So I’m frantically trying to read the manager’s amendment (turn on CSPAN-2 and you can follow along yourself) and all the supplementary information that’s out there on just what’s now in this health care bill, and here’s what I’ve got so far:
• The CBO score is out. The top line numbers? The bill costs $871 billion and would save the federal government $132 billion over the next ten years. The changes in the manager’s amendment amounted to a net $2 billion dollar savings. The bill would cover 31 million people and leave 23 million uninsured by 2019.
• On the abortion issue: states could prohibit abortion coverage in the exchange if they passed a law. This basically punts the Stupak issue to the states, and if the exchanges expand over time as expected, essentially end abortion services coverage in states that pass a law. This becomes a huge culture war battle in states for years and years to come. Good for pro- and anti-abortion groups’ fundraising coffers, bad for women.
• The CLASS Act, the federally managed, voluntary long-term care program, is still in the bill. Lieberman may have mentioned it on Face The Nation, but he didn’t kill it.
• The public option is replaced with the OPM-managed multi-state plans in the exchanges. Not all of them have to be non-profits; in fact, only one of them has to be.
• The individual mandate penalty actually looks a little higher here, although it’s phased in over time. It would be the “greater of a flat dollar amount per person or a percentage of the individual’s income,” up to 2% by 2015.
• Apparently Nebraska and maybe a few other states get more money for Medicaid funding. I can’t get entirely worked up over a legislator securing more money for poor people in their own state. It beats kickback deals for local defense contractors of developers. I think Paul Wellstone would have done no less.
• Small business tax credits to purchase insurance have been expanded by $12 billion and phase in immediately, and are eligible to companies that pay higher wages. Every bill in Congress has to include small business tax credits, it’s the law.
• The medical loss ratio, which was floated to be at 90%, had to be dropped down because of a nakedly political act by the CBO, which said that a 90% MLR would have amounted to nationalizing the insurance industry. So the MLR is now 85/80%, but that apparently does not include the money insurers get through risk adjustment, which means that in practice it’s actually higher.
• They’ve banned pre-existing conditions for children immediately, starting in 2010.
• There are new insurance regulations, including the ability to ban insurance companies from the exchange if they raise their rates above a certain amount. And if an insurer denies a claim, there will be an independent board to which customers can appeal. The design of that board is crucial.
• The nationwide plans, which could have gutted state-level insurance regulations, have been dropped. This is a good thing.
• There are $1.25 billion in new resources for community health centers in the bill, totaling $10 billion overall (there’s $14 billion in the House bill). I’ve written about community health centers before, which could provide a base of low or no-cost primary coverage for all low-income Americans in communities throughout the country. I actually think this is the best thing in the bill. Bernie Sanders is actually talking about this now on CSPAN. He says that 10,000 more communities will have access to community health centers with this legislation.
• Increased debt forgiveness for medical students to work at community health centers.
• The “doctor’s fix” was removed (probably to improve the CBO score) and will be dealt with in separate legislation.
• There’s an increase to the payroll tax for high-income Americans to pay for the bill. Before the increase was 0.5% for individuals with income above $200,000 and for families with income above $250,000; now it’s 0.9%.
• They traded the Botax for a Boehner tax; there’s now a 10% excise tax on indoor tanning.



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Has Lieberman made it back from Connecticut through the snowstorm? Without 60 votes on the floor today, won’t their schedule slip?
no, because the first vote wouldn’t take place until 1am monday.
LoL. Protection for gun owners added. “Premium rate may not be increased, health insurance coverage may not be denied,” for owning or storing a gun and/or ammo.
Looks like owning a gun is not a pre-existing condition.
edit: found at page 5 line 11 of the pdf
I also see this amendment exempts some members of certain religious sects from the mandate. Makes sense. Why should a person opposed to health care buy health insurance.
So guns and bibles are covered now.
page 74 line 4
For the same reason a person who’s a pccifist cannot withhold the portion of their taxes that pay for Defence Dept.
How do we start our own non-prift mutual healt insurance company, with the brand “The Public Option”?
David, what’s the demographic of the 23 million uninsured?
That would be nice, but I don’t think Congress has the power to do that.
I think you mean they ban excluding coverage of preexisting conditions in children.
My guess: almost poor, darker hued, female, young & almost medicare-eligible.
Seems to me an awful lot of important decisions are vested in unelected boards, commissions, and panels. More examples of Congress not doing its job. And even more opportunities for industry to stack the deck.
Yes. For more on why, see Jon’s posts from yesterday and today.
That second link also ties in with this:
I do not see how a Democratic congress can send a bill like this to a Democratic president for signature. I guess we understand now what it means to have a Majority Leader who is anti-choice.
It’s just maddening.
I honestly cannot believe what Obama turned out to be and how fast the so called progressive senators caved in.
I was a first time voter and never really followed politics because I always considered politicians to be nothing more then a group of corrupt narcissists who’s only goal in life is to obtain power and wealth at whatever cost.
In this short 2 yr period of time, I founds out all my assumptions were correct and it really does not matter who is in power because both parties ultimate goal is to keep the wealthy people wealthy and the middle class, middle class and the poor, poor!
Each party will serve a different flavor of koolaid to the american people to achieve those goals and make it look like they are fighting for a particular group, when in reality both parties are fighting to accomplish the same goal.
Think of it as professional wrestling as both sides know the final outcome and their job is to put on a good show while their predetermined checks will be waiting for them at the box office after the match is over!
So all the work that was done in The House never meant a gaddamned thing?
p.s. Is there anything in this amendment about forcing Tom Coburn to shut up? (or at least force him to admit that he was in the fucking majority party when all of the earmarks he’s bitching about were passed?)
Obama said if we are happy with our present insurance we could keep it. I’m happy with mine. Will I be dunned by the government (Obama did not say my cost would be the same)?
Don’t you hate those people that just bitch and bitch and bitch?
Now, there’s an idea.
are we bitching about bitchers? *g*
Tom just bitched about one project that went to *gasp* Oklahoma. Umm, Tom buddy, aren’t you forgetting one little fact?
p.s. Is there anything in this amendment about forcing Tom Coburn to shut up?
It used to be in there, but Lieberman made Reid deal it away…
Two of my least favorite provisions:
The mandate penalty is changed to a complicated formula that on average effectively doubles it, to $15 billion over 10 years.
The affordability exemption is still bizarrely indexed to rising health costs, so that it is 8% initially but could be 10% or more by 2019.
Here’s what Harry Reid tells me:
Book Salon up at the Mothership with Jonathon Hafetz and Mark Denbeaux, The Guantanamo Lawyers hosted by Mary
Just keepin things going. . .
this bill will be a millstone around the necks of dems for years to come.
A mandate forcing people to buy insurance without a non profit Goverment run alternative results in a republican sitting behind the desk in the oval office in 2012.
The part about Coburn shutting the f up was written in invisible ink.
But forcing people to pay X% of their income is not “nationalizing” their labor.
Socialism for the corporations!
Serfdom for the human beings!
Welcome to the US of A.
Now what do you do, become a complete cynic and believe that the system is always going to be “The System” or try to educate yourself and your friends to fight for change? If you are young (and I’m assuming you are) think of what dropping out would mean for your future and the future of your peers. Nothing but people like Eric Cantor, John Boehner, Joe Liebermann, and other self-absorbed narcissists deciding your future.
What about the 300% rate differential if you’re older vs. younger… that still in?
There was strong inclinations of the House being treated as a vestigal organ when Obama got together with the healthcare lobbyists and Baucus to cut backroom deals…unsurprisingly what Baucus crafted and what the final bill is quite similar. Rahm’s Chief of Staff (“Rahm’s Rahm”) is Baucus’s former Chief of Staff.
Did the immediate Catastrophic Insurance make it? That could give some peace of mind to people (if it’s “affordable”)
That’s a good thing. Freedom of religion is in the 1st amendment of the US constitution. If you don’t have the freedom of how to spend your money, you’re not free.
Education cant fight greed, When you see so called progressives like Sharrod Brown, Anthony Weiner and Ron Wyden talk a big game for a yr and then do the opposite when the money is on the table, you realize the current crop of progressives are not the answer.
I would love to fight, but there needs to be a purge on the left like the tea party is doing on the right. They are building for 2016 and beyond, they are willing to take 3 steps back to get the 1 foot forward which is what I am willing to do.
I will not fight or give donations to the current crop on the left after what I have witnessed during this last month, not one stood up and said this bill is unacceptable, they just shut their mouths and got in line while the so called blue dogs gutted them!
unfortunately 300% still in. it’s the worst part of HCR.
on another subject since no one cares about the Senate speeches, can’t the Dems just waive their half of debate for a quicker vote?
The bill, and the Democratic party, with Obama at its head, is a farce.
When national right to life AND National Org for Women hate the same bill, it sucks beyond all comprehension.
Well, first stop is to quit pretending the D party has anything to do with the left. That’s all slick marketing.
It’s going take some time to sort through this. Different people will probably judge it differently, even they have the same politics. I know some people whose lives would have been made much better by the part about pre existing conditions for children, so I might think that has more relative importance than others might. However, I am still mad about the pharmaceutical importation double cross.
“I would love to fight, but there needs to be a purge on the left like the tea party is doing on the right. They are building for 2016 and beyond, they are willing to take 3 steps back to get the 1 foot forward which is what I am willing to do.”
That is the stupidest thing I’ve read in a long time: A progressive hoping for the same sort of purity pogrom that is happening on the Right.
You realize that the “Tea Party” is the 21st century’s answer to the Know Nothings and is leading the Republican Party to extinction, don’t you? Guess not if you are looking to take a page out of their playbook for the sake of moral righteousness. It’d be funny if it weren’t such a caricature of the self-immolating “Liberal.”
Please take your ball and go home. You (and those on the Left who think like you) are deeply depressing.
Was he able to keep a straight face while telling all those lies? Or did his pants smoke the whole time?
I no longer think that it is inevitable that it is a millstone around the necks of Democrats in 2010 and 2012.
It really depends on whether we stand and fight or slink away back into the shells we were in before 2001. If we stand and fight we can make it a millstone around the necks of those Democrats in Congress who, knowing the will of the people, decided to deliver for their corporate donors.
Lanny Davis is going to feel mighty relieved to discover that he is in the company of a whole lot of political has-beens.
The public does not know the who is on the take and who is not on the take. The public does not yet realize that they can change the situation by voting in candidates who pledge to change the situation and voting them out when they don’t. That is likely to happen in NC to one Larry Kissell, who campaigned as a populist and voted as a Blue Dog (although carefully distancing himself from the Blue Dog Coalition).
It can happen to others – in both parties.
• There are new insurance regulations, including the ability to ban insurance companies from the exchange if they raise their rates above a certain amount. And if an insurer denies a claim, there will be an independent board to which customers can appeal. The design of that board is crucial.
Actually, the language is not as clear on this appeal issue as you make it here. In fact, it’s not clear whether the only role of the appeal board is administrative to make sure the insurance companies have followed certain procedures, not on the merits of the case. And remember, unless the appeal board can respond with in days, or at most weeks, it does little for most people to be able to appeal “eventually”. Time is critical in medical care.
Hey! Where’s my pony!!!!
(yer still killin me hoss, don’t ever change)
Can I get a mule?
A chicken?
Some lube?
*G*
“Starts with a B, Bob.”
“Ends with a B Bob.”
“30 seconds, Bob.”
*G*
Bad manners again . . . thanks David D, this whole Manager’s Amendment and what ever Senate Bills are up for grabs still has me frazzled, not to mention what it’s doing to what I’ve been told about the PROCESS to wade thru it all, and then, what happens when Senate and House have to converge and cope.
‘Preciate all you and Jon W and Mz. H and Pups are doing to keep us all apprised and up to date.
Howard Dean/Elizabeth Warren!!!!!
Badda boom, badda bing.
So, its still a sellout to insurance companies, and a pos for citizens.
Is anyone out in this discussion qualified, lawyer types, who can answer, “is the mandate constitutional”? If it is not will it be challenged on these grounds? Doesn’t seem to me that it is but I am just a layman on these things.
One further change. You’ll all remember the snafu when it emerged that Reid didn’t ban annual coverage limits, only “unreasonable” limits. (As I noted, we oouldn’t even tell what he had in mind since the clause referred to an Internal Revenue Code section that never uses the concept.)
The Manager’s Amendment provides a “fix” — if you trust the Department of Health and Human Services till the end of time. It allows policies to contain a “restricted annual limit” as the term is defined by HHS.
It goes on to say: “In defining the term ‘restricted annual limit’ … the Secretary shall ensure that access to needed services is made available with a minimal impact on premiums.”
Would this allow HHS and lobbyists too much wiggle room?
Guess what I think.
Footnote: The amendment allows group health plans to place annual or lifetime limits on specific covered benefits that are not “essential health benefits” or otherwise prohibited. I’d guess these aspects of coverage were on the cutting room floor of Sicko, but I’m not putting money on it.
Hasn’t Kissell officially join the Blue Dogs yets?
http://healthcare.change.org/actions/view/we_the_undersigned_ask_the_democratic_party_to_create_one_large_insurance_group
http://www.change.org/actions/view/we_demand_that_you_joe_lieberman_get_us_a_strong_single_payer_public_option_enacted_into_law
The only reason to pass this bill is that arguemnt is the fact that protest to retain the Public Option is too late. The Public Option in the bills has already been so severely lobotomized that it will not have much of an impact.
The same is true however of exchanges, where they are not open to every body. It is gimmicky reform at best.
One should listen to Dylan Ratigan, hardly a liberal, to see why the thing is a give away to Insurance Companies and not real reform.
The biggest moral problem I see is not sticking to one’s word. During his campaign Obama introduced the word Public Option to most Americans including me. And after selling its virtues he allowed it to be lobotomized and then killed, without as much as a peep. When a postmortem is done, I am pretty sure Rahm will not have a glorious review. You will find the rapacious fingerprints of Big Biz all over the HCR plans. For a very nice Christmas Card for Rahm, please see Joshua Blog.
The other bigger problem is the false exploitation of 45K dying a year by O and other Dem Pols. With budgetary BS (GOPsters are right on this one) the exchanges and subsidies come into play only in 8014. It is clear that the tears that these fellows shed to get public sympathy during campaign were only Crocodile Tears. Why? Because they are willing to preside over the killing (using Grayson’s Words) of an additional 200k+ Americans.
thank you for going through the bill so quickly for us dday. much appreciated.
have you seen any language on regulation that undermines state insurance regulation?
I hate most of what Reid did, but the Boehner/Ensign tax is just wonderful! If it only brings in a million bucks (all from overaged Redumbican Senators), it’s worth it!