Paying For The Health Bill

One of the more interesting conundrums of the health bill negotiations is the desire to increase the affordability provisions of the bill (in essence, the subsidies, the Medicaid eligibility will almost certainly remain at 133% of FPL as set by the Senate bill) while at the same time cutting the reach of the excise tax (without replacing it with with the House surtax on the wealthy.) E.J. Dionne writes:

Almost everyone in both houses wants to find ways of making insurance more affordable. Steps in this direction would include more generous subsidies for the purchase of insurance than those in the Senate bill and expanding its Medicaid provisions. The bill's price tag will grow from the Senate's $871 billion over a decade, probably to somewhere between $930 billion and $950 billion.

Expanding Medicaid eligibility would actually make the bill cheaper, because Mediciad will be less expensive than subsidizing the purchase of private insurance. Of course, it will not happen because that takes away market share from the insurance companies. The question then is how would the expanded subsidies be paid for? The excise tax is under assault:

The tax on "Cadillac" insurance plans, opposed by both organized labor and the insurance industry, is likely to be scaled back but not eliminated. Currently, the Senate bill includes a 40 percent excise tax on high-end health insurance plans -- those at or above $23,000 for families and $8,500 for individuals. Many opponents would settle for raising that ceiling to $28,000 for families, with a comparable increase for individuals. That would reduce the number of policyholders covered by the levy.

(Emphasis supplied.) It would indeed. And of course it would reduce the revenue from the excise tax. so where's the money going to come from? We have an increase in the subsidies and a decrease in the revenue from the excise tax.

In addition, Ben Nelson's deal has been such a headache, that the negotiators are looking to extend that deal to all the states:

negotiators are looking to extend to all states a version of the special deal that saved Sen. Ben Nelson's home state of Nebraska from the bill's increased Medicaid costs. Nelson himself is pushing for this change, which would cost $25 billion to $30 billion over 10 years. One solution: somewhat more modest across-the-board Medicaid relief to all states.

Huh? "More modest across-the board Medicaid relief" to all states sounds like the OPPOSITE of the Nelson deal. What's Dionne talking about?

This sounds like mostly malarkey to me. I expect we'll get the Senate bill, and Nelson will probably have to give up the deal for Nebraska. It is possible however that a trade off of the reach of the excise tax for expansion of the Senate Medicare tax on income over $200,000 a year will happen. Other than that, I expect the Senate bill.

Speaking for me only

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  • Display: Sort:
    It's unconscionable that (5.00 / 4) (#1)
    by Anne on Mon Jan 11, 2010 at 10:22:37 AM EST
    almost everyone in both houses is hell-bent on making insurance more affordable, and doing very little - maybe nothing - to make the CARE people need more affordable.

    But, I guess this is what happens when our legislators decide it is more important to keep their corporate relationships well-greased than it is to see to the needs of their constituents.

    It's beyond disappointing.

    Oh but the poor . . (5.00 / 1) (#4)
    by SOS on Mon Jan 11, 2010 at 10:53:27 AM EST
    ya know and those people barely getting by from paycheck to paycheck . .  they can still afford $800 a month extra! That's easy in the United States of America!

    Go to college! (none / 0) (#5)
    by SOS on Mon Jan 11, 2010 at 10:58:26 AM EST
    Get a degree so your entitled to sit out the rest of your life in an office or cubical.  

    That's really what this always was going to be (none / 0) (#2)
    by andgarden on Mon Jan 11, 2010 at 10:29:39 AM EST
    given the 60 vote insistence.

    IMO it wouldn't have been (5.00 / 1) (#7)
    by dk on Mon Jan 11, 2010 at 10:59:38 AM EST
    any different if only 50 votes had been necessary.

    Now we know why the AMA got on board (none / 0) (#6)
    by jimakaPPJ on Mon Jan 11, 2010 at 10:58:35 AM EST
    You read my mind! (none / 0) (#15)
    by mjames on Mon Jan 11, 2010 at 01:14:45 PM EST
    Incredible how insurance and actual care keep getting mixed up.

    LOL (5.00 / 2) (#3)
    by SOS on Mon Jan 11, 2010 at 10:52:02 AM EST
    "Almost everyone in both houses wants to find ways of making insurance more affordable."


    Being politically "pragmatic" once meant (5.00 / 3) (#9)
    by esmense on Mon Jan 11, 2010 at 11:28:55 AM EST
    not getting too far out ahead of the voters. But the health care debate has more clearly than ever revealed that for these beltway "liberals" it has come to mean not ruffling the feathers of vested interests -- voters and consumers be damned.

    They refuse to challenge the conservative myths and marketing that serve those interests -- no matter how impractical, wrong-headed and outright disasterous they may be when applied to the problem at hand. Their own career interests, apparently, requires that they instead spend their time arguing with those who do challenge those myths.

    What health bill? (5.00 / 3) (#10)
    by TeresaInSnow2 on Mon Jan 11, 2010 at 12:07:35 PM EST
    This is an insurance bill.

    If only last winter we had had a popular Dem (5.00 / 1) (#20)
    by ruffian on Mon Jan 11, 2010 at 02:10:06 PM EST
    with a very high approval rating who could have sold the country on the need for progressive across the board tax increases to pay for the wars and government provided services, while keeping the deficit under control.

    1 - 2 punch to political wilderness (none / 0) (#8)
    by pluege on Mon Jan 11, 2010 at 11:09:01 AM EST
    1. forcing people who don't want health insurance at all to pay for crappy insurance

    2. forcing people to choose between paying more for insurance they already have or get crappier insurance for the same money.

    The democrats are truly political geniuses. The republicans OTOH are in pure ecstasy with this turd the democrats are planning to lay; and even if the republicans manage to kill the bill with a Senate win in Ma., the political damage to democrats is already substantial.

    If the republicans win MA-Sen (none / 0) (#11)
    by cenobite on Mon Jan 11, 2010 at 12:44:40 PM EST
    The administration is likely to get an HCR bill passed anyway.

    A bill has already passed the senate, the administration will just ram it down the house's throat verbatim, voila, HCR bill for preznit to sign.


    Dodd (none / 0) (#12)
    by jbindc on Mon Jan 11, 2010 at 12:50:06 PM EST
    Says the bill is "hanging on by a thread"

    Then it should save itself (5.00 / 2) (#13)
    by Militarytracy on Mon Jan 11, 2010 at 01:06:03 PM EST
    It should become something that the voters want!  What a huge bunch of total fricken idiots!

    They should have liked something (5.00 / 1) (#14)
    by Militarytracy on Mon Jan 11, 2010 at 01:11:04 PM EST
    different indeed!  They should have pulled their heads out of their arses and took a good look at their constituents.  Liked something different pffft....they should have taken one moment to care about somebody other than themselves.  Now that they've tasted the public outrage they should have liked something different?  And Dodd tries to explain it away with magnitude?  God Dodd, if this is your new freedom to speak openly because you aren't running I can't wait for you to be completely GONE and it is no wonder that you are GONE in the fashion that you are!

    Now yo'ure just talkin' crazy (5.00 / 2) (#16)
    by jbindc on Mon Jan 11, 2010 at 01:19:31 PM EST
    Politicians?  Actually listen to what their constiuents want?

    Just lie down and get a cold cloth for your head.  Maybe call a priest for an exorcism.  Don't know where you'd get crazy thoughts like that....


    I have been diagnosed nuts (5.00 / 1) (#17)
    by Militarytracy on Mon Jan 11, 2010 at 01:27:40 PM EST
    many times in the Sphere :)

    Jesus I'm just livid after reading that (none / 0) (#18)
    by Militarytracy on Mon Jan 11, 2010 at 01:32:02 PM EST
    I have to get beyond it somehow.  You can certainly tell that Dodd has something nice, juicy, and lucrative lined up for his "retirement".  KMA Dodd, you Daschle wannabe!

    Maybe Dodd (none / 0) (#19)
    by jbindc on Mon Jan 11, 2010 at 01:38:22 PM EST
    feels liberated to say anything he darn well pleases, now that he doesn't have to worry about a campaign?

    So this is the real Dodd? (none / 0) (#21)
    by Militarytracy on Mon Jan 11, 2010 at 02:10:13 PM EST
    I had him built up in my imagination into something that was human.

    You know, I don't get the impression (none / 0) (#22)
    by inclusiveheart on Mon Jan 11, 2010 at 02:16:05 PM EST
    that he is all that bright.

    Me too! (none / 0) (#23)
    by Militarytracy on Mon Jan 11, 2010 at 02:23:01 PM EST
    I don't think I'm all that bright because I just suddenly realized that Senator Dodd is not all that bright.  What are those brain vitamins called again?

    You're plenty bright. (5.00 / 2) (#24)
    by inclusiveheart on Mon Jan 11, 2010 at 03:36:52 PM EST
    The level of packaging that these politicians come with these days makes it really difficult to take a full measure of their value.  Not that it was ever really easy, but the art of spin and publicity is at an all time high while at the same time the reporting class have fallen into deep decline and corruption.  That leaves a gap a mile wide for these pols to slither through.  As long as they toe the party line within the ranks of the powerful, it doesn't matter how dumb, scummy or morally bankrupt they are, they will continue to be allowed to fail upwards as it seems Dodd may have done for so many years.

    Why would intelligent people (none / 0) (#26)
    by Cream City on Mon Jan 11, 2010 at 09:29:32 PM EST
    want to be surrounded by the fools in politics these days.  Really.  I can recall when at the top there was a sufficient number of truly brainy and dedicated folks to make a difference.  And they did.

    Now, I begin to see why Congress has such a great health insurance plan for itself.  As employers have found, you have to give good benefits to get people to work there.  Of course, as soon as Congress started to go downhill, it did stoopid human tricks that encouraged other employers to stop offering good benefits. . . .


    nonsense (none / 0) (#25)
    by Abdul Abulbul Amir on Mon Jan 11, 2010 at 06:01:08 PM EST
    Almost everyone in both houses wants to find ways of making insurance more affordable.

    What utter nonsense.  Taxing medical devices and health insurance will raise not lower insurance cost.  Both bills are chock full of mandates that will raise costs and thus insurance premiums.

    As a second observation, the feds did such a fine job making housing "affordable."