Public option will leave 15 to 20 million uninsured - CBO preliminary analysis

[slipslidingaway]

http://www.cbo.gov/ftpdocs/104xx/doc10445/07-07-2009-ExpandingMedicaid.pdf

"...CBO has not yet had time to produce a full estimate of the cost of incorporating any specific Medicaid expansion in the HELP committee’s legislation. However, our preliminary analysis indicates that such an expansion could increase federal spending for Medicaid by an amount that could vary in a broad range around $500 billion over 10 years. Along with that increase in federal spending would come a substantial increase in Medicaid enrollment, amounting to perhaps 15 million to 20 million people. Such an expansion of Medicaid would also have some impact on the number of people who obtain coverage from other sources (including employers). All told, the number of non-elderly people who would remain uninsured would probably decline to somewhere between 15 million and 20 million. (For comparison, CBO’s analysis of the draft legislation that was released by the HELP committee found that, absent any expansion of Medicaid or other change in the legislation, about 33 million people would ultimately remain uninsured if it were to be enacted.)...."

[steelmania75]

1. It's sad....

[slipslidingaway]

5. At some point there is not much more to say...the lower estimates

for the HELP draft bill did not include the expanded costs for Medicaid and even then they estimate there will be millions left uninsured.

You are right...it's just sad.

[steelmania75]

33. It's not universial healthcare if there's still 15-20 million Americans uninsured

[slipslidingaway]

34. Many will say it is the best we can do, I think we can do better if

we force the discussion to include all options.

Thanks.

[Jkid]

38. And it's not universal health care

If people are forced to buy insurance that is unaffordable or they don't get complete coverage.

[county worker]

2. Wouldn't there be a payroll deduction to cover the cost of the increased Medicaid?

Now there is a Medicaid deduction along with social security deduction. I would think that if Medicaid were expanded the deduction would expand also. So the $500 billion would come from workers paychecks and employer payroll taxes.

If I am right then to say that it will cost an extra $500 billion does not tell the whole story.

[slipslidingaway]

8. I believe you are correct and you make an important point

about all the costs, what is focused on is the cost to the government, not the individuals.

We really need to examine ALL costs.

[DJ13]

3. F this phony "reform"

And F any politician who supports it.

[Thrill]

4. What models are they using?

[slipslidingaway]

9. The draft HELP bill, check the link. nt

[Oregone]

6. How many covered will still go bankrupt in case of a catastrophic injury? 75% still?

Did they check that? Doubt it.

[Echo In Light]

10. Soon there'll likely be legislation making it harder to file bankruptcy re medical bills

Now there's 'change' the bloated medical system entire can and will get behind!

[glitch]

35. Good God. It's like they really are flesh-eating zombies.

I thought I was half-kidding all these years.

[slipslidingaway]

11. Doubt it as well :( nt

[angstlessk]

7. Thought it was MEDICARE expansion...what's this with Medcaid ..for the poor Expansion?

or my quesiton is ..WHICH PUBLIC OPTION...AS COMPARED TO WHAT OTHER PUBLIC OPTION?

[Jakes Progress]

12. True public option from a government

supported program is what the term public option should mean. Who knows what we will get?

Remember the Clean Air program under Nixon. And then there is Homeland Security. Our air isn't clean, our homeland is not secure. Who knows what options the public will have after it goes through the language wringer.

[slipslidingaway]

13. Check the link and see this link as well...

http://www.pnhp.org/blog/2009/07/08/can-medicaid-fill-the-gap/

"...From the start it was recognized that insurance exchanges, even if they included a public option, could never provide affordable coverage for low-income individuals. The Medicaid program would have to be expanded to cover this more vulnerable population.

It was also recognized that, even with subsidies, there are many individuals who could not afford to purchase plans through an exchange yet have incomes above the thresholds that would qualify them for Medicaid..."

[KamaAina]

14. Have they scored H.R. 676 yet?

Single-payer now!

[slipslidingaway]

15. They're too afraid to score HR 676, much better to ignore it....

this is an interesting exchange.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6014522&mesg_id=6014522

"...In early June, he was invited to speak before the Progressive Caucus of the House of Representatives about single payer health care.

He sent his presentation ahead of time to Bill Goold, the executive director of the Progressive Caucus, and Darcy Burner, executive director of the American Progressive Caucus Foundation. Both were not pleased with Skala.

“Bill Gould emailed me after reading my testimony and materials I was going to present to tell me that they were not acceptable and that there could be no comparison between single payer and the public option with side by side comparison,” Skala told Single Payer Action. “Darcy Burner told me that they would construe talking about the public option — even comparing it to single payer — as an attack on the members of the Progressive Caucus.”

[SoCalDem]

16. Unnecessary.

Halt:

Medicaid
VA (except for specialized re-hab facilities)
Make it illegal for employers to "offer" coverage

It all becomes medicare, and insurance is offered for ONLY supplemental coverage for the 20% that medicare does not cover.

Health care delivery services (all of them, except for the cosmetic enhancements) become not-for-profit.

If an employer is currently "paying" $200 a week for an employee's "coverage", and the employee is paying $100, that employee just got a $300 a week "raise".

Of course "part" of it would have to go back into the "kitty", but as a percentage ...just like a new FICA entry. It would not be an additional "tax", since it;s already BEING PAID, in the form of "lost wages".

[slipslidingaway]

17. I agree with most of your ideas...

but it is not even on the table.

:(

Instead we'll spend over a trillion and still leave millions uninsured.

[SoCalDem]

18. Amazing how politicians look for the most complicated, instead of the simplest, isn;t it?

:grr:

[slipslidingaway]

20. It sure is and now we'll add another layer with the exchanges...

:wtf:

[RufusTFirefly]

26. Perhaps they're hoping if it's complex enough...

... that no one will notice that they're capitulating to the Health Insurance Robber Barons.

It sickens me (perhaps even literally) how much of society (including ostensibly "public" institutions) play according to the corporate rulebook.

Rule No. 1. You don't really have to change. All you have to do is to create the appearance of change, generally through the use of public relations and marketing.

Rule No. 2. If the facts reveal a problem, create a diversion, roll out an alternate set of "facts," or call the original facts into question.

If Americans knew the truth about their own health "care" system, had a clear sense of how single-payer really works, and if the will of the insurance companies could be offset by the will of the people, we might finally join the rest of the civilized world.

[slipslidingaway]

32. +1 n/t

[Horse with no Name]

40. It's much harder to misappropriate funding and slip it to lobbyists

and special interests and croneys when the language is simple and straightforward.

[SoCalDem]

41. I've always wished we had "single issue" bills in congress

It would sure make things more transparent, and would make a lot more sense.. But then that's why we have the mish-mash we have now... tey don;t want transparency.. They just want a perpetual "gotcha-game", by each side putting in poison pills to trip the other side up, or by putting in their own little pork pies./.

[Vinca]

19. Why? I don't understand.

Most of us aren't expecting a free ride. Are they taking into account a monthly premium to a public plan? All we're asking is not to be taken to the cleaners by greedy insurance companies.

[slipslidingaway]

22. Check the link, maybe there are details in other communications

they had...just guessing.

I just wish we would finally cover everyone.

:(

[bobbolink]

21. Important information...thanks. K&R n/t

[slipslidingaway]

23. YW n/t

[kath]

24. NOT. GOOD. ENOUGH.

such utter bullshit that we are the ONLY developed nation where health care is not available to all.
That situation needs to stop NOW.

As Dean said, we are SIXTY YEARS BEHIND the other developed democracies. Shameful.

[mark olson]

25. Bad vibes on the "public option"; employer said they would end benefit program.

About 60 employees and the employer has made it clear when a public option is offered they will discontinue our plan and everybody will have to move to the public plan. We have a really good plan and already pay about 50% of the premiums with the employer paying the other 50%. Our 50% is paid on a pre-tax basis so out of pocket is a lot less.

[bigwillq]

27. Hello.

Welcome to DU! :hi:

[Ken Burch]

37. And you should wish him farewell, as well.

The man was 'stoned already.

[TomCADem]

28. It Appears CBO Is Referring To A Non-Public Option Version

The description only refers to an insurance exchange, and there is no mention of mandates.

[slipslidingaway]

29. The CBO references the second estimate done on the draft HELP

bill, if you read the 7/2/2009 letter that they mention, it does include the mandates and the public option.

http://www.cbo.gov/ftpdocs/104xx/doc10445/07-07-2009-ExpandingMedicaid.pdf

"In response to your request, the Congressional Budget Office (CBO) has considered the likely effects on federal spending and health insurance coverage of adding a substantial expansion of eligibility for Medicaid to the Affordable Health Choices Act, a draft of which was recently released by the Senate Committee on Health, Education, Labor, and Pensions (HELP). CBO’s preliminary analysis of that draft legislation was provided to Senator Edward M. Kennedy on July 2, 2009; that analysis is available on CBO’s web site, www.cbo.gov..."


http://www.cbo.gov/ftpdocs/104xx/doc10431/07-02-HELPltr.pdf


July 2, 2009
Honorable Edward M. Kennedy
Chairman
Committee on Health, Education,
Labor, and Pensions
United States Senate
Washington, DC 20510
Dear Mr. Chairman:

"The Congressional Budget Office (CBO) and the staff of the Joint
Committee on Taxation (JCT) have completed a preliminary analysis of the
provisions of title I of draft legislation called the Affordable Health Choices
Act, which has been posted on the Web site of the Senate Committee on
Health, Education, Labor, and Pensions (labeled BAI09F54.xml).
Much of title I addresses health insurance coverage. Among other things,
that title would: require all legal residents to have insurance; establish
insurance exchanges (called “gateways”) through which individuals and
families could purchase coverage; set certain minimum requirements
regarding the availability, pricing, and actuarial value of policies; and
provide federal subsidies to substantially reduce the cost of coverage for
some enrollees. (Attachment 1 summarizes the major provisions of title I
dealing with health insurance coverage.) Title I also includes provisions
that, among other things, would establish a reinsurance program for early
retirees and improve access to and availability of community living
assistance services and supports.

The attached tables summarize CBO’s preliminary assessment of the
effects of title I on federal revenues and direct spending and its likely
impact on health insurance coverage. According to that assessment,
enacting those provisions would result in a net increase in federal budget
deficits of $597 billion over the 2010-2019 period—reflecting net costs of
$645 billion for the coverage provisions, which would be partially offset by
net savings of $48 billion from other provisions of title I. (CBO has also
estimated the budgetary impact of provisions in titles III and VI of an
earlier draft of the legislation, which would add another $14 billion to the
net cost of the proposal.)

Honorable Edward M. Kennedy
Page 2

Once the legislation was fully implemented, CBO and JCT staff estimate,
about 20 million fewer people would be uninsured compared with
projections under current law. About 26 million individuals would obtain
coverage through the new insurance exchanges, and about 6 million fewer
people would purchase nongroup coverage outside the exchanges. In the
aggregate, the number of people obtaining coverage through an employer
would change very little.

The draft legislation does not include a significant expansion of the
Medicaid program or other options for subsidizing coverage for those with
income below 150 percent of the federal poverty level (FPL); such
provisions may be incorporated at a later date. By CBO’s estimate, about
three-quarters of the people who would remain uninsured under this version
of the legislation would have income below 150 percent of the FPL.

The figures presented in this letter do not represent a formal or complete
cost estimate for the draft legislation. This estimate reflects the major
provisions of the legislation but CBO has not yet completed an analysis of
all of its effects. Specifically, the agency has not yet estimated the
administrative costs to the federal government of implementing the
specified policies or the costs of establishing and operating the new
insurance exchanges, nor has it taken into account all of the proposal’s
likely effects on spending for other federal programs or their potential
effects on revenues from corporate taxes.

The estimated cost of this draft of the legislation is roughly $400 billion
less over 10 years than the cost CBO estimated for an earlier version of the
proposal (in CBO’s letter dated June 15, 2009). A number of changes in the
legislation account for that difference. First, the subsidies available in the
insurance exchanges would be less extensive; there would now be no
premium subsidies for individuals and families with income above
400 percent of the federal poverty level, and subsidies for people below that
level would be smaller. Second, a penalty (labeled an “equity assessment”)
was added for employers that do not offer insurance coverage to their
workers and contribute a specified share of the premium. Third, the new
draft substantially limits the opportunity for employees with an offer of
health insurance from their employer to receive subsidies in the insurance
exchange because their employer’s offer was deemed unaffordable.
Collectively, those changes contributed to a substantially lower estimate of

Honorable Edward M. Kennedy
Page 3

the number of people who would purchase coverage through the insurance
exchanges (and a corresponding reduction in federal subsidy payments) and
led to a much smaller estimated impact on the amount of coverage provided
through employment-based plans. The new draft also includes provisions
regarding a “public plan,” but those provisions did not have a substantial
effect on the cost or enrollment projections, largely because the public plan
would pay providers of health care at rates comparable to privately
negotiated rates—and thus was not projected to have premiums lower than
those charged by private insurance plans in the exchanges..."

[TomCADem]

30. Here's My Question - What's The Impact On Underinsured?

A lot of people are insured, but they are underinsured and their insurance depends on maintaining their employment AND they can be dropped or excluded due to pre-existing conditions. I understand that a big part of the reform is to limit the ability to exclude people with pre-existing conditions or to rescind policies based on pre-conditions.

[slipslidingaway]

31. Not everyone will be eligible for the public option according to the

latest draft making it hard to determine, this is from page 6.

:shrug:

"In general, individuals with an offer of employer-sponsored insurance would not be
eligible for exchange subsidies under the proposal. However, employees with an offer
from an employer that was deemed unaffordable could get those subsidies. The proposal
would define an employer’s offer of coverage as unaffordable if the portion of workerpaid
premiums exceeded 12.5 percent of the worker’s adjusted gross income in 2013 (a
cap that would grow over time at the rate of medical price inflation)."

[slipslidingaway]

36. kick nt

[slipslidingaway]

39. kick nt