Actually, its greatest point of vulnerability will be the 2012 election, since much of it doesn't take effect until 2013. The mandates that will drive up costs will take effect before then--young people will pay much more since premiums will be equalized for all age groups and private companies will have to cover even sick people. Since there will be no opt-out or no competition, they will be able to charge whatever they want.

By 2012, the exchanges that will get small business owners and employees insured are not supposed to be set up. So basically, all the politically and economically costly things go into effect first, and the beneficial things (insuring people and taking burdens off small business) will not have materialized. It's perfect for demonization.

The mandates that will drive up costs will take effect before then--young people will pay much more since premiums will be equalized for all age groups and private companies will have to cover even sick people. Since there will be no opt-out or no competition, they will be able to charge whatever they want.

H.R. 3962

• Expand Medicaid to all individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 150% FPL. Provide Medicaid coverage for all newborns who lack acceptable coverage and provide optional Medicaid coverage to low-income HIV-infected individuals (with enhanced matching funds) until 2013 and for family planning services to certain low-income women. In addition, increase Medicaid payment rates for primary care providers to 100% of Medicare rates by 2012. Require states to submit a state plan amendment specifying the payment rates to be paid under the state's Medicaid program. The coverage expansions (except the optional expansions) and the enhanced provider payments will be financed with 100% federal financing through 2014 and 91% federal financing beginning in year 2015. (Effective January 1, 2013)
• Repeal the Children's Health Insurance Program (CHIP) and require CHIP enrollees with incomes above 150% FPL to obtain coverage through the Health Insurance Exchange beginning in 2014. CHIP enrollees with incomes between 100% and 150% FPL would be transitioned to Medicaid and states would receive the CHIP enhanced match rate for children above current levels and up to 150% FPL. Require a report to Congress with recommendations to ensure that coverage in the Health Insurance Exchange is comparable to coverage under an average CHIP plan and that there are procedures to transfer CHIP enrollees into the exchange without interrupting coverage or with a written plan of treatment. (Report due by December 31, 2011)

Baucus Bill:

• Expand Medicaid to all individuals (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% FPL (to be implemented in 2014). Adults with incomes between 100-133% FPL will have the option of obtaining coverage through Medicaid or with federal subsidies through the exchange. All newly eligible adults will be guaranteed a benchmark benefit package that at least meets the minimum creditable coverage standards. Require states to provide premium assistance to any Medicaid beneficiary with access to employer-sponsored insurance if it is cost-effective for the state. To finance the coverage for the newly eligible (those who were not previously eligible for a full benchmark benefit package or who were eligible for a capped program but were not enrolled), states will receive an increase in the federal medical assistance percentage (FMAP). Initially, the percentage point increase in the FMAP will be 27.3 for states that already cover adults with incomes above 100% FPL and 37.3 for other states. These percentage point increases will be adjusted over time so that by 2019, all states will receive an FMAP increase of 32.3 percentage points for the newly eligible. High need states--those with total Medicaid enrollment that is below the national average for enrollment as a percentage of the state population and unemployment rates of 12% or higher for August 2009--will receive full federal funding for the newly eligible for five years.
• Require states to maintain current income eligibility levels for children in Medicaid and the Children's Health Insurance Program (CHIP) until 2019. CHIP benefit package and cost-sharing rules will continue as under current law. Beginning in 2014, states will receive a 23 percentage point increase in the CHIP match rate up to a cap of 100% and a .15 percentage point increase in the Medicaid match rate. CHIP-eligible children who are unable to enroll in the program due to enrollment caps will be eligible for tax credits in the state exchanges.

H.R. 3962

• Establish a temporary national high-risk pool to provide health coverage to individuals (and spouses and dependents) with pre-existing medical conditions. Individuals who have been denied coverage, offered unaffordable coverage, have an eligible medical condition or who have been uninsured for at least six months will be eligible to enroll in the national high-risk pool. Premiums for the high-risk pool will be set at not higher than 125% of the prevailing rate for comparable coverage in the state and could vary by no more than 2:1 due to age; annual deductibles will be limited to $1,500 for an individual; and maximum cost-sharing will be limited to $5,000 for individuals. (Effective January 1, 2010 and until the Health Insurance Exchange is established)
• Individuals eligible for COBRA continuation coverage may retain COBRA coverage until the Exchange is established or they obtain acceptable coverage. (Effective upon enactment)
• Limit health plans' medical loss ratio to not less than 85% to be enforced through a rebate back to consumers and prohibit plans from imposing aggregate dollar lifetime limits on coverage. (Effective January 1, 2010) Prohibit insurers from rescinding coverage except in cases of fraud. (Effective July 1, 2010)
• Adopt standards for financial and administrative transactions to promote administrative simplification. (Effective upon enactment)
• Require review of increases in health insurance premiums prior to implementation of the increases. (Effective upon enactment)
• Provide dependent coverage for children up to age 27 for all individual and group policies. (Effective January 1, 2010)
• Limit pre-existing condition exclusions for group policies prior to implementation of the insurance market reforms by shortening the period plans can look back for pre-existing conditions from six months to 30 days and shortening the period plans can exclude coverage of certain benefits from 12 months to three months. (Effective January 1, 2010)
• Prohibit reductions to retiree benefits unless reductions also apply to current employees. (Effective upon enactment)
• Prohibit coverage purchased through the individual market from qualifying as acceptable coverage for purposes of the individual mandate unless it is grandfathered coverage. Individuals can purchase a qualifying health benefit plan through the Health Insurance Exchange. (Effective January 1, 2013)
• Impose the same insurance market regulations relating to guarantee issue, premium rating, and prohibitions on pre-existing condition exclusions in the insured group market and in the Exchange. (See creation of insurance pooling mechanisms). (Effective January 1, 2013)
• Improve consumer protections by establishing uniform marketing standards, requiring fair grievance and appeals mechanisms and accurate and timely disclosure of plan information. (Effective January 1, 2013)
• Create the Health Choices Administration to establish the qualifying health benefits standards, establish the Exchange, administer the affordability credits, and enforce the requirements for qualified health benefit plan offering entities, including those participating in the Exchange or outside the Exchange.
• Permit states to form Health Care Choice Compacts to facilitate the purchase of individual insurance across state lines. (Effective January 1, 2015)
• Remove the anti-trust exemption for health insurers and medical malpractice insurers. (Effective upon enactment)

Baucus Bill (No dates set for implemetation):

• Impose the same insurance market regulations relating to guarantee issue, premium rating, prohibitions on pre-existing condition exclusions, risk adjustment, and rescissions in the individual market, in the exchange, and in the small group market, phasing in the new rules for small group market over five years. (See new rating and market rules in Creation of insurance pooling mechanism.)
• Require health plans to report the proportion of premium dollars spent on items other than medical care and require plans to compile information on coverage in a standard format.
• Require all new policies (except stand-alone dental, vision, and long-term care insurance plans) to comply with one of the four benefit categories, including those offered through the exchanges and those offered outside of the exchanges. Require health plans in the individual and small group markets to at least offer coverage in the silver and gold categories. Existing individual and employer-sponsored plans do not have to meet the new benefit standards. (See description of benefit categories in Creation of insurance pooling mechanism.)
• Require small employers to provide a plan with a deductible that does not exceed $2,000 for individuals and $4,000 for families unless contributions are offered that offset deductible amounts above these limits. This deductible limit will not affect the actuarial value of bronze plans and does not apply to "young invincible" plans. (See description of benefit categories in Creation of insurance pooling mechanism.)
• Allow states the option of merging the individual and small group markets.
• Create a temporary reinsurance program to help stabilize premiums during the first three years of operation of the exchanges when the risk of adverse selection due to enforcement of the new rating rules and market changes is greatest. Finance the reinsurance program through mandatory contributions by health insurers.
• Allow insurers to offer a national health plan with a uniform benefits package in the states in which they are licensed.  National plans would be required to offer plans with silver and gold benefit packages and would be exempt from state benefit requirements. Allow states to opt out of the national plan.
• Permit states to form health care choice compacts and allow insurers to sell policies in any state participating in the compact. Insurers selling policies through a compact would only be subject to the laws and regulations of the state where the policy is written or issued.

H.R. 3962

• Create an essential benefits package that provides a comprehensive set of services, covers 70% of the actuarial value of the covered benefits, limits annual cost-sharing to $5,000/individual and $10,000/family, does not require cost-sharing for preventive services, and does not impose annual or lifetime limits on coverage. The Health Benefits Advisory Council, chaired by the Surgeon General, will make recommendations on specific services to be covered by the essential benefits package as well as cost-sharing levels. Prohibit abortion coverage from being required as part of the essential benefits package; require segregation of public subsidy funds from private premiums payments for plans that choose to cover abortion services beyond those for which public funding is permitted (public funding of abortions is permitted to save the life of the woman and in cases of rape or incest); and require there be no effect on state or federal laws on abortions. (Health Benefits Advisory Council report due one year following enactment; essential benefits package becomes effective January 1, 2013)
• All qualified health benefits plans, including those offered through the Exchange and those offered outside of the Exchange (except certain grandfathered individual and employer-sponsored plans) must provide at least the essential benefits package. (Effective January 1, 2013)
• Require a report on including oral health benefits in the essential benefits package. (Report due one year following enactment)

Baucus Bill (No dates set for implementation):

• Create minimum creditable coverage that provides a comprehensive set of services, covers 65% of the actuarial value of the covered benefits, limits annual cost-sharing to $5,950/individual and $11,900/family, does not impose annual or lifetime limits on coverage, and is not more extensive than the typical employer plan. Require the Secretary to define and annually update the benefit package through a transparent and public process. (See description of benefit categories in Creation of insurance pooling mechanism.)
• Prohibit abortion coverage from being required as part of the minimum benefits package; require segregation of public subsidy funds from private premium payments for plans that choose to cover abortion services beyond Hyde--which allows coverage for abortion services to save the life of the woman and in cases of rape or incest; and require there be no effect on state or federal laws on abortions.

H.R. 3962

• Require all individuals to have "acceptable health coverage". Those without coverage pay a penalty of 2.5% of their adjusted income above the filing threshold up to the cost of the average national premium for self-only or family coverage under a basic plan in the Health Insurance Exchange. Exceptions granted for those with incomes below the filing threshold (in 2009 the threshold for taxpayers under age 65 is $9,350 for singles and $18,700 for couples), religious objections and financial hardship. (Effective January 1, 2013)

Baucus Bill:

• Require U.S. citizens and legal residents to have qualifying health coverage. Enforced through a tax penalty of $750 per adult per year. The penalty will be phased-in according to the following schedule: $0 in 2013; $200 in 2014; $400 in 2015; $600 in 2016; and $750 in 2017. Exemptions will be granted for financial hardship, religious objections, American Indians, and if the lowest cost plan option exceeds 8% of an individual's income or if the individual has income below 133% of the poverty level.

H.R. 3962

• Provide small employers with fewer than 25 employees and average wages of less than $40,000 with a health coverage tax credit for up to two years. The full credit of 50% of premium costs paid by employers is available to employers with 10 or fewer employees and average annual wages of $20,000 or less. The credit phases-out as firm size and average wage increases and is not permitted for employees earning more than $80,000 per year. (Effective January 1, 2013)
• Create a temporary reinsurance program for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare. Program will reimburse employers for 80% of retiree claims between $15,000 and $90,000. Payments from the reinsurance program will be used to lower the costs for enrollees in the employer plan. Appropriate $10 billion over ten years for the reinsurance program. (Effective 90 days after enactment)

Baucus Bill:

• Provide small employers with fewer than 25 employees and average annual wages of less than $40,000 that purchase health insurance for employees with a tax credit.
• Phase I : For tax years 2011 and 2012, provide a tax credit of up to 35% of the employer's contribution toward the employee's health insurance premium if the employer contributes at least 50% of the total premium cost or 50% of a benchmark premium. The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $20,000. Tax-exempt small businesses meeting these requirements are eligible for tax credits of up to 25% of the employer's contribution toward the employee's health insurance premium.
• Phase II : For tax years 2013 and later, for eligible small businesses that purchase coverage through the state exchange, provide a tax credit of up to 50% of the employer's contribution toward the employee's health insurance premium if the employer contributes at least 50% of the total premium cost or 50% of a benchmark premium. The credit will be available for two years. The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $20,000. Tax-exempt small businesses meeting these requirements are eligible for tax credits of up to 35% of the employer's contribution toward the employee's health insurance premium.
• Create a temporary reinsurance program for employers providing health insurance coverage to retirees ages 55 to 64. Program will reimburse employers or insurers for 80% of retiree claims between $15,000 and $90,000. Appropriate $5 billion to finance the program.

On Saturday, October 24, the Washington Post published an article which said in passing that the "public option" will be run by insurance companies. "The public option would effectively be just another insurance plan offered on the open market," said the article. "It would likely be administered by a private insurance provider, charging premiums and copayments like any other policy." To my knowledge, that is the first time any media outlet or blog, with the exception of the blog maintained by Physicians for a National Health Program, has warned the public that the "public option" will be run by private corporations, not public employees.

Originally posted on February 3, 2009 . . .

tpmcafe.com/.../oldengoldendecoy/2009/02/how-to-push-obama

It's just as timely now as when I first posted it . . . If not more so.

The heat must be kept on the White House to push through this health care legislation with a strong Public Option intact. Now's not the time to sit back and let those in Washington water down the bill any further than it's already been watered down.

And it can't hurt to understand how and why it's important to keep pushing Obama on this health care coverage plan.

I've elected to copy the following article in total due to the nature of the importance of having it handy for re-reading whenever necessary.

How to Push Obama

by John Nichols

commondreams.org/view/2009/01/12-9

January 15, 2009

On November 4, the American people by a popular majority of more than eight million votes selected as their new President a Democratic contender who had been attacked by his Republican foe as a radical who "began his campaign in the liberal left lane of politics and has never left it."

If only. In truth, Barack Obama was never the Che Guevara in pinstripes that the rightwing attack machine conjured up. His record on Capitol Hill was never "more liberal than a Senator who calls himself a socialist [Vermont's Bernie Sanders]," as John McCain wheezed at the last stops of a dying campaign. And he has never even been in competition for the title bestowed upon him by former Senator Fred Thompson during last summer's Republican National Convention: "the most liberal . . . nominee to ever run for President."

Thompson had apparently forgotten not just George McGovern but Walter Mondale and Michael Dukakis, all of whom sought the Presidency as more left-leaning contenders than did Obama in 2008. And, as McGovern, an able historian, himself reminds us: Franklin Roosevelt put contemporary Democrats to shame when it came to embracing and advancing radical notions.

For today's liberals and progressives, who find themselves moving from the comfortably predictable opposition stance of the Bush-Cheney interregnum to the more challenging position of dealing with the first Democratic President elected with something akin to a mandate since Lyndon Johnson in 1964, it is important to see Barack Obama for who he is and his admini-stration for what it can be. The best way to do this is not by listening to Obama's Republican detractors-or to the lite-Republicans of the Washington Democratic establishment-but by hearing the President- elect in his own words.

After he secured the delegates required to claim the Democratic nomination, Obama found himself at a town hall meeting in suburban Atlanta, where he was grilled about whether-having run as a primary-season progressive-he was now shifting to the center.

The Senator was clearly offended by the suggestion. "Let me talk about the broader issue, this whole notion that I am shifting to the center or that I'm flip-flopping or this or that or the other," he began. "You know, the people who say this apparently haven't been listening to me."

Obama continued: "I am somebody who is no doubt progressive. I believe in a tax code that we need to make more fair. I believe in universal health care. I believe in making college affordable. I believe in paying our teachers more money. I believe in early childhood education. I believe in a whole lot of things that make me progressive."

Those were not casually chosen words. Barack Obama knows exactly what it means to say he is a "progressive." When he does so, he is not merely avoiding the word "liberal," as the sillier of his rightwing critics like to claim. Obama actually understands the subtle nuances of the American left. This is a man who moved to Chicago to be part of the political moment that began with the 1983 election of leftie Congressman Harold Washington as the city's first African American mayor, who studied the organizing techniques of Saul "Rules for Radicals" Alinsky, who worked with proudly radical labor leaders to defend basic industries and avert layoffs, who used his Harvard-minted legal skills to fight for expanded voting rights, who was mentored by civil libertarian legislator and federal judge Abner Mikva, who discussed the intricacies of Middle East policy with Edward Said and Rashid Khalidi, and who learned about single-payer health care from his old friend and neighbor Dr. Quentin Young, the longtime coordinator of Physicians for a National Health Program. And, famously, Obama did not just make anti-war sounds before Iraq was invaded, he appeared at an anti-war rally in downtown Chicago with a "War Is Not an Option" sign waving at his side.

Obama knows not just the rough outlines of the left-labor-liberal-progressive agenda, but the specifics. He does not need to be presented with progressive ideas for responding appropriately to an economic downturn, to environmental and energy challenges, to global crises and democratic dysfunctions. He has, over the better part of a quarter century, spoken of, written about, and campaigned for them.

I first covered Obama a dozen years ago, when he was running for the Illinois state senate as a candidate endorsed by the New Party, the labor-left movement of the mid-1990s that declared "the social, economic, and political progress of the United States requires a democratic revolution in America-the return of power to the people." When we spoke together at New Party events in those days, he was blunt about his desire to move the Democratic Party off the cautious center where Bill Clinton had wedged it. And when we spoke in the years that followed, as he positioned himself for a 2004 U.S. Senate run, Obama told me that he saw Wisconsin Democrat Russ Feingold-the lone dissenter against the Patriot Act-as the best role model in the chamber.

So why not pop the champagne corks and celebrate Obama's nomination and election as a victory for what the late Paul Wellstone described as "the Democratic wing of the Democratic Party"? Because knowing the ideals and values of the left is not the same as practicing them. As a Senator, Obama did not take Feingold as a role model. In fact, they differed on essential constitutional, trade, and Presidential accountability issues, with Obama consistently taking more cautiously centrist positions. One of Obama's first votes in the Senate was to confirm Condoleezza Rice as Secretary of State. Dr. Young wrote to his friend. "I told him I was disappointed in him," the veteran campaigner for peace and social and economic justice recalled. "Rice was the embodiment of everything that was wrong with this Administration. So, he called me back and he said: 'Why didn't you pick up the phone and call me? Do you think Bush would ever send to the Senate a nominee for Secretary of State who I could vote for?  I said: 'You ara the constitutional lawyer. It's about advice and consent, right? You should have denied him your consent.' "

Young was, of course, right. But the lesson that should be taken away from the Rice vote, and from the many disappointments that have followed it, ought not be that Obama is a hopeless case. In fact, quite the opposite. In that conversation with Young, the Senator outlined the relationship that the left ought to develop with a powerful but as yet ill-defined President.

Obama was nominated and elected in 2008 by progressives, both younger tech-savvy activists who made his candidacy an early favorite of the blogosphere and old-school liberal precinct walkers who saw in his candidacy an extension of the frustrating work of opposing all that was Bush and Cheney. The Senator won the Democratic nomination because he was the only first-tier contender who could say that he had opposed authorizing Bush to take the country to war with Iraq. In the Iowa caucuses that would define the 2008 race, those anti-war credentials, above all other factors, made the young Senator from Illinois a contender.

Similarly, as he campaigned in key states such as Wisconsin, Obama's call for a new approach to free trade agreements and for massive infrastructure investments allowed him to secure backing from labor and liberal farm activists at critical stages in the process. The progressives who committed to Obama early on were the essential foot soldiers of his long march through the caucuses, the primaries, and the fall campaign. These activists formed a base within the campaign and the Democratic Party, centered on but not limited to the Obama team's quasi-open website and blog, ww.MyBarackObama.com, which did not always cheerlead for the candidate. In June, when Obama broke with Feingold and other Senate progressives to support Bush's rewrite of the Foreign Intelligence Surveillance Act, the Senator felt enough heat from his own and independent netroots sites that he was compelled to explain himself, making what Obama described as a "firm pledge" that he would revisit the issue as President to shore up privacy protections.

What Internet activists such as OpenLeft.com's Matt Stoller and Firedoglake.com's Jane Hamsher did during the FISA fight was roughly equivalent to what Obama told Dr. Young to do back in 2005: "Pick up the phone and call me." They were undermined by a rally-round-the-candidate mentality that protected Obama during the campaign season. Yet netroots activists made themselves heard and earned a response from candidate Obama. And they can do much more with respect to President Obama. As Hamsher notes, "We can get the public engaged."

And so they must, especially with that portion of the public that took seriously the candidate's promise of "change we can believe in." But to do this effectively, activists cannot wait for Obama to define the playing field. They must assume that he knows what they know. And this requires a radically different approach than the left took to Southern centrist Democratic Presidents such as Bill Clinton and Jimmy Carter.

The way to influence Obama and his Administration is to speak not so much to him as to America. Get out ahead of the new President, and of his spin-drive communications team. Highlight the right appointees and the right responses to deal with the challenges that matter most. Don't just critique, but rather propose. Advance big ideas and organize on their behalf; identify allies in federal agencies, especially in Congress, and work with them to dial up the pressure for progress. Don't expect Obama or his aides to do the left thing. Indeed, take a lesson from rightwing pressure groups in their dealings with Republican administrations and recognize that it is always better to build the bandwagon than to jump on board one that is crafted with the tools of compromise.

Smart groups and individuals are already at it. The United Steelworkers union has been way ahead of the curve in critiquing the financial services bailout and in working with Congressional allies such as Ohioans Marcy Kaptur and Dennis Kucinich to challenge the basic assumptions of a top-down bailout. The Laborers union has been promoting a fully developed infrastructure-investment plan that represents a smart stimulus. The American Civil Liberties Union is already prodding Obama to keep a series of promises he made during the campaign with regard to civil liberties and abuses of executive power, and providing concrete examples of how he can do so. The ACLU and other groups will be working with members of the Senate Judiciary Committee such as Feingold to assure that Obama's Justice Department nominees are asked the right questions.

Perhaps most impressive are the moves made by the California Nurses Association/National Nurses Organizing Committee, Physicians for a National Health Program, and Progressive Democrats of America to ensure that the option of single-payer is not forgotten as Obama and House Speaker Nancy Pelosi establish their domestic policy priorities. To that end, sixty activists from these and allied groups met one week after Election Day at the AFL-CIO headquarters in Washington with Michigan Congressman John Conyers, an early Obama backer and the chief House proponent of real reform, to forge a Single-Payer Healthcare Alliance and plot specific strategies for influencing the new Administration and Congress.

The point won't be to teach Obama about single-payer. Less than six years ago, he told the Illinois AFLCIO: "I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care, cannot provide basic health insurance to everybody . . . a singlepayer health care plan, a universal health care plan. And that's what I'd like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House."

Since then, Democrats have taken back the House, the Senate, and the White House. The man who set those prerequisites in 2003 will sit in the Oval Office in 2009. But change didn't just come to Washington. It came to Barack Obama. His statements, his strategies, and his appointments evidence a caution born of the political and structural pressures faced by Presidential contenders and Presidents-elect. Whether the previous, more progressive Obama still exists within the man who will take the oath of office on January 20 remains to be seen. But the only way to determine if Obama really is the progressive he claimed as recently as last summer to be is to push not just Obama but the public.

Franklin Roosevelt's example is useful here. After his election in 1932, FDR met with Sidney Hillman and other labor leaders, many of them active Socialists with whom he had worked over the past decade or more. Hillman and his allies arrived with plans they wanted the new President to implement. Roosevelt told them: "I agree with you, I want to do it, now make me do it."

It is reasonable for progressives to assume that Barack Obama agrees with them on many funda-mental issues. He has said as much.

It is equally reasonable for progressives to assume that Barack Obama wants to do the right thing. But it is necessary for progressives to understand that, as with Roosevelt, they will have to make Obama do it.

John Nichols is Washington correspondent for The Nation and associate editor of The Capital Times in Madison, Wisconsin. A co-founder of the media reform organization Free Press, Nichols is is co-author with Robert W. McChesney of Tragedy & Farce: How the American Media Sell Wars, Spin Elections, and Destroy Democracy - from The New Press. Nichols' latest book is The Genius of Impeachment: The Founders' Cure for Royalism.

commondreams.org/view/2009/01/12-9

~OGD~

 Destor ... Raised an issue . . .

You may find Destor's comment posted yesterday in this thread:

"This isn't a public option because it's not open to everyone. If your employer offers you insurance, you're stuck with that. What does this do to free the millions of Americans from entrapment by the for-profit health insurance system?"

I realize that many commentators have suggested that the public option will be available to only a few people.

But this just isn't true.

The uninsured, the self-employed and those who work for very small companies will be eligible to sign up. (In the first year "small companies "means 10 or fewer employees, but by the second year, it includes companies with 30 or fewer employers--a large group of workers.)

Moreover--and this is what has been overlooked, the House bill (HR 3200, which includes the most detail on the public option) makes it clear that if you are temporarily uninsured (in between jobs, etc) you are eligible to go the Insurance Exchange and choose a plan (either a private plan or the public option).

In addition--and this is very important-- even if your circumstances change (you get a job and have access to good insurance) you can stay in the Exchange until you're 65 and qualify for Medicare. (See section 202 of House Bill)

SEC. 202. EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS.

(a) Access to Coverage- In accordance with this section, all individuals are eligible to obtain coverage through enrollment in an Exchange-participating health benefits plan offered through the Health Insurance Exchange unless such individuals are enrolled in another qualified health benefits plan or other acceptable coverage.

(b) Definitions- In this division:

(1) EXCHANGE-ELIGIBLE INDIVIDUAL- The term `Exchange-eligible individual' means an individual who is eligible under this section to be enrolled through the Health Insurance Exchange in an Exchange-participating health benefits plan and, with respect to family coverage, includes dependents of such individual.

(2) EXCHANGE-ELIGIBLE EMPLOYER- The term `Exchange-eligible employer' means an employer that is eligible under this section to enroll through the Health Insurance Exchange employees of the employer (and their dependents) in Exchange-eligible health benefits plans.

(3) EMPLOYMENT-RELATED DEFINITIONS- The terms `employer', `employee', `full-time employee', and `part-time employee' have the meanings given such terms by the Commissioner for purposes of this division.

(c) Transition- Individuals and employers shall only be eligible to enroll or participate in the Health Insurance Exchange in accordance with the following transition schedule:

(1) FIRST YEAR- In Y1 (as defined in section 100(c))--

(A) individuals described in subsection (d)(1), including individuals described in paragraphs (3), (4), and (5) of subsection (d); and

(B) smallest employers described in subsection (e)(1).

(2) SECOND YEAR- In Y2--

(A) individuals and employers described in paragraph (1); and

(B) smaller employers described in subsection (e)(2).

(3) THIRD YEAR- In Y3--

(A) individuals and employers described in paragraph (2);

(B) larger employers described in subsection (e)(3); and

(C) largest employers as permitted by the Commissioner under subsection (e)(4).

(4) FOURTH AND SUBSEQUENT YEARS- In Y4 and subsequent years--

(A) individuals and employers described in paragraph (3); and

(B) largest employers as permitted by the Commissioner under subsection (e)(4).

(d) Individuals-

(1) INDIVIDUAL DESCRIBED- Subject to the succeeding provisions of this subsection, an individual described in this paragraph is an individual who--

(A) is not enrolled in coverage described in subparagraphs (C) through (F) of paragraph (2); and

(B) is not enrolled in coverage as a full-time employee (or as a dependent of such an employee) under a group health plan if the coverage and an employer contribution under the plan meet the requirements of section 312.

For purposes of subparagraph (B), in the case of an individual who is self-employed, who has at least 1 employee, and who meets the requirements of section 312, such individual shall be deemed a full-time employee described in such subparagraph.

(2) ACCEPTABLE COVERAGE- For purposes of this division, the term `acceptable coverage' means any of the following:

(A) QUALIFIED HEALTH BENEFITS PLAN COVERAGE- Coverage under a qualified health benefits plan.

(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER CURRENT GROUP HEALTH PLAN- Coverage under a grandfathered health insurance coverage (as defined in subsection (a) of section 102) or under a current group health plan (described in subsection (b) of such section).

(C) MEDICARE- Coverage under part A of title XVIII of the Social Security Act.

(D) MEDICAID- Coverage for medical assistance under title XIX of the Social Security Act, excluding such coverage that is only available because of the application of subsection (u), (z), or (aa) of section 1902 of such Act

(E) MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE)- Coverage under chapter 55 of title 10, United States Code, including similar coverage furnished under section 1781 of title 38 of such Code.

(F) VA- Coverage under the veteran's health care program under chapter 17 of title 38, United States Code, but only if the coverage for the individual involved is determined by the Commissioner in coordination with the Secretary of Treasury to be not less than a level specified by the Commissioner and Secretary of Veteran's Affairs, in coordination with the Secretary of Treasury, based on the individual's priority for services as provided under section 1705(a) of such title.

(G) OTHER COVERAGE- Such other health benefits coverage, such as a State health benefits risk pool, as the Commissioner, in coordination with the Secretary of the Treasury, recognizes for purposes of this paragraph.

The Commissioner shall make determinations under this paragraph in coordination with the Secretary of the Treasury.

(3) TREATMENT OF CERTAIN NON-TRADITIONAL MEDICAID ELIGIBLE INDIVIDUALS- An individual who is a non-traditional Medicaid eligible individual (as defined in section 205(e)(4)(C)) in a State may be an Exchange-eligible individual if the individual was enrolled in a qualified health benefits plan, grandfathered health insurance coverage, or current group health plan during the 6 months before the individual became a non-traditional Medicaid eligible individual. During the period in which such an individual has chosen to enroll in an Exchange-participating health benefits plan, the individual is not also eligible for medical assistance under Medicaid.

(4) CONTINUING ELIGIBILITY PERMITTED-

(A) IN GENERAL- Except as provided in subparagraph (B), once an individual qualifies as an Exchange-eligible individual under this subsection (including as an employee or dependent of an employee of an Exchange-eligible employer) and enrolls under an Exchange-participating health benefits plan through the Health Insurance Exchange, the individual shall continue to be treated as an Exchange-eligible individual until the individual is no longer enrolled with an Exchange-participating health benefits plan.

(B) EXCEPTIONS-

(i) IN GENERAL- Subparagraph (A) shall not apply to an individual once the individual becomes eligible for coverage--

(I) under part A of the Medicare program;

(II) under the Medicaid program as a Medicaid eligible individual, except as permitted under paragraph (3) or clause (ii); or

(III) in such other circumstances as the Commissioner may provide.

(ii) TRANSITION PERIOD- In the case described in clause (i)(II), the Commissioner shall permit the individual to continue treatment under subparagraph (A) until such limited time as the Commissioner determines it is administratively feasible, consistent with minimizing disruption in the individual's access to health care.

(5) ADVERSELY AFFECTED RETIREE HEALTH BENEFITS GROUP PARTICIPANTS AND BENEFICIARIES-

(A) IN GENERAL- Beginning in Y1, an individual who is a participant or beneficiary in an adversely affected retiree health benefits group who does not have coverage described in paragraph (2)(C) is an Exchange eligible individual, whether or not such an individual has other acceptable coverage.

(B) ADVERAGE AFFECTED RETIREE HEALTH BENEFIT GROUP DEFINED- In this paragraph, the term `adversely affected retiree health benefits group' means the retired participants and their beneficiaries of a group health plan that cancelled or substantially reduced the amount, type, level, or form of health benefit or option provided prior January 1, 2008.

(e) Employers-

(1) SMALLEST EMPLOYERS- Subject to paragraph (5), smallest employers described in this paragraph are employers with 15 or fewer employees.

(2) SMALLER EMPLOYERS- Subject to paragraph (5), smaller employers described in this paragraph are employers that are not smallest employers described in paragraph (1) and that have 25 or fewer employees.

(3) LARGER EMPLOYERS- Subject to paragraph (5), larger employers described in this paragraph are employers that are not smallest employers described in paragraph (1) or smaller employers described in paragraph (2) and that have 50 or fewer employees.

(4) LARGEST EMPLOYERS-

(A) IN GENERAL- Beginning with Y3, the Commissioner may permit employers not described in paragraphs (1) (2), or (3) to be Exchange-eligible employers.

(B) PHASE-IN- In applying subparagraph (A), the Commissioner may phase-in the application of such subparagraph based on the number of full-time employees of an employer and such other considerations as the Commissioner deems appropriate.

(5) CONTINUING ELIGIBILITY- Once an employer is permitted to be an Exchange-eligible employer under this subsection and enrolls employees through the Health Insurance Exchange, the employer shall continue to be treated as an Exchange-eligible employer for each subsequent plan year regardless of the number of employees involved unless and until the employer meets the requirement of section 311(a) through paragraph (1) of such section by offering a group health plan and not through offering Exchange-participating health benefits plan.

(6) EMPLOYER PARTICIPATION AND CONTRIBUTIONS-

(A) SATISFACTION OF EMPLOYER RESPONSIBILITY- For any year in which an employer is an Exchange-eligible employer, such employer may meet the requirements of section 312 with respect to employees of such employer by offering such employees the option of enrolling with Exchange-participating health benefits plans through the Health Insurance Exchange consistent with the provisions of subtitle B of title III.

(B) EMPLOYEE CHOICE- Any employee offered Exchange-participating health benefits plans by the employer of such employee under subparagraph (A) may choose coverage under any such plan. That choice includes, with respect to family coverage, coverage of the dependents of such employee.

(7) AFFILIATED GROUPS- Any employer which is part of a group of employers who are treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated, for purposes of this subtitle, as a single employer.

(8) OTHER COUNTING RULES- The Commissioner shall establish rules relating to how employees are counted for purposes of carrying out this subsection.

(9) TREATMENT OF MULTIEMPLOYER PLANS- The plan sponsor of a group health plan (as defined in section 733(a) of the Employee Retirement Income Security Act of 1974) that is multiemployer plan (as defined in section 3(37) of such Act) may obtain health insurance coverage with respect to participants in the plan through the Exchange to the same extent as an employer not described in paragraph (1) or (2) is permitted by the Commissioner to obtain health insurance coverage through the Exchange as an Exchange-eligible employer

(f) Special Situation Authority- The Commissioner shall have the authority to establish such rules as may be necessary to deal with special situations with regard to uninsured individuals and employers participating as Exchange-eligible individuals and employers, such as transition periods for individuals and employers who gain, or lose, Exchange-eligible participation status, and to establish grace periods for premium payment.

(g) Surveys of Individuals and Employers- The Commissioner shall provide for periodic surveys of Exchange-eligible individuals and employers concerning satisfaction of such individuals and employers with the Health Insurance Exchange and Exchange-participating health benefits plans.

(h) Exchange Access Study-

(1) IN GENERAL- The Commissioner shall conduct a study of access to the Health Insurance Exchange for individuals and for employers, including individuals and employers who are not eligible and enrolled in Exchange-participating health benefits plans. The goal of the study is to determine if there are significant groups and types of individuals and employers who are not Exchange eligible individuals or employers, but who would have improved benefits and affordability if made eligible for coverage in the Exchange.

(2) ITEMS INCLUDED IN STUDY- Such study also shall examine--

(A) the terms, conditions, and affordability of group health coverage offered by employers and QHBP offering entities outside of the Exchange compared to Exchange-participating health benefits plans; and

(B) the affordability-test standard for access of certain employed individuals to coverage in the Health Insurance Exchange.

(3) REPORT- Not later than January 1 of Y3, in Y6, and thereafter, the Commissioner shall submit to Congress on the study conducted under this subsection and shall include in such report recommendations regarding changes in standards for Exchange eligibility for for individuals and employers.

For your general information . . .



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