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EXCLUSIVE: The Finance Committee's Health Reform Outline

A Senate source just passed me the latest outline of the Senate Finance Committee's health reform proposal. This is the post-CBO revision. Apparently, after the committee staff received the scores, they dug deep and quickly developed this proposal to circulate among members and then send back to CBO. It was presented earlier today at a closed-door meeting.

Sources say that it's a major scale-back of the outline they had before. Specifically, subsidies have dropped from 400 percent of the poverty line to 300 percent. Medicaid eligibility has been tightened to 133 percent of poverty for children and pregnant women and 100 percent of poverty for parents and childless adults. The plans being offered in the exchange have seen their actuarial values sharply lowered.

Beyond the changes, this is also the clearest look we've had at the specific policies being considered. There's a fairly strong individual mandate, albeit with exemptions for those beneath the poverty line, those who would have to spend more than 15 percent of income for a plan, and undocumented workers. There are a variety of options for an employer mandate, or the absence of one. Sen. Kent Conrad's co-op idea is up for discussion. There's no public plan mentioned anywhere in the document.

Incidentally, I apologize for the size, and formatting, of the file: There's not an electronic version floating around, so this had to be scanned in. You can download it here.

UPDATED: Here's a version of the file with all the pages right side up.

By Ezra Klein  |  June 18, 2009; 5:37 PM ET
Categories:  Health Reform , Primary Documents  
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Comments

Well this is where health care reform goes to die. I can't picture progressives making calls and holding events to get this passed. Health care will go from completely unaffordable to life crippling unaffordable.

Co-op with no government oversight, what the f? I would prefer nothing.

Posted by: JonWa | June 18, 2009 5:59 PM | Report abuse

I agree. This isn't worth having. A lot of money spent to line the pockets of the insurance companies. Where is Obama's supposed ledership ability and where are his campaign pledges when we need them!

Posted by: forrest1 | June 18, 2009 6:09 PM | Report abuse

I've been biting my tongue on pronouncing health care 'reform' dead on arrival, but the ambulance has arrived at the ER and rigor mortis has set in on the extremities. It was a strange death, not subject to anything resembling a democratic process and with no overt and physical violence. Some will say it was killed by its friends, but the more honest ones will say less charitable things.

R.I.P.

The nation would be far better off to wait another 20 years to try again on making sense of the insensible - if there is still a Congress making laws in that distant future. It will be interesting for those who are left to observe it exactly how the corporations exercise their powers. Basiji?

Posted by: JimPortlandOR | June 18, 2009 6:13 PM | Report abuse

BRILLIANT

Someone finally figured out, there's NOT an endless bucket of TAXPAYER money?

Brilliant. Way to go.

FIX THE G.D. SYSTEM FIRST -- GET RID OF WASTE, FRAUD AND STUPIDITY.

Then work on Reid, Pelosi, Robert Byrd, Murtha, "Swimmer" Kennedy, Bwarney Fwrank, "CountryWide" Dodd, and OLD CARL Levin.

Posted by: russpoter | June 18, 2009 6:18 PM | Report abuse

I am a Canadian. Every province has 45% of it's budget dedicated to health care - and it's all taxes! Could any state afford this without raising taxes? It's time for Obama to man-up and tell the truth, socialized medicine is only reached one way - TAXES - and don't let anyone tell you otherwise - check with the U.K. and Europe - same story.

Posted by: brely | June 18, 2009 6:18 PM | Report abuse

Co-ops, individual manadtes, and no employee mandate. This seems less like an honest proposal and more like a way to kill health care reform and blame liberals for not supporting a compromise bill.

Posted by: paulrichardson82 | June 18, 2009 6:18 PM | Report abuse

"The plans being offered in the exchange have seen their actuarial values sharply lowered."
"There's no public plan mentioned anywhere in the document."

My goodness, this is catastrophic failure.

The short-sightedness of the political calculation here is astonishing to me. After this is passed and fails to improve coverage or costs for anyone, who do these idiots think the public is going to blame? Republicans? Absolutely not.

Posted by: jbrians | June 18, 2009 6:20 PM | Report abuse

Wow! With these proposals, Baucus could gain Grassley's support, the bill could pass, be signed by Obama, and everyone would walk away for the remainder of Obama's presidency pretending that this was reform. It would be far better to defeat this, and then go back to crafting reform that would make care affordable for everyone. It's not that we don't know how to do that, but this certainly won't. A single-payer national health program would.

Posted by: dmccanne | June 18, 2009 6:25 PM | Report abuse

300 % FPL as the cap for subsidies?

Spend "up to 15% of income on a plan"??

This is WORSE than what Massachusetts is doing if that means "up to 15% of income" on premiums alone!!

300% FPL is as follows for households and set out is how much 15% would be:

1 person $32,490 15% of $32491 is $4873.

2 people $43,710 15% of $43,711 is $6556.

3 people $54930 15% of $54931 is $8239

4 people $66150 15% of $66151 is $9922

5 people $77370 15% of $77371 is $11605

6 people $88590 15% of $88591 is $13288


IF by '15% of income on a plan" INCLUDES the deductibles and caopys, there will merely be a lot of people excused from purcahsing insurance.

The average price for a non-group plan for an individual is pushing $4000 in premiums with a $1000 -1500 deductible plus copays of 20-30%. Such a plan can easily blow past costs of $6000-12000 a year. For $6000-12000 a year to be 15% of gross income would take an income of $40000 (33% in excess of the average wage) to $80000.

If one is near or over 50, expect $6000 -8000 a year in premiums with a $2500 deductible and 30% copays.

The average price for a family plan is over $13,000 with a $2000 -5000 deductible plus 20-30% copays. A household of 3 would need an income of over $100,000 for $13000 in premiums with a $2000 deductible to only be 15% of gross income.

IF "15% of income for a plan" means JUST the premiums, there will be open defiance of the mandate. The deductibles and copays can easily drive the cost of a plan to 2 - 4 times that of the premiums. Expecting household to ante up 15% of gross income ($4873 in premiums alone for 1 person with a $32,491 income) and then to pay a $1000 -2500 deductible plus 20-30% copays on top of that iis NUTS! They will be sinking wel over 20% of their income into medical insurance and copays and deductibles. How on earth are they supposed to pay 20% of their income in taxes, spend 25% on housing, save 10% for retirement, 5% for retirement, pay for transportation, repay student loans and still eat when 80% of their income is committed to health insurance, taxes, housing, and savings?

Massachusetts quickly learned that capping subsidies at 300% FPL left a LOT of people unable to afford coverage even when 'affordable' was defined as aaround 5-8% of gross income.

Then they propose to lower the income limits for Medicaid..... Currently the limits are 150$ FPL for children, pregnant women and disabled adults.

Posted by: eabpmn | June 18, 2009 6:29 PM | Report abuse

I can't see big cuts coming out of Medicare. The seniors who have, or are waiting to have these benefits will not easily give them up.

Posted by: davidwayneosedach | June 18, 2009 6:40 PM | Report abuse

shopping list for the coming health care plan

1. broccoli
2. blueberries
3. the complete works of mary baker eddy

Posted by: jkaren | June 18, 2009 6:56 PM | Report abuse

What the Senators & CBO seem to be telling us is that universality is not possible without a strong public option. If they deliver universality without a strong public option, then I'd accept that bargain. If they deliver neither universality nor a strong public option . . .I for one would support primarying every Senator who was a part of that.

Posted by: roublen | June 18, 2009 6:56 PM | Report abuse

AMERICA’S NATIONAL HEALTHCARE EMERGENCY!

It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.

STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.

We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.

And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.

Progressive democrats and others should stand firm in their demand for a robust public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and demand that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).

Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.

In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!

Contact congress and your representatives NOW! AND SPREAD THE WORD!

God Bless You

Jacksmith – WORKING CLASS

Posted by: JackSmith1 | June 18, 2009 8:08 PM | Report abuse

No public health option?...I am not surprised..you have both the Senate Democrats and the House Democrats lobbying FOR the Health care industries..the GOP... (and the right-wing talking heads) lying about what "single payer" or a "public option" is, scaring everybody, (no one will step forward and contradict the lies)...and a President who just wants every one to get along and like him..(I also suspect that the corporations (AIG?) are spending some of their "bail-out money" to pay people to contact the White House and Congress and say they are against a public-option) add that to a bunch of uninformed, to lazy to protest, Americans and "health care reform ends up being just another corporate "gimme" (with Congress and the Administrations blessings, apparently!)

Posted by: susannelsen | June 18, 2009 8:23 PM | Report abuse

Folks, you do realize a) this is just a PRELIMINARY proposal and; b) there are TWO houses of Congress, right? Do you really think Pelosi will allow anything remotely resembling this incrementalist BS anywhere near her chamber?

It's easy to get all pessimistic, but it doesn't do anybody any good, so I'll wait until a bill reaches Obama's desk before slit my wrists.

Posted by: Jasper99 | June 18, 2009 9:07 PM | Report abuse

This plan is ludicrous at best, evil at the very least. The Insurance Industry must be exceedingly tumescent right about now, ready to put "it" to us, the American Public.

Posted by: lorrainemiller1951 | June 18, 2009 9:37 PM | Report abuse

I read the proposal and the AHIP proposal and they are nearly indentical. In fact besides the Co-op, the AHIP is in fact slightly better. The AHIP is more generous with subsidies and Medicaid Eligibility.

To say this bill was written by industry lobbyist would be an insult to lobbyist. Even they are not this cruel.

http://jwalkerreport.blogspot.com/2009/06/baucuss-health-care-plan-is-worse-than.html

Posted by: JonWa | June 18, 2009 10:10 PM | Report abuse

Max Baucus and the Senate Finance Committee Should NOT Be Deciding Health Care for America

“Senator Max Baucus and the Senate Finance Committee are too corrupted by corporate health industry profiteers donations to give America the health care policy it needs.

“Here’s why Baucus is not doing the peoples business:

According to OpenSecrets.org over his career he has taken donations from:

The Insurance Industry: $1,170,313

Health Professionals $1,016,276

Pharmaceuticals/Health Products Industry $734,605

Hospitals/Nursing Homes $541,891

Health Services/HMOs $439,700

“THAT IS A GRAND TOTAL OF $3,902,785.

Can we trust Baucus to put aside the profits of the industries that have kept him in the senate? Will he put the people’s necessities ahead of the profits of his contributors? Baucus has shown his bias and should be removed from leading the health care reform effort by the Democratic Party leadership.

“It is time to remove Baucus from the leadership of health care reform, and to vote him OUT of office.

Read the whole story: http://www.pnhp.org/news/2009/may/max_baucus_should_no.php

Posted by: 4progress | June 19, 2009 12:56 AM | Report abuse

Senator Grassley has taken a lot of money the pharmaceutical industry and the health insurance industry over the years. Yet he launches witch-hunts against others for doing the same. POT CALLING THE KETTLE BLACK? Is this why he is blocking single-payer healthcare reform from even being on the table—because he’s in the pockets of the industry?

According to OpenSecrets.org from 2003 – 2008 alone, Senator Grassley has taken donations from:

The Insurance Industry: $643,643

Health Professionals $812,077

Pharmaceuticals/Health Products Industry $352,222

Hospitals/Nursing Homes $288,895

Health Services/HMOs $245,416

THAT’S A GRAND TOTAL OF: $2,342,253.

GRASSLEY’S 2ND HIGHEST CONTRIBUTOR IS BLUE CROSS / BLUE SHIELD.

Grassley refuses to put aside the profits of the industries that have kept him in the Senate. He, Baucus, and other legislators put the profits of their contributors ahead of Americans’ health and lives .

It is time to remove Grassley from his “leadership” of health care reform, and to vote him OUT of office.

Posted by: 4progress | June 19, 2009 12:59 AM | Report abuse

Great! Now everyone is covered. Except for the people who can't afford it. What progress!

Posted by: debb1 | June 19, 2009 1:01 AM | Report abuse

Wow, I look at the numbers quoted above that someone thinks are "too much". Just my husband and I covered by CareFirst BC/BS as self-employed are paying over $20,000 per year for health insurance.

That IS what it costs to get 100% coverage with co-pay prescription ($15/$30), full medical ($10) plus vision (about 50%) for 2 people who have been subscribed for over 15 years.

I would welcome a plan where the 2 of us could have everything covered less a small co-pay as we have now for $5,000 per year.

Everything is not owed to us. There is no constitutional right to health care.

Posted by: auntpittypat | June 19, 2009 1:40 AM | Report abuse

This progressive Democrat will fight against passage of this plan if it even resembles the final product.

This plan is NOT reform of American health care. It's merely rearranging the deck chairs on the Titanic.

Posted by: Jimdotz | June 19, 2009 8:29 AM | Report abuse

Once again, the Senate goes for the lowest common denominator of what their friends and lobbyists recommend instead of something that might, you know, actually address the problem.

If the final version looks anything like this mess, there will be massive numbers who will refuse to take part. Hell, those lovely people who live high on The Hill will be lucky not to get beaten by mobs.

Posted by: uberblonde1 | June 19, 2009 9:02 AM | Report abuse

A few things jumped out at me:

I think the best analog to the defined-structure of the plans in the exchange would be Medicare Supplement plans created in the mid 90’s. The skeleton of benefit design and administration was dictated to private companies by, I think, COBRA 96, and they were then sent off to sell and administer the plan so long as they followed the rules. I haven’t really kept up with it but I recall it being profitable for a time and got pretty good customer satisfaction scores. As I haven’t heard much about them lately, they might’ve tanked or part D might’ve taken the wind out of their sails.

I’m fairly certain they’re taking Walmart behind the woodshed with that ‘penalty’ for companies whose employees are on Medicaid. Sadly, there was no one in my office for me to high-five.

I understand the state-run exchanges but I’m still not clear what competing exchanges would look like. I’m imagining some sort of agency->products situation where insurance agents become relevant again or maybe some ehealthinsurance situation.

Posted by: ThomasEN | June 19, 2009 11:16 AM | Report abuse

These proposals are all designed to make us give up on what should be our real objective: single-payer, universal health*care*.

By presenting proposals that are clearly unacceptable, the legislators involved set up a false dichotomy between bad and worse. You cannot compromise a bad plan into something acceptable. We need to reject these things out of hand and keep up the pressure for real reform.

Employer-paid, for-profit insurance is what dug us into this hole. That model is bankrupting individuals, companies, and pretty soon the nation. Any plan that uses that model as its centerpiece cannot really address the two major problems we have now -- inadequate coverage and escalating costs. We need to get off this treadmill, take a walk and give serious study to how other nations have avoided our problems.

http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande

Posted by: Athena_news | June 19, 2009 1:13 PM | Report abuse

It's time for the pitchforks and torches coalition to enter the discussion, several million strong all the way around the capitol and at the tunnel exits.

Posted by: exomike | June 19, 2009 2:08 PM | Report abuse

"I am a Canadian. Every province has 45% of it's budget dedicated to health care - and it's all taxes!... snip/"
Posted by: brely | June 18, 2009 6:18 PM

Brely,
You are not a Canadian, your IP address shows you are a Health Care Industry Astroturf shill of the worst kind. FOAD.

Posted by: exomike | June 19, 2009 2:17 PM | Report abuse

Insurance is the problem, not the solution. The individual mandate is an affront to personal freedom essentially gives the insurance industry the power of taxation.

Real reform will get us out of the inflationary spiral created by insurance in the first place. The insurance industry know this and is pushing the individual mandate as a last ditch effort to keep us playing there game. Wake up people!!!

Posted by: dblack2 | June 19, 2009 3:20 PM | Report abuse

The sooner the Democratic Party breaks up into the Finance Wing and the Populist wing, the better. I might get some representation then.

Posted by: lambert_strether | June 20, 2009 12:03 AM | Report abuse

This plan is garbage. We need real reform.

Posted by: jsps | June 20, 2009 1:01 AM | Report abuse

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