I knew this was coming, but as a proponent of a public health plan I must admit it still hurts to see it (or rather not see it) in black-and-white.
The Senate Finance Committee’s draft proposal (hat tip: Washington Post) on healthcare reform doesn’t include a public health plan that would compete with private insurers. It does leave the door open to government funding of not-for-profit co-op health plans (essentially mutual insurers), an 11th-hour proposal that frankly raises more questions than it answers — and that’s being generous (see prior post).
As expected, the SFC proposal calls for individual market reforms including an individual mandate and guaranteed issue. It also calls for “adjusted community rating,” with rate variation capped at 7.5 to one.
Under the proposal, private insurers could offer up to four standard benefit packages through a “state-based exchange.” The benefit packages would have varying actuarial values: Bronze (65%), Silver (73%), Gold (81%) and Platinum (90%). Health plans would be required to offer at least the Silver and Gold options.
States would have the option to “contemplate multiple, competing Exchanges after five years,” according to the proposal.
Writes the Post’s Ezra Klein, who broke the story: ”Sources say that it’s a major scale-back of the outline they had before. Specifically, subsidies have dropped from 400 percent of the poverty line to 300 percent. Medicaid eligibility has been tightened to 133 percent of poverty for children and pregnant women and 100 percent of poverty for parents and childless adults. The plans being offered in the exchange have seen their actuarial values sharply lowered.”
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Here’s a different angle: I’ve just posted on the alternatives in the health-care insurance reform debate, assessing them with respect to federalism. That is, I suggest that we include an assessment of the likely impact on the system of governance itself. If you want to have a look, here is the link: http://euandus3.wordpress.com/2009/10/27/health-care-insurance-reform-a-spectrum-of-alternatives-with-respect-to-federalism/
You might also be interested in this NYT article:
http://www.nytimes.com/2009/10/27/health/policy/27health.html?_r=1&hp