The Baucus Plan – Thoughts

I didn’t post yesterday because Senator Baucus released his proposal for healthcare reform, and I wanted to have a good chance to look it over before posting any remarks, since I’d prefer my opinions to be formed based on the actual document rather than what people tell me it contains.

The Chairman’s Mark  (a vernacular version of the bill) is available for download as a PDF file here: Baucus Proposal PDF

It’s a 223 page document comparing the provisions of the law as it stands now with the reforms proposed by Senator Baucus. It’s intended to be a starting point, a first draft, of sorts, for the new healthcare legislation.

It does not include a public option.  After reading through it I decided the best way to form a good opinion on the matter was to classify what it said in terms of pros and cons, the things I liked vs. the things I didn’t, so I made some lists.

Here’s a quick summary of the main points after the more tag. (This is going to be long!):

THE GOOD:

• The Baucus plan would limit the ways in which insurance companies can deny coverage, drop coverage, and hike rates extensively, including denial of coverage for pre-existing conditions.
• Those who are pleased with their current coverage will be allowed to keep that coverage.
• A health insurance exchange, run by the individual states, will make it easier for patients to shop for plans themselves, comparing coverage and premium rates among the available options.
• All insurance plans, at all benefit levels, must provide primary and preventative care, without cost-sharing passed on to the patient for that care (deductibles, co-payments, etc.)
• Plans that increase rates for tobacco use must cover programs to assist in quitting smoking.
• No lifetime or annual limits for benefits.
• Tax Credits and cost-sharing subsidies to help pay for healthcare for policies bought through the state exchanges. (But they’re severely limited! See below)
• Small businesses would be eligible for a tax credit for providing insurance to employees.
• Insurance co-ops to promote creation of not-for-profit insurance providers eligible for federal grants and loans.
• Creation of an ombudsman program to represent and act as an advocate for those insured in the individual or small group markets.
• Insurance companies will be required to report the amount of premium dollars spent on things other than healthcare, and enumerate what those things are. Health providers will be required to provide lists of the standard charges for individual services.
• Prescription drug coverage will be mandatory in all plans

THE BAD:

• The subsidies to help with the cost of premiums have been reduced for middle class families making more than $50,000.00/year, removing sorely needed assistance from a large segment of the population.
• Under the plan, every individual will be required to have health insurance.  However, the subsidies provided will not guarantee that everyone can actually afford that health insurance. Compliance will be enforced by forcing uninsured people to pay a fee – an exorbitant excise tax.
• Though not as expensive as the detractors might claim, there is no possible way that this or any such plan will not cost the taxpayers a great deal of money.  It’s still doubtful if they’ll be getting their money’s worth back in the services provided.

THE THINGS THAT COULD BE GOOD OR BAD:

• The Non-Profit Re-insurance, intended to replace the function of the public plan in providing a low-premium competition with for-profit insurance companies, by keeping premiums low by helping to minimize risk to the insurance companies. (I’d still prefer a public option)
• People with certain pre-existing conditions will have to acquire their insurance through a “high risk pool” where premiums will be higher. Subsidies are promised, but it’s unclear how well they’ll help. They could either make the premiums affordable, or offer a bare minimum of assistance and still leave sick people going bankrupt on medical bills.
• You’ll be able to buy coverage across state lines under set circumstances, which could increase competition and provide better premiums to the patient.  There will also be an opportunity for national plans. This is intended to create competition, but since it’s still pretty much the same companies (which have separate state branches now) it is uncertain how well it will work. What it will do, especially with the national plans, is increase the number of people grouped into the risk pool, which could help with premium cost.
• The “Young Invincibles Plan” for adults under 25.  It offers a low-premium catastrophic coverage plan for students no longer covered under their parent’s plans. They’re a low-risk demographic, but that doesn’t mean they don’t get sick, and there are already folks falling through the cracks and ending up in horrible debt this way.

THE THINGS OTHERS ARE SAYING ABOUT IT THAT ARE EITHER WRONG OR OUTRIGHT LIES:

• Nowhere does the plan extend coverage to illegal immigrants, regardless of individuals who seem to want to insist it does. Individuals will have to prove their citizenship before being allowed to purchase a subsidized plan.
• The plan will not mean that abortions are paid for with tax dollars.  Plans accepting federal subsidies will be prohibited from funding abortion except in cases of rape, incest, or if the mother’s life is in danger. (YAY, more welfare babies, just what we need.) Any plans appearing in the clearing-house that offer abortions beyond that will not qualify for federal funding.
• “The bill would create 53 new government bureaucracies.” – Nope, nowhere near that many. It’s mostly an expansion on pre-existing and already established agencies.
• There are no death panels.  There never were.  Even the very desirable provision covering counseling on end-of-life care options has been removed entirely due to right-wing protests.
• “They’re going to mandate circumcision!” – Uh…yeah, Rush, where exactly is that? Circumcision isn’t even mentioned. (That people actually believe anything that comes out of that man’s mouth makes me weep for the intelligence of our society anyway, but that one was just funny…)

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• The Max Tax: Baucus Plan Shafts Workers, Rewards Walmart (emptywheel.firedoglake.com)
• The Chairman’s Mark – Good Ideas, Potentially Fatal Flaws (thehealthcareblog.com)
• More Baucus Bill: Subsidies and a ‘Young Invincible’ Plan (blogs.wsj.com)

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