IF we get the Public Option, WHO will Get the Choice?

(10 am. – promoted by ek hornbeck)

Health Reform’s Missing Ingredient

By Ron Wyden, Senator D-OR, NYTimes Op-Ed

September 17, 2009

The various bills making their way through Congress would, as the president explained, provide some consumer choice by establishing large marketplaces where people could easily compare insurance plans and pick the one that best suits their needs.

[…]

The problem with these bills, however, is that they would not make the exchanges available to all Americans. Only very small companies and those individuals who can’t get insurance outside of the exchange – 25 million people – would be allowed to shop there. This would leave more than 200 million Americans with no more options, private or public, than they have today.

http://www.nytimes.com/2009/09…

Wait a second, I thought the Public Option, would give us a Choice —

give US ALL a Choice?

The Insurance Exchange will be closed to “more than 200 million Americans”?

that must be a typo!?!

This would leave more than 200 million Americans with no more options, private or public, than they have today.

Well that’s a significant problem!

Jay Rockefeller, like Wyden, also gets to Vote on the final Baucus Bill, since they are among the “silent members” of that Committee.

Jay Rockefeller, like Wyden, is worried about those Americans — who will get NO Choice, within the current Finance Bill. Worse yet, many Americans will be exempted from the New Rules, meant to improve Coverage quality, due to the insurance give-aways already written into the Bills.

What’s Wrong With the Finance Bill? An Interview With Senator Jay Rockefeller.

By Ezra Klein,  Washington Post — September 18, 2009

Question: Can you support the Finance Committee bill in its current form?

Rockefeller: No.

Why?

Rockefeller: Obviously the public option. I feel very strongly about that as a discipline on the private health insurance market.

[…]

Another issue is that 46 percent of the American people have health insurance from fairly large companies that self-insure. And they’re not included in the regulations. They have to have protection from preexisting conditions and lifetime caps and rescissions too.

http://voices.washingtonpost.c…

Huh? What that?

… 46% of the Americans … not included in the regulations [for] preexisting conditions and lifetime caps and rescissions.

Well that’s another significant problem!

What is “Self Insurance” anyways — since, almost half of us have it?

http://www.biztimes.com/news/2…

When to Self-Insure?

By Elizabeth Hockerman, of BizTimes

Any size company can become self-insured, which means that the company assumes the risk of paying medical claims […] The majority of companies that are self-insured purchase stop/loss insurance. […] The company pays every claim that is under $10,000, and the stop loss insurance would cover anything over $10,001.

Interesting, I wonder if those us with Self-Insured plans through our Employers, even know it?  I wonder if that 46% of us will end up with the Choice of a Public Option, assuming one is eventually passed, in one form or another?

Look out for Self-Insurance exclusions, Check!

Jay Rockefeller has stated he will NOT vote for the Baucus Bill in its current form.

Hopefully Ron Wyden will join him, since both are on Max Baucus’ Finance Committee — Yet, Neither Senator was included in Baucus’ infamous “Gang of Six” — aka. the “See No Evil from Insurers” Gang!

Both Senators DO get to Vote on the Final Finance Committee Bill however.

Ron Wyden is planning to leverage his Vote, by offering a “Real Choice” Admendment to Max’s reversed- bi-partisan Bill:

Senator Ron Wyden: The Free Choice Proposal (pdf)

(selected legislative excerpts and emphasis added)

Brief Description:

The Free Choice Proposal gives EVERY American

the ability to either choose to keep the coverage they have

or

pick a plan that works better for them and their family.

It guarantees both choice and portability

by creating a path for employers

to insure their workers through

a national

or

state-based insurance marketplace

known as the “Exchange.”

[…]

Free Choice Will Help Working Americans

With the Free Choice Proposal, workers will be able to keep the coverage they have or go to the exchange if they want another plan.

Low-income workers will be ensured affordable health care.

[…]

Transition to the Free Choice System

Year 1 – People who are currently in the individual market plus small employers with up to 10 workers and the uninsured have access to the exchange.

Year 2 – Add small employers with up to 25 workers to the exchange.

Year 3 – Give State Medicaid programs the choice to be in exchange.

Year 4 – Open up the exchange to medium sized employers with up to 250 workers using the Free Choice approach.

Year 5 – Open exchanges to all employers.

Woo Hoo! — I like that Result, in Year Five … Hmmm? I wonder if “MY Public Option” Bill will do that?

Those are some good principles to be carried forward, into WHATEVER Reconciliation Committee Process eventually unfolds, in the upcoming months. Just because a Bill talks about the Public Option, it doesn’t mean that YOU will get a Choice!

Consumers Beware!

In many ways a Watered-down Public Option, is more dangerous than NO Public Option. A Watered-down Public Option would give us the illusion of Change, WITHOUT the sweeping RESULTS OF actual CHANGE!

Without Wyden’s “Free Choice” Amendment, the Baucus Bill is a non-starter. It’s little more than a Gift to the Insurance Lobby — mandating coverage, while restricting Consumer Choice of “qualified private plans”, and excluding a Choice to a Public Option entirely!

Well there ARE OTHER Health Care Bills out there, that do INCLUDE the Public Option, Right?. What kind of Choice, do Consumer’s get in those competing Bills?

Here’s the Kennedy Bill, which is being promoted by Jay Rockefeller lately:

(By the way, Kennedy Bill IS a Bi-partisan Bill, unlike the “Faux Baucus Bill”.)

The Affordable Health Choices Act

In July 2009, Senator Kennedy’s Health, Education, Labor and Pensions (HELP) Committee passed The Affordable Health Choices Act, landmark legislation that will reduce health costs, protect individuals’ choice in doctors and plans, and assure quality and affordable health care for all Americans.

The legislation builds on the existing employer-based system and strengthens it. If people like the health insurance they have, they get to keep it. The bill provides better choices for those with no coverage now, and those for whom coverage is unaffordable. It also gives small businesses better options for high value health coverage.

Ted Kennedy’s Web Site

If people like the health insurance they have, they get to keep it.

OK … What if they “Don’t like” their health insurance plan, DO they get to Exchange it? … do we get to trade in our Clunkers, for a better model, here?

Good question.  Let check some of the legislative specifics from Kennedy’s Affordable Health Choices Act, designed to HELP ordinary Americans:

In Historic Vote, HELP Committee Approves the Affordable Health Choices Act

July 15, 2009

(selected legislative excerpts and emphasis added)

WASHINGTON, D.C. – The Senate’s Health, Education, Labor and Pensions (HELP) Committee today passed The Affordable Health Choices Act, landmark legislation that will reduce health costs, protect individuals’ choice in doctors and plans, and assure quality and affordable heath care for Americans. The bipartisan bill includes more than 160 Republican amendments accepted during the month-long mark-up, one of the longest in Congressional history.

The bill also includes a strong public option that responds to the wishes of the American people to have a clear alternative to for-profit insurance companies. Like private insurance plans The Community Health Insurance Option will be available through the American Health Benefit Gateway, a new way for individuals and small employers to find and purchase quality and affordable health insurance in every state.

The non-partisan Congressional Budget Office estimates the bill to cost less than $615 billion over 10 years.

Subtitle B. Available Coverage for All Americans

Synopsis: This subtitle authorizes the establishment of an Affordable Health Benefit Gateway in each state and of a Community Health Insurance Plan.

Planning grants are provided to each state to support the creation of state Gateways.

States can establish Gateways as quickly they wish, thus qualifying their residents for premium credits.

If a state takes no action, the Secretary will establish and operate that state’s Gateway.

Gateways are established to help

qualified individuals and

qualified employer groups

to purchase affordable health insurance and related insurance products.

The Gateway will establish procedures

to qualify health plans to be offered through them,

develop tools to enable consumers to obtain coverage,

establish open enrollment periods, and

assist consumers in the purchase of long term services and supports.

Affordable Choices of Health Benefit Plans.

Each state will have an Affordable Health Benefit Gateway,

established either by the state or

by the Secretary of Health and Human Services

that will be administered through a governmental agency or

non-profit organization.

Within 60 days of enactment, the Secretary will make planning grant awards to states to undertake activities related

to establishing their own Gateway.

The Gateway exists to facilitate voluntary purchase of health insurance coverage and related insurance products

at an affordable price by

qualified individuals and

qualified employer groups.

States may require benefits in addition to essential health benefits but must assume additional costs.

Risk pools include all enrollees in an individual plan

or a group health plan.

The Gateway will include a public health insurance option.

The Gateway will establish procedures to qualify

interested health plans to offer

their health insurance policies through the Gateway. (§ 3101)

Subtitle D. Shared Responsibility for Health Care

Definitions: (§ 3116)

“An eligible employee” is an individual for whom if the employer-sponsored coverage does not meet criteria for minimum qualifying coverage or is not affordable for the employee.

“A qualified individual” is residing in a participating or establishing State, not incarcerated, not eligible for Medicare or Medicaid, TRICARE, FEHBP, or any qualifying employer-sponsored coverage.

HELP Committee Approves the Affordable Health Choices Act (pdf)

Hmmm? that’s a lot of “qualifiers”!?

Do we, or Do we Not — Get a Choice of the Public Option, offered in the Exchange?

if the employer-sponsored coverage does not meet criteria for minimum qualifying coverage or is not affordable for the employee.

Those are 2 Big IFs.  … Kind of sounds like, It’s up to the Employer — NOT up to US!

SO What kind of Choice do we Consumer’s get in the popular House Bill — H.R. 3200?

America’s Affordable Health Choices Act: Complete Bill Text (H.R. 3200)

(selected legislative excerpts and emphasis added)

— A Health Insurance Exchange.

The new Health Insurance Exchange creates a transparent and functional marketplace

for individuals and small employers

to comparison shop among private and public insurers.

It works with state insurance departments to set and enforce

insurance reforms and

consumer protections,

facilitates enrollment, and

administers affordability credits to help low- and middle-income individuals and families purchase insurance.

Over time, the Exchange will be opened to additional employers as another choice for covering their employees.

States may opt to operate the Exchange in lieu of the national Exchange provided they follow the federal rules.

— A public health insurance option.

One of the many choices of health insurance within the Health Insurance Exchange

is a public health insurance option.

It will be a new choice in many areas of our country dominated by just one or two private insurers today.

The public option will operate on a level playing field.

It will be subject to the same market reforms and consumer protections as other private plans in the Exchange and

it will be self-sustaining – financed only by its premiums.

America’s Affordable Health Choices Act: Summary (pdf)

OK that’s a Good Summary of the House Bill.  Sounds like it plans to — much like the Wyden “Free Choice” Proposal — to eventually expand to all employers:

Over time, the Exchange will be opened to additional employers as another choice for covering their employees.

Does “be opened to” — mean employers, have to offer it?

Does “additional employers”  imply ALL employers? … not really.

Drilling further into the nitty, gritty of HR 3200:

America’s Affordable Health Choices Act Section-by-Section Analysis

July 14, 2009

(selected legislative excerpts and emphasis added)

TITLE I – PROTECTIONS AND STANDARDS FOR QUALIFIED HEALTH BENEFITS PLANS

SUBTITLE C – STANDARDS GUARANTEEING ACCESS TO ESSENTIAL BENEFITS

Sec. 121. Coverage of essential benefits package.

Requires qualified plans to meet the benefit standards recommended by the Benefits Advisory Committee and adopted by the Secretary of HHS.

Plans outside the Exchange must offer

at least the essential benefits

and others as they choose.

Plans within the Exchange must meet

the specified benefit packages,

which includes a tier with offerings of additional benefits.

Allows for the continued offering of separate

excepted benefits packages

as in current law outside of the Exchange.

TITLE II-HEALTH INSURANCE EXCHANGE AND RELATED PROVISIONS

SUBTITLE A – HEALTH INSURANCE EXCHANGE

Sec. 202. Exchange-eligible individuals and employers.

Defines who is eligible for participation in the Health Insurance Exchange

including employers and individuals.

In year one,

individuals not enrolled in other acceptable coverage

are allowed into the Exchange

as well as small employers with 10 or fewer employees.

In year two,

employers with 20 and fewer employees are allowed into the Exchange.

In subsequent years, the Health Choices Commissioner is granted authority to

expand employer participation as appropriate,

with the goal of allowing all employers access to the Exchange.

SUBTITLE B – PUBLIC HEALTH INSURANCE OPTION

Sec. 221. Establishment and administration of a public health insurance option as an Exchange-qualified health benefits plan.

Requires the Secretary of Health and Human Services to develop a public health insurance option

to be offered starting in 2013 as a plan choice

within the Health Insurance Exchange.

It participates on a level playing field with private plan choices.

Like private plans, it must

offer the same benefits,

abide by the same insurance market reforms,

follow provider network requirements and

other consumer protections.

Sec. 222. Premiums and financing.

Premiums for the public option are geographically-adjusted

and are required to be set so as to fully cover

the cost of coverage as well as

administrative costs of the plan.

This includes a requirement that the public option,

like private plans, include

a contingency margin in its premium to cover unexpected cost variations.

In order to establish the public option, there is an initial appropriation of $2 billion for administrative costs and in order to provide for initial claims reserves before the collection of premiums such sums as necessary to cover 90 days worth of claims reserves based on projected enrollment.

These start up funds are amortized into the premiums for the public option to be recouped over the first 10 years of operation.

The plan must be self-sustaining after that initial funding.

Section-by-Section Analysis (pdf)

OK, this is good to see:

goal of allowing all employers access to the Exchange

It’s Good to Have Goals!!

This one bit of legislation however, kind of seems like a worrisome Weasle Word restriction:

In year one, individuals not enrolled in other acceptable coverage are allowed into the Exchange as well as small employers with 10 or fewer employees.

Which Lobbyist, I wonder, wrote that clause:

“not enrolled in other acceptable coverage”

Who decides what is “acceptable coverage” or not?

Who decides what is “affordable coverage” or not?

Who decides if and when, we get to go into the Insurance Exchange, no questions asked?

When I want to shop for a New Car, I don’t have to check with anyone, least of all my Employer — I just go out into the Market, and find the best deal!

This leads me back to Senator Wyden again.  He is calling for ALL Americans to be offered the Choice on the Exchange.

Wyden is advocating that giving EVERYONE a CHOICE, is critical for the competitive forces of an “open” Marketplace, to drive down the Costs for everyone.

Health Reform’s Missing Ingredient

By Ron Wyden, Senator D-OR, NYTimes Op-Ed

September 17, 2009

Under the nation’s current employer-based system, most people have little if any choice about where they get their insurance. They just have to accept the plan that comes with their job. That insurance company, in turn, is provided a captive group of customers, so it has no incentive to earn their loyalty.

[…]

I believe there is a way to work with the present employer-based system to guarantee that all Americans have choices, and I am proposing it in an amendment to the latest Senate health care bill. My amendment, called Free Choice, would let everyone choose his health insurance plan.

http://www.nytimes.com/2009/09…

Question: Without giving EVERYONE a Free CHOICE, Does a competitive Marketplace, even exist??

… or rather, Without that Choice for Everyone, aren’t we really continuing with the “captive group of customers” that make up the Status Quo of our current Insurance system?  …

Consumers with NO Choice, are Easy Pickins for Big Insurers! (especially when those Consumers, are mandated by law, to get Coverage.)

In many ways a Watered-down Public Option, is more dangerous than NO Public Option. A Watered-down Public Option would give us the illusion of Change, WITHOUT the sweeping RESULTS OF CHANGE!

Any Bill that the Insurance Industry is happy with, is a Bill which simply perpetuates the Status Quo — our Premium Payments should GUARANTEE us Quality Care, at an Affordable Price — NOT just more of the same!

A Strong Public Option, available to EVERY American who wants it, will force Private Insurers, to provide Quality, or to Fail.

It would level the Playing Field, so that Insurers, can feel the Pain of “hearing that word NO!”

A Strong Public Option, means American citizens would get that Choice, to SAY NO! — say NO to our Faux Care Policies!  

No Longer, would “NO” be that exclusive weapon, of the Insurance “Money Changers” — By giving US the chance to SAY NO to THEM — the true Force of the Marketplace will be brought to bear, wielded from where it belongs —

In the hands of the People!

By giving EVERYONE the Choice … WE end up in the Driver’s Seat, driving the Process of Real SWEEPING Change, for the benefit of All the People!

… and not just the privileged few.