CommunityFDL Main Blog

What’s In The Manager’s Amendment

courtesy Seattle Municipal Archives

courtesy Seattle Municipal Archives

So I’m frantically trying to read the manager’s amendment (turn on CSPAN-2 and you can follow along yourself) and all the supplementary information that’s out there on just what’s now in this health care bill, and here’s what I’ve got so far:

• The CBO score is out. The top line numbers? The bill costs $871 billion and would save the federal government $132 billion over the next ten years. The changes in the manager’s amendment amounted to a net $2 billion dollar savings. The bill would cover 31 million people and leave 23 million uninsured by 2019.

• On the abortion issue: states could prohibit abortion coverage in the exchange if they passed a law. This basically punts the Stupak issue to the states, and if the exchanges expand over time as expected, essentially end abortion services coverage in states that pass a law. This becomes a huge culture war battle in states for years and years to come. Good for pro- and anti-abortion groups’ fundraising coffers, bad for women.

• The CLASS Act, the federally managed, voluntary long-term care program, is still in the bill. Lieberman may have mentioned it on Face The Nation, but he didn’t kill it.

• The public option is replaced with the OPM-managed multi-state plans in the exchanges. Not all of them have to be non-profits; in fact, only one of them has to be.

• The individual mandate penalty actually looks a little higher here, although it’s phased in over time. It would be the “greater of a flat dollar amount per person or a percentage of the individual’s income,” up to 2% by 2015.

• Apparently Nebraska and maybe a few other states get more money for Medicaid funding. I can’t get entirely worked up over a legislator securing more money for poor people in their own state. It beats kickback deals for local defense contractors of developers. I think Paul Wellstone would have done no less.

• Small business tax credits to purchase insurance have been expanded by $12 billion and phase in immediately, and are eligible to companies that pay higher wages. Every bill in Congress has to include small business tax credits, it’s the law.

• The medical loss ratio, which was floated to be at 90%, had to be dropped down because of a nakedly political act by the CBO, which said that a 90% MLR would have amounted to nationalizing the insurance industry. So the MLR is now 85/80%, but that apparently does not include the money insurers get through risk adjustment, which means that in practice it’s actually higher.

• They’ve banned pre-existing conditions for children immediately, starting in 2010.

• There are new insurance regulations, including the ability to ban insurance companies from the exchange if they raise their rates above a certain amount. And if an insurer denies a claim, there will be an independent board to which customers can appeal. The design of that board is crucial.

• The nationwide plans, which could have gutted state-level insurance regulations, have been dropped. This is a good thing.

• There are $1.25 billion in new resources for community health centers in the bill, totaling $10 billion overall (there’s $14 billion in the House bill). I’ve written about community health centers before, which could provide a base of low or no-cost primary coverage for all low-income Americans in communities throughout the country. I actually think this is the best thing in the bill. Bernie Sanders is actually talking about this now on CSPAN. He says that 10,000 more communities will have access to community health centers with this legislation.

• Increased debt forgiveness for medical students to work at community health centers.

• The “doctor’s fix” was removed (probably to improve the CBO score) and will be dealt with in separate legislation.

• There’s an increase to the payroll tax for high-income Americans to pay for the bill. Before the increase was 0.5% for individuals with income above $200,000 and for families with income above $250,000; now it’s 0.9%.

• They traded the Botax for a Boehner tax; there’s now a 10% excise tax on indoor tanning.

CommunityThe Bullpen

What’s In The Manager’s Amendment

So I’m frantically trying to read the manager’s amendment (turn on CSPAN-2 and you can follow along yourself) and all the supplementary information that’s out there on just what’s now in this health care bill, and here’s what I’ve got so far:

• The CBO score is out. The top line numbers? The bill costs $871 billion and would save the federal government $132 billion over the next ten years. The changes in the manager’s amendment amounted to a net $2 billion dollar savings. The bill would cover 31 million people and leave 23 million uninsured by 2019.

• On the abortion issue: states could prohibit abortion coverage in the exchange if they passed a law. This basically punts the Stupak issue to the states, and if the exchanges expand over time as expected, essentially end abortion services coverage in states that pass a law. This becomes a huge culture war battle in states for years and years to come. Good for pro- and anti-abortion groups’ fundraising coffers, bad for women.

• The CLASS Act, the federally managed, voluntary long-term care program, is still in the bill. Lieberman may have mentioned it on Face The Nation, but he didn’t kill it.

• The public option is replaced with the OPM-managed multi-state plans in the exchanges. Not all of them have to be non-profits; in fact, only one of them has to be.

• The individual mandate penalty actually looks a little higher here, although it’s phased in over time. It would be the “greater of a flat dollar amount per person or a percentage of the individual’s income,” up to 2% by 2015.

• Apparently Nebraska and maybe a few other states get more money for Medicaid funding. (more…)

Previous post

Last-Minute Healthcare Amendment: Pay-Raise For Iraqi Whores in Syria

Next post

How the White House Misjudged the Political Landscape

David Dayen

David Dayen