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The Public Option As Scapegoat

seiu_logoThe Hill’s Jeffrey Young is reporting that in light of the Democrats’ decision to drop the public option and the Medicare buy-in provision from the Senate health bill, SEIU is backing away from their support of the legislation:

The SEIU had planned to participate in a Capitol Hill press conference along with the AARP, the liberal advocacy group Families USA, Consumers Union and the American Cancer Society Action Network. As recently as Tuesday morning, the organizations distributed an advisory to the news media that included the SEIU. But the move by Senate Majority Leader Harry Reid (D-Nev.) to excise provisions of the healthcare reform bill to create a government-run public option health insurance program and to allow people between 55 and 64 years old to buy into Medicare gave the labor union pause, spokeswoman Lori Lodes said.

This explanation is a bit hokey. Initially, the public option would only be available to individuals, small businesses and the self-employed. Union members would presumably remain in their generous employer-sponsored plans — far from the public option or any other health insurance program offered in the exchange. Thus, their reaction to the latest developments is either just a misunderstanding of the policy — which I highly doubt — or a back door way of opposing the 40% excise tax on so-called Cadillac health care plans. The indexing of the excise tax may be problematic, but overall the the excise tax would exempt most union members from the fee, help slow the rate of health care cost and reduce the deficit.

I’ll leave that policy debate for another day and simply point out that the so-called compromise debacle has provided progressive critics of health care reform with cover to register their discontent with other parts of the Senate health care bill. The reality is, most progressives rated the chances of a public option passing the senate as highly unlikely at best. Sen. Reid’s decision to include an opt-out extended the public option dream, if only briefly, but it didn’t change the fundamental political reality. Without converting conservative Democratic senators to the progressive cause, the policy was still a no-go.

For this reason, among others (including the plan’s narrow reach), the heart of health care reform was never about the public plan. The real game was in improving affordability standards, enhancing the exchanges, and figuring out the payment reform. At this juncture, to pretend that health care reform is synonymous with the public plan is a bit opportunistic and disingenuous.

Update

This post wasn’t intended as a hit against the SEIU, but in making the larger point that progressives are overreacting to the loss of the public option, I unintentionally mischaracterized the motives of the organization.

Regrettably, I failed to mention that the SEIU is a membership-driven organization that polls its members before supporting legislation and actually includes many members who are in jobs that don’t offer benefits and would have benefited from the public option.

Bernie Sanders: ‘As Of This Point, I’m Not Voting For The Bill’

Moments ago, Sen. Bernie Sanders (I-VT) announced that he is prepared to vote against the Senate health care bill in light of the recent decision to strip the public option and the Medicare buy-in provision from the legislation. Appearing on Fox Business’ Cavuto, Sanders said “I’m struggling with this, but as of this point, I’m not voting for the bill.”

Sanders is the only member of the Democratic caucus to publicly oppose the Senate legislation and it’s unclear if he would vote for cloture but oppose the final bill. Still, Sanders’ objections raise new doubts about whether Reid has the votes to file cloture on the bill tomorrow and pass it before Christmas:

I’m struggling with this. As of this point, I’m not voting for the bill…I’m going to do my best to make this bill a better bill, a bill that I can vote for, but I’ve indicated both to the White House and the Democratic leadership that my vote is not secure at this point. And here is the reason. When the public option was withdrawn, because of Lieberman’s action, what I worry about is how do you control escalating health care costs?

Watch it:

“How do you give competition to the private insurance companies who are raising rates, premium rates outrageously every year, who’s only function in life is to make as much money as they can?’ Sanders asked. “What a strong Medicare-type public option would do is at least provide competition and prevent, I believe these large increases in rates.”

Earlier today, Republicans filibustered Sanders’ single payer amendment by asking clerk to read all 767 pages. After 2.5 hours, Sanders reluctantly withdrew his amendment.

The Progressive Case For Passing The Senate Health Bill

Our guest blogger is John Podesta, President and CEO of the Center for American Progress Action Fund.

pod-deanSince Joe Lieberman demanded stripping the public option and Medicare buy-in provisions from the merged Senate bill, some strong progressives like Howard Dean have argued that without a public option or a Medicare buy-in provision, the bill is a giveaway to private insurers and should be killed. Other progressive leaders like Senators Jay Rockefeller, Tom Harkin and Sherrod Brown believe that the bill represents the best chance for passing health care reform in the foreseeable future. “I’m going to vote for it,” Brown told reporters. “I can’t imagine I wouldn’t. I mean there’s too much at stake.”

Change of the magnitude envisioned by health care reformers does not come easily. There have been many frustrations and there will be more. But, as a senior White House staffer with a ringside seat for the slow death of comprehensive care in 1994, I am keenly aware of the real alternative to the bills now before us: millions more Americans without health care and billions more for health care spending as the same challenges President Clinton tried to resolve continue to metastasize unchecked.

So while I have great respect for Governor Dean, and we have worked together to provide the strongest health care reform bill for the American people, I come down on the side of the Senate passing the bill.

Here’s why:

The Senate health care bill is not without its problems. But if enacted, it would represent the most significant public reform of our health care system that Congress has passed in the 40 plus years I have worked in politics. The bill will give health care coverage to a record 31 million Americans who are currently uninsured, lay a foundation that will begin to lower costs for millions of families, and provide all Americans with the access to adequate and dependable coverage when they need it most.

All of us are anxious to see the final language from the Senate. And a final bill must ensure that the subsidies provided are sufficient to make insurance truly affordable for working families. But based on what we know, here are my top ten reasons for why progressives should support the Senate passing the bill:

1. Largest Expansion Of Coverage Since Medicare’s Creation: Thirty-one million previously uninsured Americans will have insurance.

2. Low/Middle Income Americans Will Not Go Without Coverage: For low-income Americans struggling near the poverty line, the bill represents the largest single expansion of Medicaid since its inception. Combined with subsidies for middle income families, the bill’s provisions will ensure that working class Americans will no longer go without basic health care coverage.

3. Insurance Companies Will Never Be Able to Drop or Deny You Coverage Because You Are Sick: Insurers can no longer deny coverage because of a pre-existing condition. They can’t rescind coverage or impose lifetime or annual limits on care. Significantly, the bill also ends insurer discrimination against women — who currently pay as much as 48% more for coverage than men — and gives them access preventive services with no cost sharing.

4. Lowers Premiums For Families: The Senate bill could lower premiums for the overall population by 8.4%. For the subsidized population, premiums would decrease even more dramatically. According to the CBO, “the amount that subsidized enrollees would pay for non-group coverage would be roughly 56 percent to 59 percent lower, on average than the nongroup premiums charged under current law.”

5. Invests in Keeping People Healthy: The bill creates a Prevention and Public Health Fund to expand and sustain funding for public prevention programs that prevent disease and promote wellness.

6. Insurers Can’t Offer Subprime Health Care: Insurers operating in the individual and small group markets will no longer sell subprime policies that deny coverage when illness strikes and you need it most. Everyone will be offered an essential benefits package of comprehensive benefits.

7. Helps Businesses Afford Coverage: Small employers can take advantage of large risk pools by purchasing coverage through the bill’s state-based exchanges. Employers with no more than 25 employees would receive a tax credit to help them provide coverage to their employees. The bill also establishes a temporary reinsurance program for employers providing coverage to retirees over the age of 55 who are not eligible for Medicare.

8. Improves Medicare: The bill eliminates the waste and fraud in the Medicare system, gets rid of the special subsidy to private insurers participating in Medicare Advantage and extends the life of the Medicare trust fund by 9 years. It also closes the doughnut hole that affected 3.4 million seniors enrolled in Medicare Part D in 2008.

9. Reduces The Deficit: Not only would the bill expand coverage to 30 million Americans without adding to the nation debt, it would also reduce the deficit by up to $409 billion over 10 years.

10. Reduces National Health Spending: A CAP-Commonwealth Fund analysis concludes the bill could reduce overall spending by close to $683 billion over 10 years – with the potential to save families $2,500. Even the most conservative government estimates conclude that the bill would reduce national health care expenditures by at least 0.3% by 2019.

UPDATE: 15,000 People Lost Health Insurance Per Day In 2009

Our guest blogger is Judy Feder, a Senior Fellow at the Center for American Progress Action Fund.

polifactYesterday, PolitiFact gave a “false” rating to Sen. Harkin’s claim that “today and every day, an estimated 14,000 Americans will lose their health insurance coverage.” The statistic cited by Sen. Harkin comes from a report we released in February showing that the job market turmoil at the end of 2008 and beginning of 2009 led to 14,000 people losing their health care coverage a day. Our report employed a method – based on an Urban Institute analysis co-authored by health economists John Holahan and A. Bowen Garret – of extrapolating insurance losses from the rise in unemployment rates.

In July, PolitiFact took a look at our report and found it to be “mostly true,” with the caveat that the rate could actually be higher than 14,000. In its latest report, PolitiFact ran the numbers on its own, and found the rate of daily losses to be lower (between 7,524 and 7,784).

While the methodology we used in February (and which PolitiFact now uses in their own analysis) offered the best approach for assessing the state of health insurance losses at the time, newer, more precise data are now available – and those data show that more than 15,000 people have lost their health insurance per day in 2009.

Specifically, we now know the extent to which enrollment is dropping among the nation’s biggest private insurers in 2009, based on the Kaiser Family Foundation’s analysis of the SEC filings of the six largest publicly-held insurance companies. Based on those filings, Kaiser estimated that in the first three quarters of 2009, 4.2 million people have lost their private insurance – an average of 15,385 people per day.

These data, and the conclusions they generate, are more accurate both because they are a more direct measurement of insurance losses, and because they are not subject to the month-to-month volatility of the unemployment rate.

Based on these reasons, we enthusiastically stand by both our conclusions and the point that Sen. Harkin and others have been using them to make: that the rate at which Americans are losing their health insurance coverage is profoundly alarming, and clearly demonstrates the urgent need for reform.

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