Olympia Snowe's Amendments
It's becoming pretty common for Hill and administration sources to tell me that "Olympia Snowe is more of a Democrat than some of the Democrats." What they mean by that is that she's pushing for a level of affordability and subsidies and consumer protections that far surpass what the Democratic swing votes are interested in. But is it true?
Here's a full summary of the amendments Snowe has offered. Her unique role in the debate means they're pretty likely to be adopted, and their adoption could potentially win her over to the bill. But are they any good?
After reading every one, I have to say: they're almost all worthy changes to the bill. Snowe vastly strengthens the exchanges, which is a huge deal. She expands subsidies to more people, sets limits on high deductible plans, and weakens the penalty in the individual mandate. If I'd read this list of amendments without an attached author, I would indeed have thought they came from a moderate, though not particularly conservative, Democrat.
1) The public plan "trigger," which I detailed here.
2) The current bill doesn't allow an employee who is offered insurance to seek help and tax credits on the exchange unless the employer's insurance would cost more than 13 percent of their income. Snowe's amendment "modifies the affordability test for granting access to subsidized Exchange coverage, scaling the criteria from 3 percent at 133 percent of poverty to 13 percent at 300 percent of poverty." Good!
3) The current bill allows small businesses with up to 50 employees to enter the exchange, and states can raise that to small businesses with up to 100 employees if they wish. Snowe's amendment makes this 100 employees from the outset. Good!
4) The current bill tells states to expand Medicaid to 133 percent of poverty in 2014. Snowe's amendment would allow them to expand to 100 percent of poverty in 2014, and "then phase in Medicaid eligibility to 133 percent of poverty more gradually." Seems bad, though potentially responsive to implementation issues I'm unaware of.
5) The current bill directs states to maintain their current Medicaid eligibility standards until the exchange starts up in 2013. Snowe's amendment would only direct that they maintain their eligibility standards up to 133 percent of poverty -- states that cover above that could drop their coverage. Bad!
6) The current bill doesn't set a maximum deductible for employer-based coverage above what the health savings account rules allow. Since those rules permit out-of-pocket spending of $5,950 for individuals and $11,900 for families, the deductibles could be incredibly high. Snowe's amendment "require[s] that an employer offering coverage shall not provide a plan with a deductible which exceeds $2,000 for individuals and $4,000 for families, unless offering contributions which offset any increase in deductible above these limits." Extremely good!
7) The current bill phases the small group market's insurance regulations into place over five years -- beginning, if I remember correctly, in 2013. This amendment accelerates that timetable so "all rating reforms are in place no later than January 1, 2014." Good!
8) The current bill directs the states to create five-year plans for including large employers in the exchange in 2017. This amendment would allow them to enter the exchange in 2013. This is a very good, totally awesome, hugely important amendment. It effectively opens the exchanges to all employers from the get-go.
9) "This amendment would allow Small Business Development Centers (SBDCs), a resource partner of the Small Business Administration, to participate in the competitive grant program." Seems fine.
10) This amendment ensures that small businesses that grow bigger can remain in the exchange. Imagine a 47-person business has been getting health insurance from the exchange, but they become a 107-person business. If this amendment is passed, they get to keep their current coverage. Good!
11) This amendments would require plans in the exchange to cover early periodic screening, diagnosis and treatment, which is very important for kids. Good!
12) This amendment allows states to access increased Medicaid funding for enrolling people who are currently eligible but simply unenrolled. Good!
1) Snowe partnered with John Kerry and Maria Cantwell on this amendment to soften the excise tax: It would make sure the cap grows a little bit faster so it doesn't begin to tax average policies (at least not as quickly), and it permanently raises the cap for individuals and families between 55 and 65 years of age. Good!
2) A revision to adjustments to payment updates that I'm not qualified to evaluate.
3) Allow people to put more money in their tax-free flexible spending accounts. Good!
4) This amendment reduces the penalty on the individual mandates, though it doesn't say by how much. I'm coming to the view that that's good, though I wouldn't drop it too far down.
5) This amendment would eliminate the individual mandate penalty, and replace it with something called a "defined minimum contribution," which would also ensure access to limited health services. This seems like a potentially good idea, at least from a political perspective. Penalties don't poll well. The devil, however, will be in the details, and right now there aren't any.
6) Directs Medicaid to extend the "prompt pay" rules -- which directs Medicaid to pay claims very quickly -- to hospitals and nursing homes.
7) "The amendment would allow small business owners to be considered as employees in order to enable them to participate in a cafeteria plan." Seems fine.
8) "This amendment would state that it is the Sense of the Senate that the Senate should not waive the Senate Pay-As-You-Go point of order and the Senate point of order against long-term deficits when considering future legislation that would amend a final bill." In other words, it's this Senate politely asking future Senates not to bust the budget when amending the bill. It's not, however, binding in any way.
9) Protects HIPPA-excluded insurance plans from the excise tax. I don't know much about those plans.
1) "Establishes a three-year, $75 million demonstration project that would allow Medicaid funding to be directed to non-publicly owned and operated psychiatric hospitals for Medicaid beneficiaries between the ages of 21-64 who require stabilization in these settings as required by the Emergency Medical Treatment and Active Labor Act."
2) "Directs CMS to develop national standards regarding air ambulances to ensure quality patient care delivery and safety of the aircraft."
Photo credit: By Karin Cooper -- CBS Face the Nation via Associated Press
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