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Cantwell Vs. Baucus: Battle of the Exchanges

Maria CantwellAs I get more information about Cantwell’s “basic health plan” amendment the more I like it. (The modified amendment is available here.) I really wish Cantwell would stop calling it a public option. It is not a public option. I think it is an idea which should be debated on its own merits and not get drawn into the battle for a real public option.

As I have said before, what Cantwell’s amendment would do is allow states to create a much better exchange for those under 200% of FPL. It is an exchange with well-defined minimum benefit package with fixed co-pays, out-of-pocket limits, and deductibles. It would allow real economies of scale to affect negotiations, and mandate a minimum medical loss ratio of 85% for participating insurers. Insurers would be required to meet “specific performance measures and standards,” and their performance would be publicly reported. The basic health program must provide a choice of at least two or more similar plans.

This is closer to a Dutch-, Belgian-, Swiss-style, well-regulated, private system. You get to choose from several similar well-defined plans, knowing all of the plans provide sufficient coverage. It is like Medicare Advantage without the option of Medicare. (It would still be dramatically improved if one of those plans was a public option. Medicare Advantage plans cost noticeably more without providing better coverage.)

The main exchanges in the Baucus bill will likely be confusing, loosely regulated marketplaces with dozens of incomprehensible choices. They will lack mechanisms that might engender the best possible bargain or drive down cost. I wish that Baucus’s exchanges could be more like Cantwell’s “basic health plan” exchanges.

Judging from an interview Cantwell did with Ezra Klein, I don’t think I’m alone.

Why only go up to 200 percent of poverty? A lot of the concern right now is for people between 200 percent and 400 percent of poverty because they don’t have as much in the way of subsidies.

Because right now, that’s where 75 percent of the uninsured population lives. They need the health insurance. You create models within our system that are efficient. I’d be willing to do more, but that’s a different question.

What about me? I make more than 200 percent of poverty. What if I want to join your plan?

That’s for another day, Ezra. This is a big mountain to climb. We’ve got to get a foothold and this is the foothold.

It sounds like Cantwell also doesn’t have a very high opinion of Baucus’s reform plan. I think it is clear that she sees expanding her “basic health plan” as a way to slowly replace Baucus’s terrible exchanges with a much better ones.

Cantwell’s amendment is a good but sadly insufficient idea. It is really at best a “foothold.” It is how all the exchanges should be run, not a small subset for some people in some states. If the current Senate Finance Committee bill was passed into law, Cantwell probably hopes progressives will fight hundreds of smaller battles using her amendment to gradually marginalize Baucus’s terrible exchanges. I appreciate the effort represented by Sen. Cantwell’s amendment; like Wyden’s state experimentation amendment, it could be a tool progressives might use to fight for real reform at the state level. But I think it is far too early to begin a strategic retreat, to prepare to fight another day. Now is not the moment to accept defeat. This is a perfect time to fight, if only elected Democrats can be forced to remember what the party stands for.

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Cantwell Vs. Baucus: Battle of the Exchanges

As I get more information about Cantwell’s “basic health plan” amendment the more I like it. (The modified amendment is available here.) I really wish Cantwell would stop calling it a public option. It is not a public option. I think it is an idea which should be debated on its own merits and not get drawn into the battle for a real public option.

As I have said before, what Cantwell’s amendment would do is allow states to create a much better exchange for those under 200% of FPL. It is an exchange with well-defined minimum benefit package with fixed co-pays, out-of-pocket limits, and deductibles. It would allow real economies of scale to affect negotiations, and mandate a minimum medical loss ratio of 85% for participating insurers. Insurers would be required to meet “specific performance measures and standards,” and their performance would be publicly reported. The basic health program must provide a choice of at least two or more similar plans.

This is closer to a Dutch-, Belgian-, Swiss-style, well-regulated, private system. You get to choose from several similar well-defined plans, knowing all of the plans provide sufficient coverage. It is like Medicare Advantage without the option of Medicare. (It would still be dramatically improved if one of those plans was a public option. Medicare Advantage plans cost noticeably more without providing better coverage.)

The main exchanges in the Baucus bill will likely be confusing, loosely regulated marketplaces with dozens of incomprehensible choices. They will lack mechanisms that might engender the best possible bargain or drive down cost. I wish that Baucus’s exchanges could be more like Cantwell’s “basic health plan” exchanges.

Judging from an interview Cantwell did with Ezra Klein, I don’t think I’m alone.

Why only go up to 200 percent of poverty? A lot of the concern right now is for people between 200 percent and 400 percent of poverty because they don’t have as much in the way of subsidies.

Because right now, that’s where 75 percent of the uninsured population lives. They need the health insurance. You create models within our system that are efficient. I’d be willing to do more, but that’s a different question.

What about me? I make more than 200 percent of poverty. What if I want to join your plan?

That’s for another day, Ezra. This is a big mountain to climb. We’ve got to get a foothold and this is the foothold.

It sounds like Cantwell also doesn’t have a very high opinion of Baucus’s reform plan. I think it is clear that she sees expanding her “basic health plan” as a way to slowly replace Baucus’s terrible exchanges with a much better ones.

Cantwell’s amendment is a good but sadly insufficient idea. It is really at best a “foothold.” It is how all the exchanges should be run, not a small subset for some people in some states. If the current Senate Finance Committee bill was passed into law, Cantwell probably hopes progressives will fight hundreds of smaller battles using her amendment to gradually marginalize Baucus’s terrible exchanges. I appreciate the effort represented by Sen. Cantwell’s amendment; like Wyden’s state experimentation amendment, it could be a tool progressives might use to fight for real reform at the state level. But I think it is far too early to begin a strategic retreat, to prepare to fight another day. Now is not the moment to accept defeat. This is a perfect time to fight, if only elected Democrats can be forced to remember what the party stands for.

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Jon Walker

Jon Walker

Jonathan Walker grew up in New Jersey. He graduated from Wesleyan University in 2006. He is an expert on politics, health care and drug policy. He is also the author of After Legalization and Cobalt Slave, and a Futurist writer at http://pendinghorizon.com