Open Thread on Senate Health Care Bill
by Bruce Webb
I am still working out the new formatting and rather than hog all the page space here I’ll just put up some links to the bill, the CBO Score, plus some extended discussion with extracted Tables at my site.
$894 billion cost offset by taxes and fees for a Ten-Year $129 billion deficit reduction.
Coverage for 94% of all legal non-elderly residents, 98% for all legal residents (includes Medicare). Public option opt-out. Abortion not covered in the PO but at least one plan in the Exchange must offer coverage, and one must not.
Otherwise take it away. Updates in Comments.
“$894 billion cost offset by taxes and fees for a Ten-Year $129 billion deficit reduction.”
I know this is the CBO score. Does anyone actually believe the numbers will actually work out this way? How much reduction is “fraud and waste’ control? how much assumes the law never changes and all the provider cuts actually happen? how much gets gutted from Medicare/Medicaid? (I heard $400B).
Saying this will reduce the deficit is ludicrous on its face.
Buff you comment is kind of loaded but lets me take your questions one by one.
One. Absent an actually fact based argument I don’t see why they wouldn’t work out this way. Incredulilty is not such an argument.
Two. Quite a bit is “fraud and waste” control. They various line items are laid out in Table 4 of the CBO score as each section is scored separately. The big line items are in Subtitles F & G on page 2 of that table dealing with Part D savings and cutbacks in DSH payments to hospitals with high Medicaid loads ($60 billion total) and then in line items 3131 and 3133 (another $60 billion in savings).
Three. Given that most of these savings would come about via changes in various formulas and that changing them back would require specific offsets I suspect they will actually happen. Because the one provider change under current law that WILL happen is the one that boosts payments to physicians under Part B (and so eliminates the annual game the Bushie’s used to project such cuts that politically would never happen).
Four. And I reject gutted. Most conservatives have spent the last few decades arguing the Medicare was both unsustainable and marked by huge layers of fraud and abuse. And you know they were not entirely wrong. But somehow attempts to take out that fraud and abuse are magically transformed to “gutting”. Special Plead Much?
What is ridiculous is seeing Conservatives recasting themselves as champions of medicare fraud.
Plus I remember when bad numbers from CBO on Obama’s Budget Plan were golden for some people as compared to OMB. Six months ago CBO was on the side of the angels, now they are incompetent hacks. A little consistency would be in order here.
Bruce,
Thanks for the response to my very sarcastic first comment.
First I do not doubt that the CBO scored the bill accurately. None at all.
I also don’t believe for a moment that these reductions would actually occur.
Both the head of the CMS and head of the CBO seem to think that the mechanism for holding down costs is realistic. And I agree. You mentioned the fact that during the Bush Presidencies neither the majority R or Majority D congress (and even to today when the D’s own it all) ever stood by the automatic cost cutting measures in Part B. Why do you think that behavior would change in the future? Yet these ‘savings’ were scored into the bill and properly scored by the CBO. And of course never materialized.
If there was that much Fraud and Waste in these programs where were the Democrats during the past 8 years not pointing them out? Probably because they can’t find them either or there is no political will to actually get that money. What makes you suddenly believe that will change? Same Dem leadership is still there that was there in 2006 – you know the ones who promised to get us out of Iraq, but instead voted in support of Bush’s Iraq policy. If the fraud is there I am all for harvesting it. But instead of this sweeping changes why not spend some years (say 2) proving that the waste was really there then starting the nationalization process?
Bottom line: You’re not going to find it.
You mentioned specifically $60B in cuts to hospitals. How do these hospitals plan to cover that gap in their budgets? Is there a projection on how many will close? Or are these costs just pushed off onto the states?
How much cost will be pushed onto state budgets with unfunded mandates? I know the Democratically controlled states like California, Michigan, and Massachusetts are in excellent financial shape and can easily afford this but what of all the other states not so wisely run by government bureaucracies?
And what happens after the first 10 years? Obama’s deficits are already projected to be worse than ever seen in US history (make Bush look like a piker) how bad does this really get?
Bruce, do you honestly believe this bill will actually be revenue neutral when actually implemented? Or any Health-Care bill?
Islam will change
Both the head of the CMS and head of the CBO seem to think that the mechanism for holding down costs is realistic
That should be UNrealistic. Missed that even after spellcheck AND proof-reading….
Keith Hennessey has provided this breakdown.
Major tax increases in the Reid health care bill
Nov 18, 2009
http://keithhennessey.com/2009/11/18/reid-tax-increases
Interesting read. Worthy of further discussion.
Keith Hennessey also provided a breakdown of coverage increases cited in the H.R. 3962 memo from Rick Foster, Chief Actuary of Medicare & Medicaid. Note how that estimate compares with the CBO analysis of the Senate healthcare bill (see next comment)
The House-passed bill’s effects on health insurance coverage
Nov 16th, 2009
http://keithhennessey.com/2009/11/16/cms-memo/
Increase in Private Coverage + 6.5 million
– Private plans in exchanges + 4 million
– Employer-provided plans + 2.5 million
Increase in Government Coverage + 29.7 million
– Public option + 6 million
– Medicaid and S-CHIP + 23.5 million
Remaining Uninsured 23 million
– Undocumented aliens 5 million
– Uninsured and paying penalty tax 18 million
CBO analysis of the latest Senate healthcare bill:
Increase in Private Coverage + 12-13 million
– Private plans in exchanges + 25 million
– Employer-provided plans – 5 million
– Nongroup & Other /c – 5 million
– *Unexplained difference (- 2 or – 3 million)
Increase in Government Coverage + 18-19 million
– Public option + 3-4 million
– Medicaid and S-CHIP + 15 million
Remaining Uninsured 24 million
– Undocumented aliens 8 million
– Uninsured and paying penalty tax 16 million
CBO – “By 2019, CBO and JCT estimate, the number of nonelderly people who are uninsured would be reduced by about 31 million, leaving about 24 million nonelderly residents uninsured (about one-third of whom would be unauthorized immigrants).”
CBO – “About 25 million people would purchase their own coverage through the new insurance exchanges, and there would be roughly 15 million more enrollees in Medicaid and CHIP than is projected under current law. Relative to currently projected levels, the number of people purchasing individual coverage outside the exchanges would decline by about 5 million, and the number obtaining coverage through their employer would also decline by about 5 million.”
CBO – “Under the legislation, certain employers could allow all of their workers to choose among the plans available in the exchanges, but those enrollees would not be eligible to receive subsidies via the exchanges (and thus are shown in Table 3 as enrollees in employment based coverage rather than as exchange enrollees). CBO and JCT expect that approximately 5 million people would obtain coverage in that way in 2019, bringing the total number of people enrolled in exchange plans to about 30 million in that year.”
CBO – “Roughly one out of eight people purchasing coverage through the exchanges would enroll in the public plan, CBO estimates, meaning that total enrollment in that plan would be 3 million to 4 million.”
I find it interesting that the analyses for the House and Senate healthcare bills indicate that the number of uninsured illegal aliens is limited to 5-8 million (5 million in the House analysis by Foster, and 8 million in the Senate version by CBO).
Let’s not forget that a new immigration bill will be undertaken in 2010 or shortly thereafter. It’s possible that the number of “healthcare programs and plans eligible” illegal aliens will change rather dramatically once status is provided whereby many of the illegal aliens qualify for Medicaid, CHIP, and exchange plans.
Should the new immigration bill be passed, one might expect Medicaid and CHIP enrollment to only increase by a maximum of 5-8 million if basing such a projection on the analyses of House and Senate healthcare bills. Yes, this observation excludes any consideration for illegal aliens who may be earning too much to qualify for Medicaid.
I expect Medicaid to take a substantial hit once the new immigration bill is passed. It’s unlikely in my opinion that 5-8 million will cover the new Medicaid enrollments resulting from the immigration bill.
On the issue of the fine for not buying insurance I don’t see the current level of around $1,000 as being enough. It seems you would have to make it about the same as a healthcare policy to make the individual want to choose the policy.
Take an individual that’s facing a 5 thousand dollar healthcare bill. If he does not get coverage in a typical year with no serious medical needs he pays the fine and pockets the 4 grand. On a years when the individual has a high medical bill what’s stopping him from checking into an emergency room and getting free care? Moreover, on years where his healthcare needs are below 4 grand he can pay the unexpected bill out of pocket and still either break even or be ahead. If he saves this money each year this money will grow until he can self insure. It seems it might also be economical to pay the fine and get a catestrophic policy.
The real point of the reform bill is to get healthy people into the insurance pools and then overcharge them to pay the insurance for others. There may be too many loop holes to achieve this goal.
Cantab. Emergency room care is not free. At a minimum the doctors, labs and ambulance services will bill you and turn you over to collections if you don’t pay. If you are lucky and get admitted to a hospital that provides a lot of charity care per their mission (both hospitals in my town are run by the Sisters of Providence) AND you can show you have limited assets you MIGHT get your actual hospital costs written off. Otherwise you are on the hook for some or all your bill.
That emergency rooms have to TREAT you without regard to your ability to pay doesn’t mean you walk away without a bill. And if necessary a collections agency dogging your ass and a ruined credit rating.
Bruce,
Not everyone is and upstanding outstanding citizen like you are. Most of the people don’t get insurance because they don’t feel its worth it to them. If you are risk neutral and your expected medical cost for some year is is around $1,000 and an insurance policy costs $5,000 you would elect not to get insurance.
And let me remind you that part of life is in the hands of fate. Even you yourself said you had some bad luck with a health related event. So for 9 out of 10 people nothing happens and they pocket the money. For the 10th person something unexpected happens and they have to pay a big bill that ruins their credit rating. Well that not good but its hardly the end of the world. And you get to live the proverb of “Neither a borrower nor a lender be”
Cantab you asked a question.
“What keeps him from checking into an emergency room and getting free health care?”
I answered that question in a way that showed your understanding of this was so shallow as to be indistinguishable. There is a pool of people who can trash their credit on a regular basis. That doesn’t include most people with jobs. Try to get a hotel reservation with no credit. Or a rent a car. Your implication that bunches of people can just game this shows you have never been truly exposed to the downsides of a credit economy. These days employers, landlords and insurors can and do check credit records and your attempt to game health insurance might end up with you being unemployable, unable to rent an apartment, and without a credit card to secure a place in a low end hotel. I hope your car is more comfotable and better heated than mine. Becuase “Oh it is just my credit” is a pretty stupid and shallow reaction.
Bruce,
Try to get a hotel reservation with no credit. Or a rent a car.
It seems you don’t know how the world works since you can make both the hotel reservation and rent a car on your bank debit card if its backed by visa. Both businesses want to make a sales afterall. And cash beats credit any day of the week. So what part of “neither a borrower nor a lender be” did you not understand?
Anyway, this line of argument is foolish since you are talking about the way you wish things were rather then the way they actually are.
The point that you totally ducked is the fact that many people today don’t get insurance because its not a value to them. Moreover, paying the fine does change their calculation but given the small size of the fine many will just pay the fine and still not sign up for healthcare.
And how does the government rationalize the fine. On what basis is the fine levied. Is it a tax and if so what does one get in return for paying this tax?
Also, what if someone without insurance gets cancer. What’s stopping that person on the day he’s diagnosed from signing up for insurance? They say you can’t be denied coverage because of pre-existing conditions so in what page of this 2000 page bill do they prevent this type of behavior. And if they do prevent it aren’t the contradicting claims of the bills backers.
Staying Focused On The Main Issue of Federal Health Care
Debra J.M. Smith – http://www.InformingChristians.com
December 08, 2009
Though we can use the details of government ran health care plans, to show just how far off the beaten path many in our federal government have gone and how severe the need is to replace them, we must keep to the fact that any federal government ran health care is unconstitutional.
If someone broke into our homes to steal from us, we would not stand there and debate with them, what they could and couldn’t take or in which way they can and cannot carry out the job. We would call the police to get their rears out of our homes!
We would not debate with a would-be rapist, as to what he could and couldn’t do to us.
We would not debate with a murderer, on what method he could kill us by.
Why on earth, would we debate with Congress over what way they can go against the U.S. Constitution and take over our health care?
We must keep focused on the fact that it is all wrong to begin with! And we must use this to educate voters and to remove those people in government who are not upholding and defending the U.S. Constitution.
For those citizens, who do not appreciate and do not wish to defend the U.S. Constitution, we need to point them in the direction of Canada. Let them move to a country that allows for such a thing.
Debra:
I guess there is always the alternative of “soylent green” for those who can not get reasonable healthcare. What planet are you from if I am understanding you correctly?
Bruce:
If I am understanding this correctly, the older cliental will be faced with premiums 3 times that of the younger cliental unless the states choose to minimize that ratio . . . so much for group coverage. Average income for a couple 55-64 is ~ $56,000. The premiums could become rather high.
Unless they decide to opt out? If the healthcare insutrance premiums exceed 8%(?) of income, a person can opt out.