The National Immigration Law Center came out with a document comparing the different health care reform proposals that are on the table in Washington right now. The piece gives side-by-side comparisons of the House tri-committee bill, the Senate Finance Committee bill, and the Senate HELP bill. There are a variety of areas of health reform that are being compared, including eligibility requirements for individuals to purchase insurance in the exchange, the subsidy system that will be available and to whom that system will be accessible, tax exemptions, how the bill treats those who are undocumented, stipulations around the expansion of Medicaid and who is eligible for Medicaid. Keep up with what’s going on with health care reform and immigration at the National Immigration Law Center here.
Things seem to be murky as we look ahead in health care reform. People are saying all different things – Speaker of the House Nancy Pelosi seems to think we’ll get all the committees to finish their bills by August (as the self-imposed timeline dictates), but House Majority Leader Steny Hoyer doesn’t agree. There has been talk of compromises about abortion issues as well as the House Energy and Commerce Committee talking of transferring the responsibility of cuts to federal health care programs to an outside panel. In addition, the media is making headlines out of setbacks and largely ignoring success stories in health reform. Leadership walks a fine line between pacifying moderate Democrats and not enraging progressives.
A very complicated part of the process is yet to come – the conference committee. This is a group put together by leadership of the parties (speaker of the House and senate majority leader as well as minority leaders). Conference committees are formed when complex bills from both chambers need to be melded into big pieces of legislation. Each party is to be represented in the correct ratio, and chair people and members of all the committees involved in the legislation are included in conference committee. There are a few set rules for when a piece of legislation goes to conference committee: no new amendments can be added, and no pieces can be taken out if they are agreed on by both chambers of congress. Other than that, the committee is left to determine the best way to synthesize the two bills, with usually significant oversight by the president.
Once the Senate Finance Committee and House Energy and Commerce come out with their versions of the bill, we can expect to see a conference committee created. Should be…tedious.
Denis Kucinich proposed an amendment in the House of Representatives committee on Education and Labor last Friday that would make states able to set up single-payer systems independent of the federal government. His amendment passed in committee, so it may end up in the conglomerate health care bill at the end of the line.
There is bipartisan support for this measure – from Democrats for the possibility of a government-run system in the states and from Republicans so as to respect states’ rights. Pennsylvania, California, Illinois, Ohio, Colorado, and Massachusetts are all states in which there are healthy campaigns for single-payer coverage, and in those states the creation of this kind of system is a possibility. As we’ve said before, a single-payer system would be a great option for women. A single-payer system provides lower costs and goes toward universal coverage – both things important to women and their families.
Two reports have come out of the Commonwealth Fund this week, both addressing important reasons we need health care reform now. One (Failure to Protect: Why the Individual Insurance Market is not a Viable Option for Most US Families) is about the failures of the individual market and the kind of reform that is needed to keep these families covered and provided for. This report describes the status of the 16 million Americans (6% of the under 65 population) who have individual-market health insurance coverage. The study found that 64% of those in the individual market spend $3,000 or more per year on premiums and out-of-pocket costs, as opposed to 20% of those with employer-sponsored health insurance. In addition, 51% of those in the individual market spend 10% or more of their yearly income on premiums and out-of-pocket costs compared to 29% of those with employer-provided insurance. Adults who have individual-market insurance have less comprehensive coverage (they are more likely to not have prescription coverage or dental insurance) and they have higher rates of benefit restrictions and problems with coverage. They are significantly less satisfied with their insurance in comparison to populations with other kinds of insurance.
This study is important because recently due to the economic slow-down more employers have been dropping coverage for employees or moving to lower cost plans for their employees. Since most states limit public insurance to children, pregnant women, those with low incomes, and the elderly, many individuals need to strike out on their own and find coverage in the individual insurance market. They then end up having to pay more out-of-pocket costs and higher premiums, in addition to higher deductibles. According to the Commonwealth Fund;
“These findings indivate that the individual insurance market in its current form does not provide a viable alternative to employer-based group coverage.”
The survey found that 47% of those that went into the individual market to find coverage said it was very difficult or impossible to find a plan that fit their needs. This was even higher for the group that had poor health (60%). Also, 57% of people found it very difficult or impossible to find a plan they could afford (again, higher in the population with poorer health – 70%). 73% of those surveyed in the study did not end up buying a plan due to the barriers.
The other report released recently (How Health Care Reform Can Lower the Costs of Insurance Administration) offers insight into the problem of private insurance costs, specifically administrative costs. The report states that $265 billion could be saved over ten years with the proposed national health care exchange and the increased utilization and availability of public plans. This money would be saved because there would be less marketing and underwriting, less claims administration, less time spent negotiating provider payment rates, and lower commissions to insurance brokers.
“The McKinsey Global Institute estimates that the US spends $91 billion more per year on health insurance administrative costs than it should, given its size and wealth.”
Most of this money is spent by private health insurance companies, where 12.4% of costs are administrative compared to 6.1% by public plans. In addition to reducing these administrative costs, the national health exchange would help lower this huge amount by increasing the transparencies of insurance products and streamlining the plan purchase/enrollment process.
The Ways and Means Committee, one of the three committees in the House of Representatives working toward a health reform bill, has passed their version of the legislation. This comes after a few days of mark-up that featured the successful defeat of abortion-restricting amendments. Representatives Sam Johnson (R-TX) and Eric Cantor (R-VA) among others made attempts at restricting abortion coverage in the essential benefits package, meaning that basic health care plans would not include abortion. Also, the House Education and Labor Committee has passed their version of the bill. That means that we are passed the point the Clinton administration was fifteen years ago – this very well may happen!! (Also check out this article by Nancy Keenan about the Senate HELP Committee and the success they had in passing their version.)
In other good news, Washington DC is now able to use money to subsidize/fund abortions for women. Though this doesn’t apply to federal funds, it does allow the District to use locally-collected revenue for women in need. Though this passed, it is scary to see some of the opposition and the claims that they make.
|The Daily Show With Jon Stewart||Mon – Thurs 11p / 10c|
|Obama’s All-Star Pitch|
There was an interesting interview last night about health care on the Daily Show with Kathleen Sebelius, the Secretary of Health and Human Services. The entire episode was pretty funny, so definitely check it out here or above. Since the Daily Show is fine comedy television and not exactly the journalistic factual news media, we don’t expect it to carry the same responsibilities or weight that other serious news shows do. However, there were some things we thought it would be important to address. If John Stewart has these concerns, many other people probably do too.
First, it’s good to go over the basic ideas in the bill that they’re talking about. It is complex and we want to give a little peak into the important points. It is the Tri-Committee bill that came out of the House yesterday – a fairly progressive and large piece of legislation (a full 1,018 pages).
Most of the changes that would happen if this bill were to become law would happen in 2013. Some of those changes would be that all those below 133% of the federal poverty line would be eligible for Medicaid. There would be federal subsidies for all those from 133 – 400% of the federal poverty line. Those subsidies would aid individuals and families to buy into health care coverage through the health care exchange. There would be a requirement for health insurance for all legal residence, and non-compliance would result in monetary penalties that would depend on the income of the individual or family.
John Stewart stated that “I feel badly for the small businesses that have to shoulder the costs”, which is answered by another element of the bill: the pay-or-play policy for employers. This essentially means that employers would be required to either offer insurance to their employees and share in the payment of premiums, or pay the federal government 8% of their payroll. This is where John Stewart’s concern about small businesses comes in – those small businesses that have annual payrolls less than $250,000 would be exempt from this federal tax.
The House Tri-Committee bill provides a public plan that would be available through the insurance exchanges. The plan would be run by the Secretary of Health and Human Services and would pay Medicare rates plus 5% to practitioners (doctors and other health care providers). Also, providers would not be required to participate in the public plan in order to participate in Medicare. Another of John Stewart’s concerns was that companies, when faced with a possibly cheaper public health care option, would switch their plans to the public plan (therefore interfering with the Obama pledge that if you like your coverage you can keep it). Theoretically, by buying into the cheaper public plan, these companies would save money. Though Sebelius did state that competition and choice would help bring the cost down, we think this is a really important element of the public plan. When insurance companies see the public plan (which, according to Sebelius, would have lower overhead administrative costs) being cheaper, they will respond accordingly. This means bringing down everyone’s costs and ensuring better care.
John Stewart said something else important – that “there’s the cost issue and the moral issue”. Health care reform is very much a moral issue. Secretary Sebelius said that “what we have is unsustainable, unconscionable, and unacceptable” and that since this is “most personal service any of us will ever get”, reform needs to happen and everyone needs access to affordable, quality care. Sebelius ended by saying the whole basis of the system needs to be re-thought, that we need to “start to invest in prevention and wellness to make American kids healthier”. Amen to that. Hopefully some of this information clears up the concerns that many health insurance consumers have about the House bill.
A report released by HCAN offers a bleak narrative of current and projected health care coverage in New York State. It shows the failures of the system: the fact that there are 2.6 million uninsured New Yorkers, and the rate of unemployment in New York is up after just 19 months from 4.6 to 7.7%. Health insurance premiums have increased 81% in New York from 2000 – 2007, and there are 1.3 million working non-elderly people that are not insured. HCAN also states that the cost of employer-sponsored health insurance is expected to grow at a rate of 7.4%, as compared with the expected 0.8% growth of income in the state.
In response to these alarming statistics, HCAN offers some solutions. Their recommendations to policy makers include providing regionally adjusted federal subsidies to those who qualify for private insurance. This adjustment would ensure that consumers have access to affordable health insurance costs of living are so variable. Also, HCAN recommends that individuals, employers, and the government share the costs to extend coverage to every person, and that the government does not tax hard-earned benefits.
The report says that benefit packages should be comprehensive and that there should be no annual or lifetime caps on benefits. The report goes into the more qualitative effects of health care costs on families and individuals, the damages being done to small businesses, and the heart breaking costs of a system that seems to do more harm than good. Over the past 9 years there has been a 120% increase in cost of health insurance but only a 29% increase in wages. The United States spends $2.5 trillion dollars per year within the health care system. Health Care for America Now insists that this is a problem that can and needs to be fixed as soon as possible.
Also take a look at this report done by Families USA that shows these same trends appearing across the country.
Check out the following resources for information about immigration issues important to health reform. These issues overlap with work Raising Women’s Voices does and we share the goal of affordable, quality, accessible health care for every person.
If conservatives get their way on health reform, we will soon have quality, affordable health care for all — except for women, terminally ill patients, gays and lesbians, people with HIV and anybody else conservatives don’t like!
A slew of proposed amendments submitted to the Senate Health, Education, Labor and Pensions (HELP) committee Tuesday night would hobble that committee’s health reform proposal. Republican Senators Michael Enzi, Orin Hatch and Tom Coburn have proposed that:
* Coverage for abortion would be banned;
* Health providers and insurers would be protected against “discrimination” for refusing to provide health care requested by their patients including abortions, removal of feeding tubes from terminally ill patients, aid-in-dying (such as in Oregon, Washington and Montana, where this is legal) or really just about any health service they find objectionable;
* Federally-qualified health centers could not provide abortions and still get government grants;
* Any independent medical advisory board empaneled to offer advice to HHS on the benefits to be included in national health reform coverage would have to include “professional ethicists…with specialty in rights of the life of the unborn.”
These amendments would be damaging to women’s health and they don’t have public support. Public opinion research shows that large majorities of U.S. voters understand that reproductive health services are part of basic health care for women. Make sure the Senate HELP committee members know that the public supports health care reform that includes these reproductive health services and opposes exclusions like the ones being proposed. We want medical experts and citizens to make these decisions, NOT politicians.
If your Senator is one of these, let him or her know that you and the majority of US voters want them to stand strong for health reform that doesn’t include political exclusions: Edward Kennedy (MA); Christopher Dodd (CT); Barbara A. Mikulski (MD); Jeff Bingaman (NM); Patty Murray (WA); Jack Reed (RI); Bernard Sanders (VT); Sherrod Brown (OH); Robert P. Casey, Jr. (PA); Kay Hagan (NC); Jeff Merkley (OR). You can contact them at email@example.com. As always, please cc firstname.lastname@example.org so we can track and feature your excellent letters!
Senate HELP committee goes to mark-up, others talk about proposals, and the Senate Finance Committee starts to make changes
The Senate Health, Education, Labor, and Pensions Committee has started its process of mark-up on the 615 page health care bill that was released about a week ago. There are over 1,000 pages of amendments that senators have put forward. Watch the process live and recorded on C-Span. Already Senators John McCain (R-AZ), Richard Burr (R-NC), and my very own Judd Gregg (R-NH) have questioned the premise of marking up a bill that was (without the key parts of the public option and employer-paid benefits) analyzed by the Congressional Budget Office to cost over $1.3 trillion. Senator Chris Dodd (D-CT) promises to be patient and a strong leader, taking the place for the time being of Ted Kennedy (D-MA) who is at home taking care of his health.
Everyone has had opinions about the health care policy proposals that have been coming up. Apparently, a few ex-senators have crafted their own ideas of what is fiscally and socially responsible in health care reform. In addition, there are some centrists that have been getting together (the left-leaning Republican Tuesday Group and the right-leaning Blue Dogs) to talk about these issues and maybe come out with proposals of their own. Kathleen Sebelius (the Director of the Department of Health and Human Services) purveys the President’s commitment to a public plan, but also says that it doesn’t necessarily need to be overseen by the government. The Senate Finance Committee is feeling the heat – Democrats are starting work to lower the projected cost of their proposal.