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EXCLUSIVE: The Baucus Framework

I'll have a fuller analysis once I've had some time to read and digest the document's contents. For now, here's the health-care reform framework (pdf) that Max Baucus is circulating.

By Ezra Klein  |  September 8, 2009; 12:38 PM ET
Categories:  Health Reform  
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Next: Baucus's Framework: Summary


The following things are very troubling to me:

-State-based health exchanges. Good luck if you live in a low-population state.

-Sale of health insurance across state lines. We get a nice race-to-the-bottom effect.

-The lack of employer mandate. There is a fee for employers that have employees getting tax credits, but the wording seems like a loophole big enough to drive a truck through.

-Allowing a 5:1 price ratio on insurance premiums based on age. Will this even change anything compare with the current age discrimination?

In summary, probably the worst bill out there. Baucus better get some Republicans on board with the compromises he's made, otherwise his delay and the quality of this bill is completely inexcusable.

That said, a bad bill is better than no bill.

Posted by: mayorm | September 8, 2009 12:58 PM | Report abuse

And that would be Max Baucus (D-Insurance Industry)?

Posted by: sensible | September 8, 2009 12:58 PM | Report abuse

This isn't a health insurance plan for the citizens and consumers of America -- its a huge gift (paid in full by campaign contributions) to the large health insurance company. When the will of the majority of the people continues to be ignored, one wonders how much longer we can claim to live in a democracy and not an oligarchy of fat cats and corporations.

Posted by: Poleman | September 8, 2009 1:03 PM | Report abuse

Insurance reforms wouldn't even start until 2013! That means until then you can still be denied coverage for a pre-existing condition. WTF? That is so basic, why can it not be in effect in 2010?

This bill is ****.

Posted by: Rhoda | September 8, 2009 1:21 PM | Report abuse

That said, a bad bill is better than no bill.

that may be good politics for democrats, but what about good policy for americans?

only in our craven cess-pool nation's capital would "a bad bill" be "better than no bill". funny the dems didnt take that approach to social security reform, which is an even bigger budget time bomb than government health care for the elderly (i.e., medicare).

Posted by: dummypants | September 8, 2009 1:24 PM | Report abuse

That said, a bad bill is better than no bill. NO IT'S NOT! This bill is just a giant gift to the insurence companies.

Posted by: obrier2 | September 8, 2009 1:29 PM | Report abuse

Ezra, as usual, thank you for your commitment to making primary sources available.

Posted by: tomveiltomveil | September 8, 2009 1:30 PM | Report abuse

I'm just waiting for Ezra to chime in with "hey, a really bad bill is sooooooo awesome! Thanks for spending the last three months negotiating in public with yourselves, Democrats!"

Posted by: scarlota | September 8, 2009 1:38 PM | Report abuse

Consider the following results of even this "bad bill":

-Extending Medicare to 133% of the federal poverty line
-Giving subsidies to middle class individuals up to 300% of the federal poverty line (and limited subsidies to 400%)
-Setting up health care exchanges to pool individuals and small business owners, thus reducing their health care costs
-Drastically increasing regulation on private insurers so that they can't deny based on previous conditions and limiting the difference in premiums between the young and old.
-Setting coverage minimums for insurance so that individuals are not paying for insurance that they discover doesn't fully pay for their health care.
-Price discovery mechanisms so that you know how much a procedure will cost before you get to the hospital.

So yes, I am saying that the small problems I have with this bill are negated by all of the good things this bill will accomplish. Nothing is perfect, least of all something that can get through the senate.

Posted by: mayorm | September 8, 2009 1:40 PM | Report abuse

Still more ripping off the American Public and transfer of cash to the health care and insurance industry. When will Congress ever get a conscience about what they are doing. Baucus and his gang are not representative of what the American people voted for in November. They have stolen control of the issue. This is not democracy; it is representative fascism.

Posted by: peter777 | September 8, 2009 1:46 PM | Report abuse


don't bother. the far left eats this up in their woe is me attitude. until you're ready at the monetary printing press to hand them everything they've ever wanted you'll never make them happy.

Posted by: visionbrkr | September 8, 2009 1:47 PM | Report abuse

People love tossing the coverage of people at the poverty line. In reality, it isn't much unless you're in the 400% range:

The 2009 Poverty Guidelines for the 48 Contiguous States and the District of Columbia

$10,830 - 1 person family
$14,570 - 2 person family

If you have kids, it starts moving up. But kids are allegedly covered by SCHIP.

133% is nothing, literally. And that number has been sold out by the House Blue Dogs and Bausus.

The subsidiary for people up to 400% of the poverty line is "great~!"... expcept it's going into the pockets of Big Health with no real negotiating value. Big Health loves that mandate.

We're putting pearls on a pig here. What I'm really more interested than reading Ezra shill it is to explain to us how this all is a backdoor to real reform. Or if this in the end is like the HMO legislation of the 70s that turned out to be a fantastic revenue gravytrain for Big Health rather than leading to cost savings.


Posted by: toshiaki | September 8, 2009 1:59 PM | Report abuse

I have to agree with mayorm. This is the worst of what we have out there to date. Grassley played Baucus as a fool, pure and simple. That said, this is an OK bill, though certainly not great. It would have been nice for Baucus to have introduced this pre-August: I think it would have forced the Republicans hands to show they are not just not wanting a public option, they don't want any reform, period.

I think a state based exchange is OK because plans are state based. Not sure a national exchange does you any good. Sale of insurance across state lines? What a bone to Republicans. A stupid idea and a race to the bottom. It will eviscerate state insurance regs and we will end up with some state being to insurance what SD is to credit cards. The $400 penalty to employers is not much. Short term, no problem: employers will hang on to coverage for competitive reasons. Longer term, if the industry can not bend the curve, you will see employers jump out, pay the $400 and give everyone a raise. And the 5:1 age ratio is actually good actuarially.

Posted by: scott1959 | September 8, 2009 2:18 PM | Report abuse

The original Vision of Health Care Reform has been lost.

This isn't reform. It's just a giant tax credit for the poor. Tax credits generally have to be paid back.

Each subsequent compromise that comes out is dumbed down more and more and more.

Where are the overall reductions to health care costs for ALL Americans?

Why are Democrats and liberals so hell-bent on passing this crappy legislation, and putting anyone opposed to it in the same corner as Neo-Cons?

I am a liberal -- and proud of it! I supported Obama in 2007 and 2008. But I am DEEPLY opposed to this type of reform. I would rather keep the status quo than support a grave error.

Supporters of reform must demand an intact version of the ORIGINAL VISION for HEALTH CARE REFORM in AMERICA!!! There can be no generic substitution!

Posted by: trambusto | September 8, 2009 2:22 PM | Report abuse

The 5:1 ratio is a killer. I speak as a 61 year old who will be kicked off COBRA at 62 yrs. Whatever happened to the bill (one in the House, one in the Senate), to lower the Medicare age to 55 or 60, but charging higher premiums than the 65+ folks pay? That would at least provide access and reasonable rates.

Posted by: obaku1 | September 8, 2009 2:29 PM | Report abuse

What's the deal with the requirement for minimum creditable coverage? They're requiring something at least actuarially equivalent to 60% of what? The question is whether this individual mandate is for real or not.

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

sensible -- That would be Max Baucus, D-BCBSND.

The evidently corrupt Blue Cross-Blue Shield of North Dakota, about as close to a monopoly on the state's health insurance as you can get, is responsible for over $14,000 of Max Baucus' campaign warchest this year alone.

Posted by: tbetz | September 8, 2009 3:41 PM | Report abuse

So do you think Max just used Liz Fowlers' computer for the bill or what?

Posted by: umprof | September 8, 2009 4:35 PM | Report abuse

That's quite a sweet deal he got on a capitol hill house, as shown in this month's Washingtonian. That price, under a million, looked extremely low for this property. Just saying. There's a great deal of money riding on this legislation, for some people. Not only him.

Posted by: truck1 | September 8, 2009 4:45 PM | Report abuse

sensible -- That would be Max Baucus, D-BCBSND.

The evidently corrupt Blue Cross-Blue Shield of North Dakota, about as close to a monopoly on the state's health insurance as you can get, is responsible for over $14,000 of Max Baucus' campaign warchest this year alone.

Posted by: tbetz | September 8, 2009 3:41 PM | Report abuse

this is hysterical. you have pro-reform polluting the airwaves to the tune of hundreds of millions of dollars and you complain about $14,000 given to a DEMOCRAT senator? Seriously? How about also looking what SEIU is giving to which people and how much. I'm sure there's a nice rock they'll crawl back under once you look.

Posted by: visionbrkr | September 8, 2009 7:12 PM | Report abuse

OH here's that rock.

Posted by: visionbrkr | September 8, 2009 7:15 PM | Report abuse

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