(This article appeared on page A - 8 of the San Francisco Chronicle, January 6, 2010.)
The insurance industry hates it because it would ding its profits. Democratic leaders fear it could kill passage of health care reform. But reports of the death of the public option have been greatly exaggerated.
Poll after poll shows that Americans want to be able to choose a public insurance plan, and for good reason. It would be tragic to lose this pillar of health care reform to cynical inside-the-Beltway political horse trading. Here's why we need the public option:
It can really deliver on the benefits. The proposed bills would outlaw common and perverse industry loopholes such as pre-existing condition exclusions, which exclude sick people from buying insurance as individuals, and rescissions, which let companies deny treatment retroactively for people they already insure. While outlawing these rules will help, private insurance plans have demonstrated that they are willing to challenge patients' rights to the grave and beyond in the interest of clinging to the premium dollar.
We've witnessed a heartbreaking parade of insured patients trooping to corporate headquarters to plead for lifesaving treatments that were denied, even though the benefits are covered in writing. In contrast, no one at the government-run Medicare program gets a bonus for turning away sick people. We need to be able to choose a plan in which the financial incentives to provide needed care line up with the proposed new laws, and that can only happen in the public sector.
It will drive down costs. Health care reform will cover millions more Americans - a great achievement. But we need to use the increased buying power of this newly covered population to control costs, a job at which private insurance companies consistently fail. Some companies can't reduce premiums because they're too small to hold leverage in negotiations with private hospital chains and big drug companies. Or if they do save a buck, they put it back in their own pockets in the form of profits and executive bonuses.
In Massachusetts, large nonprofit insurers recently testified that they had negotiated sweetheart deals that benefited certain employers and hospitals - and confidentiality agreements that kept the details secret. When the Veterans Administration negotiates lower drug prices, the savings buy more drugs for veterans, and the transactions are all transparent. We'd like to be sure that the change we voted for turns into change we save on reduced premiums, which is possible only in a public plan.
It will allow us to re-engineer how we deliver and pay for care. How? By coordinating with Medicare initiatives that will bolster quality while lowering costs, like financial incentives that promote primary care and better coordination of medications. The public plan will be most effective if it starts right away and is available to everyone - policies we can continue to fight for. But the projection that the public option would offer savings too small for too few, or would be too expensive, is off the mark.
It's democratic. Most Americans know this in our bones. The majority of the House voted for it, including many in our powerhouse delegation from California. The majority of senators expressed support for it - including committee chairs Max Baucus and Tom Harkin. We're tired of arcane rules that let minorities of one hijack the public's interest.
There will be efforts to leverage the public option for other benefits. One benefit of that debate would be if the antitrust exemption for health insurance companies were revoked so they can be regulated by the Federal Trade Commission. But we need a real institutional alternative to the present system. Americans want - and need - a public option. Don't let your representatives trade it away.
Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/01/05/EDNG1BDU6L.DTL#ixzz0boK3i2R0
Tuesday, January 5, 2010
Tuesday, December 22, 2009
MoveOn
Dear MoveOn member,
In just about 48 hours, the Senate will vote on its health care bill, and then House and Senate leaders and the White House will meet to negotiate the final bill.
While the House bill is quite strong, the Senate health care bill is seriously flawed. And with negotiations about to begin, we have one last chance to fight for key fixes in the final bill.
Here are five key problems with the Senate bill that must be fixed. Please check this out, then pass it on! Click here to post on Facebook, or here to post on Twitter.
Five Critical Flaws in the Senate Health Care Bill
The Senate bill would:
#1—Deny Americans the choice of a public option. In contrast, the House bill contains a national public option, the key to real competition, greater choice, and lower costs.1
#2—Leave insurance unaffordable for some lower income and working people. Both bills require virtually all Americans to buy insurance. But even with the subsidies provided, some families could have to pay up to 20% of their income on health care expenses.2
#3—Impose dangerous restrictions on women's reproductive health care. Unfortunately, both bills do this and the House provision is worse. Both versions would be a dangerous step and neither should be in the final bill.3
#4—Tax American workers' health coverage to pay for reform. The Senate would pay for part of reform by taxing the hard-won benefits packages of some working Americans. The House, on the other hand, pays for reform with a small surcharge on only the wealthiest Americans—a far better approach.4
#5—Allow insurance companies to remain exempt from anti-trust laws. Under current law, insurance companies are actually exempt from laws designed to prevent monopolies and price-gouging. The House bill would fix this, but the Senate bill leaves it in place.5
Of course, these aren't the only problems with the bill. Most glaringly, both the Senate and House bill would leave millions uninsured,6 a far cry from the vision of universal coverage so many of us have fought for. That remains a long-term goal.
But these five things need to be fixed immediately—and we need to spread the word to make sure House and Senate leadership and the White House get the message we're counting on them to craft a final bill with these key fixes.
Can you spread the word? Forward this email, and click here to post on Facebook, or here to post on Twitter.
Thanks for all you do.
–Kat, Carrie, Michael, Joan, and the rest of the team
In just about 48 hours, the Senate will vote on its health care bill, and then House and Senate leaders and the White House will meet to negotiate the final bill.
While the House bill is quite strong, the Senate health care bill is seriously flawed. And with negotiations about to begin, we have one last chance to fight for key fixes in the final bill.
Here are five key problems with the Senate bill that must be fixed. Please check this out, then pass it on! Click here to post on Facebook, or here to post on Twitter.
Five Critical Flaws in the Senate Health Care Bill
The Senate bill would:
#1—Deny Americans the choice of a public option. In contrast, the House bill contains a national public option, the key to real competition, greater choice, and lower costs.1
#2—Leave insurance unaffordable for some lower income and working people. Both bills require virtually all Americans to buy insurance. But even with the subsidies provided, some families could have to pay up to 20% of their income on health care expenses.2
#3—Impose dangerous restrictions on women's reproductive health care. Unfortunately, both bills do this and the House provision is worse. Both versions would be a dangerous step and neither should be in the final bill.3
#4—Tax American workers' health coverage to pay for reform. The Senate would pay for part of reform by taxing the hard-won benefits packages of some working Americans. The House, on the other hand, pays for reform with a small surcharge on only the wealthiest Americans—a far better approach.4
#5—Allow insurance companies to remain exempt from anti-trust laws. Under current law, insurance companies are actually exempt from laws designed to prevent monopolies and price-gouging. The House bill would fix this, but the Senate bill leaves it in place.5
Of course, these aren't the only problems with the bill. Most glaringly, both the Senate and House bill would leave millions uninsured,6 a far cry from the vision of universal coverage so many of us have fought for. That remains a long-term goal.
But these five things need to be fixed immediately—and we need to spread the word to make sure House and Senate leadership and the White House get the message we're counting on them to craft a final bill with these key fixes.
Can you spread the word? Forward this email, and click here to post on Facebook, or here to post on Twitter.
Thanks for all you do.
–Kat, Carrie, Michael, Joan, and the rest of the team
Why Fight Now? A Single Payer View on the Public Option
Time to say a few things:
Health reform is important. The bills before Congress can make a difference for millions.
The President needs to win this one, soon. If the insurance industry can demoralize progressives over the holidays, the win comes on their terms. If progressives keep up the fight we could win.
The public option is not optional. It is our toe-hold on structural change.
Women and immigrants are more numerous and better organized than the turkeys who think we are wedge issues.
On the other hand, there is no organization that will swoop in and win this for us. Social justice, labor, women’s rights and other groups have been battered by 30 years of neoliberal economics and politics. Progressive political leaders in the Senate – Sanders, Brown and Burris - took their bows for talking up a single payer amendment that failed even more spectacularly than expected, and they ducked last minute appeals to them to cross Harry Reid and the White House by threatening a No vote.
Mike Huckabee is heading to Omaha to rally and revive the teabaggers. It won’t matter right now. Huckabee, like a lot of others, is building his lists and organization for other fights.
For those of us who think the next step toward health reform, however limited, should be at least a step forward and not a wholesale retreat on reproductive and immigrants’ rights, we will have to be enormously creative and persistent this week. Stay tuned..
Posted by Ellen Shaffer at 10:20 PM 0 comments Links to this post
Tuesday, December 15, 2009
Fight for Real Health Reform!
The President and the Senate are likely to meet on Tuesday regarding health reform. Following is a message to Congress and the President - please add your own, and call or write TODAY!
Also: links to statements below from the Congressional Progressive Caucus and Rekindling Reform
To Congress and the White House:
We need and support real health reform. Stick us with us and demand a bill that preserves and expands the strongest points of House and Senate proposals, starting on day one:
1. A public option is critical to advance access, quality, affordability and cost control. A buy-in to the public Medicare program for ages 55-65 must also be affordable.
2. All plans must be affordable, limit out-of-pocket expenses, require fair financing by employers and high-income individuals, end insurance company abuses, and require insurance companies to spend at least 90% of revenues on health care.
The federal government should promote innovations in delivery and financing of health care, including more primary care providers and public health funding.
3. Defeat diversions on wedge issues:
Advance reproductive rights.
Assure that all people who live in the U.S., including immigrants, have access affordable, quality, culturally appropriate care.
4. Promote states’ ability to move to single payer systems.
This historic bill will be an important step forward. States must be empowered to advance to a single payer system.
http://www.whitehouse.gov/CONTACT/
http://speaker.house.gov/contact/
http://reid.senate.gov/contact/index.cfm
Congress: thomas.loc.gov
_____________________________________________
Statement by Congressional Progressive Caucus: http://cpc.grijalva.house.gov/index.cfm?ContentID=564&ParentID=0&SectionID=107&SectionTree=107&lnk=b&ItemID=562
Statement by Rekindling Reform: http://www.rekindlingreform.org/index.php
______________________
We have won important victories for better access to affordable health care.
Enemies of reform are now out in force.
Progressives must stay informed and engaged to achieve a truly historic victory.
Posted by Ellen Shaffer at 12:14 AM 2 comments Links to this post
Saturday, December 12, 2009
The Senate Compromise: Does it Help?
The Senate compromise seems to be this:
For the slice of the population age 55 - 64 that would have gone into health exchanges with subsidies – uninsured, self-employed – let them instead buy in to Medicare. Except without subsidies.
The Medicare Part B premium is now means-tested – that is, based on annual income. It covers 25% of the cost of the program. Individuals earning less than $85,000 a year pay no premium; going up from there from about $44 a month to about $353 a month. Buying in to Part B alone could presumably cost 4 times those amounts, or between zero and $1400 a month. Plus the $155 deductible.
Offer the same group, under age 55, the choice of 2 nonprofit health plans, administered by the federal Office of Personnel Management.
No public option.
Til now we’ve heard that Congress would abolish lifetime caps on what the plans would pay. Now we’re hearing the caps may be back. (After which you’re on your own.)
The great thing about Medicare is that it has the clout of 40 million beneficiaries and the federal government when it comes time to negotiate with Sutter Health. So sure, add more folks in over there.
But. If they’re the oldest and sickest, and everyone under 55 is still left to the depredations of the private insurance industry…Well. Perhaps at least a few more of them will be covered.
And rumor has it that the Senate would also require the companies to spend 90% of the premium dollar on actual benefits (a big hike from the 70% or so that some plans spend now).
Ok marginally a little better than nothing. But so diluted from the House bill, in terms of a stepping stone to the future: less public involvement than any proposed public option (so less cost control), less affordability, less coverage. Makes you think that maybe the regular legislative process has some advantages over the Gang of 10 system.
Painful as it may be, and tempting as it is to go for expanding Medicare by any means necessary, it’s looking like getting something through the Senate, to be followed by a conference with the House’s better bill, is our best hope.
Posted by Ellen Shaffer at 4:09 AM 0 comments Links to this post
Labels: health reform, Medicare, public option, Senate
Wednesday, December 9, 2009
The Senate: Getting to the Public Option
It is important that health reform continue to move forward through the Senate. The most recent announcement offers some elements that sound attractive. As a whole, though, the package seems to leave a lot of gaping holes, that the Senators will need to address, or that will be resolved in conference.
What the proposal is, as far as we can tell:
Opening up something like the Federal Employees Health Benefits Plan (FEHBP) to the public, through the Office of Personnel Management.
Offering some or all people age 55-64 the chance to buy in to Medicare.
A trigger to create a public option in the future.
Progressives need 3 things:
1. An expanded role for the public sector, in order to effectively control the charges by health care providers: drug companies, hospitals, medical supply companies, hospitals. Doctors too. Private insurance companies have no stake in controlling prices and are often too weak to bargain successfully with organized providers.
2. To the extent there will continue to be private for-profit insurance companies in the mix, they need to be strictly regulated, so that the uninsured will have a fair shake at getting covered, and the insured and underinsured have a fair shake at getting our claims paid.
3. Subsidies to make insurance affordable, and to put some pressure on the government as prices rise.
Increasing enrollment in Medicare for seniors, while expanding coverage for middle age/middle income people, would be a great step forward.
But marginally opening up Medicare selectively to a subset of seniors does not accomplish these objectives. It likely will not increase significantly the number of beneficiaries; and they will be the most expensive to treat.
FEHBP has the same inflationary insurance spiral as any other set of private insurance plans. It does function somewhat like the proposed health insurance exchanges. It is not a public option. A trigger needs to be pulled now.
The Illinois Campaign for Better Health Care proposes this:
"It is NOT an either or - we demand a strong public option, strong insurance reforms, and expanding access to Medicare to all individuals 55 and older. Better yet, let everyone join Medicare."
Call your U.S. Member of Congress at 1-888-801-4426. Tell them:
For Democratic reps: "Stay firm on the public option plan on which you have already voted yes and on expanding Medicare eligibility."
For Republican reps: "Quit playing politics with my and my family's life. Support the American people and support health care reform."
What do you think?
Posted by Ellen Shaffer at 11:52 AM 0 comments Links to this post
Labels: Medicare rates, public option, Senate
Thursday, November 19, 2009
Real Health Reform: Positions for Progressives
What Now
It has been both an exhilarating time for progressives and a bumpy one: the House passed a bill (yay) with a public option (yay). These are victories for progressives, inside and outside of Congress: we made this happen.
But House leaders caved at the last minute to an anti-abortion spoiler, the Stupak-Pitts amendment, and dropped a popular provision proposed by Rep. Dennis Kucinich to protect states that opt for single payer systems from lawsuits under ERISA.
Many of us who both support and desperately need health reform are still trying to make sense of the news of the last week. Advocates and the public need to be unified and energized for the final push to get the best possible bill through the Senate and back through the conference committee with the House.
Here’s what we think all Senators need to hear, and why:
1. The House bill is a major achievement. Preserve and expand on its strong points, including the public option.
There is a lot here for access, quality, affordability and cost control, in fact more than there was in any of the bills that passed through the House Committees. The public option is likely to be more robust than the Congressional Budget Office’s preliminary projection.
2. We need to advance reproductive rights, not retreat.
The anti-abortion amendment is a real threat and a wake-up call.
We can beat it. Many members who voted “yes” on Stupak are on record as pro-choice.
Pro-choice energy can propel reform forward.
3. Protect single payer states from ERISA lawsuits.
It is important to continue to point this out and to organize for single payer, and against the for-profit private insurance industry States will be a far cry further in the march toward single payer if we can win waivers from federal obstacles including ERISA.
The House is still in play; they will be involved in the conference with the Senate, and will vote again on final passage. Our messages to House members depends on how they voted. (See Tables on p. 8):
1. Voted Yes on the bill and No on the Stupak Amendment (178 Democrats): Thank you! You’re the progressive Democratic majority. Help us win the ERISA waiver, and keep what we’ve won.
2. Voted Yes on the bill and Yes on Stupak: Stick with the bill and stick up for women. [For those historically pro-choice: Shame on you for voting Yes on Stupak]
3. Voted No on the bill and No on Stupak: Thanks for opposing Stupak. I’m asking you to stand up for health care reform now and support the bill.
4. Voted No on the bill and Yes on Stupak: We need health care reform now, and need our member of Congress to stick up for women. Will you change your vote and stand up for health reform and for women? [For those historically pro-choice: Shame on you for voting Yes on Stupak]
(for full statement and to see how Menbers voted go to: http://www.centerforpolicyanalysis.org/id62.html)
Posted by Ellen Shaffer at 12:06 PM 1 comments Links to this post
Labels: abortion, ERISA waiver, health reform, progressives, public option, single payer
Thursday, November 12, 2009
Anti-abortion amendment threatens all women, all health plans
Media coverage of the Stupak amendment underestimates its impact on privately-funded abortion. The impact is also being downplayed by the right.
This looks specifically at the language of the amendment to show how it:
1. Certainly eliminates the ability of any health insurance plan participating in the new health insurance exchange from covering abortions for any enrollee, if the plan accepts any enrollee who uses federal funds to pay any part of the premium. This would include the public option, but also any other plans that participate in the exchange.
It also prohibits any plan that would offer “affordability credits” from covering abortions.
2. Could eliminate current practices by 17 states to cover abortion under Medicaid, and prevent other states from doing so.
In addition, it has the following potential effects:
3. Can eliminate the ability of any health insurance plan covered by any part of HR 3962 to cover abortion, depending on the menaning of "any costs."
This could mean any health insurance plan offered through the new health insurance exchanges. The Exchanges, in turn, include both private insurance plans, and a public option.
4. Can eliminate all health insurance funding for abortion, depending on the meaning of "authorizes."
1. Certainly eliminates the ability of any health insurance plan participating in the new health insurance exchange from covering abortions for all enrollees, if the plan accepts any enrollee who uses federal funds to pay any part of the premium. In this way it restricts abortion coverage both to low-income and middle-income women who receive federal funds for subsidies. It also restricts coverage for women who pay entirely with their own funds. This would include the public option, but also any other plans that participate in the exchange.
There is general agreement that the amendment prevents health plans in the new health insurance exchanges from covering abortions, if they will accept women who use federal subsidies to pay part of their premiums.
This prohibition applies to all plans in the exchange. These include the public option, as well as all other private insurance plans in the exchange.
Some people (those earning up to 400% of the federal poverty limit, or about $88,000 for a family of 4) will use federal subsidies (or “affordability credits”) to pay for their premiums. Those people could not buy a health plan that covers abortion through the exchange.
It will apply even though the federal subsidies constitute only a part of the premium, and the rest is paid through private funds.
In addition, any plan that intends to enroll people who accept federal subsidies to help pay part of their premiums will not be able to cover abortion, for anyone who enrolls in the plan. This means women who do not accept federal subsidies, who pay the entire cost of insurance privately, cannot buy an insurance plan that covers abortion through the exchange, if the same health insurance plan covers women who do use the subsidies.
The bill offers women the ludicrous option of buying supplemental abortion plans, as long as they do so outside of the exchange and using their own money. Supplemental abortion plans cannot be purchased using affordability credits, which are public funds. This extra punch assures that in case the Supreme Court balks at outlawing abortion outright for millions of women with employer-provided insurance, women earning up to 400% of the poverty level who take advantage of public subsidies won't be able to use their insurance when they find out their birth control has failed.
All of this is worse than current law. Current law, through the Hyde amendment of 1976, says no federal funds can be used for abortion except if the mother’s life is in danger or in the case of rape or incest. Where the language is ambiguous, the Supreme Court will decide.
"Sec. 265. LIMITATION ON ABORTION FUNDING.
(a) IN GENERAL.- No funds authorized or appropriated by this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from [life-threatening illness related to the pregnancy, or pregnancy is a result of rape or incest]."
2. Could eliminate current practices by 17 states to cover abortion under Medicaid.
17 states now find ways to use state funds to pay for abortion through Medicaid. Medicaid is a program for low-income women which is funded jointly by state and federal dollars. The amendment appears to explicitly prohibit this:
"(b) OPTION TO PURCHASE SEPARATE SUPPLEMENTAL COVERAGE OR PLAN. – Nothing in this section shall be construed as prohibiting any nonfederal entity (including an individual or State or local government) from purchasing separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as –
(2) such coverage or plan is not purchased using –
(B) other nonfederal funds required to receive a federal payment, including a State’s or locality’s contribution of Medicaid matching funds."
3. Could eliminate the ability of any health insurance plan covered by any part of HR 3962 to cover abortion, whether or not it includes people who use federal subsidies to pay for their premiums, depending on the menaning of "any costs."
This explicitly could mean any health insurance plan offered through the new health insurance exchanges, both private insurance plans, and the public option.
The amendment says “No funds authorized or appropriated by this act…may be used to …cover any part of the costs of any health plan that includes coverage of abortion.”
It also does not restrict the use of federal funds to premiums. “Any part of the costs of any health plan” could refer to the administrative costs of setting up a health insurance exchange.
There will be people covered in the Exchanges who do not receive any federal subsidies for their premiums. They will pay every penny of the premium out of their own pockets. Some others will pay the premium by a combination of funds from their employers and from themselves.
These people may not be able to buy a plan through the Exchange that covers abortion
4. Can eliminate all health insurance funding for abortion, depending on the meaning of "authorizes."
It says that no funds "authorized or appropriated" by HR 3962 can be used to pay for abortion or to cover the costs of any health plan that covers abortion. It does not limit the application of this prohibition to funds authorized by any section of the bill, to health insurance exchanges, or to the public option. It applies to every word in HR 3962.
It also doesn’t necessarily restrict its application to funds “authorized” by Congress to be paid through federal sources.
Authorization and appropriation are particular acts by Congress to direct public funds to various purposes. That could be what this language means. Which would be bad enough.
The bill also "authorizes" employers and individuals to contribute to health insurance. These are private funds. The funds can be used to buy health insurance entirely privately. Or they could be used to buy insurance within the new health insurance exchanges. It could mean that no health insurance plan purchased as a result of the bill can be used to pay for abortion. None. It is possible that no health plan that covers abortion could be offered through programs created by this bill.
In the case of ambiguity, the Supreme Court could make the final decision.
Posted by Ellen Shaffer at 12:35 PM 0 comments Links to this post
Labels: abortion, health reform, Stupak
Monday, November 9, 2009
Enough
I think that HR 3962 offers many important improvements over the status quo, in the areas of coverage, affordability and quality, despite significant limitations, I will document these shortly.
The Stupak amendment however is exactly the poison pill it is meant to be. It virtually rolls back women's current legal right to choose abortion. It is an unacceptable political compromise. It cannot stand. Read it here:
http://www.centerforpolicyanalysis.org/id58.html
It says that no funds "authorized or appropriated" by HR 3962 can be used to pay for abortion or to cover the costs of any health plan that covers abortion.
Authorization and appropriation are particular acts by Congress to direct public funds to various purposes. That could be what this language means. Which would be bad enough.
The bill also "authorizes" employers and individuals to contribute to health insurance. These are private funds. It could mean that no health insurance plan purchased under the auspices of the bill can be used to pay for abortion. None. It is possible that no health plan that covers abortion could be offered through programs created by this bill. This may be a debatable interpretation. If it is challenged, the Supreme Court will decide.
It adds that supplemental abortion plans cannot be purchased using affordability credits, which are public funds. This is an extra punch to be sure that just in case the Supreme Court balks at outlawing abortion outright for millions of women with employer-provided insurance, women earning up to 400% of the poverty level who take advantage of public subsidies won't be able to use their insurance once they find out their birth control has failed.
Why are we facing this devil's bargain at the 11th hour in this campaign? Where was the vigorous organizing and mobilization campaign to get the votes needed to pass this bill without dismantling women's hard-fought rights? Was it news to anyone that the Catholic bishops oppose abortion, that they have access to an energized constituency, or that this constituency represents a minority of opinion even among Catholics?
This is not a re-election pitch or a solicitation for funds, which usually prompts messages like these from our leaders. It is also not a proposal for a particular action, People will need to figure out together what to do about this.
Planned Parenthood to their credit suggests writing to the President, calling this the outrage that it is and calling for actual leadership. Good start.
Posted by Ellen Shaffer at 12:30 AM 0 comments Links to this post
Labels: abortion, choice, health care reform, Obama, Stupak amendment
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Health reform is important. The bills before Congress can make a difference for millions.
The President needs to win this one, soon. If the insurance industry can demoralize progressives over the holidays, the win comes on their terms. If progressives keep up the fight we could win.
The public option is not optional. It is our toe-hold on structural change.
Women and immigrants are more numerous and better organized than the turkeys who think we are wedge issues.
On the other hand, there is no organization that will swoop in and win this for us. Social justice, labor, women’s rights and other groups have been battered by 30 years of neoliberal economics and politics. Progressive political leaders in the Senate – Sanders, Brown and Burris - took their bows for talking up a single payer amendment that failed even more spectacularly than expected, and they ducked last minute appeals to them to cross Harry Reid and the White House by threatening a No vote.
Mike Huckabee is heading to Omaha to rally and revive the teabaggers. It won’t matter right now. Huckabee, like a lot of others, is building his lists and organization for other fights.
For those of us who think the next step toward health reform, however limited, should be at least a step forward and not a wholesale retreat on reproductive and immigrants’ rights, we will have to be enormously creative and persistent this week. Stay tuned..
Posted by Ellen Shaffer at 10:20 PM 0 comments Links to this post
Tuesday, December 15, 2009
Fight for Real Health Reform!
The President and the Senate are likely to meet on Tuesday regarding health reform. Following is a message to Congress and the President - please add your own, and call or write TODAY!
Also: links to statements below from the Congressional Progressive Caucus and Rekindling Reform
To Congress and the White House:
We need and support real health reform. Stick us with us and demand a bill that preserves and expands the strongest points of House and Senate proposals, starting on day one:
1. A public option is critical to advance access, quality, affordability and cost control. A buy-in to the public Medicare program for ages 55-65 must also be affordable.
2. All plans must be affordable, limit out-of-pocket expenses, require fair financing by employers and high-income individuals, end insurance company abuses, and require insurance companies to spend at least 90% of revenues on health care.
The federal government should promote innovations in delivery and financing of health care, including more primary care providers and public health funding.
3. Defeat diversions on wedge issues:
Advance reproductive rights.
Assure that all people who live in the U.S., including immigrants, have access affordable, quality, culturally appropriate care.
4. Promote states’ ability to move to single payer systems.
This historic bill will be an important step forward. States must be empowered to advance to a single payer system.
http://www.whitehouse.gov/CONTACT/
http://speaker.house.gov/contact/
http://reid.senate.gov/contact/index.cfm
Congress: thomas.loc.gov
_____________________________________________
Statement by Congressional Progressive Caucus: http://cpc.grijalva.house.gov/index.cfm?ContentID=564&ParentID=0&SectionID=107&SectionTree=107&lnk=b&ItemID=562
Statement by Rekindling Reform: http://www.rekindlingreform.org/index.php
______________________
We have won important victories for better access to affordable health care.
Enemies of reform are now out in force.
Progressives must stay informed and engaged to achieve a truly historic victory.
Posted by Ellen Shaffer at 12:14 AM 2 comments Links to this post
Saturday, December 12, 2009
The Senate Compromise: Does it Help?
The Senate compromise seems to be this:
For the slice of the population age 55 - 64 that would have gone into health exchanges with subsidies – uninsured, self-employed – let them instead buy in to Medicare. Except without subsidies.
The Medicare Part B premium is now means-tested – that is, based on annual income. It covers 25% of the cost of the program. Individuals earning less than $85,000 a year pay no premium; going up from there from about $44 a month to about $353 a month. Buying in to Part B alone could presumably cost 4 times those amounts, or between zero and $1400 a month. Plus the $155 deductible.
Offer the same group, under age 55, the choice of 2 nonprofit health plans, administered by the federal Office of Personnel Management.
No public option.
Til now we’ve heard that Congress would abolish lifetime caps on what the plans would pay. Now we’re hearing the caps may be back. (After which you’re on your own.)
The great thing about Medicare is that it has the clout of 40 million beneficiaries and the federal government when it comes time to negotiate with Sutter Health. So sure, add more folks in over there.
But. If they’re the oldest and sickest, and everyone under 55 is still left to the depredations of the private insurance industry…Well. Perhaps at least a few more of them will be covered.
And rumor has it that the Senate would also require the companies to spend 90% of the premium dollar on actual benefits (a big hike from the 70% or so that some plans spend now).
Ok marginally a little better than nothing. But so diluted from the House bill, in terms of a stepping stone to the future: less public involvement than any proposed public option (so less cost control), less affordability, less coverage. Makes you think that maybe the regular legislative process has some advantages over the Gang of 10 system.
Painful as it may be, and tempting as it is to go for expanding Medicare by any means necessary, it’s looking like getting something through the Senate, to be followed by a conference with the House’s better bill, is our best hope.
Posted by Ellen Shaffer at 4:09 AM 0 comments Links to this post
Labels: health reform, Medicare, public option, Senate
Wednesday, December 9, 2009
The Senate: Getting to the Public Option
It is important that health reform continue to move forward through the Senate. The most recent announcement offers some elements that sound attractive. As a whole, though, the package seems to leave a lot of gaping holes, that the Senators will need to address, or that will be resolved in conference.
What the proposal is, as far as we can tell:
Opening up something like the Federal Employees Health Benefits Plan (FEHBP) to the public, through the Office of Personnel Management.
Offering some or all people age 55-64 the chance to buy in to Medicare.
A trigger to create a public option in the future.
Progressives need 3 things:
1. An expanded role for the public sector, in order to effectively control the charges by health care providers: drug companies, hospitals, medical supply companies, hospitals. Doctors too. Private insurance companies have no stake in controlling prices and are often too weak to bargain successfully with organized providers.
2. To the extent there will continue to be private for-profit insurance companies in the mix, they need to be strictly regulated, so that the uninsured will have a fair shake at getting covered, and the insured and underinsured have a fair shake at getting our claims paid.
3. Subsidies to make insurance affordable, and to put some pressure on the government as prices rise.
Increasing enrollment in Medicare for seniors, while expanding coverage for middle age/middle income people, would be a great step forward.
But marginally opening up Medicare selectively to a subset of seniors does not accomplish these objectives. It likely will not increase significantly the number of beneficiaries; and they will be the most expensive to treat.
FEHBP has the same inflationary insurance spiral as any other set of private insurance plans. It does function somewhat like the proposed health insurance exchanges. It is not a public option. A trigger needs to be pulled now.
The Illinois Campaign for Better Health Care proposes this:
"It is NOT an either or - we demand a strong public option, strong insurance reforms, and expanding access to Medicare to all individuals 55 and older. Better yet, let everyone join Medicare."
Call your U.S. Member of Congress at 1-888-801-4426. Tell them:
For Democratic reps: "Stay firm on the public option plan on which you have already voted yes and on expanding Medicare eligibility."
For Republican reps: "Quit playing politics with my and my family's life. Support the American people and support health care reform."
What do you think?
Posted by Ellen Shaffer at 11:52 AM 0 comments Links to this post
Labels: Medicare rates, public option, Senate
Thursday, November 19, 2009
Real Health Reform: Positions for Progressives
What Now
It has been both an exhilarating time for progressives and a bumpy one: the House passed a bill (yay) with a public option (yay). These are victories for progressives, inside and outside of Congress: we made this happen.
But House leaders caved at the last minute to an anti-abortion spoiler, the Stupak-Pitts amendment, and dropped a popular provision proposed by Rep. Dennis Kucinich to protect states that opt for single payer systems from lawsuits under ERISA.
Many of us who both support and desperately need health reform are still trying to make sense of the news of the last week. Advocates and the public need to be unified and energized for the final push to get the best possible bill through the Senate and back through the conference committee with the House.
Here’s what we think all Senators need to hear, and why:
1. The House bill is a major achievement. Preserve and expand on its strong points, including the public option.
There is a lot here for access, quality, affordability and cost control, in fact more than there was in any of the bills that passed through the House Committees. The public option is likely to be more robust than the Congressional Budget Office’s preliminary projection.
2. We need to advance reproductive rights, not retreat.
The anti-abortion amendment is a real threat and a wake-up call.
We can beat it. Many members who voted “yes” on Stupak are on record as pro-choice.
Pro-choice energy can propel reform forward.
3. Protect single payer states from ERISA lawsuits.
It is important to continue to point this out and to organize for single payer, and against the for-profit private insurance industry States will be a far cry further in the march toward single payer if we can win waivers from federal obstacles including ERISA.
The House is still in play; they will be involved in the conference with the Senate, and will vote again on final passage. Our messages to House members depends on how they voted. (See Tables on p. 8):
1. Voted Yes on the bill and No on the Stupak Amendment (178 Democrats): Thank you! You’re the progressive Democratic majority. Help us win the ERISA waiver, and keep what we’ve won.
2. Voted Yes on the bill and Yes on Stupak: Stick with the bill and stick up for women. [For those historically pro-choice: Shame on you for voting Yes on Stupak]
3. Voted No on the bill and No on Stupak: Thanks for opposing Stupak. I’m asking you to stand up for health care reform now and support the bill.
4. Voted No on the bill and Yes on Stupak: We need health care reform now, and need our member of Congress to stick up for women. Will you change your vote and stand up for health reform and for women? [For those historically pro-choice: Shame on you for voting Yes on Stupak]
(for full statement and to see how Menbers voted go to: http://www.centerforpolicyanalysis.org/id62.html)
Posted by Ellen Shaffer at 12:06 PM 1 comments Links to this post
Labels: abortion, ERISA waiver, health reform, progressives, public option, single payer
Thursday, November 12, 2009
Anti-abortion amendment threatens all women, all health plans
Media coverage of the Stupak amendment underestimates its impact on privately-funded abortion. The impact is also being downplayed by the right.
This looks specifically at the language of the amendment to show how it:
1. Certainly eliminates the ability of any health insurance plan participating in the new health insurance exchange from covering abortions for any enrollee, if the plan accepts any enrollee who uses federal funds to pay any part of the premium. This would include the public option, but also any other plans that participate in the exchange.
It also prohibits any plan that would offer “affordability credits” from covering abortions.
2. Could eliminate current practices by 17 states to cover abortion under Medicaid, and prevent other states from doing so.
In addition, it has the following potential effects:
3. Can eliminate the ability of any health insurance plan covered by any part of HR 3962 to cover abortion, depending on the menaning of "any costs."
This could mean any health insurance plan offered through the new health insurance exchanges. The Exchanges, in turn, include both private insurance plans, and a public option.
4. Can eliminate all health insurance funding for abortion, depending on the meaning of "authorizes."
1. Certainly eliminates the ability of any health insurance plan participating in the new health insurance exchange from covering abortions for all enrollees, if the plan accepts any enrollee who uses federal funds to pay any part of the premium. In this way it restricts abortion coverage both to low-income and middle-income women who receive federal funds for subsidies. It also restricts coverage for women who pay entirely with their own funds. This would include the public option, but also any other plans that participate in the exchange.
There is general agreement that the amendment prevents health plans in the new health insurance exchanges from covering abortions, if they will accept women who use federal subsidies to pay part of their premiums.
This prohibition applies to all plans in the exchange. These include the public option, as well as all other private insurance plans in the exchange.
Some people (those earning up to 400% of the federal poverty limit, or about $88,000 for a family of 4) will use federal subsidies (or “affordability credits”) to pay for their premiums. Those people could not buy a health plan that covers abortion through the exchange.
It will apply even though the federal subsidies constitute only a part of the premium, and the rest is paid through private funds.
In addition, any plan that intends to enroll people who accept federal subsidies to help pay part of their premiums will not be able to cover abortion, for anyone who enrolls in the plan. This means women who do not accept federal subsidies, who pay the entire cost of insurance privately, cannot buy an insurance plan that covers abortion through the exchange, if the same health insurance plan covers women who do use the subsidies.
The bill offers women the ludicrous option of buying supplemental abortion plans, as long as they do so outside of the exchange and using their own money. Supplemental abortion plans cannot be purchased using affordability credits, which are public funds. This extra punch assures that in case the Supreme Court balks at outlawing abortion outright for millions of women with employer-provided insurance, women earning up to 400% of the poverty level who take advantage of public subsidies won't be able to use their insurance when they find out their birth control has failed.
All of this is worse than current law. Current law, through the Hyde amendment of 1976, says no federal funds can be used for abortion except if the mother’s life is in danger or in the case of rape or incest. Where the language is ambiguous, the Supreme Court will decide.
"Sec. 265. LIMITATION ON ABORTION FUNDING.
(a) IN GENERAL.- No funds authorized or appropriated by this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from [life-threatening illness related to the pregnancy, or pregnancy is a result of rape or incest]."
2. Could eliminate current practices by 17 states to cover abortion under Medicaid.
17 states now find ways to use state funds to pay for abortion through Medicaid. Medicaid is a program for low-income women which is funded jointly by state and federal dollars. The amendment appears to explicitly prohibit this:
"(b) OPTION TO PURCHASE SEPARATE SUPPLEMENTAL COVERAGE OR PLAN. – Nothing in this section shall be construed as prohibiting any nonfederal entity (including an individual or State or local government) from purchasing separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as –
(2) such coverage or plan is not purchased using –
(B) other nonfederal funds required to receive a federal payment, including a State’s or locality’s contribution of Medicaid matching funds."
3. Could eliminate the ability of any health insurance plan covered by any part of HR 3962 to cover abortion, whether or not it includes people who use federal subsidies to pay for their premiums, depending on the menaning of "any costs."
This explicitly could mean any health insurance plan offered through the new health insurance exchanges, both private insurance plans, and the public option.
The amendment says “No funds authorized or appropriated by this act…may be used to …cover any part of the costs of any health plan that includes coverage of abortion.”
It also does not restrict the use of federal funds to premiums. “Any part of the costs of any health plan” could refer to the administrative costs of setting up a health insurance exchange.
There will be people covered in the Exchanges who do not receive any federal subsidies for their premiums. They will pay every penny of the premium out of their own pockets. Some others will pay the premium by a combination of funds from their employers and from themselves.
These people may not be able to buy a plan through the Exchange that covers abortion
4. Can eliminate all health insurance funding for abortion, depending on the meaning of "authorizes."
It says that no funds "authorized or appropriated" by HR 3962 can be used to pay for abortion or to cover the costs of any health plan that covers abortion. It does not limit the application of this prohibition to funds authorized by any section of the bill, to health insurance exchanges, or to the public option. It applies to every word in HR 3962.
It also doesn’t necessarily restrict its application to funds “authorized” by Congress to be paid through federal sources.
Authorization and appropriation are particular acts by Congress to direct public funds to various purposes. That could be what this language means. Which would be bad enough.
The bill also "authorizes" employers and individuals to contribute to health insurance. These are private funds. The funds can be used to buy health insurance entirely privately. Or they could be used to buy insurance within the new health insurance exchanges. It could mean that no health insurance plan purchased as a result of the bill can be used to pay for abortion. None. It is possible that no health plan that covers abortion could be offered through programs created by this bill.
In the case of ambiguity, the Supreme Court could make the final decision.
Posted by Ellen Shaffer at 12:35 PM 0 comments Links to this post
Labels: abortion, health reform, Stupak
Monday, November 9, 2009
Enough
I think that HR 3962 offers many important improvements over the status quo, in the areas of coverage, affordability and quality, despite significant limitations, I will document these shortly.
The Stupak amendment however is exactly the poison pill it is meant to be. It virtually rolls back women's current legal right to choose abortion. It is an unacceptable political compromise. It cannot stand. Read it here:
http://www.centerforpolicyanalysis.org/id58.html
It says that no funds "authorized or appropriated" by HR 3962 can be used to pay for abortion or to cover the costs of any health plan that covers abortion.
Authorization and appropriation are particular acts by Congress to direct public funds to various purposes. That could be what this language means. Which would be bad enough.
The bill also "authorizes" employers and individuals to contribute to health insurance. These are private funds. It could mean that no health insurance plan purchased under the auspices of the bill can be used to pay for abortion. None. It is possible that no health plan that covers abortion could be offered through programs created by this bill. This may be a debatable interpretation. If it is challenged, the Supreme Court will decide.
It adds that supplemental abortion plans cannot be purchased using affordability credits, which are public funds. This is an extra punch to be sure that just in case the Supreme Court balks at outlawing abortion outright for millions of women with employer-provided insurance, women earning up to 400% of the poverty level who take advantage of public subsidies won't be able to use their insurance once they find out their birth control has failed.
Why are we facing this devil's bargain at the 11th hour in this campaign? Where was the vigorous organizing and mobilization campaign to get the votes needed to pass this bill without dismantling women's hard-fought rights? Was it news to anyone that the Catholic bishops oppose abortion, that they have access to an energized constituency, or that this constituency represents a minority of opinion even among Catholics?
This is not a re-election pitch or a solicitation for funds, which usually prompts messages like these from our leaders. It is also not a proposal for a particular action, People will need to figure out together what to do about this.
Planned Parenthood to their credit suggests writing to the President, calling this the outrage that it is and calling for actual leadership. Good start.
Posted by Ellen Shaffer at 12:30 AM 0 comments Links to this post
Labels: abortion, choice, health care reform, Obama, Stupak amendment
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