The Camel's Nose Barely Sneaks Under The Tent In The Health Insurance Premium Assistance Bill

Ezra Klein generally has the best sources on the health insurance bill and he writes:

The deal looks pretty much like it's looked for the past few days: The Office of Personnel Management will shepherd national, non-profit plans into existence. Medicare will open to folks between 55 and 64 who are eligible for the exchange. If the national non-profit plans don't materialize, then there appears to be a trigger that will call a public plan into the market, but that seems pretty unlikely. All of this, of course, is contingent on CBO giving it a good score.

The camel's nose here is the expansion of Medicare eligibility to a group beyond those 65 and over. That group is defined as persons between the age of 55 and 64 who qualify for the Exchange (stevie makes a great point in comments - if dependents can be covered in a Medicare buy-in this becomes a more meaningful provision - progressives should demand that concession.) It's a start. Lowering the eligibility age now becomes an acceptable concept. Now there needs to be a tweak to all of this imo - the individual mandate must be limited to those persons who will be eligible for the Exchange AND who qualify for the new Medicare expansion and/or the new Medicaid expansion. To wit, you are only mandated to purchase health insurance IF you are eligible for a public insurance plan (Medicaid or Medicare.) I would also support mandating coverage for persons who make $200K a year or more. I also prefer the House funding mechanism.

If the bill can end up in that final form, I would support it.

Speaking for me only

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    Medicare for 65+ is for eligible individuals only. (5.00 / 1) (#2)
    by steviez314 on Wed Dec 09, 2009 at 08:25:29 AM EST
    I wonder if the 55-64 buy in will allow younger dependents to buy in too, like spouses.  (I'm 53 and my wife would be eligible, but I'm not saying more!)

    In fact, if they combine that with a dependent cutoff age of 30 (which New York State has now gone to), a whole lot of people could get into the 55-64 Medicare buy-in.

    Note, the definition of dependent in all this is not the one used per IRS tax rules, but much looser.

    Great point! (none / 0) (#3)
    by Big Tent Democrat on Wed Dec 09, 2009 at 08:31:25 AM EST
    I'll add that to my post.

    Will the House accept this though? (5.00 / 1) (#4)
    by lilburro on Wed Dec 09, 2009 at 08:34:27 AM EST
    Also this sounds sort of dumb (TPM):

    That buy-in option would initially be made available to some uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized--people will have to pay in without federal premium assistance--and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.  [emphasis supplied]

    Is Obama trying to lose an election?  

    Medicare for the rich???  Jeebus.

    The public option was not subsidized ... (5.00 / 1) (#7)
    by Demi Moaned on Wed Dec 09, 2009 at 08:48:00 AM EST
    either, IIRC, apart from some seed money to make the plan solvent from the start.

    Expensive is relative. Would it be more expensive than what people could expect under the public option?


    Less expensive (5.00 / 2) (#15)
    by Big Tent Democrat on Wed Dec 09, 2009 at 09:10:55 AM EST
    Remember Robust Po was Medicare +5.

    That's what I would have thought (none / 0) (#18)
    by Demi Moaned on Wed Dec 09, 2009 at 09:21:02 AM EST
    No one was ever promising that health insurance under the public option would be cheap to consumers, just that you could actually get it and that you would really be covered if you need it.

    Well, I am not sure (none / 0) (#12)
    by lilburro on Wed Dec 09, 2009 at 09:02:12 AM EST
    how expensive it will be, so I can't speak to what expensive really means here.  It just seems like a dumb idea - here, we fixed things slightly, but it's still not at the price point it should be.  Ugh.  To me this kind of dumb sh*t makes me wonder WTF Obama is thinking.

    Less expensive than private insurance (none / 0) (#6)
    by Big Tent Democrat on Wed Dec 09, 2009 at 08:46:26 AM EST
    If structured exactly like Medicare, (5.00 / 2) (#19)
    by MO Blue on Wed Dec 09, 2009 at 09:55:04 AM EST
    it will also provide less coverage than your standard insurance policy.

    Medicare Part A deductible in 2009 is $1,068. Medicare Part B deductible is $135.00 per year.

    After the deductible is met, Medicare only pays 80% of the amount of services for the remainder of the period. Also, Medicare does not have any prescription drug benefits. So you would have to pay full price for all drugs.

    Here is what some of the cost for hospital or Skilled Nursing Facility would be in 2009.

    For each benefit period you pay:

    *A total of $1,068 for a hospital stay of 1-60 days.
    *$267 per day for days 61-90 of a hospital stay.
    *$534 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
    *All costs for each day beyond 150 days

    Skilled Nursing Facility Coinsurance

    *$133.50 per day for days 21 through 100 each benefit period.

    If the Medicare buy-in premium is expensive to begin with and would require a person to either pay out of pocket for services or purchase additional private insurance, the cost might well exceed the private insurance premium.


    So (5.00 / 1) (#26)
    by hookfan on Wed Dec 09, 2009 at 10:26:59 AM EST
    is this new proposal a camel's nose or a pig's snout? Hmmmm. . . . .
       Let's see:
    Extremely limited population, something like 2-3 million check
    Limited financial resources to qualify, possibly limited to 133% of poverty check
    no subsidies to defray expense for 4 or so years check
    limited price controls due to no cap deductible or co pays for catastrophic coverage check
    no subsidy to defray expense of purchasing supplemental insurance to cover for lack of deductible or co pay controls check

    So, what's not to like about charging more to people who make less, while mandating everyone to purchase insurance that will continue to rise at 10 to 15 per cent/year? By the time we get to the exchanges we'll all be paying 50% more than now, on wages that appear to not be going anywhere but south (or at best, stay the same-- if you have or can keep a job). But the insurance companies will be happy! That really is a type of reform.
       But is it a camel's nose or a pig's snout?


    If this proposal does not turn out to (5.00 / 2) (#35)
    by Anne on Wed Dec 09, 2009 at 12:14:24 PM EST
    be a firewalled program separate from the existing Medicare structure, the premiums for buy in may not be as daunting as have been suggested.

    What's missing from your 2009 information is this (which is 2010 info):

    Part A: (Hospital Insurance) Premium

    Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.

    The Part A premium is $254.00 per month for people having 30-39 quarters of Medicare-covered employment.

    The Part A premium is $461.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

    Part B: (Medical Insurance) Premium

    Most beneficiaries will continue to pay the same $96.40 premium amount in 2010.  Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium in 2010.  For additional details, see our FAQ titled: "Will my Medicare Part B premium increase in 2010?"

    For all others, the standard Medicare Part B monthly premium will be $110.50 in 2010, which is a 15% increase over the 2009 premium.  The Medicare Part B premium is increasing in 2010 due to possible increases in Part B costs.  If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $110.50 per month.  For additional details, see our FAQ titled: "2010 Part B Premium Amounts for Persons with Higher Income Levels".

    I agree that a $461 monthly premium may be prohibitively expensive for those who are unemployed and do not have enough quarters of Medicare-covered employment, but if someone had 10 years of qualified employment, their premiums would be less than $100/month.

    What I am afraid of, though, is this so-called expansion of Medicare will not end up being a real expansion, but a creation of something they will call Medicare Junior or Pre-Medicare that will be firewalled off from the real thing.  

    And they probably believe that as long as the name "Medicare" is in there somewhere, this will make people happy; they just don't get that eventually, people will know the truth.


    Yup, Medicare Junior (5.00 / 1) (#39)
    by beowulf on Wed Dec 09, 2009 at 01:43:05 PM EST

    They aren't talking about expanding Medicare eligibilty, which would simply involve amending the Social Security Act to drop the threshold age from 65 to 55 (or for that matter, 50 or birth) and then increase the payroll tax to cover the projected Part A spending increase (the 75% premium subsidy for Part B and Part D are paid out of general revenue).  Most seniors buy a private Medigap policy to cover catastrophic costs, Medicare doesn't cap out of pocket costs.

    Apparently, this proposal would use the Medicare provider network and rates (though Conrad wants to gut this part) but would require those in the 55 - 64 group who qualify to  "buy in" to Medicare.  I dunno, giving near-seniors the opportunity to pay without subsidy, 4 separate unsubsidized monthly premiums (A, B, D, Medigap), doesn't strike me as not the best proposal, politically or policywise.

    As I mentioned here the other day, I think the smarter play is to let civilians buy into the Tricare Reserve Select (even if the premiums were age-adjusted and unsubsidized, it'd still be a bargain).


    The more I read, the more I realize (5.00 / 3) (#40)
    by Anne on Wed Dec 09, 2009 at 02:23:52 PM EST
    that once again, there is precious little real information to be had beyond a lot of catch-words that lead people to think they might be able to get something of real value.

    What bothers me most is that there are so many people out there who are just desperate for help; it's a pretty sad day when, for some people, a real treat is being able to afford to see the doctor, or pay for much-needed medicine.

    And these desperate people, along with the rest of us who are nervously watching our premiums go up and our coverage go down, are being bamboozled to a fare-thee-well by politicians whose priorities have had almost nothing to do with effecting real and positive change, and almost everything to do with keeping their own jobs - which they are performing well below the level at which they ought to still have them - and for which they will no doubt have not a scintilla of humility about asking us for money to let them keep up that cr@ppy work.

    There is going to be hell to pay, and the shame of it is that the consequences, the least of which will be political - will be paid in real lives by real people.


    Probably (none / 0) (#8)
    by andgarden on Wed Dec 09, 2009 at 08:49:02 AM EST
    I'd like to see the numbers, though.

    I think Ezra calculated (none / 0) (#16)
    by Big Tent Democrat on Wed Dec 09, 2009 at 09:11:34 AM EST
    30% less. but I can't just rely on Ezra when I question him on other things.

    Not very onerous (5.00 / 1) (#5)
    by Demi Moaned on Wed Dec 09, 2009 at 08:44:31 AM EST
    I would also support mandating coverage for persons who make $200K a year or more.

    I expect the percentage of such people without insurance is very small, so it shouldn't be a hard sell.

    I doubt (5.00 / 2) (#10)
    by Ga6thDem on Wed Dec 09, 2009 at 08:50:53 AM EST
    that the mandate situation will be changed though. Through all the changes the fact is that the mandate has NOT changed. So no matter what's in the final bill I find it likely that everyone will be mandated to have insurance.

    True but (none / 0) (#14)
    by Big Tent Democrat on Wed Dec 09, 2009 at 09:10:09 AM EST
    the Medicare expansion idea came out of the blue as well.

    But for Obama, (none / 0) (#43)
    by Makarov on Wed Dec 09, 2009 at 07:00:52 PM EST
    who campaigned in opposition to a personal mandate, the mandate is likely sancrosanct. Same for Congressional leaders and the lobbyists who wrote these bills.

    thank you again BTD (5.00 / 3) (#13)
    by Capt Howdy on Wed Dec 09, 2009 at 09:03:16 AM EST
    for staying on this.  if I had to do it I would blow my brains out.  it makes my head hurt.

    Most important part (5.00 / 1) (#22)
    by robotalk on Wed Dec 09, 2009 at 10:10:28 AM EST
    is ability of OPM to set up a public option if cost goals are not met.  Leverage baby.

    The problem with this (and FEHBA) is you would now have two levels of bureaucracy where one or none is necessary.  OPM will be negotiated with insurers which will in turn negotiate with healthcare providers.  So, we keep all of the high costs of administration and bad claims processing of the insurers when there is no reason the OPM could not just negotiate and administrate itself.  Or you could have medicare for all and eliminate both.

    BTW, there needs to be OPM control on insurer claims administration as well as cost containment to make this work.

    Yeah right - a trigger (5.00 / 2) (#23)
    by MO Blue on Wed Dec 09, 2009 at 10:15:47 AM EST
    Please provide me with a link for a trigger that was actually ever pulled.  

    I got no problem with them (none / 0) (#28)
    by robotalk on Wed Dec 09, 2009 at 10:41:19 AM EST
    pulling the trigger right now, if the target is the insurance companies.  I just don't think they've got the power to get that done.

    They do have to have language that the trigger is fixed and certain, not just a bluff.


    I agree completely (none / 0) (#1)
    by andgarden on Wed Dec 09, 2009 at 08:24:00 AM EST

    Looks like Feingold doesn't agree (5.00 / 1) (#20)
    by Cream City on Wed Dec 09, 2009 at 09:58:08 AM EST
    yet that it's good for the public, just more goodies for the insurance industry.  His office just sent this from his announcement of opposition to the newly negotiated mess last night:

        "While I appreciate the willingness of all parties to engage in good-faith discussions, I do not support proposals that would replace the public option in the bill with a purely private approach.  We need to have some competition for the insurance industry to keep rates down and save taxpayer dollars.  I will base my vote on the bill on the entirety of what is in the bill, and whether I think the bill is good for Wisconsin."


    he very "ho hum" in my book. (none / 0) (#25)
    by Salo on Wed Dec 09, 2009 at 10:19:04 AM EST
    He would have been a good Presidential standard bearer for a PO.  But he backed off.

    He had to do so -- the second divorce (none / 0) (#29)
    by Cream City on Wed Dec 09, 2009 at 11:07:30 AM EST
    tainted his purity, per some polling.  Plus, the timing probably meant he wanted time with his daughters.

    This is good news (none / 0) (#44)
    by Makarov on Wed Dec 09, 2009 at 07:03:37 PM EST
    Bernie Sanders seemed to indicate last night he wouldn't support the bill. I think three liberals opposed to this pile is all we need to sink it.

    And . . . IF Nelson and Reid are stopped (none / 0) (#9)
    by Cream City on Wed Dec 09, 2009 at 08:49:32 AM EST
    from another pseudo-Stupak Amendment attempt.  Reid is reported as "happy" to keep working with Nelson.

    Camel's nose is about right (none / 0) (#11)
    by ruffian on Wed Dec 09, 2009 at 08:59:26 AM EST
    In the inevitable event that the new insurance regulations fail to change insurance company practices or keep rates down, there will be a structure in place for further expansion of Medicare in 5 years, or whenever enough people decide they have finally had enough of being ripped off by insurance companies.

    I thought/hoped we could do so much more now, but I guess I was wrong.

    BTD (none / 0) (#17)
    by ding7777 on Wed Dec 09, 2009 at 09:20:53 AM EST
    You're doing a great job... here's another site demanding/expalining HCR

    good plan (none / 0) (#24)
    by Salo on Wed Dec 09, 2009 at 10:17:08 AM EST
    good progress.  However why is it impossible for working age people to have a publically administered p[lan they can buy into?  

    I suppose that teh next logical reform in about 8 years or so.

    Not impossible, just violates the first (5.00 / 4) (#27)
    by ruffian on Wed Dec 09, 2009 at 10:31:57 AM EST
    principle of "Health Care Reform":

    No customers with measurable income shall be diverted from for-profit insurance companies.


    No Medicaid exansion in new Senate (none / 0) (#30)
    by MO Blue on Wed Dec 09, 2009 at 11:28:58 AM EST

    It appears as if liberals lost out on a Medicaid expansion that would have opened the program up to everybody under 150 percent of the poverty line. That ceiling will likely remain at 133 percent, as is called for in the current bill. link

    Lieberman still opposed to even a trigger for a public option.

    In a statement to reporters this morning, Sen. Joe Lieberman (I-CT) reiterated his longstanding position on the public option: Namely that he opposes any form of it, including if it's attached to a trigger mechanism.

    "My opposition to a government-run insurance option, including any option with a trigger, has been clear for months and remains my position today," Lieberman says.link

    Be interesting to see who has the most power in the Senate, Snowe or Lieberman.

    conflicting stories on that (none / 0) (#31)
    by Big Tent Democrat on Wed Dec 09, 2009 at 11:35:37 AM EST
    Conflict on which issue? (none / 0) (#33)
    by MO Blue on Wed Dec 09, 2009 at 12:05:05 PM EST
    Expanded Medicaid or Lieberman?

    The Medicaid part (none / 0) (#34)
    by Big Tent Democrat on Wed Dec 09, 2009 at 12:12:39 PM EST
    I was bemoaning (none / 0) (#32)
    by TeresaInSnow2 on Wed Dec 09, 2009 at 12:02:26 PM EST
    healthcare to my inlaws, at which point, my MIL told me the following that she hadn't previously shared.

    MIL was on federal retirement insurance.  She contracted uterine cancer when she was 64 (December 11, 2000) for which she saw a particular oncologist.  She became eligible for Medicare the following year, at which time the oncologist would no longer see her.  Dropped her like a hot potato when she wasn't even finished with her chemo.  If you have Medicare, it becomes your primary insurance and if the doctor doesn't take that insurance, they don't take you.  

    I hope people who opt for the 55+ Medicare know what little coverage they're going to get because of the fact that I've iterated over and over again.  Many doctors don't accept Medicare patients.

    It isn't necessarily that they don't accept (5.00 / 1) (#36)
    by Anne on Wed Dec 09, 2009 at 12:30:33 PM EST
    Medicare patients, it's that they don't accept Medicare's reimbursment rates as payment in full (along with co-pay by the patient).  

    Before my mother moved to a retirement community, she had an internist who did not participate in Medicare; my mother paid the doctor's fees, his office submitted the claim forms to Medicare as an accomodation, and the reimbursement was paid directly to my mother.  

    Did this mean she paid more?  I'm sure it did, and she was lucky to be able to do that - I know not everyone can.  And in the case of your mother-in-law, it had to be terrifying to have to start the process of finding a new doctor in the middle of cancer treatment.

    If anything, as we bounce between the good and the bad in the many proposals that have been made, it ought to be getting clearer to a lot of people that it was a huge, huge mistake not to give serious consideration to making the move to a single-payer system.  Medicare For All + 5 might very well be the answer to a number of problems with existing Medicare, but no one wanted to have it on the table, or the proponents even in the room.

    And so we muddle along...through the looking glass, indeed.


    There are Medicare Gap policies (none / 0) (#41)
    by MO Blue on Wed Dec 09, 2009 at 03:45:00 PM EST
    that pay for the excess of Medicare rates vs non provider rates. They are not that more expensive. Maybe a couple of dollars per month. The problem is if you have to pay for the services up front and don't have the funds to do so or if you have to have to file all the paper work yourself.

    So far I have not run into this situation, but who knows what will occur in the near future.


    This is why I do not want to be on Medicare! (none / 0) (#47)
    by BrassTacks on Wed Dec 09, 2009 at 09:58:39 PM EST
    I will gladly pay for my insurance forever, even though it isn't cheap, to avoid going on medicare.  Unfortunately, no one has that choice.  We have to go on medicare at 65.  

    This happened to my good friend when she turned 65.  Not only does she have to pay more for her medigap than she paid for insurance, she got dropped by some of her doctors.  She's a good democrat but she's upset that she's on medicare.  

    As a cancer survivor, I will pay whatever I have to pay to keep my oncologist.  Right now my insurance pays all of his fees, but I don't know what will happen when I have to go on medicare.  


    I'm not impressed (none / 0) (#37)
    by s5 on Wed Dec 09, 2009 at 12:43:04 PM EST
    I'm 34. This does absolutely nothing for me, and at this rate, we'll have Medicare for all in 400 years.

    It's interesting how this "compromise" gets its strongest supporters from people who are already middle aged. Way to play the identity politics, Senate.

    As usual, aging white Boomers own America. The rest of us just work here.

    Yup, YOU are the ones who will get stuck (none / 0) (#48)
    by BrassTacks on Wed Dec 09, 2009 at 10:00:42 PM EST
    With the BIG bills for the boomers, Black and White and Asian and Hispanic.  YOUR generation will pay for ALL of them.  I worry about you, my kids, and my grandkids.  You all will be paying up the wazoo, for the rest of your lives.  I'm sorry we're sticking you with the debts.  

    President Liberman not so sure (none / 0) (#38)
    by Slado on Wed Dec 09, 2009 at 01:10:01 PM EST
    Liberman reacts and points out the obvious

    I'm actually glad (5.00 / 1) (#46)
    by s5 on Wed Dec 09, 2009 at 08:31:02 PM EST
    If the trigger isn't good enough for Lieberman, if Snowe doesn't like the Medicare expansion, if Burris demands a public option, and if Nelson demands control over the nation's uteruses, then maybe we don't have 60 votes for even the crappy compromise, and we go back to trying to ram the original decent bill through using reconciliation.

    Don't hold your (none / 0) (#42)
    by BackFromOhio on Wed Dec 09, 2009 at 06:43:40 PM EST

    The Baucus Bill (none / 0) (#45)
    by Socraticsilence on Wed Dec 09, 2009 at 07:58:30 PM EST
    if you read the whole thing, or just the Chairman's Summary is actually pretty good- its various clauses seem to have a real point.