As Democrats move to reconcile the Senate Finance bill with the far more progressive HELP legislation, some are hoping to attract the vote of so-called moderate Sen. Susan Collins (R-ME). This morning, during an appearance on Fox & Friends, Collins laid out her objections to the Senate Finance legislation. “I have a lot of concerns about the Baucus bill,” she began:
- Better affordability measures: “I think it could very well drive up the costs of insurance for middle income families.”
- Opposes the free-rider provision: “I think it unfairly penalizes small businesses when they hire low income workers.”
- Better cost controls: “I don’t think it does enough to reign in costs.”
Some of this is reconcilable. Progressives want to improve the bill’s affordability measures and replace the clunky free-rider provision with a real pay-or-play mandate that would require large employers to offer coverage or pay a fee. To improve affordability standards, policy makers can either lower the value of the benefits packages, exclude more people from the individual mandate, expand subsidies, give the Exchange some real bargaining power, and/or insert a real robust public option. But Collins won’t support a bill with a higher price tag (so the subsidy option is out) and she is unwilling to consider a public plan. Unfortunately, diminishing the value of the benefit packages or leaving more Americans without coverage would only increase costs over the long term and undermine Collin’s third objection. And that should be taken seriously.
The Baucus bill goes a long way towards “reining in costs” and controlling spending (over the long term and the short term). It restructures payments to Medicare Advantage plans (to base payments on plan bids with bonus payments), establishes an independent Medicare Commission to submit proposals for reducing excess Medicare cost growth by targeted amounts, reduces Medicare DSH payments by an amount proportional to the percentage point decrease in the uninsured, reduces payments for preventable hospital readmissions in Medicare, establishes a hospital value-based purchasing program in Medicare to pay hospitals based on performance on quality measures, and invests in all kinds of payment reform models.
Collins says that “reining in costs” should be “one of the primary goals” of health reform, yet she opposes many of these measures. She wants to reign in costs without voting for cost containment policies and Medicare cuts. Rally against the expensive health care system without conceding that the Baucus bill actually moves the system in that direction. To be fair, Collins does call for medical liability reform, which could save some $54 billion over 10 years. The Baucus bill encourages states to develop and test alternatives to the current civil litigation system, and the Senate may include stronger tort reforms in the final bill. But $54 billion isn’t enough to fund health reform and it has done little to reduce the practice of so-called “defensive medicine.” Again, if Collins was interested in reducing costs or making coverage more affordable, she would support the existing measures in the Baucus bill or a robust public option (which according to the CBO, saves twice as much as tort reform).
If Collins is unwilling to recognize or support real cost containment measures, then Democrats are wasting their time wooing the other Senator from Maine. After all, she’s not willing to back policies that support her own rhetoric.