Debate has largely centered on developing a government-run insurance plan, known as the public option, and expanding Medicare, two measures strongly supported by progressives that were dropped from the bill last week after independent Connecticut Sen. Joseph Lieberman demanded their removal.
Republicans and conservatives have united to oppose any reform that doesn’t benefit for-profit insurance companies.
While progressives may be disappointed that Lieberman’s demands appear to be successful—at least until the Senate bill is reconciled with the House of Representatives’ bill, which includes a public option—health care expert Robert Kraig, executive director of Citizen Action of Wisconsin, says there are significant provisions in the Senate bill that will help Wisconsin families.
“Frankly, there is a lot in this bill that could not be achieved absent a comprehensive health care bill that would make things better for a lot of people,” Kraig said.
Progressives may not be enthusiastic about the public-option-lacking Senate bill, but the nonpartisan research group Families USA found that the bill would extend health care coverage to an additional 332,000 Wisconsinites by 2019. In contrast, an additional 86,000 people in Wisconsin would lose their health care coverage by 2019 if health care reform is not enacted at the national level. That is a difference of 418,000 Wisconsinites.
While the Senate’s version of the bill may be altered—and even strengthened—as the legislative process grinds on, here are the highlights of the plan as of this writing:
- Extends coverage to 30 million people. People who do not have coverage through their employer or who cannot afford coverage on the individual health insurance market would be able to purchase insurance on a state-based or regional health insurance exchange. In time, more people could be eligible for the exchange—for example, those who work in medium-sized businesses, or, ultimately, everyone, if the secretary of Health and Human Services makes that determination.
- Includes a nonprofit insurer in the health care exchange. President Obama advocated for the public option to “keep insurance companies honest” and lower costs for everyone. That provision is included in the House of Representatives’ bill, but was removed in the Senate. Instead, at least one nonprofit insurer would have to be included in the health insurance exchange. “We would rather have a public option, but it’s not a small matter to require a nonprofit option” along with for-profit insurance plans, Kraig said.
Kraig pointed to a Citizen Action study released on Tuesday that analyzed health care costs and quality in the state. The study found “a strong correlation between [the] quality and [the] type of health plan, with national for-profit insurance companies offering by far the lowest quality plans, and nonprofit provider networks offering the highest quality plans.” That should bode well for people who purchase a nonprofit plan in the exchange.
The establishment of the insurance exchange also means that the expensive and highly unregulated individual policy market would fade away. After all, if people who aren’t insured through their employers can purchase affordable, quality insurance on the exchange, why settle for an expensive policy that covers little?
- Expands Medicaid coverage to more people. Under the Senate bill, folks with incomes less than 133% of the poverty level ($29,327 for a family of four) would be eligible for Medicaid—about 14 million people nationwide. This includes the people who are eligible for Wisconsin’s BadgerCare, BadgerCare Plus and BadgerCare Plus Core Plan.
Kraig said Medicaid expansion is critical to preserving these state programs in the long run, which he said were “stop-gap” measures intended to last until reform was enacted nationally. “If national reform falls through now, then we’re going to have catastrophic effects,” Kraig said. “We’d like to keep [these programs], but it’s going to be very difficult to keep those benefits in the medium- and long-term given the state’s finances if Congress fails to pass health care reform.”
- Subsidizes health insurance policies. While some have blasted government-subsidized premiums as a “bailout for the insurance industry,” the inclusion of a nonprofit plan in the health insurance exchange doesn’t necessarily mean that private insurers will be getting fistfuls of taxpayer money. Kraig called the subsidies—to be paid on a sliding-scale basis for those who can’t afford health insurance on their own but aren’t eligible for Medicaid—an extremely progressive element of the reform bill that should help working families. Tax credits would also be granted to small businesses and charities so they can cover their employees.
- Reforms insurance practices. Individuals would have to purchase health insurance; the tradeoff is that insurers would have to end some if not all of their discriminatory practices. Policies within the health insurance exchange would have the strongest protections for consumers, Kraig said. To gain access to these potential policyholders, insurers would not be able to discriminate based on gender, age or pre-existing conditions; they’d also have to stop putting lifetime limits on policies, which would end medical-bill-related bankruptcies; and end the practice called “rescission”—otherwise known as canceling coverage when a consumer needs to make a claim. Outside of the exchange, insurers would have to end most of their discriminatory practices. Insurance companies would also have to spend at least 80% of their revenues on medical care—not administration or profit.
- Abortion. Not surprisingly, some pro-life legislators made comprehensive health care reform hinge on women’s access to affordable (and legal) abortion. In the Senate’s version of the bill, people who purchase plans with federal subsidies could opt for one that covers abortion. The hitch is that they’d have to write two checks: one for the policy without abortion coverage, and another for the additional abortion coverage.
- Cost and payment. According to the Congressional Budget Office, the Senate’s version of reform would cost $871 billion over the next decade, but overall would reduce the federal budget deficit by $132 billion over those 10 years. (The House version costs more—about $1 trillion—but still reduces the deficit and covers 5 million more people.) The programs would be paid for by raising taxes on policies with high premiums; pharmaceutical companies, manufacturers of medical devices and insurance companies; those who earn more than $200,000; and indoor tanning services. About $483 billion would be cut out of Medicare and other programs.
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