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

By Big Tent Democrat, Section Other Politics
Posted on Wed Dec 09, 2009 at 08:11:24 AM EST
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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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The Camel's Nose Barely Sneaks Under The Tent In The Health Insurance Premium Assistance Bill | 47 comments (47 topical)

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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

Anne,

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).
http://www.tricare.mil/mybenefit/home/overview/Plans/ReserveSelect


: 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