The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Posts Tagged ‘Affordable Health Choices Act’

CBO Analysis Highlights Difficulty of Affordable Universal Coverage

Posted by Alan on June 15, 2009

Among the duties of the Congressional Budget Office is determining the financial impact of legislation proposed by lawmakers. Their highly credible analyses is given great credence within Congress. Which means today’s preliminary report on the health care reform package crafted by Senator Edward Kennedy and other members of the Senate Health, Education, Labor and Pensions Committee is especially important.

The CBO Preliminary Analysis of the Affordable Health Choices Act, released on Monday, underscores the challenge Congress faces in attempting to insure the uninsured without breaking the federal budget. Before discussing the finding, it is important to note: this is a preliminary analysis of draft legislation. The CBO analysis focused on “major provisions on health insurance coverage,” leaving several important elements out of their review. There are elements of the draft bill that have not yet been modeled, for example, allowing children through age 26 to be considered dependents on their parents’ policies. There are a host of other caveats involved. So it is best to treat the findings of this report as broad and directional.

Considering the sincere commitment Senator Kennedy and his allies have for universal coverage, the direction of the Congressional Budget Office’s conclusions must be disappointing.

Without intervention, the CBO estimates that by 2019 approximately 228 Americans under the age of 65 will have health care coverage, but from 50-to-54 million people — about 19 percent of this population — will not. If the HELP Committee’s health care reform package were enacted, the CBO estimates the percentage of uninsured would fall to 13 percent of the non-elderly population would still be without coverage — approximately 36 or 37 million.

The net increase to the federal budget for covering these 13-to-18 million Americans would be $1.o trillion between 2010 and 2019, most resulting from the subsidies the legislation would offer to individuals earning up to 500 percent of the federal poverty level purchasing coverage through a government-run Exchange.

In the CBO Director’s blog posting on the analysis, Director Douglas Elmendorf points out that while the study estimates that 39 million Americans would obtain coverage through the Exchange, “the number of people who had coverage through an employer would decline by about 15 million (or roughly 10 percent).” He pegs the net decrease in the nation’s uninsured at about 16-to-17 million people.

No one claims comprehensive health care reform will be easy. The Affordable Health Choices Act is only one reform package on the table. And, as Politico.com reports, the White House made clear it is not the Obama Administration’s plan.  The CBO preliminary analysis on the draft legislation developed by the Senate HELP Committee makes clear just how difficult — and expensive — it will be.  Will the CBO report convince lawmakers to scale back their ambitions for government’s involvement in America’s health care. Perhaps, but I wouldn’t count on it. Health care reform is as much about ideology as pragmatism. 

The CBO study should embolden Congressional moderates, however, to stand firm for comprehensive reform that neither breaks the budget of the federal government nor American families.

Posted in Barack Obama, Health Care Reform, Healthcare Reform | Tagged: , , , | 4 Comments »

Kennedy Health Care Reform Bill Launches New Phase of Debate

Posted by Alan on June 9, 2009

The health care reform debate moved to a new phase Senator Edward Kennedy and his fellow Democrats on the Senate Health, Education, Labor, and Pensions Committee (HELP) introduced sweeping legislation. Senator Kennedy is Chair of the ccommittee. What is significant is not what is in the bill — it’s general outline has been known for awhile — but the publication of the bill itself. It marks the beginning of the move from discussions on generalities to negotiations on specifics.

The HELP Committee Legislation is entitled the “Affordable  Health Choices Act.” (Virtually every piece of health care reform legislation will include the word “choice” as the lack of choice — see as evidence The Patients’ Choice Act four Republican lawmakers are planning to introduce. The reason is that many in Washington believe opponents framing of the Clinton Administration’s health care reform plan as limiting choice was a leading contributor to it’s downfall.) The HELP Committee press release proclaims the legislation “reduces health care costs, allows Americans to keep the coverage they have if they want it, and makes health insurance affordable to those who do not have it today.”

That remains to be seen. The 615 page draft health care reform bill covers a lot of territory and it will take some time to sort through its many provisions. A quick skim, however, indicates that it generally hews to the outlines Senator Kennedy has been talking about in recent days. It would create state gateways through which individuals and some businesses could purchase coverage and a government-run carrier would compete with private carriers  Individuals earning up to 150 percent of the Federal Poverty Level ($16,245 for an individual in 2009) will be eligible for Medicaid. Insurance premiums for those earning up to 500 percent of the federal poverty level (currently $110,250 for a family of four) so their payments do not exceed 10 percent of their gross adjusted income.

At this stage, the details actually are not all that important. Discussions among the HELP Committee’s Democrats and Republicans continue (now those would be interesting to watch). And several other bills by different committees in both the House and the Senate are due. All will wind up in the sausage making process. What any one draft contains is not necessarily what will emerge at the end.

For now, Senator Kennedy is anchoring the left in the debate. (Anchoring a position is done by both liberals and conservatives. It is a negotiating tool in which the anchor calls for extreme provisions in the hopes of having any compromise which emerges from moving too far toward the other side). I don’t mean this cynically. Senator Kennedy is no doubt sincere in supporting the provisions of his committee’s legislation. However, he is a practical policitian and knows compromise is inevitable. Being the first Congressional committee to issue a draft, there is no need for him to introduce a watered down bill. After all, he would be foolish to negotiate with himself. Better to stake out his ideal position and see what the other committees produce.

A public hearing on the HELP Committee bill is scheduled for June 11, 2009 and the committee will begin editing the bill at a June 16, 2009 meeting. The Democrat’s press release emphasized that negotiations with GOP members of the committee are ongoing so it will be interesting to see what changes emerge  once mark-up begins.

All this is important and interesting. But again, the details of the Affordable Health Choices Act are less important than the existence of the Affordable Health Choices Act. A new phase of the journey toward comprehensive health care reform has begun. The debate continues.

Posted in Health Care Reform, Healthcare Reform, Politics | Tagged: , , , , , | 5 Comments »