This morning, the Washington Post offers fresh details about the Senate Finance Committee’s behind-the-scenes health care negotiations. Previous reports have indicated that the committee was replacing the employer mandate with a free rider provision, establishing a cooperative in place of the public option, and financing reform by taxing ‘Cadillac’ health care benefits.
In today’s Post, Baucus said preliminary estimates from the CBO show that the committee’s plan would cover 94% of all Americans, cost some $900 billion and would “not only pay for itself but would begin to reduce projected budget deficits by 2019.” Below are some more details:
- Insurance market reforms: Prohibits insurance companies from denying coverage for pre-existing conditions. Everyone would be guaranteed coverage at a modified community rating.
- Expanding Medicaid: While eligibility rules are still unclear, an earlier version of of the compromise opened Medicaid to children and pregnant women below 133% of the poverty level ($28,200 for a family of four) and parents and childless adults at or below 100% of the poverty level ($10,800 per year).
- A network of cooperatives in place of a public option: The committee has long abandoned the President’s call for a “robust” public option. According to the Post, Americans will have the option of enrolling in “a network of member-owned cooperatives.”
- $70 billion — Taxing Cadillac health care plans:The legislation levies an excise tax of “up to 35 percent” on insurance companies and businesses that sell/offer “extremely generous policies worth at least $21,000 a year for family coverage or $8,000 a year for individuals.” About 7 percent of taxpayers hold such polices.
- $180 billion — Increased income tax collections:“With employers paying less for insurance, tax analysts predict, they would pay workers more in wages, increasing income tax collections by as much as $180 billion over the next decade.”
- $500 billion — Savings from Medicare and Medicaid: The legislation identifies $500 billion in savings from Medicare and Medicaid. For example, wealthier seniors would “pay more for prescription drug coverage under Medicare, and they would charge co-payments for clinical lab procedures.” The lab co-pays are potentially lucrative, raising about $20 billion over 10 years.
- $43 billion — Revenue from individual mandate and free rider penalties: Penalties from individuals who fail to obtain coverage and companies that “reimburse the federal government for workers who switch to subsidized coverage through an insurance exchange” could yield “about $43 billion over 10 years.” (By comparison, the CBO estimated that the employer mandate in the House bill would bring in $163 billion.)
Bending the curve of long-term spending:
- Encourage Americans to use less care: Proponents believe that the tax on “Cadillac health care plans” would lead insurers to pass the costs to policy holders and discourage the use of unnecessary services, thus driving down overall health-care costs.
- MedPAC trigger: If reform does not meet a certain target for savings, a new MedPAC-like panel, called the Medicare Preservation Commission, would recommend ways to obtain additional savings. The recommendations would go into affect unless Congress votes down the entire package.
According to negotiators, the committee is still considering how to structure a Medicaid expansion to make it fair to individual states, establish subsidy levels to maximize assistance to the uninsured, squeeze savings from Medicare without imposing an undue burden on seniors or compromising the quality of care and maintain coverage for abortion services.
Given the outstanding issues and the reluctance of Republicans to support a popular Democratic initiate, an agreement is far from certain. On Wednesday, Sen. Chuck Grassley (R-IA) said the talks may still fall apart. “Who knows, we may not have a product,” he said. “But sometimes that’s the result of negotiations.”