A 'framework' made in health insurer's workshopThe Baucus plan stinks - it really stinks. The process stinks too -
Posted by Judy Dugan
The latest proposal in the Washington health reform debate protects a lot of groups. Employers get protection from cost, paying very little if they don't offer insurance. Insurers get millions of new customers and protection from effective competition. Overall medical cost reduction is vague (Can you say "pilot program?"). The middle class, the group with no free-spending Washington lobby, gets the lump of coal--less help with premiums and higher out of pocket costs than in other proposals.
Today's new plan is just a set of ideas labeled "Framework for Comprehensive Health Reform." But its author, Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee, has become the center of power in health reform.
The plan Baucus has in mind is suited to a small-state legislator who reaps big contributions from the health industry--health-related companies and their employees gave Baucus's political committees nearly $1.5 million in 2007 and 2008 alone. My colleague Jerry Flanagan earlier described one of the worst features of the Baucus "Framework"--insurance companies can weasel out of state-level protections for consumers and patients--things like required maternity benefits and state reviews of benefit denials.
The numbers in the plan also raise consumers' costs. First, there is no direct premium subsidy for famiies making more than $66,000 a year. And the basic ("Bronze") plan would have to cover only 65% of the average cost (the "actuarial value") of all medical claims that are covered by the plan--never mind care that isn't covered. That, of course, leaves the patient on the hook for the other 35% on average, on top of the cost of the premium. That means very high copays and deductibles. And 65% is exactly the level that the insurance industry demanded of Congress.
As for the premium costs, families that don't get a subsidy could be charged up to 13% of family income for the premium alone, based on second-most-modest ("Silver") policy. That's $10,400 for a family of five with income of $80,000. On top of that, the family could end up with out of pocket costs in the high thousands. If insurers also get to dump state regulation, the family may also get much less in the way of benefits--meaning they won't really understand how worthless their coverage is until they file a claim.
What we're seeing in Congress is a health reform plan that comes down to what the insurance industry and some of its allies want. It's still a system driven by profit, not health. It's not not what American families need. It won't fundamentally reform the fragmented and wasteful way that health care is delivered. The Baucus plan may be better than nothing, but it's far from what other nations offer, and far from what Americans deserve.
Tuesday, September 08, 2009
A great post on Baucus' Health Care proposal (disaster) at consumerwatchdog.org: