fact, according to the Congressional Budget Office, under the Republican alternative, the number of uninsured Americans would increase to 52 million by 2019. The plan would provide coverage to only 3 million more uninsured Americans. Earlier in the hearing, Foxx suggested that it’s better to be uninsured than enrolled in the government’s Medicaid program. “I want to ask you if you know that Medicaid patients visit the emergency room at twice the rate of uninsured patients in this country,” she said. “More government paid insurance is going to increase the number of people going to the emergency rooms.”

Over at MYDD, Bruce Webb calls the provision, “Sweatshop Insurance.” This bill goes far beyond merely “stripping states of power over insurance rates and conditions,” he notes. It “explicitly expands the definition of ‘State’ to include not just D.C. and Puerto Rico, which makes some sense in context, but adds BY NAME the Virgin Islands, Guam, American Samoa and Jack Abramoff’s favorite client-the Northern Marianas home of the ‘Made in the USA’ Chinese-owned close to slave labor sweatshops.” From pages 121-122 of the bill:

In 2001, the Commonwealth of the Northern Mariana Islands famously hired corrupt lobbyist Jack Abramoff to enlist his support in stopping “legislation aimed at cracking down on sweatshops and sex shops in the American territory.”

“Given the record of corruption in the N. Marianas,” Webb writes, “and the willingness of various Caribbean and Atlantic Island nations to let themselves be used as off-shore banking and tax shelter entities, you can bet Aetna and WellPoint are slavering at the prospect of ‘basing’ their plans out of a PO Box on some tropical nation.”

The GOP is conceding the progressive argument. Specifically, it is admitting that insurance companies would have little incentive to continue doing business under certain state rules which “require that companies issue coverage to all new customers and not set higher rates for people who are already sick.” Instead, companies could chose a state with scarce regulations and sell policies that don’t provide mental health parity, cancer screenings, or abide by regulations that limit the rates that can be charged to higher-cost consumers. This way, plans can attract the healthiest applicants and detract the sick.

Holtz-Eakin said he’s been paying about $1,000 a month to extend the private health insurance he received on McCain’s campaign through the government’s COBRA program, but that will expire in a few months. This is the first time in his life he has not had employer-provided health coverage. “I worry about where I go next in the way many Americans do,” he said.

During the campaign, Holtiz-Eakin fervently defended McCain’s proposal to shift more Americans out of their employer-sponsored coverage and into the individual health insurance market. “The key to real reform is to restore control over our health-care system to the patients themselves,” Holtz-Eakin said in August. “Instead of only getting it in the employer market, you would get it regardless of your source of insurance. And you get the same amount whether you’re rich or poor, $5,000 for every working family.”

Responding to proponents of the public plan who argue that it would actually lower costs, Lieberman insisted that if the public option paid lower reimbursement rates than private insurers, medical providers would shift costs to Americans with private coverage:

LIEBERMAN: If the public option, the government run health insurance company negotiates hard to lower the reimbursement — the money it’s paying to hospitals, doctors — they’re [providers] going to have to get that money somewhere. And where they’re going to get it is from the 200 million Americans who today have private health insurance. Premiums will go up. It’s exactly what’s happened with Medicare and Medicaid. [...]

When people hear public option, I think they think it’s for free. It’s not for free. Somebody is going to have to pay for it and you can bet it’s going to be the taxpayers and the people who pay health insurance premiums now.

Watch it:

Contrary to Lieberman’s claims, the public option envisioned by Senate Majority Leader Harry Reid (D-NV) would be required to compete on a level playing field with private insurers and charge premiums “in an amount sufficient to cover expected costs.” Instead of stifling the “economic recovery” and increasing “the debt,” the Congressional Budget Office concluded that the self-sustaining public option (similar to the one envisioned by Reid) could actually save the government money and slightly lower premiums.

Like Lieberman, America’s Health Insurance Plans (AHIP) — the insurance industry’s lobby — and the Business Roundtable have also argued that a public option that reimburses providers at lower rates than private payers would force providers to raise costs for Americans with private coverage in order to make-up the difference. MedPAC, the Congressional Budget Office, and numerous actuarial studies dispute the insurers’ claims.

These critics confuse cost shifts with price differentials. Economists point out that “price differentials are not necessarily the recouping of losses from one payer by overcharging another”; providers often “charge different prices to different market segments” to maximize profits, not to shift costs. MedPAC has concluded that “hospitals that are forced to run efficiently are adequately funded by Medicare payments. Therefore, increasing Medicare reimbursements to hospitals would not reduce rates providers charge to private insurers.” The research suggests that hospitals “are raising prices when they have the market power to do so,” not because they are reimbursed at Medicare rates.

I — speaking only on behalf of myself — suggested one possible idea could be that instead of creating an entirely new government bureaucracy to administer a public option, Medicare could be offered as a choice to compete alongside private insurers for those Americans eligible to enter the national health insurance exchange, but at a reimbursement rate much greater than current Medicare rates.

The last sentence is key: reimbursing providers who treat the new enrollees at market rates satisfies the provider community and conservative politicians from rural states who argue that their hospitals would close if they were reimbursed at Medicare rates. This scheme preserves the integrity of a single national program and takes advantage of Medicare’s administrative efficiencies to lower costs and spearhead delivery reforms. Still, Ross’ solution will likely save less money than a robust public option that uses Medicare-like rates and leverage.

After cutting a deal with Energy and Commerce Committee Chairman Henry Waxman to increase the public option’s reimbursement rates in August, Ross announced last month that “he will vote against health care legislation if it includes a public option.” “I have been skeptical about the public health insurance option from the beginning and used August to get feedback from you, my constituents,” Ross wrote in a newsletter to constituents. “An overwhelming number of you oppose a government-run health insurance option and it is your feedback that has led me to oppose the public option as well.”

The industry’s very selective analysis undermines its conclusions and exposes the study as an industry attempt to protect the bottom line. An actual analysis of Congressional Budget Office data has concluded that premiums in the exchange would be lower than they are in the none group market today. The Wonk Room has more.

The industry has issued a new report arguing that the weak personal responsibility requirement, taxes on health care providers, spending reductions in Medicare and taxes on high-value health plans will increase “the cost of coverage for both single and family policies in the individual, small group, large group, and self-funded insurance markets.”

Ezra Klein and Jonathan Cohn dispute the report’s methodology here and here, but it’s worth pointing out that industry’s argument that reform will increase insurance premiums for all Americans is simply untrue. It could also backfire. As Rep. Anthony Weinder (D-NY) explained this morning on MSNBC, “the health insurance lobby today fired the most important salvo in weeks for the public option“:

If you have the health care industry complaining that we’re going to raise costs because of these changes, it is them putting us on notice that we haven’t put enough cost containment in the bill. You know, the health care industry themselves is putting out a whole report saying that. That should be a tell to the Baucus team that you know what, maybe it’s time for them to go back and revisit the public option. In a strange way, and look, obviously they didn’t mean this, the health insurance lobby today fired the most important salvo in weeks for the public option, because they have said, as clear as day, left to their own devices, according to their own number crunchers, they’re going to raise rates 111%.

The reality is, some reform provisions would tend to make premiums higher than current-law premiums; other provisions would “tend to make them lower.” Americans from different income brackets will pay different amounts for health care, but on the whole, the Baucus bill, which provides affordability subsidies for Americans between 133-400% federal poverty line, will offer health insurance policies that are far more affordable than what the insurance industry report predicts.

Here is a comparison between the non partisan Congressional Budget Office’s analysis of the cost of premiums in the Exchange and the industry’s report. As it points out, under reform, Americans — even those that don’t qualify for a subsidy — will have far more affordable insurance options than industry’s “average” suggests:

Still, the Baucus bill must do more to control health care spending and lower premiums in the private market. After all, Congress shouldn’t force Americans to purchase unaffordable coverage. But for all their concern about ‘average health care costs’, insurers have a poor track record of controlling prices. As Families USA points out, insurers are “like a poker player who complains about his hand when, in fact, he is the dealer.”

Indeed, despite complaining about high health care premiums, insurers have lobbied against system-wide cost containment. They’ve spent millions of dollars opposing a public option that could reduce health case spending by some $150 billion and are even suing the state of Maine to increase premiums.

The insurance lobby is “conveniently forgetting that they imposed significant premiums increases during the past decade that are making health coverage unaffordable for families and businesses.” Now, since they’ve published a report promising to increase health insurance premiums even higher, the Senate must insert a public option mechanism (along with other cost-containment provisions) to competitively lower rates and keep the private health insurers honest.

Cross posted at The Wonk Room.

Weiner insisted that a robust public plan could restore competition to concentrated health care markets and reduce health care costs by an estimated $150 billion. McCaughey, the architect of the false “death panels” myth, continued her scare-mongering campaign against seniors: “The elephant in the room here is that all these bills are devastating care for seniors and the Baucus bill is the deadliest of all!”

Throughout the interview, McCaughey was constantly on the defensive, complaining that she was being shut out of the debate. “Anthony, you are ignorant about health insurance,” she said, before insisting to Ratigan that “this will go down in history as one of the most browbeating interviews in television history.” “I hope that it does,” Ratigan replied. “And maybe you’ll learn at that point then to answer questions as opposed to go on television and cast accusations.” Watch a compilation:

After repeatedly refusing to explain how she would reduce health care spending, McCaughey finally proposed “inching up the eligibility age [for Medicare] one month a year until 2043 when the eligibility age reaches 70.” That could “put Medicare on a firm footing without cutting care for Medicare recipients.”

“That was a solid answer to your question,” Weiner exclaimed facetiously. “Take away 100% of Medicare for people 65 to 70.” According to the Congressional Budget Office, which McCaughey credited with the idea, eliminating “younger beneficiaries” from the Medicare program would do little to control costs. “Outlays for Medicare would [still] rise to 7.7 percent of GDP by 2050,” the CBO concluded.

Weiner pounced on McCaughey’s solution, which could cut as many as 11.3 million seniors from Medicare. “You want to gut Medicare,” Weiner told McCaughey. “You just said on this show you wanted to cut Medicare for everyone 65 to 70, isn’t that right?”

– “…Finance Committee passed a quasi, state-based public option sponsored by Sen. Maria Cantwell…” [Politico, 10/1/2009]

– “…the committee voted in favor of a proposal by Sen. Maria Cantwell (D-Wash.) to enable states to form their own public options.” [The Hill, 10/1/2009]

– “The Senate Finance Committee narrowly passed an amendment Thursday from Sen. Maria Cantwell (D-Wash.) that moves the conservative panel as close as it will likely get to a public health insurance option.” [Huffington Post, 10/1/2009]

Under Cantwell’s proposal, states would use their purchasing power to negotiate for more affordable coverage options, improve efficiencies, and even lower the health care costs within the Exchange (by shifting lower income and disproportionately sicker individuals into the Basic Health Plan), but they would have to contract with private insurers. Cantwell herself “declined to liken her proposal to a controversial public option, which has become a major sticking point in health care reform.” “I think we’ve hit the sweet spot,” she said. “Everybody says they want to have private providers and we’re saying fine.”

It’s my duty and pride tonight to be able to announce exactly what the Republicans plan to do for health care in America… It’s a very simple plan. Here it is. The Republican health care plan for America: “don’t get sick.” If you have insurance don’t get sick, if you don’t have insurance, don’t get sick; if you’re sick, don’t get sick. Just don’t get sick. … If you do get sick America, the Republican health care plan is this: “die quickly.”

Watch it:

No Republican wants Americans to die, but the party’s efforts to stonewall meaningful health care reform perpetuate a status quo in which 45,000 Americans die every year because they lack health care coverage and thousands more see their policies canceled or denied by private insurers that are beholden to Wall Street’s profit expectations and not patient health.

Grayson intentionally over-stated his case. It’s not that Republicans want to kill people; it’s that their opposition to meaningful health care reform and their “free market” alternatives would further deregulate insurers and allow companies to continue pushing individuals into high deductible policies that don’t provide adequate coverage and actually harm Americans who can’t afford their medical bills:

“Don’t get sick.” Under the Republican alternatives, private insurers will deny coverage to Americans who suffer from chronic illnesses like cancers or asthma and lure healthier applicants into high deductible policies that provide limited coverage once they become sick.

“Die quickly.” If Americans in these policies do fall ill, they will go bankrupt paying off their medical bills and join the 78 percent of bankruptcy filers burdened by health care expenses who had health insurance but “still were overwhelmed by their medical debt.” Grayson is facetiously suggesting that Americans would be urged to skip the “bankruptcy” part, avoid being a financial burden on their family, and simply pass away.

In other words, the Republican alternatives harm Americans by placing our fate in the hands of the very same private for-profit corporations that have created the health care crisis in the first place.

Cross-posted on The Wonk Room.

During this morning’s debate over Sen. Jay Rockefeller’s (D-WV) public plan amendment, Sen. Chuck Schumer (D-NY) challenged Sen. Chuck Grassley’s (R-IA) claim that the public option would lead to single payer health care. The exchange flustered Grassley. He admitted that Medicare is part of the “social fabric” of America and praised the competition between traditional Medicare and Medicare Advantage, but then said moments later that the government is a “predator.” “So you don’t want Medicare?” Schumer asked. Grassley concluded, “Medicare is part of the social fabric of America, and I think there’s a lot wrong with it.” Watch it:

According to a Congressional Budget Office analysis of Rockefeller’s amendment — which establishes a plan that reimburses providers at 5% above Medicare rates for the first two years — the public option would save the government an estimated $50 billion. Only eight million Americans would sign-up for the program, leaving the overwhelming majority of Americans to private coverage. Rockefeller’s amendment ultimately failed by a vote of 15-8.

“We ought to look at these things seriously and we ought to ask all the questions that we have,” Hatch insisted, before proceeding to ask staffers with no experience in constitutional law at least four separate questions about the phony issue regarding the constitutionality of the individual mandate. The Wonk Room has more.

And while Republicans have proposed several compromise amendments, most of their provisions seek to delay the mark-up process and undermine the bill. Sen. Orrin Hatch (R-UT), for instance, introduced an amendment (Hatch F7) to “add transition relief for the excise tax on high cost insurance plans for any State with a name the begins with the letter ‘U.’” The amendment would increase the threshold at which high-cost insurance plans could be taxed.

Below are some of the other superfluous amendments introduced by Republicans:

Hatch rationalizes his amendment by explaining that “the transition relief provided in the Chairman’s mark for the 17 states with the least affordable health care is obviously arbitrary and unfair. What about the 18th state? This amendment would add further transition relief in another, but no less arbitrary way to certain states.”