Responding to Howard Dean’s argument that Democrats should “kill” the Senate health bill, John Podesta made the case that the merged Senate legislation goes a long way towards achieving universal coverage and ending abusive insurer practices. “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,” Podesta writes before listing 10 reasons why the bill is still worth passing even without a public option or a Medicare buy-in provision.
Indeed, the loss of the public plan and Medicare buy-in undermines, to some degree, the effectiveness of the Senate bill, but it does not substantially harm the core of the proposal. The merged Senate bill may be without its flashiest provision, but on the whole, the legislation is an improvement over earlier drafts. Consider the Finance Committee’s proposal. It lacked a public option, but also included weaker affordability standards, individual mandate provisions, and insurance regulations:
Merged Senate BillSenate Finance Committee DraftAffordability For Middle ClassFamilies and individuals between 133% and 400% of the poverty level will spend 2.8% to 9.8% of their income on premiums. Families and individuals between 133% and 400% of the poverty level will only have to spend 2% to 12% of their income on premiums. Insurance RegulationsRating variation is based only on age (limited to 3:1). Limits deductibles for health plans in the small group market. Prohibits individual and group health plans from requiring a waiting period for coverage of more than 90 days. Insurers are required to maintain an 85% medical loss ratio until 2014.Rating variation is based only on age (limited to 4:1). Insurers are only required to report their medical loss ratio.Matching Funds For State Medicaid Expansions To finance the coverage for the newly eligible, states will receive 100% federal funding for 2014 through 2016. States receive higher FMAP matching funds thereafter. To finance the coverage for the newly eligible, states would not see 100% match, but would receive an increase in FMAP. Individual MandateFewer Americans would be exempt from purchasing coverage. According to the CBO, the merged Senate bill would cover 31 million Americans, compared to SFC’s 28 million.More Americans would be exempt from purchasing coverage. The draft included a zero-penalty year and the proposal as a whole would have covered fewer people. Long Term Care InsuranceContains a long-term care insurance program, the CLASS Act, a voluntary long-term care insurance program which covers medical and non-medical services like dressing, bathing, and using the bathroom.Did not contain a CLASS Act provision.Younger AmericansYounger Americans are eligible for a catastrophic plan up to age 30. Provides dependent coverage for children up to age 26. Younger Americans are eligible for a catastrophic plan up to age 25.
Moreover, while the debate on the Senate floor has been far from constructive, Senators did attach an important amendment offered by Sen. Mark Pryor (D-AK) to improve the exchanges and adopted Sen. Barbra’s Mukulski’s (D-MD) amendment to ensure that women can access critical cancer screenings and preventive services at no cost sharing.