Senate Healthcare Reform - Any better than HR3200? (NOT)

[WhiskeyGirl]

Here are some idea's I've seen this morning -

The GVS interview - from memory the CBO couldn't do a good job scoring because Baucus is not in 'legislative' language.  What does that mean?  How do you score something if you can't feel or touch it?

Senator Bunning also goes on about giving the American public 72 hours to READ the bill.  If Congress won't read the bill before voting on it, why can't the American people read it before they vote on it?

Something is wrong in Washington.  Who do these people represent?  Why are they voting in ignorance?

see the interview here - http://gretawire.blogs.foxnews.com/2009/10/08/how-about-the-senate/


From NPR -

2. This is again a preliminary score, as they have specs, but not legislative language, from the committee. This is somewhat akin to test-driving the blueprint of a car rather than the actual car itself.

   

"a detailed year-by-year projection, like those that CBO prepares for the 10-year budget window, would not be meaningful because the uncertainties involved are simply too great."

I can hear Obama/Biden whining already because it add trillions to the deficit - 'we didn't know this would happen...the CBO didn't tell us...'   Is this what Americans voted for? 

What happened to change people could believe in?  The change = ignorance and stupidity on steroids?

The Baucus people are probably happy that CBO gave them a score that didn't increase the deficit, but that doesn't change the fact that this remains a cumbersome and expensive way of getting at only about half (54%) of the problem of the uninsured.

read more here - http://www.npr.org/templates/story/story.php?storyId=113606955


FROM THE CBO BLOG the scary bits -

"Those estimates are all subject to substantial uncertainty."

However, a detailed year-by-year projection, like those that CBO prepares for the 10-year budget window, would not be meaningful because the uncertainties involved are simply too great. CBO has therefore developed a rough outlook for the decade following the 10-year budget window by grouping the elements of the proposal into broad categories and assessing the rate at which the budgetary impact of each of those broad categories is likely to increase over time.

The new healthcare bubble?  Big banks and investment firms will make money on fees but carry no financial risk? 

The imprecision of that calculation reflects the even greater degree of uncertainty that attends to it, compared with CBO’s 10-year budget estimates.

Sounds like derivatives and gambling.  Who's backing up the taxpayer?

These projections assume that the proposals are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the sustainable growth rate (SGR) mechanism governing Medicare’s payments to physicians has frequently been modified (either through legislation or administrative action) to avoid reductions in those payments. The projected savings for the proposal reflect the cumulative impact of a number of specifications that would constrain payment rates for providers of Medicare services. The long-term budgetary impact could be quite different if those provisions were ultimately changed or not fully implemented. (If those changes arose from future legislation, CBO would estimate their costs when that legislation was being considered by the Congress.)

I listened to something last night that asked, how well has Congress cut expenses in the past?  Reduced doctor reimbursements?  Hospital and other provider reimbursements?

Hmmm...I remember the proposed taxes on medical devises - won't that raise the price of medical care?  Taxing something that is already paid for by say Medicare/Medicaid?

Cutting off your nose to spite your face?

http://cboblog.cbo.gov/?p=387

The country is broke.  Our currency is failing.  The world does not seem to have confidence in Obama or the nation.

How long before the dollar is worthless?

We'll just print money with Obama and Ayers faces on it and everyone will be happy.

imho

[WhiskeyGirl]

The letter -

Among other things, the Chairman’s mark, as amended, would establish a
mandate for most legal residents of the United States to obtain health
insurance; set up insurance “exchanges” through which certain individuals
and families could receive federal subsidies to substantially reduce the cost
of purchasing that coverage; significantly expand eligibility for Medicaid;
substantially reduce the growth of Medicare’s payment rates for most
services (relative to the growth rates projected under current law); impose
an excise tax on insurance plans with relatively high premiums; and make
various other changes to the Medicaid and Medicare programs and the
federal tax code.

Here is the scary part "relative to the growth rates projected under current law" - What happens when the country enters a period of hyperinflation?  Would that skew the projections? 

What are the current projections?  Were they calculated/determined by the same folks, or using the same methodology used in the stimulus bill unemployment calculation?

This administration doesn't seem to have a good track record.  "We didn't know this would happen."  "no one could predict..." 

An 'Excise Tax' on 'high' premiums?  I'm thinking that is different from a tax on 'rich' benefit plans.  Who determines what is a high premium?  What if the premium is high due to the number or special needs of the participants?  Example - a group with lots of sick people...should they pay more in taxes because they are sick?  A large self insured company - should they pay more because their premium is over a certain amount?

This looks like another loophole to put private insurance out of business.  A never ending tax on prosperity. 

Where are the changes to the federal tax laws shown online?  More reinsurance pass throughs to GM & Chrysler? 

http://www.cbo.gov/ftpdocs/106xx/doc10642/10-7-Baucus_letter.pdf

The nation is bankrupt and our currency is being devalued/falling/collapsing, and Obama is spending and driving the nation further into debt.

Why not produce concrete savings first?  Put the country on the right track, not the road to destruction? 

imho

[WhiskeyGirl]

Policies purchased through the exchanges (or directly from insurers) would
have to meet several requirements: In particular, insurers would have to
accept all applicants, could not limit coverage for preexisting medical
conditions, and could not vary premiums to reflect differences in enrollees’
health. The proposal also would provide start-up funds to encourage the
creation of cooperative insurance plans (co-ops) that could be offered
through the exchanges; existing insurers could not be approved as co-ops.

Why couldn't existing insurers offer to manage co-ops?  Are the co-ops excused from government mandated premiums?  Are they true cost sharing programs?

I'm thinking this will be the end of private insurance.  Will the co-ops be forced to take all applicants, regardless of health history?  Or, will they be allowed to pick and choose based on some membership criteria? 

As an example, instead of a high premium investment bank insurance plan, subject to the excise tax, here will be a high value/benefit rich co-op for members of large investment banks. 

Somehow, I can't imagine Main Street will be able to sustain a co-op.  Will the 'co-op' replace private high premium plans that exist today?  A new way to escape taxation?

Members only co-op?

Beginning in 2013, insurance policies with relatively high total
premiums would be subject to a 40 percent excise tax on the amount by
which the premiums exceeded a specified threshold. In general, that
threshold would be set initially at $8,000 for single policies and $21,000 for

Honorable Max Baucus
Page 5

family policies (although a number of exceptions would apply); after 2013,
those amounts would be indexed to overall inflation plus 1 percentage
point.

On a preliminary basis, CBO and JCT estimate that the proposal’s
specifications affecting health insurance coverage would result in a net
increase in federal deficits of $518 billion over fiscal years 2010 through
2019. That estimate primarily reflects $345 billion in additional federal
outlays for Medicaid and CHIP and $461 billion in federal subsidies that
would be provided to purchase coverage through the new insurance
exchanges and related spending.2 The other main element of the coverage
provisions that would increase federal deficits is the tax credit for small
employers who offer health insurance, which is estimated to reduce
revenues by $23 billion over 10 years.

Is this the cost before the unproven 'savings'?  The true deficit?

Why not realize the savings first?  Does Congress and the president have the will to change?

Budget savings -

Reducing Medicare and Medicaid payments to hospitals that serve a
large number of low-income patients, known as disproportionate
share (DSH) hospitals, by almost $45 billion—composed of roughly
$22 billion each from Medicaid and Medicare DSH payments.

If hospitals cannot manage the costs of the uninsured/uncompensated care they provide today, how will they manage when get less for low-income patients?

The proposal also would establish a Medicare Commission, which would
be required, under certain circumstances, to recommend changes to the
Medicare program to limit the rate of growth in that program’s spending.
Those recommendations would go into effect automatically unless blocked
by subsequent legislative action.

How is the Medicare Commission going to reduce spending?  Ration care?

Is there a similar plan for the 'Public Option'?  Why isn't everyone sharing he reduction in benefits?

The commission would develop its first set of recommendations during
2013 for implementation in 2015. CBO estimates that—given all of the
reductions that would result from other provisions—this arrangement
would reduce Medicare spending by an additional $22 billion over the
2015–2019 period.

Anyone tell me today what Medicare rationing will look like in 2013?  Implemented in 2015?  It's hard to vote for something that targets the elderly.

Where are the provisions for rationing care for the public plan?

http://www.cbo.gov/ftpdocs/106xx/doc10642/10-7-Baucus_letter.pdf

[WhiskeyGirl]

Unfunded mandates/legislation?  How much will this add to the deficit?

The budgetary information shown in the above and enclosed tables
reflects many of the major cash flows that would affect the federal
budget as a result of implementing the specified policies and
provides a preliminary assessment of the net effects on the federal
budget deficit....

I have this vision of a never ending appropriations and deficit/borrowing due to the need to keep funding 'implementation' - think of how much keeps being channeled to GM & Chrysler...

How many billions for 'Whitehouse.gov' have been spent?  Added to the deficit?

Federal spending that would be funded by future appropriations is
not reflected in these estimates. For example, implementation costs
for operations of the Internal Revenue Service and the Centers for
Medicare and Medicaid Services are not included. Those
discretionary costs could total several billion dollars over the 10-year
period, but CBO has not yet completed an estimate of the
appropriations that would be necessary. (In contrast, administrative
costs for establishing and operating the exchanges, largely funded
through a premium surcharge, are included in Table 1.)

Why not?  How much more will be added to the deficit to pay for the IRS and CMS?

Premium surcharges?  How much is that?  Will this premium surcharge be used to pay community groups and Wall Street banks for their help?  Outsourced to India?

There are some horrible examples of premium surcharges that exist today.  Will the surcharge be may 100-200% of the premium?  Pure profit and no risk?

http://www.cbo.gov/ftpdocs/106xx/doc10642/10-7-Baucus_letter.pdf

The nation is broke, busted, bankrupt.  All that's missing are the vultures and the shovels - they're waiting in the wings.

jmho

[WhiskeyGirl]

Will a trip to the Emergency Room bankrupt a family?  Why are trips to the ER subject to 'balance billing'?  'Balance Billing' is one the things many people consider bad about Medicare Advantage and other Medicare programs.

Emergency Room Protections

 The limitation on cost sharing for emergency services received outside of a plan’s
network of providers would not prevent emergency departments and other
providers from charging additional amounts to enrollees (a practice known as
balance billing).

Who is being protected from the ER?  Are public plan participants limited by geography? 

It seems like this is a profit thing.  What about coverage for those that are travelling?  I seem to think that states or private insurance today consider consumers to pay/be in-network when they go to the ER outside of their area.  With my private / group insurance, I don't think emergency ER visits are a money problem.  I know this from actual experience. 

How much more would I have to pay under the Public Plan?  The big sucking sound of my money disappearing into the hospital ER?

If there is a government rate plan, why the balance billing?  Where is the saving?  This sounds more like a cost shifting to the folks on Main Street.  It's something people hated about private / group plans.

I'm thinking some families could be bankrupt by this balance billing in the ER if they are unlucky while on vacation.  The ER can be expensive.  Is this another example of corporate welfare?

Maybe folks will be assigned an ER?  No choice of providers?

It seems like many plans today have coverage for out of network services, some do not. 

http://www.cbo.gov/ftpdocs/106xx/doc10642/10-7-Baucus_letter.pdf

In another thread, the Soylent Green one, iirc, there was the case of Dawn and her coverage problems due to cancer and brain tumors.  If she were travelling, or went to an ER outside of her network, due to her cancer, how much balance billing would she be subject to?

It seems like this is a profit loophole or welfare benefit for hospitals.

jmho

The nation is broke.  Taxpayers are broke and in debt.  There is no money.  And, our currency seems to be worth less each day!!!

[WhiskeyGirl]

Medicare Advantage

 The provision that would permit certain private fee-for-service plans to “deem”
that providers outside of their main service area were participating in their plan
would be limited to plans offered by employers that contracted directly with the
Centers for Medicare and Medicaid Services.

This looks like more tricky stuff to me.

Medicare Advantage is for seniors, Part C, iirc.  How many employers today offer Medicare Advantage?  

Maybe some retiree plans?  How many companies offer retirees any kind of medical coverage in addition to or instead of Medicare?  Not many - my opinion.  Seems like most are getting out of providing that benefit.

There is one exception I can think of - the GM, Chrysler, and Ford VEBA retiree health plans. 

Why would this 'deeming' need to be included JUST for plans offered by employers and contracted directly with CMS?

A bonus for the unions?  Taxpayer subsidy to the VEBA?

Why does this provision need to be in there?  There has to be more to this than what it appears to be. 

http://www.cbo.gov/ftpdocs/106xx/doc10642/10-7-Baucus_letter.pdf

The country is bankrupt.  We ran out of money years ago. 

If the Obama administration had focused on the economy, would people be worried about losing coverage?

jmho