Single-payer supporters, Harvard Med on the Senate reform bill

The president of Harvard Med School doesn’t like the reform will, he says in the Wall Street Journal. He refers to the Mass global payments plan with the dirty word “capitation.”

 Single-payer supporters at MassCare offer their opinion in an email that  arrrived before Sunday’s vote to open debate on the bill. No link yet so here’s the whole thing:

 Senate Majority Leader Harry Reid has released a bill that he will try and get introduced to the floor of the Senate shortly. It weighs in at over 2000 pages, but many of the details appear to be similar to the bill passed by the House last week, with a couple of critical exceptions. We are working hard to put together a table that compares all of the important details of the House and Senate bills: public subsidies to low-income people, the individual mandate and who will be required to purchase insurance, the public options proposed and their limitations, how the bills are paid for, immigrant access, employer responsibility, abortion access, insurance market reforms, small business subsidies, and Medicare reforms. For the time being, however, here is a very brief summary of what Senator Reid has proposed:

Like the House bill, the Senate proposal would expand Medicaid, and would give sliding scale subsidies for people up to 400% of the poverty line. Most uninsured people would be required to purchase coverage. None of these provisions in the Senate bill begin until 2014.

Market reforms would begin in the first year of implementation, including a ban on lifetime and most annual insurance caps, no canceling policies after you get sick, and expanded dependent coverage under family plans up to age 25. Beginning in 2014 the Senate bill would also prevent insurance companies from charging different premium rates based on anything except whether the plan is for an individual or a family, geographic area, age, and tobacco use: insurers could not charge more than 3 times more to the oldest enrollee than they do the youngest, or more than 1.5 times more to smokers than to non-smokers. They would also be required to accept any business or individual applying, and guarantee renewability.

None of the above provisions would have much impact on Massachusetts, where we already have a mandate, subsidies, and stricter regulations on insurers than most states. The bill would also try to facilitate co-operative insurance plans (defined in the bill essentially as non-profit insurers, which we already have in Massachusetts) through loans and grants, and would set up a public option (called the “Community Health Insurance Option”). The public option would not be available until 2014, and then only to uninsured individuals and small businesses with 50 or fewer employees; expanding to include employers with up to 100 employees in 2016. Starting in 2017 each state would then have the choice of expanding the option to larger employers. The Senate bill borrowed language from the House stating that the public option would have to negotiate its own rates with providers, and would not be using Medicare rates.

TWO KEY DIFFERENCES between this Senate bill and what emerged out of the


First: the House paid for its bill largely through a tax on the highest income earners in the country. The Senate bill instead contains a very high tax on the most expensive insurance plans. These are being called “cadillac” plans and the press are assuming that it will affect the most comprehensive insurance coverage, but in reality the most expensive plans are those that cover older people and people with higher risk of illness, and those purchased by individuals and small businesses with less ability to negotiate low premium rates. This version of the bill raised the threshold at which such plans would be taxed, but this completely misses the point.

 Second: there is no language in Reid’s bill that outright prevents plans receiving federal funding from offering abortion services. It does not allow federal funds to pay for abortion, which is the current practice, but it does allow plans that are federally subsidized to cover abortion services so long as this is paid for through state or private contributions. The Senate bill appears to allow states to have the final word on what can and can’t be offered, or what must be offered, in the new insurance Exchanges. The Stupak amendment, which was added to the House bill, stated that none of the public subsidies “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” under the Exchanges.

 We will provide a more detailed analysis of the two bills on our web-site, and send you all a link, hopefully by next week.


Mass-Care: The Massachusetts Campaign for Single Payer Health Care



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