October 2009 Archives

Are there any downsides to creating a national public health insurance option and allowing states to opt out? Would it do any good?

Senate Democratic leaders seem intrigued with the idea. CongressDaily on Friday quoted Sen. Charles Schumer, D-N.Y., as saying, "Liberals live with it. Moderates live with it. It's in the middle."

But what about the policy implications? While such a proposal could potentially get enough votes to pass Congress, would a public option really lower costs if only some states offered it? How many would opt out, and why?

8 responses: Len Nichols, Denis Cortese, Jason Rosenbaum, James P. Gelfand, Karen Ignagni, Michael F. Cannon, Sec. Mike Leavitt, Paul B. Ginsburg

How should Congress define universal coverage? The Senate Finance Committee bill is estimated to cover 94 percent of the population. Massachusetts has covered 97 percent of its population through its health reform, although it had a relatively low level of uninsured to begin with.

What is the best way to define universal coverage, and what are the most important factors that could keep the nation from getting there? How many of the uninsured should be covered under health reform?

8 responses: Michael F. Cannon, John C. Goodman, Uwe Reinhardt, Uwe Reinhardt, Michael F. Cannon, Ron Pollack, John C. Goodman, Uwe Reinhardt

How much merit is there to 11th-hour insurance industry claims that the health reform bill scheduled for a vote in the Senate Finance Committee this week would raise insurance premiums? And how big a problem is it that the industry, which had generally been cooperative in the reform effort, is now lashing out?

America's Health Insurance Plans Sunday created a stir when it released a report commissioned from PriceWaterhouse Coopers that pointed to four provisions in the Finance Committee bill as potentially increasing private insurance costs for individuals, families and businesses above what their costs would be minus reform. With the enactment of four specific provisions, the cost of coverage would increase by 111 percent, according to the report. The problems, it says, are "insurance market reforms coupled with a weak coverage requirement, a new tax on high-cost health care plans, cost-shifting as a result of cuts to Medicare, and new taxes on several health care sectors."

With these provisions in place, would health insurers still benefit from reform?

11 responses: Michael F. Cannon, Rep. Pete Stark, D-Calif., Jason Rosenbaum, Karen Davis, Henry Simmons, Drew Altman, Ron Pollack, John C. Goodman, Michael F. Cannon, Len Nichols, Marilyn Werber Serafini

Updated at 5:48 p.m. on Oct. 7.

The Congressional Budget Office and the staff of the Joint Committee on Taxation have issued a preliminary analysis of the Senate Finance Committee chairman's mark for the America's Healthy Future Act of 2009. They note it would reduce the federal budget deficits by $81 billion over the 2010-2019 period. Here are excerpts from CBO Director Douglas Elmendorf's blog:

"The estimate includes a projected net cost of $518 billion over 10 years for the proposed expansions in insurance coverage. That net cost itself reflects a gross total of $829 billion in credits and subsidies provided through the exchanges, increased net outlays for Medicaid and the Children's Health Insurance Program (CHIP), and tax credits for small employers; those costs are partly offset by $201 billion in revenues from the excise tax on high-premium insurance plans and $110 billion in net savings from other sources. The net cost of the coverage expansions would be more than offset by the combination of other spending changes that CBO estimates would save $404 billion over the 10 years and other provisions that JCT and CBO estimate would increase federal revenues by $196 billion over the same period. In subsequent years, the collective effect of those provisions would probably be continued reductions in federal budget deficits. Those estimates are all subject to substantial uncertainty.

"By 2019, CBO and JCT estimate, the number of nonelderly people who are uninsured would be reduced by about 29 million, leaving about 25 million nonelderly residents uninsured (about one-third of whom would be unauthorized immigrants). Under the proposal, the share of legal nonelderly residents with insurance coverage would rise from about 83 percent currently to about 94 percent. Roughly 23 million people would purchase their own coverage through the new insurance exchanges, and there would be roughly 14 million more enrollees in Medicaid and CHIP than is projected under current law. Relative to currently projected levels, the number of people either purchasing individual coverage outside the exchanges or obtaining coverage through employers would decline by several million.

"All told, the proposal would reduce the federal deficit by $12 billion in 2019, CBO and JCT estimate. After that, the added revenues and cost savings are projected to grow more rapidly than the cost of the coverage expansion."

What's your take?

Accountable Care Organizations -- Realistically Speaking

Is it realistic to think that most doctors will radically change their practice structure to assimilate into broad multi-specialty practices and potentially become employees of large, integrated health systems?

Today, most doctors still operate in small group practices. Yet, major congressional health reform bills are counting on doctors to significantly change their business model. They hold up large, integrated health care systems like the Mayo Clinic and the Cleveland Clinic, both of which employ doctors, as models. They propose accountable care organizations, which would require doctors to at least affiliate with physicians of other specialties. They also propose bundling payments, which would necessitate financial arrangements with other types of medical providers.

Will doctors really buy into this? Would such a system improve quality and lower costs?

14 responses: Henry Simmons, Michael F. Cannon, Karen Davis, Uwe Reinhardt, Marilyn Werber Serafini, Jason Rosenbaum, Ron Pollack, Marilyn Werber Serafini, Jack Lewin, John C. Goodman, J. James Rohack, Darrell G. Kirch, Paul B. Ginsburg, Denis Cortese