Health care reform took one step further this past week when Senate Finance Committee Chairman Max Baucus (D-MT) unveiled his proposal for health care reform. Now every committee of jurisdiction has come out with a health care reform bill which is a huge achievement. The Senate Finance Committee bill will play a critical role in health care reform. This makes it all the more imperative that this be a strong bill. The stronger the bills passed in the House and Senate, the stronger the ultimate legislation and the more likely that hour health care system will undergo the changes it so desperately needs.
Unfortunately, the Baucus bill as proposed falls far short of the kind of strong and helpful reform Nebraskans need in a variety of ways:
- Fails on Affordability: The Baucus bill does not provide adequate tax credits for low and moderate income families, meaning coverage will remain unaffordable and too expensive for many families. The affordability provisions received criticism from all sides and the good news is some changes have already been made in the mark-up process to improve the bill.
- Does Not Offer a Choice: The bill does not include a public health insurance plan. It calls for the creation of state based “co-ops.†But many experts believe these co-ops will have little bargaining power and provide almost no competition for private insurers. In the last day or two it has become clear that the Committee is also seriously considering a “trigger option” as well. This option would require a state to create a public health insurance plan only if certain market conditions are met. But, it is set up so that the trigger will never be tripped. This is not a real alternative to a strong public health insurance plan.
The discussion around a public health insurance plan is important not only because choice is best for patients, but because the failure to include a public health insurance plan has implications for the rest of the bill. This bill should be focused on the needs of the people being insured — not on protecting insurance companies. If there is no public health insurance plan, then the consumer protections in the bill and regulation of the insurance industry becomes even more critical. As noted below, these protections are not serious enough in the current bill. - “Free-Rider Provisionâ€: The House and Senate HELP Committee bills include a “pay or play†provision that requires employers to offer health coverage to their employees or pay into the system to help cover the costs of providing coverage to their employees. The Baucus bill, however, does not require employers to offer health coverage to their employees. Rather, employers only have to make payments if their workers get subsidies (or tax credits) in the Exchange to help them buy insurance on their own. This gives employers incentive to prevent their employees from accessing Exchange coverage, whether by avoiding hiring lower income workers who would be eligible for subsidies, or by providing minimal coverage to employees so their employees. (At least in the first several years, if a person has employer coverage they will not be able to buy coverage through the exchange.)
- Fewer Consumer Protections: The Baucus bill allows insurers to vary premiums based on age and a few other factors. The difference in premiums based on age can be as much as 5:1. All the other reform bills in Congress limit the difference to 2:1. This is a huge issue for those middle-aged and older Americans. In addition, the Baucus bill does not create a standard benefits package as the others bill do which would make sure that everyone would get the basic services needed (e.g., preventative care, some hospital stay, well child visits, etc.). Finally, the bill does not extend the insurance regulation provisions to all markets.
The Senate Finance Committee began marking up (amending and editing) this bill Tuesday and hoped to finish by today, Thursday but that looks increasingly unlikely. The bill is a good start, but it must be fixed. Now is the time our senators need to hear from us if we want to make this bill better!