After months of delay, Sen. Max Baucus (D-MT) has finally released the chairman’s mark to the Senate Finance Committee’s health bill without Republican support. “The $856 billion dollar package will not add to the federal deficit. The Finance Committee will meet to begin voting on the Chairman’s Mark next week,” Baucus wrote in a press release.
Rockefeller has expressed his opposition to the mark and other Democrats have since criticized the bill’s affordability standards and financing mechanisms.
Meanwhile, Sens. Chuck Grassley (R-IA) has issued a statement alleging that the bill “does not meet the shared goals for affordable, accessible health coverage that we set forth when this process began” and expressed disappointment that the White House did not assure him that the bill would not change in conference. Both Grassley and Sen. Mike Enzi (D-WY) — two members of the so-called Gang-of-Six — have indicated that they favored smaller bill that does not impose fees on health insurance companies, establishes a five-year waiting period for legal immigrants to obtain coverage, and strictly prohibits “the use of federal money to pay for abortion.” Meanwhile, Sen. Olympia Snowe (R-ME) signaled Tuesday “she is unlikely to immediately support” Baucus’ bill, “but emphasized strongly that she is prepared to jump on board in the coming days.” “I’ll issue my statement tomorrow. But that’s not the end of the process, tomorrow. It’s just the beginning. So, I wouldn’t read too much into it,” Snowe told reporters.
So did Baucus’ mark meet Republican demands? Below is a summary of some of the most contentious issues in the Baucus bill:
Would federal dollars be used to fund abortion? No. Federal subsidies cannot be used to cover abortions that do not involve rape or incest. All abortion procedures would have to be financed through private premiums.
Are illegal immigrants eligible for coverage and government subsidies? Illegal immigrants are exempt from the mandate and would not be eligible to purchase coverage within the Exchange; they’re relegated to the individual market (which would shrink but would presumably have the same protections as the Exchange.) Legal permanent residents with incomes below 100% of the federal poverty are ineligible for Exchange subsidies and (presumably, following existing law) have to wait five years before qualifying for Medicaid. Thus, for the first five years of their residency, most legal immigrants may remain uninsured.
What are the verification requirements? To obtain coverage within the Exchange, an applicant’s “name, social security number, and date of birth will be verified with Social Security Administration (SSA) data.” “For individuals who do not claim to be U.S. citizens but claim to be lawfully present in the United States, if the claim of lawful presence is consistent with Department of Homeland Security (DHS) data then the claim will be considered substantiated”
Is tort reform part of the bill? Yes, states are encouraged “to develop and test alternatives to the current civil litigation system as a way of improving patient safety, reducing medical errors, encouraging the efficient resolution of disputes, increasing the availability of prompt and fair resolution of disputes, and improving access to liability insurance, while preserving an individual‘s right to seek redress in court.”
Who will finance Medicaid expansion? Beginning in 2014, “additional Federal financial assistance would be provided to all states to defray the costs of covering newly-eligible beneficiaries.” The Federal government would pay states on a sliding scale. “States that offer minimal or no coverage of the newly-eligible population currently would receive more assistance initially than those states that currently cover at least some non-elderly, non-pregnant individuals.” The states that already cover more than 133% FPL (like Maine, for instance) would still receive extra federal assistance, but they would see less money than states that just offer the bare minimum Medicaid coverage.
The Baucus bill saves money on subsidies by reducing the actuarial value of the different benefit tiers. The actuarial values actually decreased between the Baucus framework and the Baucus mark:
Bronze: 65% in framework >> 65% in mark
Silver: 73% in framework >> 70% in mark
Gold: 81% in framework >> 80% in mark
Platinum: 90% in framework >> 90% in mark
,At his press conference unveiling the bill, Baucus explained that combined with the FMAP increase, increase in drug rebates, CHIP flexibility (states can move their CHIP applicants into the Exchange), states will see an average increase in costs of 0.89 percent.