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Baucus's Framework: Summary

baucuspodium.jpg

Let's begin by stating what isn't in Max Baucus's health-care reform framework (pdf): a public plan, serious subsidies between 300 percent and 400 percent of poverty, and a real employer mandate for health-care coverage. Those omissions are disappointing, and will be the focus of a lot of wrangling over the next few days.

But much that's in Baucus's plan is encouraging. The proposal has three primary parts: insurance market reforms, affordability measures and mandates. We'll take each in turn.

Insurance Market Reforms: Beginning Jan. 1, 2013, insurers in the individual market are "required to offer coverage on a guaranteed issue basis and ... prohibited from excluding coverage for pre-existing health conditions." Policy prices can vary substantially based on age, and a bit based on family size and tobacco use. The small group market is subject to all the same rules, though their rules begin phasing in on Jan. 1, 2013, and states can take up to five years to implement them.

All plans sold on the individual and nongroup markets are required to cover "preventive and primary care, physician services, outpatient services, emergency services, hospitalization, day surgery and related anesthesia, diagnostic imaging/screenings (including X-rays), maternity and newborn care, pediatric services (including dental and vision), medical/surgical care, prescription drugs, radiation and chemotherapy, and mental health and substance abuse services that meet minimum standards set by federal and state laws." They're also "prohibited from applying annual or lifetime limits on benefits."

The proposal includes three types of risk sharing to further dissuade insurers from going after the healthy and leaving behind the sick: risk sharing, risk corridors and reinsurance. In other words, the government will impose heavy fees on insurers trying to risk select, making it a far less profitable strategy.

The exchanges are state-based, and, if I'm reading this right, different for the individual and small-group markets. That's not a good thing. The emphasis here, however, is on making them easy to use: "The exchange will provide a standardized enrollment application, a standard format for describing insurance options and marketing, call center support and customer service." It's not clear why you'd do all that if you weren't planning to let them expand.

Affordability: The exchanges transition us neatly into affordability, as that's where the subsidies live. Well, some of them. The first tier of subsidies are in Medicaid, which is expanded to 133 percent of the poverty line and now covers all adults, regardless of their parental status. That's a huge change.

The next tier lies in the exchanges, and actually includes a few different types of assistance. The first is tax credits to help families afford premiums. These are sliding scale subsidies that limit the percent of income that premiums can chew up. For a family at 100 percent of the poverty line, a "silver" class plan can only consume three percent of their income. For a family at 300 percent of the poverty line — about $65,000 a year for a family of four — the premiums are capped at 13 percent of income. There's some sort of flat credit for families between 300 percent and 400 percent of poverty that caps premiums at 13 percent of income, but that's not well defined in the paper.

Those work alongside cost-sharing subsidies to help families with coverage expenses that aren't related to premiums. For the poorest enrollees, cost sharing is quite substantial — equivalent to the very best plans offered on the exchange. As you go up the income ladder, subsidies are progressively lowered. This pairs with the out-of-pocket caps: For families between 100 percent and 200 percent of poverty, the out-of-pocket limit is about $3,900. Between 200 percent and 300 percent, the out-of-pocket limit is $5,800.

The Mandates: The Baucus plan de-emphasizes the employer mandate in favor of the individual mandate. Importantly, this mandate comes with an affordability exemption: If the lowest cost premium available exceeds 10 percent of a person’s income, they're exempt from the mandate. Beyond that, the fee for people who are not eligible for subsidies is $950 per year, up to $3,800 for a family. Compared to the cost of insurance, that's not a ton of money. But then the intent isn't to make not having insurance unaffordable: It's primarily to create a hard deadline so people don't simply put off the purchase of insurance, and secondarily to make sure free riders are paying something into the system.

The employer mandate is pretty much the free rider plan that the Center for Budget and Policy Priorities tore apart here. It's bad policy. An addendum though is that individuals whose employers offer them insurance are not eligible for subsidies, unless the insurance their employer offers would cost more than 13 percent of their income. I'd feel better about that if it were lower for low-income workers, but the plan says that the Secretary of Health and Human Services must revisit this number within five years to see if it should be lowered.

Co-Ops: I'm not going to analyze the co-ops as a substitute for the public plan. They aren't that, and shouldn't be considered such. But they're interesting policy on their own merits. There would be 51 co-ops (including D.C.) and they'd be able to band together "into collective purchasing arrangements for services and items that increase administrative and other cost efficiencies." That might actually make them viable. They will receive start-up loans and grants from the government, with priority going to "statewide proposals, integrated care models, and applications with significant private support."

2010: Much of Baucus's proposal comes into play in 2013. But the first page is full of elements that would start in 2010, and so provide workers with a more immediate benefit from health reform. Among them are huge — 50 percent — discounts for seniors in Medicare Part D's infamous "donut hole," state-based ombudsman who would "act as a consumer advocate for those with private coverage in the individual and small group markets," small-business tax credits, more transparency requirements for insurers and hospitals (including, finally, prices for hospital services), and funding for state-based high-risk pools.

Those are the basic specs for Baucus's proposal. Later today, I'll write a less technical post outlining my thoughts on whether the bill will work, and how it compares with the other pieces of legislation under consideration.

Photo credit: By J. Scott Applewhite — Associated Press

By Ezra Klein  |  September 8, 2009; 1:57 PM ET
Categories:  Health Reform  
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Next: Areas of Dispute

Comments

It looks to me like couples aged 50+ (Age – 5:1) making 300%-400% of poverty are going to be hit pretty hard by this bill.

They could be charged top dollar for a plan that still leaves them responsible for about 25% of the cost of their health care (a silver plan)

Which is much worse than my current (barely affordable) COBRA plan.

Which sucks.

Posted by: katiebird36 | September 8, 2009 2:24 PM | Report abuse

wow what an advance

you MUST have health insurance UNLESS it would cost you more than 10% of your income

THEN you can do without health insurance

Posted by: jamesoneill | September 8, 2009 2:32 PM | Report abuse

If I were giving Baucus'plan a grade, it would be a C-. What I don't understand is why Obama deferred so much to Baucus for this extremely watered-down bill.

Huge Red Flags--
1. Weak, weak, weak health exchange. Instead of it being a national exchange so as to get the max benefits from a huge purchasing pool, we are getting a state pool exchange. Small states with two major insurers like North Dakota aren't going to get any benefit from a weak state-based exchange.

2. Without significant subsidies tied to the poverty level, this plan is bound to fail.

Posted by: jasonr3 | September 8, 2009 2:37 PM | Report abuse

So the insurance compainies get 40 million new suckers and don't have to do diddley until 2013? That's a plan?

Posted by: obrier2 | September 8, 2009 2:38 PM | Report abuse

What's the point of giving subsidies to people so they can buy insurance that doesn't cover anything? Enjoy your last few years in office Max, you're done back home.

Posted by: BeavisfromMontana | September 8, 2009 2:41 PM | Report abuse

this is so funny watching, yes, socialist-minded positive-righters hem and haw over the amount of free insurance coverage the government is going to offer group A using group B's money, all while we are experiencing an unfolding debt crisis caused by the positive-righter's over-promising to the american people.

that said, if democrats cant refrain from sh!t-talking this bill from the left, then they need to find a new country: say france or holland.

Posted by: dummypants | September 8, 2009 2:41 PM | Report abuse

>>>>>Enjoy your last few years in office Max, you're done back home.

Hopefully.
But we can't expect much more from Congress members who accept HUGE donations from the very industries and corporations tied to certain legislation.

Funny how Repubs scream "socialism" when taxpayers have spent BILLIONS bailing out corporations - and Congre$$ writes laws allowing pay-to-play.

Posted by: angie12106 | September 8, 2009 2:56 PM | Report abuse

This, my friends, is called nibbling around the edges of a problem and calling it reform. People in countries with guaranteed health insurance must read this and wonder why Americans cannot get it right. And, this bill is simply a huge boondoggle for the insurance industry. I will not be able to support Obama or the Democrats on this one. If this passes, true reform is DEAD for another generation.

Posted by: goodisgood | September 8, 2009 2:58 PM | Report abuse

This sounds too complicated. If health reform is passed, it should be simple for everyone to understand. There are far too many different numbers, etc. based on your income. Also, people who smoke and those who are obese should pay more for insurance, than people who are otherwise healthy. I am not sure why those of us who do not smoke and maintain our weight should subsidize smokers and fat people.

Posted by: columbiaheights | September 8, 2009 3:01 PM | Report abuse

Ah, dummypants, content to live under a bridge in a cardboard box as long as Those People Over There can't have any of his cardboard.

Off to the dunce corner with you.

Posted by: pseudonymousinnc | September 8, 2009 3:05 PM | Report abuse

Health Care ‘TORT’ reform would provide the Insurance Companies with monies to accept people with prior conditions ……

Additionally it would allow a DR to send a patient home with an aspirin
for a headache without giving him an MRI ……

Posted by: UpAndOver | September 8, 2009 3:07 PM | Report abuse

Just become someone smokes - or his obese - does'nt necessarily mean they are unhealthy. If risk is a criteria, then why not tax people who drink, eat at McDonald's, jog or drive automobiles?

Posted by: CubsFan | September 8, 2009 3:07 PM | Report abuse

This is a good start. Restrict medical malpractice lawsuits and allow insurance companies to compete across state lines and you have real, positive reform. This plan could help a few Democrats keep their jobs next year.

Posted by: kenpasadena | September 8, 2009 3:12 PM | Report abuse

When I look at the men in the photo accompanying this article, I no longer wonder why our policy and politics no longer work. I see four plutocrats who have grown rich and powerful accepting legal money donations that would be bribes in any other line of work.

Members of the U.S. Senate constitute the most dangerous criminal class in America.

Posted by: KarimAbdulTares | September 8, 2009 3:14 PM | Report abuse

I think you've highlighted some major points:
* Individual mandates w/religious and affordability exemptions, combined with a viable alternative for the young-and-foolish;
* State-centric co-ops which can combine (many Colleges do something similar with purchasing already, and it works well);
* Medicaid without current counterproductive birthing-machine requirements; and
* Regulations which make profiteering from risk-selecting less attractive.

The loudest nay-saying (and a dose of utopianism) will come from the far-left, to its own demise: at some point, the far left has to come to recognize that "government pays" means "citizens pay".


Posted by: rmgregory | September 8, 2009 3:15 PM | Report abuse

Watch for unintended consequences in this plan. Since the plan calls for the major provisions to not kick in until 2013, watch the health insurance companies start dropping people like crazy over the next three years to avoid covering them. The 2013 date creates some very perverse incentives to the insurance markets. also watch employer coverage to disappear as well--without employer mandates and a new individual mandate + subsidies, employers will see perverse incentives to kill health care benefits altogether and tell employees to find their own coverage since they *have* to or face a fine.

This is looking like a very badly written bill.

Posted by: Sprintaway1 | September 8, 2009 3:16 PM | Report abuse

Is it Constitutional to force people to spend up to 10 percent of their income on private health insurance premiums? This is different than mandatory car insurance that is linked to the privilege of driving. Good car insurance is about 100 dollars per month while the health insurance can easily be 600 to 1000 dollars per month. This high cost insurance will drive out other personal goals such as going to technical school or college or starting one's own business. Do you think that the current U.S. Supreme Court and appellate courts will approve of this mandatory insurance? I have not seen any lawyers commenting on the Constitutionality of such a mandate that would require an expenditure as large as many persons' rent.

Posted by: nleggett | September 8, 2009 3:17 PM | Report abuse

Is it Constitutional to force people to spend up to 10 percent of their income on private health insurance premiums? This is different than mandatory car insurance that is linked to the privilege of driving. Good car insurance is about 100 dollars per month while the health insurance can easily be 600 to 1000 dollars per month. This high cost insurance will drive out other personal goals such as going to technical school or college or starting one's own business. Do you think that the current U.S. Supreme Court and appellate courts will approve of this mandatory insurance? I have not seen any lawyers commenting on the Constitutionality of such a mandate that would require an expenditure as large as many persons' rent.

Posted by: nleggett | September 8, 2009 3:22 PM | Report abuse

The Baucus plan is a sick joke.

Posted by: sensible | September 8, 2009 3:24 PM | Report abuse

The loudest nay-saying (and a dose of utopianism) will come from the far-left, to its own demise: at some point, the far left has to come to recognize that "government pays" means "citizens pay".

------------------

And pay less in *all* of the developed countries that have universal care.

It's Decline and Fall of the Empire time. Even when faced with an obvious problem, we create a "solution" that feeds the problem: Big Health Inc. Just more looting.

It would be nice if Ezra would come clean that all he's hitting the pom-poms over is just Coverage Expansion. It's not coverage reform or healthcare reform. Frankly it's rather piss poor coverage expansion.

John

Posted by: toshiaki | September 8, 2009 3:26 PM | Report abuse

This is terrible. I'm going to have to join the side that's rioting at town meetings. Obama, just forget about it. Leave well enough alone.

Posted by: AnnsThought | September 8, 2009 3:30 PM | Report abuse

Baucus needs to retire and go on medicare and give up his golden parachute.

We elected a Democrat controled house, senate and president because we wanted real change not a Republican plan in a blue coat.

No Public Option, No Deal...! & No VOTES in 2010.., if you want a Republican controled overnment then have at it and see what you get...!

Can anyone spell Death Panels...! Republicans can...!

Posted by: LeeMentley | September 8, 2009 3:30 PM | Report abuse

Actually if you are fat and/or smoke you will definitely be more unhealthy than people who are the correct weight for their height and do not smoke. The idea that people dispute that is just amazing to me. It may not show up today, but eventually it will. Those are issues that can be controlled. I am just saying that why should someone be able to free ride off me being healthy and not smoking. If you want to be a fatty, that is fine with me, you should just pay for all the problems it will cause you.

Posted by: columbiaheights | September 8, 2009 3:46 PM | Report abuse

>>>>>Enjoy your last few years in office Max, you're done back home.

Hopefully.
But we can't expect much more from Congress members who accept HUGE donations from the very industries and corporations tied to certain legislation.

Funny how Repubs scream "socialism" when taxpayers have spent BILLIONS bailing out corporations - and Congre$$ writes laws allowing pay-to-play.

Posted by: angie12106 | September 8, 2009 2:56 PM | Report abuse


actually Angie, it seems as if the biggest MONEY is coming from those screaming for reform.

http://money.cnn.com/2009/09/08/news/economy/health_care_lobbying/index.htm?postversion=2009090812

The makers of drugs would be Pharma who made that nice little early deal with Obama to save themselves more in the long run in exchange for $150 million of PRO reform propaganda. We'll finance your agenda for reform as long as you don't bite too much of our hand off. Oh and those evil insurers are only at 16 million. What a shock!!

Posted by: visionbrkr | September 8, 2009 3:53 PM | Report abuse

Mr. Bacus and the Gang in both houses seem to think that if they delay and dazzel the Public will forget. Well, we've delayed since 1947 on Universal Care. OUR TIME IS NOW. Real Care can start, NOW. Why 2013, when 2010 and a half would give the health mogels plenty of time to adjust to the new 'Sheriff' in town. *TORT REFORM?--We put caps on in my state five year's ago and All Patient Fees, Health Insurance Premiums, and Malpractice Insurance continued to increase.Tort Reform is a strawman. *PART D--I fell into the 'doughnut' hole last week in spite of a healthy 12% '09 premium increase. Big Pharma must be forced to negotiate price and to stop their manipulation to keep Generics from being released, regardless of any backroom deal with the Whitehouse staff. My medicare suppliment went up 18% this year. *We must have true Health Care REFORM, not a cosmetic, Health Care ADJUSTMENT.

Posted by: sturdivantl1 | September 8, 2009 4:00 PM | Report abuse

Perhaps the Post can identify for its readers the industry legal and lobby staffers who worked behind the scenes with Baucus committee staffers in drafting the actual legislation.

Posted by: emoran1 | September 8, 2009 4:02 PM | Report abuse

50 million Americans dropped into the pockets of insurance companies is a complete disgrace.

Repubs so concerned about the deficit is laughable, since medical costs spiraled out of control under them and helped create the deficit gap through medicare, a worthwhile program. Not to mention their wars and corporate bailouts. But this as reform is extremely disappointing and coops will have no weight in NYC.

I'm refusing to pay a dime to the government for no healthcare.

Posted by: eeave | September 8, 2009 4:18 PM | Report abuse

This is called a compromise plan that gives all the loud mouths and big money what they want and in the edn really addresses nothing.

It is akin to the classic line of "re-arranging the deck chairs on the Titanic". It does not address costs (subsidies do not lower costs it just shifts them to the Government - translation tax payers), it does not address Tort Reform, it does not address "Fee-for-Service", it does not address increased competition (across state lines or versus government options).

As an independent looking for a true health care reform proposal, this is a non-starter.

Posted by: thecontributist | September 8, 2009 4:21 PM | Report abuse

Look at Harry Reid in the picture. It looks like Dodd is sticking a Red Hot Poker up his posterior.

Caption "Shut up Harry or we stick it in further."

Posted by: thecontributist | September 8, 2009 4:23 PM | Report abuse

Hmm. What your explanation leaves unclear Ezra, is at what point does the boot kick over the bucket, sending the ball down the rickety stairs towards the chute?

Why must everything in this country be a Rube Goldberg-esque festival of stupidity?

Posted by: antontuffnell | September 8, 2009 4:26 PM | Report abuse

Easy to have universal coverage when all you have to do is make it illegal to not have insurance.

Ten percent of income is "affordable"??? That's more than what most people spend on food. That's more than what most people spend on utilities.

But they are going to force people to pay through the nose for "insurance" coverage for a bunch of things that do not apply to them and they will therefore never use? They are going to force people to use their food money and rent money and utility money -- you know, living expenses -- to buy their gold-plated plans?

How about you fascists just leave people alone? How about a little concern for freedom?

I know that "freedom" is a word that Obama does not know, but it's time he learned it.

Posted by: ooyah32 | September 8, 2009 4:26 PM | Report abuse

Ezra, where do you come off saying the cost for insurance for folks at 100-200% of poverty is "not bad" at $950/per person or $3980/family of four?

Or do you think that a family of four making 22k-44k can just take that $4k out of savings?

Posted by: jdgssf | September 8, 2009 4:29 PM | Report abuse

this plan scares me a whole lot less than a public option. it looks like it could drive us toward a competitive private insurance industry gently and cover more uninsured people with better health services for cheaper. it may be a little too moderate though, too much employer provided insurance smells bad to me.

Posted by: feistymick | September 8, 2009 4:29 PM | Report abuse

The complexity of this proposal turns the tangled mess of our current system into an even more tangled mess. People are going to need an accountant just to understand how to get their care. Just make Medicare available to everyone and be done with it already! Simple, direct, effective. Why do we have to spend twice as any other country so that a handful of private insurance companies can make a profit off of our healthcare needs?

Posted by: skrut003 | September 8, 2009 4:33 PM | Report abuse

So what are you going to do Klein if I don't cough up an extra several thousand dollars a year to get the "insurance" that you want to shove down people's throats?

What if people tell you where you can shove your autocratic "individual mandate" and they refuse to comply?

Are you going to throw them in jail?
Are you going to simply seize their assets? Raid their bank accounts, slap liens on their homes, seize their cars?

Posted by: ooyah32 | September 8, 2009 4:34 PM | Report abuse

The plan has no public option and therefore no cost control mechanism.

Posted by: sanjay08544 | September 8, 2009 4:37 PM | Report abuse

I like to think of myself as fairly intelligent, but this plan is so complicated that I have to admit I do not fully understand it. Some elements of it sound intriguing, but others leave me weary.

The biggest question on my mind is, how does this protect people who have lost their jobs? (thankfully, there's no danger of that happening to me, but I'm sure it's on others minds). From what I gather, Baucus' proposal seems to center largely around personal income levels as a general marker for determining how much the government subsidizes.

But what happens if a person loses his job -- even temporarily -- and effectively has no income level? Do they automatically lose their coverage? How are they protected?

Posted by: Gladiator2008 | September 8, 2009 4:49 PM | Report abuse

The Baucus approach will encourage employers to drop health insurance as an employee benefit, leaving us individually exposed to insurance companies, which will offer us complicated programs that only experts can understand. Next thing you know, we'll have a new and entirely unregulated business -- health insurance consultants -- and how long before the insurance companies own the consultants, too?

Posted by: Bob22003 | September 8, 2009 4:51 PM | Report abuse

Big Health should love this--after all they wrote it. I'm sure Max calls this the ALL AMERICAN PLAN, because no one else in the world would put up with it.

Posted by: rusty3 | September 8, 2009 4:54 PM | Report abuse

The proposal makes its a point to say "no illegal immigrants will benefit from the health care tax credits."

Nowhere in the proposal does it say illegal immigrants will not be eligible for coverage under one of the "metal options."

The way the proposal is written, pregnant illegal aliens WILL be elgible for the tax funded free coverage during their pregnancy and post natal.

Democrats are working overtime to find a back door to sneak in the illegals. Either they ignore it in their bills or build loop holes large enough to drive a coyote's van through.

Posted by: asmith1 | September 8, 2009 5:02 PM | Report abuse

Instead of all this bipartisan manure, let's abandon health insurance reform. Apparently, it's perfect as it is! Okay, we'll leave you alone. It is not socialistic. Instead, we will offer Medicare just for those who want it, paid for out of premiums but subsidized by the wealthy who will lose their Bush tax cuts. (Arrived at through reconciliation, Dems. Amazing.) In five years, Aetna and so on will be crying uncle. We let them in on it, if they agree to regulation like power utilities. End of story.

Posted by: jimhass | September 8, 2009 5:04 PM | Report abuse

So what are you going to do Klein if I don't cough up an extra several thousand dollars a year to get the "insurance" that you want to shove down people's throats?

What if people tell you where you can shove your autocratic "individual mandate" and they refuse to comply?

Are you going to throw them in jail?
Are you going to simply seize their assets? Raid their bank accounts, slap liens on their homes, seize their cars?

Posted by: ooyah32 | September 8, 2009 4:34 PM | Report abuse

so wait you have home"S". You have car"S" and you don't care enough to avoid medical bankruptcy through not having insurance to cover it. Do you have homeowners insurance in case there is damange to the home? Auto insurance in case your car is in an accident? Why wouldn't you make sure your most precious assets (yourself) is taken care of?? THe idiocy of some is amazing.

Posted by: visionbrkr | September 8, 2009 5:18 PM | Report abuse

I'll want to listen to further analysis of the "Baucus Plan" from sources like NPR and the Economist before I can make a reasoned assessment.

The postings so far show the difficulties of reforming health care.

While I support Tort Reform as a matter of fairness, I want to note that we have pretty strict tort reform in Texas already. I did not notice my health insurance premiums dropping after the law passed in our state.

Posted by: guitar1 | September 8, 2009 5:23 PM | Report abuse

IT'S WAY TOO COMPLICATED!!

My eyes are burning from reading this!

Posted by: hoos3014 | September 8, 2009 5:24 PM | Report abuse

It's interesting that premiums would vary only slightly for smokers but that old people can be forced to pay 5 times the premiums that younger people can.

Or that employer-provided health benefits aren't subject to the standards/protection that people in the individual market would have.

Middle income people are going to be absolutely killed, financially, under this bill. I hope this never sees the light of day.

Posted by: chi-town | September 8, 2009 5:27 PM | Report abuse

Tell me this:

1. Where is the Constitutional authority for the Federal government to require me to buy insurance? Where in our history or traditions is support for this found?

2. How will baucus pay for his mandates? Where is a detailed budget or buisiness plan for this insanity? If I wanted to borrow $100K from a bank for a business they would want a lot more documentation than my good intentions.

Continuing leftist idiocy devoid of reason, facts or any connection to the reality of the Nation's current state.

Posted by: JoeDBrown | September 8, 2009 5:37 PM | Report abuse

looks like the insurance companies continue to win on this plan. seniors without insurance and within the 200-300% are gonna be hit hard. let congress be put in this plan first and see if it works for them. let them work the bugs out and then lets see how it gets improved.

Posted by: mj9501 | September 8, 2009 5:39 PM | Report abuse

The requirement to cover pre-existing illnesses in individual plans means we are not talking about insurance of risk, but subsidized healthcare. That's the discussion that needs to be had. The incentives against companies risk selecting means the cost of insurance must rise to the healthy. It should be made clear to to the healthy public that they will be subsidizing the healthcare of the obese, smokers and other victims of their own lifestyles.

Posted by: GRILLADES | September 8, 2009 6:02 PM | Report abuse

This plan is good for covering more people and whittling down the number of uninsured.

Covering the medicare doughnut hole.

Also making insurance more affordable, especially when your at 100% to 300% of poverty rate.

Waiting till 2013 for most changes makes no sense, that sucks. There is no reason why the date shouldn't be the end of 2010.

The insurance exchanges are weakened by not being at the national level instead at the state.

I'll give it a C.

Posted by: yarbrougharts | September 8, 2009 6:07 PM | Report abuse

But what happens if a person loses his job -- even temporarily -- and effectively has no income level? Do they automatically lose their coverage? How are they protected?

--------------------

Isn't that what Medicaid is for? Poor people with no income?

Posted by: thetan | September 8, 2009 6:08 PM | Report abuse

Moderate Democrats in Congress are often actually conservatives in sheep's clothing. If there were a reversal in party domination of congress tomorrow, they would be switching to the Republican Party. One only has to look at the last time majority in congress switched from Democrat to Republican, during the Clinton years. Why are Obama and the Democratic Party letting a few so-called "moderates" drive the health care reform? Shouldn't this be decided by the majority of the liberals? Furthermore, it's pointless to aim for bipartisanship because the Republicans are opposed to any significant reform, save one: They want to force everyone to buy insurance to fatten their friends from the private health insurance industry, or worse, themselves for they own part of the private health insurance industry.

Posted by: pspox | September 8, 2009 6:11 PM | Report abuse

Ezra, where do you come off saying the cost for insurance for folks at 100-200% of poverty is "not bad" at $950/per person or $3980/family of four?

Or do you think that a family of four making 22k-44k can just take that $4k out of savings?

Posted by: jdgssf | September 8, 2009 4:29
........................................

That family of 4 is already paying for insurance. If they get it through their employer and the employer pays half, they might not want to change. If they are paying for it by themselves, they are currently paying significantly more than $4000 a year.

Posted by: yarbrougharts | September 8, 2009 6:15 PM | Report abuse

This comment is incredibly uninformed:

-Just become someone smokes - or his obese - does'nt necessarily mean they are unhealthy.-

These are the two most dangerous predictors of later disease, and are correctable by modifying behavior.

Posted by: maus92 | September 8, 2009 6:15 PM | Report abuse

Legislation on such a huge issue that touches everyone, and will require public support, must be simplified. Just as a starting point, people have to understand what they are saying yes or no to. All of these provisions, while there are few needed changes, don't attack the key problems, affordability and portability. Affordability may go a long way toward providing portability, but as long insurance is primarily tied to employment we still have a problem.

Posted by: Reactive1 | September 8, 2009 6:15 PM | Report abuse

Wow. What a package for wonks. Let's have a simple plan: every American is covered by catastrophic health insurance that pays hospital bills more than $100,000.
If you want more than that, you can buy it from an insurance company.

Posted by: edwardallen54 | September 8, 2009 6:16 PM | Report abuse

Are you trying to tell me that it took Sen Baccus all this time to come up with this?
First of all he did not let any of the Single Payer Advocates to testify before his committee. Then this plan is a give a way to the same Insurance Companies that have been ripping us off for decades. This is a Bonanza for the Insurance Companies.
This plan does not have ghost of a chance in passing. PUNT.
Are you trying to tell me that he is going to ingnore the cries of the People for a Public Option?.
Obama needs to scrap the whole thing and regroup. This is not acceptable.
Unless we get real reform it makes no sense passing a bill just so we can say we passed a Bill.
Its like marrying a fat Ugly Girl just to say you have a wife.

Posted by: Carprin | September 8, 2009 6:19 PM | Report abuse

So the 48 states that are in the red will be put further in the red by increasing Medicaid enrollment, thereby raising taxes on citizens across the country.

I would like to know if the $10 billion earmarked for the UAW is still in the health care plan. The WaPo still hasn't reported on it, but the credible media (bloggers) are reading the bill and informing the people.

Posted by: Cornell1984 | September 8, 2009 6:20 PM | Report abuse

"Beginning Jan. 1, 2013..."

That kills it from the start! That's FOUR MORE YEARS of this BS!!!

What about starting in January of 2010??????

Posted by: gce1356 | September 8, 2009 6:24 PM | Report abuse

This is a hidden fee that the consumer will have to pay when the dust settles. I wonder if this fee will also affect Medicare cost?
New Fee on Health Insurance Companies Is Proposed to Help Expand Coverage

http://www.nytimes.com/2009/09/07/health/policy/07health.html?_r=1

Posted by: billisnice | September 8, 2009 6:36 PM | Report abuse

Implementing this on a state basis (plus DC) means there will be 51 systems to worry about synchronizing instead of one.

We should start with the goal of TOTAL NATIONAL COVERAGE (i.e. NATIONAL HEALTHCARE), then work to implement it under ONE system.

Posted by: gce1356 | September 8, 2009 6:36 PM | Report abuse

The bill will be determined to be unconstitutional. Dead in the water. Next try!!!!

Posted by: mrhonda | September 8, 2009 6:38 PM | Report abuse

$950.00 versus the cost of insurance? I'll pay the $950.00 and let everyone else subsidize my healthcare. Thanks.

Posted by: mrhonda | September 8, 2009 6:39 PM | Report abuse

MAINE already has much of this...MAINECARE is Medicaid + 150% above poverty level and a small biz policy called DIRIGO CHOICE.

But the State has hyperregulated the insurance industry so much...no prior issue, etc. that Maine has been blacklisted by 95% of health insurance companies and has perhaps the highest health insurance rates in the world.

The bottom line is that despite all this LIB/DEM manipulation, Maine's health hasn't gotten any better, while costs have soared into the top five states.

Amazing people haven't used Maine as a text book example of how wrong OBAMACARE is!

Posted by: Common_Cents1 | September 8, 2009 6:51 PM | Report abuse

If there's 51 coops, what's the deal for Guam, Virgin Islands, American Samoa, the Estado Libre Asociado de Puerto Rico, and perhaps Micronesia?

Posted by: DaveoftheCoonties | September 8, 2009 6:52 PM | Report abuse

This is just another typical Democratic redistribution plan. As usual, it punishes the responsible to lavish goodies on the irresponsible.

As a case in point, take the Health Insurance Provider Fee. Just who do you think will pay this $6 billion tax on insurance premiums? Well it sure won’t be the insurance companies. Of course, it will just be passed along to the policyholders.

So if you have been playing by the rules and buying health insurance at market rates with no government subsidies, guess what? Now, not only will you have to pick up your own tab, which is painful enough, but you’ll have to help cover the uninsured as well.

And if they opt for coverage starting after their houses burn down (i.e., they have pre-existing conditions), well, not to worry, you’ll foot the bill for that as well.

Wonderful, just wonderful.

Posted by: ToddLC | September 8, 2009 6:52 PM | Report abuse

This country has become a collection of pillagers both at the individual and government levels. The politicians have no shame, they will steal from anyone who had the gall to work hard and prosper. The freeloaders will suck anything from anybody. They have no pride and no initiative. This is nothing more than out right theft. The thought that a family of four making $66,000 a year can't afford health care is ludicrous. First of all, if you can't afford kids, keep it in your pants! Don't expect others to pay for your stupidity! Secondly, if you make $66,000 and don't have insurance, it's because you don't want to get it! Sell the d*mn HDTV, the boat and the SUV! Dump cable and the cell phone! Don't steal from me because your toys are more important than your family. Grow up!!! This class warfare, regularly created by the Demoncrats, at some point in time will lead to another civil war. Word to the wise- freeloaders, be careful what you wish for!!!

Posted by: yankee11 | September 8, 2009 7:07 PM | Report abuse

Why wait until 2013? What is so magic about that? Regarding what elements begin in 2010 and 50% discount for those caught in the "donut hole" (Medicare Part D). Part D was foisted on us by the last administration which caved in to not negotiating drug prices. I believe it's still a "sell out" to big pharma.

Posted by: McGregor1 | September 8, 2009 7:31 PM | Report abuse

Are you trying to tell me that it took Sen Baccus all this time to come up with this?
First of all he did not let any of the Single Payer Advocates to testify before his committee. Then this plan is a give a way to the same Insurance Companies that have been ripping us off for decades. This is a Bonanza for the Insurance Companies.
This plan does not have ghost of a chance in passing. PUNT.
Are you trying to tell me that he is going to ingnore the cries of the People for a Public Option?.
Obama needs to scrap the whole thing and regroup. This is not acceptable.
Unless we get real reform it makes no sense passing a bill just so we can say we passed a Bill.
Its like marrying a fat Ugly Girl just to say you have a wife.

Posted by: Carprin | September 8, 2009 6:19 PM | Report abuse
---------------------------------------------------------------
Frankly, the 'fat ugly girl' most often makes for the very best wife and mother. They know from the outset you are not marrying them for their physical beauty. They can concentrate on being good and faithful companions. And most important, Most all girls become fat ugly women as they age. So bank on it! And you won't be so svelte yourself!

Posted by: mosthind | September 8, 2009 8:00 PM | Report abuse

I am having a difficult time trying to understand the many Health Care Reforms being proposed. Even having retired from a huge Insurance Company and Special training in the industry, along with my BA and 50 yrs of life experience, it is confusing and difficult to comprehend.
Having said this, what about the poor guy who has no Insurance knowledge or even a college education!? This group has to be the majority of people in the U.S. People are waiting around being led by their special interest groups; political affiliations and just plain "praying" that an acceptable and fair plan is passed. Frankly, after 7 decades as an American, it is nearly impossible to establish a Health Plan which will not infuriate a large group of people! The Republicans have been trashing everything Pres. Obama is trying to do, BUT are unable to come up with a plan that would work!
The majority of middle & working class Americans really have No say on the end result. Politicians, Special Interest Groups and people who control the economy will place our health plan.

Posted by: Miyagi1 | September 8, 2009 8:02 PM | Report abuse

With friends like Ezra Klein, the left does not need enemies. This is not good, Ezra, unless you have a healthy portfolio of health insurance stocks. Or in Walmart, who are strongly incentivised to enter the health insurance business themselves.

Posted by: drzen1 | September 8, 2009 10:47 PM | Report abuse

This framework seems very similar to the one that was issued several months ago. It retains the 5:1 range for premiums by age group, the 65% coverage ratio for the lowest cost plan, and the confinement of the exchanges to the state level. All bad ideas which could end up being worse than the status quo, at least for lots of people.

I am particularly concerned that older working people will be forced to incur significant financial strain to buy a policy that they will not be able to afford to use (because they will have to pay a large portion of the cost) in case of really serious medical problems. And which will not appreciably reduce the risk that such problems will lead to their financial ruin.

I'd be very interested if other more knowledgeable people could tell me why my fears are unfounded.

Posted by: cpigott1 | September 9, 2009 4:40 AM | Report abuse

Oh I see, we feed the beast and call it reform. I see nothing, nothing at all in this plan that will contain costs. This is the health industry's wet dream. It will throw vast quantities of borrowed money at the industry.

Seriously, shouldn't we ask the Chinese for permission, are they are willing to finance this plan?

America seems to have made its choice, health "reform" or not, we could see the health industry growing to 40% of gdp for the next generation.

That, as it happens, is fine with me.
Not just that I am a doctor, I don't think all the new jobs that will be created by "health reform" as a bad thing. Americans need to do something. We can't export health care (or can we?!), but we can spend all our time and money creating and consuming health care. It is better than wars, it is better than creating and consuming cars and smart phones and TVs.

Posted by: shrink2 | September 9, 2009 8:35 AM | Report abuse

People might keep in mind just what they are up against with a Health Care Right process, which hasn't even been constitutionally or ethically defined yet. A human body contains several hundred thousand complex molecular structures all trying to work together in spite of inherited distortion, chemical alteration, viral infection or violent environmental damage to any one or several of those molecular combinations. To seek to create a health system that is geared toward the individual protection of these molecular structures for 300 million people is absurd in this half of the century. It wasn't even possible to consider the idea of treating all of these molecular combinations until twenty years ago because 80 percent of them weren't even scientifically defined. A family doctor in some mid western town had very little to work with except his own intuition, which might be an advanced molecular structure itself. Things have changed in the definitions of the structures, but there is a long way to go before any health benefits for individuals are created as a ‘right’.

All of these proposals are dealing with one set of molecular structures or another for various ages and injuries and who gets what from the process. Obviously, if the socialistic inability to count beans by giving a little of something to all or the capitalistic desire to extract wealth from ‘consumers’ becomes the goal of ANY health care proposal, then the purpose of improving an individual’s existence and freedom by making his molecular entities work better through health will be defeated. It is this freedom from molecular disaster that enhances the mind, body, and spirit and such a freedom should be the purpose of any health care system.

Anything that does not keep this enhancement focus should be viewed with extreme suspicion and the American people have sensed correctly that there is a ‘wrongness’ to many of the ‘earmarks’ and ‘laws’ embedded in this complex life and death process. The political and economic control of a thirty trillion dollar, twenty year process can do things to a person’s baser instincts, in and out of government, that can quickly take his perception out of ‘enhancement’ mode and back to ‘cave’ mode. On the other hand, the complexity of health attributes itself is causing many people problems, including Electeds and the Electeds of the federal and state governments need to be given some serious bipartisan slack on dealing with such scientific, economic and cultural dynamics. The focus should still be to exclude anything that doesn’t enhance a person’s wellness for his individual future. It took twenty years to create the Bill of Rights and those were an obvious need even then. A new Right won’t be that easy.

Posted by: arjay1 | September 10, 2009 8:22 AM | Report abuse

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