Worse Than We Hoped; Better Than We Expected

The public option survived - that's good. But so did opt-out - that's bad. The bill saves so much money it shuts down the fiscal opposition - that's good. But to get there it had to postpone implementation to 2014 - that's bad. It raises taxes on the rich - that's good. But it also keeps subsidies too low to help the middle-class - that's bad.

The best thing about it is that it can probably get through Congress. The worst thing about it is that it can probably get through Congress.

Steve Benen has the overview:

Cost and deficit reduction: The Senate bill carries a price tag of $848 billion over 10 years, well below the arbitrary White House limit of $900 billion and less than the House version. The CBO estimates that the legislation will cut the federal budget deficit by $130 billion in the first decade, and a hard-to-believe $650 billion in the second decade.

Timing of implementation: To make the bill more affordable, the effective date of the Senate reform package would be 2014, a year later than the House bill.

Financing: To pay for reform, Reid's plan would impose an excise tax on the so-called "Cadillac" plans (insurance packages worth more than $23,000). There would now also be a 5% tax on elective cosmetic surgery (which would exclude procedures on those with congenital abnormalities, disfiguring diseases, or traumatic injuries). Reid also proposes a 0.5% increase to the Medicare payroll tax for families earning more than $250,000.

Subsidies: Medicaid would be expanded to 133% of the poverty line, and subsidies would help those making up to 300% of the poverty line -- which is short of the 400% threshold that many progressive reform advocates had hoped for. Instead, Reid would impose regulations on insurers to cap expenses for those between 300% and 400% of the poverty line.

Coverage: The bill would extend coverage to 31 million uninsured Americans, bringing insurance to 94% of the population. About a third of those left out would be undocumented immigrants.

Public Option: As expected, Reid went with a national public-option plan, which states could pass laws to opt out of.

Abortion: Reid steered clear of the Stupak amendment language, but would separate abortions paid for through premiums and taxpayer subsidies. The provision is a little complicated, but to make a long story short, Sen. Barbara Boxer (D-Calif.) loves what Reid came up with, and the U.S. Conference of Catholic Bishops is livid.

Mandates: There's an individual mandate, but the penalties are fairly weak. There is no formal employer mandate, but there are some modest fines imposed on larger employers who fail to cover their workers.

Anti-trust: Bucking to demands from Sen. Ben Nelson (D-Neb.), the Senate bill does not end anti-trust exemptions for the insurance industry.

Jane Hamsher at Firedoglake has the bad news bottom line.

Yet in the midst of quibbling about $90 billion a year for health care, the President just signed a one year $680 billion defense spending bill, which does not include the cost of the wars in Iraq and Afghanistan. This represents a serious problem with the priorities of those in government.

But while people struggling with crippling health care costs and pre-existing conditions may have to wait until 2014 for relief, states can begin opting out immediately. That means for the next four years, health care will become a partisan football at the state level, easily gamed by the same insurance company lobbyist dollars that flooded on to Capitol Hill this year. And just as 42 members of the House did the bidding of PhRMA and inserted language into the Congressional Record in support of their endless monopolies on biologic “drugs of the future,” the Senate bill followed suit and included the Anna Eshoo-written language which prevents generic versions of vital lifesaving drugs from ever coming to market.

Seventy-two percent of Americans believe it is important to give people the choice of a public option when forcing them to buy insurance. They do not trust insurance companies. A clear majority of the Senate agrees with them, and would willingly pass a bill with an unfettered public option. But Harry Reid has capitulated to lobbyist money and has allowed the Senate to be held hostage by Senators like Blanche Lincoln and Ben Nelson, who have each received over half a million dollars in campaign donations from insurance companies.

It is time to acknowledge that the Senate process is broken and undemocratic, and is working against the interests of the American people. It is too easily gamed by lobbyist money and has become unresponsive to the needs of small businesses struggling to pay for the health care costs of their employees at a time when unemployment is skyrocketing. The Senate filibuster — and the ability of any one Senator to hold the entire body hostage on behalf of lobbying interests — must come to an end.

If Harry Reid truly cares about fighting for the good of the country over the good of Wellpoint, he will immediately dispense with the opt-out and move to reconciliation and allow a majority in the Senate to deliver to Americans what they want and desperately need.