Senate Bill: Two-thirds of Newly Insured in Public Plans
- Hundreds of Billions of Dollars for State Public Plans in Bill
Here's the good news from the Senate bill: of the 31 million uninsured projected to gain coverage under the Senate plan by 2018, the Congressional Budget Office projects that two-thirds of them will gain coverage via some form of public plan. Yes, the limited public option will enroll only a projected 4 million folks, but expansions in Medicaid and SCHIP will enroll 15 million more people than would be expected under current law. 54 million people will be covered by Medicaid, CHIP or the public option by 2018.
Step back from the mechanics and the dollars invested are impressive. $347 billion in additional funds will go directly to Medicaid and CHIP programs.
- By 2014, most nonelderly people with incomes below 133 percent of the federal poverty line would be made eligible for Medicaid. The government would pay for this whole expansion through 2016 and roughly 90% of the costs thereafter.
- Federal support for childrens health insurance plans (CHIP), which cover kids much farther above the poverty line, would expand to an average of 93% of costs under the bill.
- States would pay a total additional $25 billion over the ten-year period.
But here's the better news, under Section 1332 of the bill, states could apply for waivers and convert their state residents' share of health insurance exchange credits and small employer credits into their own more comprehensive state health care program.
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Quite a few states in recent years have been debating plans to create integrated comprehensive health plans for all their residents. The hitch in most cases has been finding the cash to fund those plans. Using such waivers, states will defacto have an additional $821 billion from the federal government due to the Senate bill to fund state-run single payer or other variations on more comprehensive public health insurance systems in their states.
The particular details of the public option may matter very little in many states, since the real fight will be to promote far more comprehensive plans using state waivers and available federal funds. The real prize for progressive health care in the Senate bill is the more than $800 billion in federal funds and a state waiver process that will likely be the real path to progressives building truly truly comprehensive and affordable health care for all Americans.
One hitch in this long-term goal is how long-term it is, since such state waivers can kick in only starting in 2017. Progressives should be fighting hard right now to allow states to apply for waivers beginning the first year that individual and employer subsidies start.
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Am I understanding this right? Let's say that I as an individual get a $5,000 subsidy to purchase health care. My state can apply to say: "give us the money instead of him so we can set up a state run system?"
Looks like we're headed right into a fight with the person or small business getting the subsidy. One where, though the intentions might be great, the message doesn't look too good for us.
November 19, 2009 9:18 AM | Reply | Permalink
Depends on how it's designed. As long as the exchange is that the individuals get an even better deal, they'll be thrilled. If the subsidies are combined to create a public option for everyone in the state not insured by their employer with premiums lower than the private alternative people would have bought even with subsidies, there's no problem. And assumably, states will raise some additional revenue themselves -- say with a more robust "pay or play" state employer mandate, to sweeten the pot and make those individual plans even cheaper. Plenty of models for this around the country.
November 19, 2009 9:22 AM | Reply | Permalink
Hope it works! You're right, it needs to be accelerated though. 2017 is too long to wait.
November 19, 2009 10:34 AM | Reply | Permalink
"31 million uninsured projected to gain coverage under the Senate plan by 2018"
How many of those 31 million will be dead because of a lack of affordable health care by 2018?
November 20, 2009 11:04 AM | Reply | Permalink
Are "state" plans portable when you relocate from state to state? Or will they wind up restricting the mobility of the work force to move to where the jobs are?
How about services when you tavel, either in the US or internationally?
November 19, 2009 10:34 AM | Reply | Permalink
Nathan, you are seeking to provide justifiable reasons for enthusiasm, preferably, or at least support, for what is before Congress on HC right now. This is sorely needed, if for no other reason than that a poor outcome on this could well reduce both the likelihood of positive initiatives in the future by this Administration, and the likelihood of their success if pursued.
Bless you, from someone who is struggling hard to find justification for both at the moment.
November 19, 2009 11:15 AM | Reply | Permalink
I may if I find time do a series on why progressives are doing better than they think. There's a lot of glass half-empty thinking out there, instead of figuring out what we've won and how to build on that to win more down the line.
November 19, 2009 1:33 PM | Reply | Permalink
I for one would welcome that. You're a hard worker and know a lot that many of us, certainly me, can and want to learn from.
November 19, 2009 3:07 PM | Reply | Permalink
That glass half empty / half full agrument is a fraud.
Glasses are full. It might be half water and half hot air, or 1/10 water and 9/10 hot air, but they are full of it.
November 20, 2009 11:07 AM | Reply | Permalink
Would you agree or disagree that sometimes, historically, what seem like half and inadequate measures at the time evolve into worthwhile measures?
Would you agree or disagree that sometimes, historically, it is provisions thought at the time to be "minor", and little discussed at the time, that are inserted into legislation turn out to have more important longer-term effects than the resolution of those issues receiving the most attention at the time?
I'm not saying the present health care effort is either of these. I don't know if it is or not. I am, as are many here, extremely unhappy with what the realistic possibilities before us are at this moment. But that doesn't tell me what I should do. I don't believe I should close my mind at this point to all arguments suggesting that "smaller print" provisions or details of legislation that could still be enacted might fit into either of the above kinds of scenarios.
November 20, 2009 12:34 PM | Reply | Permalink
Oh, good, finally a "Stop the negativity, it has grown tiresome!" thread?
I have a small offering to add:
November 20, 2009 5:52 PM | Reply | Permalink
Premiums may have gone down, but I bet total spending on health care went up in MA.
If more people are paying for insurance, then the total number of buyers could more than compensate for a decrease in the cost of individual plans.
So I supsect he MA plan has failed to control costs.
November 20, 2009 6:31 PM | Reply | Permalink
Isn't there also something in one of the bills about more over-65 poor becoming eligible for Medicaid as well, to help those that can't afford a supplemental policy to cover those Medicare deductibles and co-pays? I thought I saw that somewhere....if so, the result would probably be more in managed care in most states, instead of fee-for-service, and also larger pools?
November 20, 2009 6:01 PM | Reply | Permalink