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'Uncharted Territory'


That's what Lori Montgomery and Shailagh Murray call the next phase of health-care reform, and they're right. At 2:08 a.m. this morning, the Finance Committee largely completed their work on health-care reform. Now they wait for an updated CBO score, and should be holding a vote early next week. Expectations are that the bill will pass. At that point, health-care reform will be further along, by far, than it has ever been: It will be passed out of every relevant committee, and heading to the floor of the Senate and the House of Representatives.

Next come the mergers. The House leadership has to build a single piece of legislation out of the bills crafted by the Energy and Commerce, Ways and Means, and Education and Labor committees. That should be fairly easy, as those bills are fairly close. The Senate leadership will have a more difficult time crafting its synthesis of the HELP Committee's bill and the Senate Finance Committee's legislation. Rather than uniting the work of three relatively liberal committees, as is happening in the House, the Senate leadership will have to somehow cut a deal between a liberal committee and a centrist committee. The public plan and the affordability measures will be the key questions there, and no one really knows how they'll come out.

Photo credit: By Susan Walsh — Associated Press

By Ezra Klein  |  October 2, 2009; 2:36 PM ET
Categories:  Health Reform  
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Next: Why Employers Like to Control Your Health Insurance


We agree. The affordability measures and the rules for insurers are key. The Senate bill will have to do better than the 4:1 community rating, the minimum benefits package at 65 percent actuarial value, the 12 percent premium cap at 70 percent actuarial value, and an Exchange without risk-adjustment. I think those provisions will do more to determine the bill's long-term political fate than any of the other items.

Also, could they take out the provision allowing insurers to charge higher premiums to smokers? I'm not a smoker by any means -- I've only smoked one cigarette my entire life when I was 16, and have never smoked anything else. But as an actuary, I can tell you all that allowing insurers to vary premiums by smoking status will just make health insurance unaffordable for older adults who smoke. At age 28, there's not much difference in claims costs between smokers and non-smokers to justify the costs of a blood test in order to determine smoking status. Also, with the community rating, people 30 and under will still be paying significantly more than their average claims costs -- even if they smoke. At age 55, it's darn worth taking the blood test as smokers at this age have much larger claims costs than do non-smokers. In other words, if insurers are allowed to charge smokers extra, insurers will compete on at what age you start taking the blood tests in order to determine smoking status and make health insurance unaffordable for older adults.

Posted by: BradGabel2002 | October 2, 2009 3:02 PM | Report abuse

Sweet picture...

Posted by: meuseman | October 2, 2009 3:11 PM | Report abuse

Suppose I do have a cigarette now and then. If they're going to charge me 150% premiums I'm going to lie. And then if they find me having a heart attack with a cigarette in my hand, will they disenroll me? It's just so much fun to beat up on smokers, even if it makes no sense.

Posted by: bmull | October 2, 2009 3:41 PM | Report abuse

But the Wyden amendment is pretty thoroughly dead, right?

Posted by: adamiani | October 2, 2009 3:43 PM | Report abuse

why is the finance cmte always referred to as centrist. on this issue it seems pretty clear that it's been conservative. this usage also seems to have become standardized at the Post recently. has there been a recent usage directive from tptb.

Posted by: PindarPushkin | October 2, 2009 4:49 PM | Report abuse

May I ask a procedural question? I thought the Fin Cmte had to plow through 500+ amendments. Last I heard, they'd completed around 100. Do they not have to complete all 500+ before the vote? Just curious about the bill-making process. Thanks anyone who can enlighten me.

Posted by: onewing1 | October 3, 2009 2:02 PM | Report abuse

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