There's a deal for the health care bill in the Senate
Posted on December 19th, 2009 by Jason Rosenbaum in Congress Watch
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Senator Nelson has announced that he is on board for cloture on the Senate health care bill. Majority Leader Reid is expected unveil his Manager's Amendment and announce he has the 60 votes needed to move forward shortly. (It'll probably be broadcast on CSPAN for those who want to watch.)
Here is the full text of the Manager's Amendment [pdf]. And here's a bit of what's in it, courtesy of Reid's office:
- Stronger medical loss ratios. Health insurers will be required to spend more of their premium revenues on clinical services and quality activities, with less going to administrative costs and profits - or else pay rebates to policyholders. These stricter limits will continue even after the Exchanges begin in 2011, and apply to all plans, including grandfathered plans. (Ed note: Reportedly, these require group insurance plans to pay 85% of premiums to health care, and individual plans to pay 80%. These would go into effect in 2011. In 2012, the ratios would be based on the average medical loss ratio in the Exchange.)
- Accountability for excessive rate increases. A health insurer's participation in the Exchanges will depend on its performance. Insurers that jack up their premiums before the Exchanges begin will be excluded - a powerful incentive to keep premiums affordable.
- Immediate ban on pre-existing condition exclusions for children. Health insurers will be immediately prohibited from excluding coverage of pre-existing conditions for children.
- Patient protections. Health insurers will have to abide by a set of patient protections that, for example, protect choice of doctors and ensure access to emergency care.
- Ensuring access to needed care. The use of annual limits on benefits will be tightly restricted to ensure access to needed care immediately, and will be prohibited completely beginning in 2014.
- Guaranteed opportunity to appeal coverage denials. All health insurers will be required to implement an internal appeals process for coverage denials, and states will ensure the availability of an external appeals process that is independent and holds insurance companies accountable.
- Multi-state option. Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees health plans for Members of Congress. At least one plan must be non-profit, and the plans will be available nationwide. This will promote competition and choice. (Ed note: At least two plans will have to be offered, one of which must be non-profit. OPM can negotiate medical loss ratio, profits, premiums and other terms.)
- Free choice vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan.
- Children's health. Support will be extended for the Children's Health Insurance Program and the adoption tax credit. Foster care children aging out of Medicaid will be able to retain its comprehensive coverage.
- Rural and underserved communities. Access will be expanded through funding for rural health care providers and training programs for physician and other types of health care providers.
- Revised abortion language, including state opt-out of abortion coverage (Ed note: details here)
The first cloture vote is expected to be filed shortly, putting the bill on track for passage in a few days.
Going forward, we'll be fighting as hard as possible to make sure we get the strongest bill to the President's desk.
This bill is a start. I hope it passes even though it falls far short of all the reform we need. I disagree with Sen McConnell's remarks that the bill is being pushed through during the holidays as a trick or nefarious way of duping the public. It is being advanced now because it is urgent to act now. The millions of citizens in a crisis with the healthcare situation, some literally in life or death crises, need action now, not later. It is clear that there are many congressmen and women who are still very interested in supporting big business much more than supporting the people.
Are you serious? If these people are in such a crisis you think that government will help? These crisis people would benefit a hell of a lot more if you just donated an hour of volunteer time at a clinic or a hospital or just donated them the money you are going to have to give the government for this healthcare bill. Now not only are they ill and have medical bills now they are going to have a mandate to purchase health insurance how the hell does that help?
If you have a major medical crisis you will lose everything you have if you are not ultra rich. I don't know about you but if I am sick or injured and can not work I don't get a paycheck. If I don't get a paycheck sick or not I can't pay my bills. If I can't pay my bills they come and take the house and the cars etc. This bill does not mean crap other than it is going to cost me more money because they are going to either fine me or mandate that I have insurance.
I don't understand how a limited donation of time or money is going to help someone in a medical crisis. Even a trip or two to a community health center will not keep someone with cancer or Multiple Sclerosis alive and without pain. Medical crises require regular doctor visits and treatments over a long period of time… with oversight by a family physician who knows you. Medical crises are not limited to a single medical event such as surgery or a broken bone. Chronic illness does not get treated without good medical insurance. If the private insurance companies won't make this affordable, then the government should step in and help. Also, mandated health insurance creates the largest pool possible because it includes healthy people who are not yet sick. That is how insurance works. Only in America do so many citizens refuse to support a system that helps their fellow citizens in time of need. What we need to do is what is happening abroad… give Americans a chance to buy what is affordable for them, based on income, rather than set prices dictated by greedy insurance companies. That's why we need government involvement.
Jason, this is not a start. It's junk. Your summary leaves all discussion of what is objectionable. The individual moarket medical loss ratios are subject to change by the department if in their opinion the market becomes unstable. The pre-existing exclusion prohibition does not control cost, so most people with pre-existing conditions will be priced out of the market, but still mandated to purchase. There is no protection for state mandated coverages in the multi-state plans. The annual limits are not exactly what they are advertised to be. Even if you ignore the time delay on lifetime limits and the exceptions to the immediate annual limits provisions, for permanent, the annual and lifetime limits per beneficiary on specific coverages live on. Again, HCAN works for this legislation by misrepresenting it.
We're reporting on facts as we get them. I think it's no secret we think a better bill needs to happen before this is over.
Thank you Jason! We all agree that this bill isn't optimal, however we need to start somwhere and amend this bill in the future. Reforming health care is not a one step all encompassing process, thanks to the republicans and the lobbyists working for big business. This bill is a monumental win for our citizens, now we need to be diligent and keep insisting that our lawmakers make the amendments required to ensure that Americans are provided a comprehensive health care system that is affordable to the many. One amendment at a time if necessary. We the American citizen will prevail!
I wonder how long this will all take. My daughter and her husband work, but they have not had health insurance for 6 years, not because they don't want to buy it, but they can't afford to pay a premium that takes 30-50% of their net income, … not when they have education debt to take care of. And they don't make more than a few hundred dollars more than the limit for state aid. They can't wait any longer. Her husband has a herniated disk in his back and goes to a community center now and then in the city for pain relief. They had to find another apartment after their landlord raised the rent in their tiny apartment. These people cannot wait. They need affordable premiums now for people whose small business employers do not give coverage.
While the bill is not ideal, it does improve the situation from what we have now and should be passed to ensure protections for some of the nation's most vulnerable. Arguing that insurers can simply price people out of the market would imply that the federal government won't take an interest in ensuring their subsidy dollars for low income earners aren't minimized. This is by no means a perfect bill, but in my mind it advances health care for almost everyone and given that the Democrats themselves represent so many divergent opinions, compromise is the only realistic option we would expect.
I don't think the Senate bill would cover many more people. With people's income declining and employers dropping insurance coverage for employees (as my daughter's did) and more people in between jobs… more and more people with either suffer and die or go bankrupt. Regulation on insurance companies has to be broader and deeper… as in Germany for example. The European nations are laughing and scratching their heads over our lack of concern for fellow citizens. I know, because my best friend has been living and working for almost 30 years in Europe. She was able to start up a small company and not worry about dealing with insurance for her employees. She has also been free to study for a doctorate because she didn't have to worry. She has experienced care over there, including emergency surgery for a ruptured appendix, and needs care for a number of chronic ailments. She can't come back to America because of her pre-existing conditions now. But she likes it over there anyway.
America would be more productive and create a better environment for would-be entrepreneurs if they spent more money on healthcare for their citizens. Americans need to see this extra expense as a bonus for the country, not a liability.
Can just one liberal democrat tell me how this bill is going to help me. I currenty do not have insurance by my choice.
I am 39 years old, married with two kids. I can tell you right now health insurance or not if I have a major medical event in my life I will lose everything. If I cant work I can't pay for my house or cars or anything elese simple as that I don't care what the health care bill does I am still the loser in the end not only am I ill or injured, but I lose everything anyway. Is the congress realy this blind that they can't see this makes no difference at all other than to force me to buy something I don't want.
You are in the same boat as my daughter and her husband. They live like poor people but work full time and have no health insurance. They would like to buy insurance, but the premiums are simply too high. They are not considered at poverty level, because they make a few hundred dollars too much. The private insurance companies don't base premiums on income. Even some of the new companies aiming at lower income people would end up taking 30% or more of their take home pay.
That said, I am going to try to convince them to buy from one of these newer companies. I will offer to help them pay for it out of my retirement money.
It is important for all Americans to be covered, and as in many other nations, one way to do that is to mandate coverage. However, we need to find a way to do this that is based on income and doesn't favor rich people. Take a look at Germany and France, for example.
You need to get health insurance somehow. A chronic ailment or an as yet diagnosed illness will bankrupt you and end up costing the tax payer even more.
I wish you luck.
Yeah, Merry Christmas to those who still won't be able to afford health care coverage in the wealthiest, greediest country in the world. Happy Lousy New Year to them from the Rethuglicans like Lie-berman (yes, don't let the "I" fool you), and the Democrats and president, who couldn't find the onions to stand up to them!
I'm sure there will be a heck of a holiday party at Aetna, UnitedHealth and Blue Cross. This legislation may have lots of Grinchy-sounding new rules, but the insurance companies will be raking in the dough and smiling happily knowing that their best interests are being protected by their friends in Washington.
Happy Holidays, big insurance.
Best of luck, everybody else. We're gonna need it.
Nothing is being said about the Health insurance agents. Do you know there are over 500,000 of us out there who have 20+ years helping people. Do you care? We self employed will not be counted in the unemployed. what a sick government!!!
Yes, we do care. The agents are not the problem. It is the management of insurance companies and the system that allows them to get away with murder and abuse of patients. My daughter and husband have no coverage with their employers. There are many people already excluded by private insurers because of the set prices of their premiums. They have not cared about the increasingly large number of lower middle class and poor who can't buy their policies. It would have been a great market, but they didn't bite. Obviously, government will have to take up the slack. I do not doubt that all of the health insurance agents will continue to find work in insurance… probably even for the same company they work for now… but the big-time corporate insurance companies need regulating. The problem is not the agents, it is the over-paid CEOs and top management, who, by the way, often reward agents for denying adequate care.
I wouldn't say anything, yet. We have to always fight for a better bill than this. This is really nothing. Also, we must always fight for the best bill so that by the time it got all watered down, at least bearable. But if we start out with piece of junk like this, then we'll gonna end up with piece of sh*#%? The opponents have been doing that already. However, we must fight to hold that public option to the end and to remove the abominable abortion provision!
I think the ACLU should block implementation of the bill if passed. We mandate education, but have a public option - name one other cirucumstance in which we are mandated to consume a private product
Yes, this is largely a piece of junk which will not help many people and will not do so in the near term. Let's hope Congress and the American people wake up in time to create a final bill that is better. The merger of the House bill with the Senate's could improve this one. The Republicans will continue to stonewall, but hopefully the people will finally see that they are the problem because they have been taking in huge funds from the insurance industry for years.
I think the line in the sand will be the 40% excise tax on union negotiated health care benefits. if it stays in the final bill there will be an exodus of working people against the bill and the democrats who supported it.
Real Health Care Reform isn't going to pass because it was hijacked by Joe Lieberman and Ben Nelson? Joe Lieberman isn't the problem. Neither is Ben Nelson.
The real problem is the filibuster.
Senator Tom Harkin (D - IA) tried to change the filibuster procedure in 1995. His co-sponsor? Naturally. Joe Lieberman (I -CT). Senator Harkin is considering making another attempt.
If Senator Harkin's attempt at a rules change is defeated, if he's unable to get 67 Senators to vote in favor, the Democrats must use the Nuclear Option to have the President of the Senate put to a floor vote the question of the constitutionality of the filibuster.
http://dir.salon.com/story/news/feature/2005/05/12/nuclear_option_primer/print.html
What began as a Senator's right to speak without restriction because no restrictions were part of the Senate's foundation has become a ploy of obstructionists and a tool for those more intent on extortion than on respecting the precedents and history of the United States Senate.
History tells us that the House used to allow the filibuster and that the procedure was eliminated in order to make the House function more efficiently.
CSPAN shows us that the Senate no longer functions.
You sure have a very scary idea of "function". I was part of the few conservatives & centrists who said NO nuclear option on judges when you were in the minority.
Sorry, fillibusters defend MINORITY RIGHTS - and the rights of those whom represent half of the country that does NOT want big government.