Adding 15 Million to the Rolls of Medicaid, CHIP

Ezra Klein is getting pessimistic about the chances healthcare reform will pass based on comments by White House Chief of Staff Rahm Emanuel, and I don't think he's wrong to be.

But at the risk of beating a dead horse, I really think it's worth considering what is being given up by giving up on healthcare reform: The prospect of advancing the cause of universal healthcare.

The Senate bill is not a perfect bill -- but it is a bill that does a lot of good. Looking at just the toplines, the bill will ensure that 30 million more people have health insurance than currently do today. In doing so, the bill would also decrease the deficit by more than a trillion dollars over the next two decades.

Many have chided the Senate bill for not including a public option. This of course overlooks the fact that the House was unable to round up even a simple majority for the type of robust public option -- one with rates tied to Medicare -- that could actually help reduce costs. Nevertheless, this is a fair criticism.

That said, this criticism does miss a key aspect of the Senate healthcare bill: Half of those 30 million newly covered under the legislation would be enrolled in a government program. Here's the relevant portion of the CBO score (.pdf):

By 2019, CBO and JCT estimate, the number of nonelderly people who are uninsured would be reduced by about 31 million, leaving about 23 million nonelderly residents uninsured (about one-third of whom would be unauthorized immigrants). Under the legislation, the share of legal nonelderly residents with insurance coverage would rise from about 83 percent currently to about 94 percent. Approximately 26 million people would purchase their own coverage through the new insurance exchanges, and there would be roughly 15 million more enrollees in Medicaid and CHIP than is projected under current law. [Emphasis added]

Enrolling 15 million more Americans in a government healthcare program, as well as enabling an additional net 16 million to access health insurance -- in the process increasing "the share of legal nonelderly residence with insurance coverage from about 83 percent currently to about 84 percent," while also reducing the deficit by more than $1 trillion -- still seems like a worthwhile achievement, even if not a perfect one. And considering that the alternative appears to be doing nothing, or close to it, I'm not sure that it doesn't make sense for the House to pass the Senate bill.

Tags: 111th Congress, healthcare reform (all tags)

Comments

16 Comments

the burden is on the Senate

Any realistic path forward involves the Senate passing some bill via the reconciliation process. Until the White House and Harry Reid start moving on that front (twisting a few arms if need be), the House will not pass the Senate bill.

Rahm seems to be sending all the wrong signals to Democratic senators now.

by desmoinesdem 2010-02-01 04:43PM | 1 recs
RE: the burden is on the Senate

Watching the Bush tax cuts being phased out in the current budget as a result of their having been passed through the reconciliation process, which gives a finite rather than infinite window for the legislation, I'm still not convinced as to how reconciliation is the answer.

by Jonathan Singer 2010-02-01 04:50PM | 0 recs
RE: the burden is on the Senate

Not to mention in when the Bush tax cuts were passed the reconcilliation timeline was 10 years. Now it is 5 years.

I still think passing or trying to pass the medicare-buy-in for 55+ under reconcilliation is a good idea. Do it seperatly and not as part of the HCR bill. It can come into effect next year and in 5 years the exchanges and subsidies should be up and running so if it is axed or dilluted by the new GOP majority it won't be a big deal.

by vecky 2010-02-01 05:36PM | 0 recs
It's all about the elections

The Q is no longer policy, but electability. They need to ditch the mandate and keep the medicaid expansion and the subsidies. That also means ditching the pre-exisitng conditions clause, for which I hope democrats will be forgiven. The PO was not about policy, it was wedge which made the mandate acceptable (to liberals atleast). Ditto the excise tax needs to go - whatever it's policy merits the dems can't afford to piss of the unions. Though I also wonder what union backs a 24$ K health insurance plan for low income workers...

by vecky 2010-02-01 05:32PM | 0 recs
The bush tax cuts are not being phased out

Only the politically unpopular parts are. They couldn't risk "raising taxes on the middle class." Which was the point.

In the late 90s, there was legislation in California that allowed for a temporary vehicle license fee rebate because of the surplus. It also had a provision that let the Governor move rates back to what they were if there was a deficit.

Which is what Gray Davis did. And he was pilloried for "increasing taxes." 

If its popular, the fact that its technically "temporary" is irrelevent. Instead of having it kick in in 2013, it could kick in now. It would expire sooner, but if it were popular, lke a Medicare buy-in, it wouldn't be going anywhere.

You would have heartrending stories about 53 yr old laid off factor workers about to get kicked! off! Medicare! It would be as permanent as anything. And we'd have an actual accomplishment to run on.

by bay of arizona 2010-02-01 05:35PM | 0 recs
RE: The bush tax cuts are not being phased out

That sort of misses the point - the democrats would never have attacked the Bush tax cuts if they had not cut taxes for the rich (39.6 down to 35 % respectively) . If it was simply a middle class tax cut there would have been nothing to worry about.

Similarily with HCR - if it didn't expand government programs like medicaid for the poor and lower-middle class, Republicans wouldn't have a problem with it.

As for the Medicare buy-in - nothing is watertight. The GOP can gut the program just as they gutted medicaid. You can be sure the PO - even if it's popular will be completely gutted by a Republican HHS or Congress.

by vecky 2010-02-01 05:51PM | 0 recs
HR 3962 and 3590 are both horrible bills

They're horrible not for increasing the Medicaid pool, but for mandating many millions purchase junk insurance.

If a family pays out 10% of their income, say $5K a year, and ends up with deductibles and co-pays that cost an additional $5K-$10K that year if they become seriously ill, they haven't bought insurance. They've been scammed.

I don't understand why congress critters and some members of the creative class can't "get" that out of pocket maximums equaling 10-20% of annual income - on top of insurance premiums - will bankrupt the average American family. Of course, one may argue, only a small number of individuals and families will reach those maximums - just the ones that need a lot of medical care.

So, you pay a lot of money for "insurance" that won't pay for your medical care when you need it. Hence, "junk insurance".

Time to start over, and take a look at the real problem these bills don't begin to address: America spends two to three times as much as other countries for poorer results. Contrary to claims by fans of the "moral hazard" theory of health care, this isn't from unnecessary procedures. Citizens of Japan, for instance, receive more diagnostic imaging procedures than people in the US. The difference? They pay a fraction of what we do for the same thing.

by Makarov 2010-02-01 05:51PM | 0 recs
RE: HR 3962 and 3590 are both horrible bills

Total out-of pocket expenses are capped under the bill, as are acurial values for insurance, for famalies with incomes upto 400% of FPL. These are in both bills, though the House bill is slightly more generous to the lower end of the scale (<200%) and the Senate bill to the higher end (>200%).

by vecky 2010-02-01 06:08PM | 0 recs
RE: HR 3962 and 3590 are both horrible bills

I wouldn't be completely opposed if the insurance wasn't junk insurance - if deductibles and out of pocket expenses were capped at affordable levels. Of course, for many families that level is $0.

Since the subsidies are tiered only to junk insurance - guaranteed to bankrupt you if you get seriously ill, I oppose these plans.

by Makarov 2010-02-01 07:02PM | 0 recs
RE: HR 3962 and 3590 are both horrible bills

This is creepy, gentle people. Very, very creepy.

by QTG 2010-02-01 07:43PM | 0 recs
RE: HR 3962 and 3590 are both horrible bills

I believe total out-of-pocket expenses in the bill is capped at 12% of income (including the premium). Those lower on the FPL get a better cap. While the level of subsidies can definitly do with some improvement, finding the money in the midst of large budget deficits and a nation which can't stomach even the modest tax increases in the bills will be difficult.  But even then the subsidy level in the bills is better than the current subsidy level, which is zero.

by vecky 2010-02-02 04:15AM | 0 recs
HR 3962 and 3590 are both horrible bills

They're horrible not for increasing the Medicaid pool, but for mandating many millions purchase junk insurance.

If a family pays out 10% of their income, say $5K a year, and ends up with deductibles and co-pays that cost an additional $5K-$10K that year if they become seriously ill, they haven't bought insurance. They've been scammed.

I don't understand why congress critters and some members of the creative class can't "get" that out of pocket maximums equaling 10-20% of annual income - on top of insurance premiums - will bankrupt the average American family. Of course, one may argue, only a small number of individuals and families will reach those maximums - just the ones that need a lot of medical care.

So, you pay a lot of money for "insurance" that won't pay for your medical care when you need it. Hence, "junk insurance".

Time to start over, and take a look at the real problem these bills don't begin to address: America spends two to three times as much as other countries for poorer results. Contrary to claims by fans of the "moral hazard" theory of health care, this isn't from unnecessary procedures. Citizens of Japan, for instance, receive more diagnostic imaging procedures than people in the US. The difference? They pay a fraction of what we do for the same thing.

by Makarov 2010-02-01 05:51PM | 0 recs
RE: HR 3962 and 3590 are both horrible bills

" Time to start over, and take a look at the real problem these bills don't begin to address: America spends two to three times as much as other countries for poorer results. Contrary to claims by fans of the "moral hazard" theory of health care, this isn't from unnecessary procedures. Citizens of Japan, for instance, receive more diagnostic imaging procedures than people in the US. The difference? They pay a fraction of what we do for the same thing. "

Well, good luck on forcing doctors and clinics to take a pay-cut. They are already claiming that Medicare (let alone medicaid) rates are too low. The House bill actually increases Medicaid payments (to on par with medicare) as a sop to doctors to cater to more people on the program.

by vecky 2010-02-01 06:12PM | 0 recs
Let's kill all the Bills

Stay the course.

by QTG 2010-02-01 06:14PM | 0 recs
RE: Let's kill all the Bills

better than handing insurance companies $100B / year to use as they see fit - making sure we don't ever have actual health CARE reform

by Makarov 2010-02-01 07:00PM | 0 recs
RE: Let's kill all the Bills

Well not all of it. 85% of it has to go to pay medical expenses. Which will go some way to stop the rot in the system.

by vecky 2010-02-02 04:17AM | 0 recs

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