Political Diagnosis: Senate Finance Committee Considers Health Care Reform Bill
By Christine Cupaiuolo — September 22, 2009
The Senate Finance Committee today began its mark up on the health care overhaul bill put forth by Sen. Max Baucus (D-Mont.). C-SPAN is covering it live.
Baucus, chair of the committee, seemed to anger all Republicans and Democrats when he released a bill last week that was more conservative than what most Democrats in Congress wanted, yet not conservative enough for any Republican to sign on.
Other committee members have since contributed 534 amendments, including three different amendments calling for a public health insurance option to compete with private insurers.
*A recent survey of more than 5,000 doctors by the Robert Woods Johnson Foundation found that the overwhelming majority support expanding health care coverage to include both public and private insurance options. Baucus’s bill shuns the public option in favor of co-ops, which are not considered much of a threat to the insurance industry.
Baucus also faces criticism on funding.
Richard J. Kirsch, national campaign manager of Health Care for America Now, told The New York Times: “The tax credits in the original Baucus plan were so low they would make premiums unaffordable for many moderate- and middle-income people, who could also face high out-of-pocket costs. And if they don’t pay the premiums, they might have to pay a fine.”
Baucus (above left, greeting the committee’s ranking Republican, Sen. Charles Grassley of Iowa) has said he will make some modifications to the bill to provide more assistance to moderate-income Americans who need help buying insurance.
Igor Volsky at Wonk Room breaks down some of the most important amendments into categories for coverage, financing and delivery reforms.
Volsky’s charts also include some of the more outrageous Republican amendments, such as this gem from Sen. John Kyl (R-Ariz.): “Prohibit the federal government’s takeover of health care.”
Ezra Klein, who previously described the Baucus bill as “a very good platform with some very severe failings,” offers five recommendations to improve it, including phasing in Sen. Ron Weyden’s Free Choice amendment and creating real competition for insurance companies. Klein also prepared a good summary of the amendments Sen. Olympia Snowe (R-Maine) has offered, including a public plan trigger.
Sen. Jay Rockefeller (D-W.V.) has proposed a number of useful amendments, including establishing a public insurance option and limiting out-of-pocket costs. But it’s his amendment #C6 (see page 12) that really intrigues me. A hero last week to progressives for his strong stance against a Senate bill that lacks a public option, Rockefeller disappointed many of those same advocates for denying women enrolled in the public plan access to abortion services:
This amendment would add a strong public health insurance option, the Consumer Choice Health Plan (CCHP), to the exchange to compete directly with private plans. Like private health plans, CCHP would be offered to all individuals and businesses purchasing health insurance through the national health insurance exchange. […] At a minimum, the Consumer Choice Health Plan would be required to follow the same insurance regulations as private plans operating in the exchange. CCHP would also be required to offer the same type of plans as private plans participating in the exchange.
Well, not exactly. The CCHP, according to Rockefeller, “shall not include abortion, except in cases of rape, incest, or the life of the mother. It also prohibits the expenditure of Federal funding for abortion and it requires the segregation of funds to ensure that no Federal dollars pay for abortions.”
Did you get the underlined points? His emphasis, not mine.
The Hyde Amendment, enacted in 1976, already prohibits spending federal dollars to pay for abortions for women on Medicaid. Rockefeller’s amendment would expand the restriction to all women who choose the public option.
The Center for Reproductive Rights is urging supporters to call members of the Senate Finance Committee and ask them to vote against anti-choice amendments. You can also contact your senators and ask them to stop anti-choice amendments from being included in the health care bill.
More good reading on health care reform and the abortion debate:
– Frances Kissling, “Exploiting the Healthcare Debate to Restrict Abortion”
– Politifact, a project of the St. Petersburg Times, is running a Truth-O-Meter on federal subsidies and abortion
– Rep. Lois Capps, “The Truth About the Capps Amendment”
Baucus Bill is “Bunk for Women”
In a post at Raising Women’s Voices outlining five reasons why the Baucus bill is no good for women, Amy Allina writes that the bill “imposes politics and ideology on what should be a purely medical decision — the question about what services an insurance plan will cover. It singles out abortion for special exclusions, rather than treating it like other medical care, by adopting language that was developed by the House Energy and Commerce Committee as a compromise to prevent anti-choice legislators from using the health reform bill as a vehicle to impose sweeping new restrictions on abortion.”
Another reason: Under the Baucus bill, older Americas could pay up to five times as much as younger customers. The bills to come out of the House allowed only a 2:1 ratio.
“Women, who live longer on average than men, are more likely to bear the costs of this age rating,” notes Allina.
Doing away with any niceties, James Ridgeway, in a post titled “How the Baucus Plan Screws Older People,” writes that “the people who stand to get screwed most by the plan are those who aren’t old enough to qualify for Medicare, but are still old enough to be discriminated against by insurance companies.”
Ridgeway quotes Uwe Reinhardt, an economics professor at Princeton University, who estimates that the age rating will enable insurers to cover roughly 70 percent of the added risk they’ll take on by extending insurance coverage to everyone.
“You’re just using age as a proxy for health status,” said Reinhardt.
Maggie Mahar, author of “Money-Driven Medicine: The Real Reason Health Care Costs So Much,” breaks down even further who benefits when health insurance premiums are allowed to vary based only on tobacco use, age, family composition and where you live (allowing for differences in local cost of care).
She writes at HealthBeatBlog.com:
If you smoke, they can charge you 50 percent more; if you have children they can charge you 50% more than they would charge a childless couple, and if you are a single parent, they can charge you 80% more than they would charge a single adult. (Since children’s health care costs are, by and large, significantly lower than adults’ costs, that seems a pretty steep surcharge for the sin of single parenthood.)
I can imagine that some readers would say that it is only fair to charge smokers more. But consider this: the vast majority of adult smokers in the U.S. are poor. Many will qualify for full subsidies; others will be eligible for partial subsidies. So who will pay 50% more for their health care—you, the taxpayer. If he receives a subsidy, the 50% surcharge isn’t likely to induce a smoker to stop smoking. This is simply another way to funnel more taxpayer money to private sector insurers.
Single parents also tend to cling to the lower rungs of the income ladder. Many will qualify for at least a partial, if not a full subsidy. Who pays the extra 80%? That’s right—you and I.
Finally, if insurers can charge 50-somethings five times as much as they charge 20-somethings (who the Baucus plan refers to as “young invincibles”), a great many of them are going to need subsidies. More tax-dollars winging their way to Aetna.
There is, however, an exemption from the mandate for people over 50 if coverage is deemed unaffordable — which makes no sense, really, since this the time they’re likely to need health care more, not less.
As Mahar concludes, “Somehow, this isn’t what I thought they meant by ‘universal coverage.'”
Everyone is talking about the crazy right-wing anger out there — and how it is making it impossible to have a rational discussion — let alone legislation on health care.
But what people aren’t talking about is how the Democrats unwittingly stoke the fire at every turn.
Abortion funding is a classic case study. Democrats — even those clearly sympathetic to women’s concerns, like Rockefeller and Obama — refuse to articulate why including abortion funding is a simple matter of equity. In fact, they run away from a debate over it — often in an overdetermined fashion (thanks, Christine, for emphasizing the emphasis — that’s amazing).
How are we supposed to have a rational discussion — as opposed to shout-downs at town halls — if the potential leaders of that rational discussion abdicate their roles? Is it any surprise that reactionary forces come in to fill the void?
And don’t talk to me about the media as the problem. Sure, 24-hour news channels are pretty scary places, but as evidence by his media blitz the last couple of days, Obama and others can find a space for their message if they are willing to put it out there.