More From the HELP Bill
The good score, as I explain below, is primarily a function of the employer mandate. But there's much else in the bill worthy of note.
The individual mandate: If you have affordable coverage available to you -- and I don't know exactly how, or if, "affordable" is defined -- and you don't purchase it, HELP envisions a penalty of not less than half the price of the coverage.
The Health Insurance Exchanges: States would run them. They would be available for the uninsured, people on the non-group market, and small businesses. There would be a so-called "firewall" preventing larger employers from using the exchanges. In the scenario where employees of a large employer are not offered coverage meeting the minimum standards and costing less than 12.5 percent of their income, then and only then can they go to the exchange. (For more on health insurance exchanges, see this primer.)
The public plan: In a slightly weird turn of events. HELP is calling its public option "the Community Health Insurance Option." You have to wonder if that's not an effort to steal some of Sen. Kent Conrad's co-op compromise thunder. It's a level-playing field style plan, and it's available on only the health insurance exchanges.
It's worth quickly doing the math on that last point. Given the composition of the exchanges that HELP is contemplating, CBO estimates that by 2019, they will have 27 million Americans enrolled. That's not all that many. And the public plan will be one of the many options on the exchanges. So imagine that a bit more than half enter the public plan -- which I'd suggest is optimistic. That's 15 million or so people in the plan. That's not a small number, but nor is it a number likely to lead to real changes in the health-care system.
This goes back to my point the other day: For health reform in general and the public plan in particular, the composition of the health insurance exchanges is arguably the single most important policy question. The larger the exchanges, the more people who will have access to a competitive insurance market (including the public plan). But the easier you make it for employers to access the exchanges, the more health reform costs because more people use government subsidies, and the more people "lose" their current coverage because their employer buys into the exchange option.
Another way of saying this is that today's CBO score is low in part because we've made some of the policy worse. It would be a good thing for 15 million Americans to move from employer-based insurance to the exchanges. It would be a good thing for 60 million Americans to do so. But no one knows how to pass that bill. So here we are.
July 2, 2009; 11:32 AM ET
Categories: Health Reform
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