The so-called ‘Gang of Six’ will be meeting today at 2:30pm to consider Sen. Max Baucus’s (D-MT) broad framework for a bipartisan health care bill. 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 early August, Baucus revealed that the preliminary estimates from the CBO show that the committee’s plan would cover 94% of all Americans, cost some $900 billion. According to media reports, Baucus’ latest framework comes in at around $880 billion over 10 years. The Wonk Room obtained a summary of Baucus’ plan and compiled this comparison of existing legislation:
HELP Bill (Cost: Around $1 trillion) (97% covered)Tri House Bill (Cost: $1.04 trillion) (97% covered)Baucus’ Draft (Cost: $774 billion) (94% covered)Individual MandateYesYesYes (exempt if lowest cost premium available exceeds 10% of income)Employer MandateYes (Large employers would pay $750 per full-time employee, $375 for each part-time employee or provide adequate coverage.)YesNo, but employers with workers receiving subsidies through the Exchange would have to contribute.Medicaid Expansion150% FPL, but still unclear133% FPL; Anyone newly covered under Medicaid can choose to be subsidized in the Exchange or Medicaid.133% FPL (Non-elderly non-pregnant adults between 100–133% of poverty would be able to choose between Medicaid and subsidized coverage through the exchange.)SubsidiesBetween 150–400% FPL on sliding scaleBetween 133–400% FPL on sliding scale. Individuals have to spend between 1.5 and 12% of income on premiums before subsidies kick in. Between 133–300% FPL on sliding scale; credits available to for 100–133% of poverty starting in 2014. Individuals have to spend between 3 and 13% of income on premiums before subsidies kick in. Public OptionYes (Will have to compete on a level playing field with private providers and offer competitive rates and premiums. )Yes, Medicare + 5%No (Conrad’s co-op compromise)Insurance RegsGuarantee issue, modified community rating (2:1 based on age), no rescissionsGuarantee issue, modified community rating (2:1 based on age), no rescissionsGuarantee issue, modified community rating (Health insurance premiums would be allowed to vary based only on tobacco use, age (5:1), and family composition.), no rescissionsFinancingOutside of jursidiction$500 billion from surtax, $500 billion from Medicare/Medicaid$60 billion from insurers who offer plans above $21,000; $40 billion from manufacturers of medical devices; $7.5 billion from clinical laboratories; $400 billion from Medicare
It’s unclear if Baucus’ outline will attract bipartisan support. Earlier today, during an appearance on C-SPAN, Sen. Chuck Grassley (R-IA) indicated that he would not support Baucus’ bill, saying that “the document Senator Baucus would put out would not fall into that category because it is about $900 billion. I was hoping that something in the $700 billion range would work.” Grassley explained that the town hall meetings — “democracy in action,” he called it — convinced him to “slow down” and support a smaller bill with “offsets that were fairly easily to arrive at.”
Meanwhile, some liberal Democrats may be surprised that the benefits offered to the new Medicaid beneficiaries “would generally be less generous than the comprehensive benefits available to other Medicaid recipients.” The Baucus proposal also offers smaller benefit packages than the House bill, allows for higher limits on out of pocket medical costs, and requires individuals to spend a higher percent of their income on premiums before receiving subsidies.
The bill also establishes “a separate ‘young invincible’” program that “would be targeted to young adults who desire a less expensive catastrophic coverage plan.” While Massachusetts offers similar plans, most health reform advocates believe the coverage to be inadequate. According to the outline circulated by Baucus, this proposal would contain “a requirement that preventive services be covered below the catastrophic amount. Cost-sharing for preventive benefits would be allowed.”