Jon Walker has gone line-by-line through the Senate health care bill and the CBO analysis, so I won’t replicate his concerns here. In short, he believes the Senate bill has poor risk adjustment, meaning that the insurance companies will be empowered to still game the system, just in different ways; he’s appalled at the creation of nationwide insurance plans, which could easily lead to the gutting of state-based insurance regulations; and he lists several other problems, including the opt-out that states could enact before reform, the 1-year implementation delay, the bad “free rider” provision for employers, and others. I do want to highlight one and expand on it a bit.
6) Incredibly Low Actuarial Value – The minimum actuarial level of the lowest level qualified health insurance is 60%. This level is far too low. This is even lower than the requirement in the Senate Finance Committee bill, which was 65%.
Let’s try to untangle the wonk-speak here. Nicholas Beaudrot does the best job of that. Basically, the bill defines down what qualifies as “insurance,” such that insuring Americans has less meaning and value.
My big fear was that Harry Reid would stay below the $900 billion by watering down the minimum benefits package. This would let the CBO continue to say that however many people are “insured” but not really get into the details of the quality of their coverage. I think I was right:
13 (A) BRONZE LEVEL.—A plan in the bronze level shall provide a level of coverage that is designed to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided under the plan.
As written, the Bronze plans will be, if not universal, certainly a popular form of individual catastrophic insurance with some first-dollar coverage for certain preventative care tacked on. Insurance with a 60% actuarial value is worse than the insurance offered by over 99% of employer-based plans (search for “exhibit 2″). And, of course, people are notoriously optimistic when it comes to assessing their own risk exposure; lots of folks will opt for these crummy bronze plans, not set aside much savings, and hope they don’t get sick.
If insurance covers less, it’s likely to cost less, and that makes the subsidies to ensure affordability less, so that’s how this saves money for the federal government.
The only mitigating factor that I can see here is that the minimum benefits package in the bill would mandate coverage and no cost-sharing for a fair amount of services, and then there are the limits on out-of-pocket expenses, elimination of lifetime caps and limiting of annual caps on spending. While there’s certainly value in catastrophic coverage, preventive coverage, and guaranteed issue for people with pre-existing conditions, that’s pretty bare-bones coverage, and unless people understand clearly what they’re getting with their insurance they’re bound to be shocked at what the Bronze plan doesn’t cover. And if they opt for a more comprehensive plan, they won’t get the same subsidy help.
I should say that there is more money available for subsidies in this bill than in the Senate Finance Committee’s bill, particularly for middle-class families.
Other analyses of the Senate bill are available at The Wonk Room and Change.org. Senate Democrats have provided a section by section summary of the bill, a somewhat more robust explanation and an implementation timeline.



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David ,appreciate your efforts but yglesias says it correctly when he says “That said, reading legislative language is hard and so I’m not totally sure that I’m interpreting this correctly as saying that even the Bronze plan needs to cover preventive services.”
And this comment in his site is ‘spot on’: “One of the problems I see is that the poor and the young will opt for the least expensive alternative, which is likely to be the catastrophic-only bronze plan. So they will still be screwed when they break a leg, have to go to the emergency room, and are suddenly facing a bill of $5000. To a poor person, that $5K is not significantly different than $500K–they can’t pay either one. All the poor get here is some minimal preventive care, which is a good thing, but they still face insolvency if they have to pay for anything major.”
I’m now reading the link to politico and came across this to be implemented in 2010:
“Create a temporary re-insurance program to support coverage for early retirees” ; what is that about? I know most FDL’ers are not even close to being ‘early retirees’ but I had to do such to survive as I couldn’t find work to support myself.
And the SS Admin is saying more and more citizens are taking early SS because of the employment situation so what is the ‘temp re-insurance program’?
Oh, and did you read this? “No out-of-pocket requirements can exceed those in Health Savings Accounts,” ; man,oh,man; see here and then re-evaluate the ‘bronze’ plan.
And this certainly obviates the idea of ‘choice’: “Individuals qualified to receive tax credits for Exchange coverage must be ineligible for affordable, employer-sponsored insurance any form of public insurance coverage.” AND “If an employer offer of coverage exceeds 9.8 percent of a worker‟s family income, or the employer pays less than 60 percent of the premium, the worker may enroll in the Exchange and receive credits.”
“states may also seek waivers to explore other reform options”; well here in CA we’re going to be pushing single payer AGAIN and hopefully won’t have a jackass for governor when it AGAIN passes.
And somebody explain this as it seems contradictory to itself: “If an employer offer of coverage exceeds 9.8 percent of a worker‟s family income, or the employer pays less than 60 percent of the premium, the worker may enroll in the Exchange and receive credits.”
And this explicitly disallows individuals from having more than $2500 deducted as pre-tax from their paychecks in an employers ‘Flexible spending accounts: “Limiting Health FSA Contributions: This provision limits the amount of contributions to health FSAs to $2,500 per year.” So they pay more income tax.
MOre ‘screw the seniors’: “Eliminating the Deduction for Employer Part D Subsidy: This provision eliminates the deduction for the subsidy for employers who maintain prescription drug plans for their Medicare Part D eligible retirees.”
All of the above is from “a somewhat more robust explanation and an implementation timeline.” which is this http://www.politico.com/static/PPM110_091119_long_summary.html
Based on all that has occurred and been said, neither Congress nor the ObamaRahma Admin ever heard the phrase ‘keep it simple,stupid’; all the machinations and new laws -without really specifying how such will be enforced- are SO UNNECESSARY when compared to going to single payer or Medicare for All.
Perfect example of how to take the ingredients for a nice cake and turn it into unleavened bread.
Thinking of buying insurance? First question to ask yourself: Can you afford contract law counsel?