Tuesday, September 22, 2009

Finance Committee Markup Liveblogging

I'm listening to a laundry list recitation of changes to the Chairman's Mark. What can I say, I find this stuff interesting. You can get the full list from Senate Finance (PDF). For the most part, these changes incorporate amendments, or tweaked versions of amendments, offered by other Senators. Max Baucus seems to have incorporated every small-bore amendment Olympia Snowe asked for that has some positive value. But he's also incorporated a number of other amendments. In the main, the bill is now better. CHIP will be protected. Out-of-pocket maximums are lowered for everyone all they way up to 400% of FPL (very important!). The exchange is now opened to employees with up to 100 employees instead of 50. Tax changes will reduce the impact of the excise tax on expensive plans.

There are five big unsolved problems.
  • The public option. We've still got these crappy co-ops. Funding for the co-ops has been boosted a little, but they're not really a Public Option By Another Name.
  • Affordability. Baucus has cut premium maximums from 13% to 12% of income. Like I said, peanuts. We've really got to get down to 7-8% of income before we're in the realm of affordability. Ron Wyden is enlisting Doug Elmendorf to bring this point home; a middle-class household could still end up with out-of-pocket expenses close to 20% of income, when you include permiums and cost-sharing.
  • Premium flexibility. The age variation has been lowered from 5:1 to 4:1. It should be 2:1.
  • The free-rider provision. It's still there. It should be an employer mandate.
  • Reforming the large-group/self-insured markets. Jay Rockefeller offered an amendment to force these markets to abide by the same reforms as the small-goup and individual markets. I thought I heard someone recite changes that would set some standards on employer-sponsored insurance, but I can't find it. There's a tension between the promise to let people keep what they have, and the promise to make insurance better overall, but at least in the long term the regulations ought to be harmonized.
But at least it's getting better.


chrismealy said...

This is brilliant. Thanks.

Blue said...

You didn't find Yglesias' discussion of age ratio's convincing? Namely, it's pretty easy for insurers to get known for bad service to old people, dump old people on the public option, and then laugh at the public option for having such high costs.

Nick Beaudrot said...

Not at all.

Real health reform inherently involves the young subsidizing the old. But the young become old! So in the long run it balances out.

Also, the Baucus reform also includes risk-adjustment payments, where plans with younger, healthier populations are net payers, and plans with older, sicker populations are net recipients. I believe the three most similar systems -- Germany, the Netherlands, and Switzerland -- have this in some form.