As featured on p. 218 of "Bloggers on the Bus," under the name "a MyDD blogger."

Tuesday, July 14, 2009

Tri-Committee Bill Released

I should mention that the Tri-Committee health care reform bill from the House has been released, and rather than bend to the dictates of marginalized Blue Dogs who value their relationships with the health care industry over their constituents, they created a pretty darn good bill. It's not perfect, of course, but it represents a far better bill on the left flank than, say, the Waxman-Markey bill did.

I'll post the brief on what the reform bill does for consumers:

• No more co-pays or deductibles for preventive care
• No more rate increases for pre-existing conditions, gender, or occupation
• An annual cap on your out-of-pocket expenses
• Group rates of a national pool if you buy your own plan
• Guaranteed, affordable oral, hearing, and vision care for your kids

• Keep your doctor, and your current plan, if you like them
• More choice, with a high quality public health insurance option competing with private insurers

• You and your doctors make health care decisions — not insurance companies
• More family doctors and nurses will enter the workforce, helping guarantee access
• Mental health care must be covered

• No more coverage denials for pre-existing conditions
• No more lifetime limits on how much insurance companies will pay
• No reason to ever make a job or life decision again based on health care coverage

The "national pool" refers to the insurance exchange, which is a hard concept to put into bullet points, but this is a pretty good list of how the average Americans would benefit from this plan.

As to the specifics, here's Ezra Klein, Scarecrow, Mcjoan and Jon Cohn. You'll notice a consensus. 97% of the population would get covered in 10 years. The subsidies are 400% of poverty and Medicaid gets expanded to 133% of poverty - both more generous subsidies than the Senate bills. Insurers are regulated against denying coverage for pre-existing condition or rescission, and the benefits floor is pretty decent. There are caps on out-of-pocket expenses, and efforts at controlling costs. It includes an individual mandate and an employer mandate that gets exempted for certain-sized small businesses. About the worst thing you can say about the bill is that some of the good stuff doesn't happen fast enough (to keep the size of the cost down):

I do have one, not minor concern: It will be a while before people see the best stuff. Most of the major elements--the insurance exchange, the subsidies, the insurance regulations, the public plan--won't come online until 2013 or later. This is, I believe, also true of counterpart bills in the Senate.

There's a sound policy rationale for going slow; it takes a lot of work to set up exchanges, regulations, and the like. But four years is a long time. And I suspect money has a lot to do with the pace. Slower implementation makes it possible to keep the price tag to around $1 trillion.

On the bright side, some provisions--filling in the Medicare drug donut hole, bolsteirng the primary care workforce, among others--would start in the next two years.

The cost of the bill, scored by the CBO at around $1 trillion dollars over 10 years, gets paid with $500 billion in internal cost savings and around $500 billion in new revenues, mostly with a surtax on the wealthy. I prefer other methods, but let's get real about this:

The details haven't been released yet, but most (if not all) of the families that fall under Rangel's tax plan will also be in this 1% range.

These are families that paid a lower rate in 2006 (the last date of available data) than they did 15 years ago. That's not an argument for upping the taxes, of course. But it puts it in perspective. (Confession: If you go back to the Reagan years, the top effective rate is lower. But the current rate is still below the historical average.)

News reports have anticipated Rangel proposing a 1-3% surtax. Even a 3% increase across the board will leave an effective rate lower than it was in 1995.

The President approves of the general approach of the House bill, and the Education and Labor Committee will start markup this week. The bill text is here and a summary is here.

We're off and running.

...more on the surtax from Tim Foley.

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