In the end, if there is no bill passed, the Congressmen most likely to go down to defeat as a result are the "Blue Dogs", in leaning Republican districts, where "failure to deliver" can easily see independents switching their support or just staying home in a midterm election.
And as long as the Senate passes SOMETHING, and the House passes a bill with a strong public option, its on the table in Conference, and what comes out of Conference "only" has to get 50 votes plus Biden.
The only way to stand up against the hardball tactics of the Congressmen trying to do everything they can to water down the bill up front so they can vote for "the President's Bill" without actually voting for the bill the President is asking for ... is to draw a line in the sand that tells the "Blue Dogs", vote for a bill with a strong public option and take the heat for that, or else see the bill go down in flames and take the more serious heat for that. I've been accused of being a Marxist, yet while Harpo's my favourite, it's Groucho I'm always quoting. Odd, that.
Highlights
SEC. 221. ESTABLISHMENT AND ADMINISTRATION OF A PUBLIC HEALTH INSURANCE OPTION AS AN EXCHANGE-QUALIFIED HEALTH BENEFITS PLAN.... (3) PROVISION OF BENEFIT LEVELS- The public health insurance option-- (A) shall offer basic, enhanced, and premium plans; and (B) may offer premium-plus plans.... (g) Access to Federal Courts- The provisions of Medicare (and related provisions of title II of the Social Security Act) relating to access of Medicare beneficiaries to Federal courts for the enforcement of rights under Medicare, including with respect to amounts in controversy, shall apply to the public health insurance option and individuals enrolled under such option under this title in the same manner as such provisions apply to Medicare and Medicare beneficiaries.... SEC. 222. PREMIUMS AND FINANCING. (2) START-UP FUNDING- (A) IN GENERAL- In order to provide for the establishment of the public health insurance option there is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, $2,000,000,000. In order to provide for initial claims reserves before the collection of premiums, there is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, such sums as necessary to cover 90 days worth of claims reserves based on projected enrollment.... (B) AMORTIZATION OF START-UP FUNDING- The Secretary shall provide for the repayment of the startup funding provided under subparagraph (A) to the Treasury in an amortized manner over the 10-year period beginning with Y1.... SEC. 223. PAYMENT RATES FOR ITEMS AND SERVICES.[capitation, i.e. constraints on earnings of medical services holding companies owned or referred to by PPO, HMO insurer firms, regardless of variance among "Exchange-participating" and non-"Exchange-participating" plans' benefit coverages]... (A) IN GENERAL- Except as provided in subparagraph (B) and subsection (b)(1), during Y1, Y2, and Y3, the Secretary shall base the payment rates under this section for services and providers described in paragraph (1) on the payment rates for similar services and providers under parts A and B of Medicare. (B) EXCEPTIONS- (i) Practitioners' SERVICES- Payment rates for practitioners' services otherwise established under the fee schedule under section 1848 of the Social Security Act shall be applied without regard to the provisions under subsection (f) of such section and the update under subsection (d)(4) under such section for a year as applied under this paragraph shall be not less than 1 percent.... SEC. 242. AFFORDABLE CREDIT ELIGIBLE INDIVIDUAL. (a) Definition- (1) IN GENERAL- For purposes of this division, the term `affordable credit eligible individual' means, subject to subsection (b), an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act)-- (A) who is enrolled under an Exchange-participating health benefits plan and is not enrolled under such plan as an employee (or dependent of an employee) through an employer qualified health benefits plan that meets the requirements of section 312; (B) with family income below 400 percent of the Federal poverty level for a family of the size involved;
(A) shall offer basic, enhanced, and premium plans; and
(B) may offer premium-plus plans....
(g) Access to Federal Courts- The provisions of Medicare (and related provisions of title II of the Social Security Act) relating to access of Medicare beneficiaries to Federal courts for the enforcement of rights under Medicare, including with respect to amounts in controversy, shall apply to the public health insurance option and individuals enrolled under such option under this title in the same manner as such provisions apply to Medicare and Medicare beneficiaries....
SEC. 222. PREMIUMS AND FINANCING. (2) START-UP FUNDING-
(A) IN GENERAL- In order to provide for the establishment of the public health insurance option there is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, $2,000,000,000. In order to provide for initial claims reserves before the collection of premiums, there is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, such sums as necessary to cover 90 days worth of claims reserves based on projected enrollment....
(B) AMORTIZATION OF START-UP FUNDING- The Secretary shall provide for the repayment of the startup funding provided under subparagraph (A) to the Treasury in an amortized manner over the 10-year period beginning with Y1....
SEC. 223. PAYMENT RATES FOR ITEMS AND SERVICES.[capitation, i.e. constraints on earnings of medical services holding companies owned or referred to by PPO, HMO insurer firms, regardless of variance among "Exchange-participating" and non-"Exchange-participating" plans' benefit coverages]...
(A) IN GENERAL- Except as provided in subparagraph (B) and subsection (b)(1), during Y1, Y2, and Y3, the Secretary shall base the payment rates under this section for services and providers described in paragraph (1) on the payment rates for similar services and providers under parts A and B of Medicare.
(B) EXCEPTIONS-
(i) Practitioners' SERVICES- Payment rates for practitioners' services otherwise established under the fee schedule under section 1848 of the Social Security Act shall be applied without regard to the provisions under subsection (f) of such section and the update under subsection (d)(4) under such section for a year as applied under this paragraph shall be not less than 1 percent....
SEC. 242. AFFORDABLE CREDIT ELIGIBLE INDIVIDUAL.
(a) Definition-
(1) IN GENERAL- For purposes of this division, the term `affordable credit eligible individual' means, subject to subsection (b), an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act)--
(A) who is enrolled under an Exchange-participating health benefits plan and is not enrolled under such plan as an employee (or dependent of an employee) through an employer qualified health benefits plan that meets the requirements of section 312;
(B) with family income below 400 percent of the Federal poverty level for a family of the size involved;
USD 0 - 185,160 (Alaska, 8 person HH)
and (C) who is not a Medicaid eligible individual, other than an individual described in section 202(d)(3) or an individual during a transition period under section 202(d)(4)(B)(ii).... SEC. 243. AFFORDABLE PREMIUM CREDIT... ------------------------------------------------------- The initial premium percentage is-- The final premium percentage is-- The actuarial value percentage is-- ------------------------------------------------------- 133% through 150% 1.5% 3% 97% 150% through 200% 3% 5% 93% 200% through 250% 5% 7% 85% 250% through 300% 7% 9% 78% 300% through 350% 9% 10% 72% 350% through 400% 10% 11% 70% -------------------------------------------------------
(C) who is not a Medicaid eligible individual, other than an individual described in section 202(d)(3) or an individual during a transition period under section 202(d)(4)(B)(ii)....
SEC. 243. AFFORDABLE PREMIUM CREDIT... -------------------------------------------------------
The initial premium percentage is-- The final premium percentage is-- The actuarial value percentage is--
-------------------------------------------------------
133% through 150% 1.5% 3% 97%
150% through 200% 3% 5% 93%
200% through 250% 5% 7% 85%
250% through 300% 7% 9% 78%
300% through 350% 9% 10% 72%
350% through 400% 10% 11% 70%
This story isn't about who is uninsured. It's not benefit quality. It's not benefit costs or the "affordability" of premiums. And it sure as shit isn't about brow-beating "teabaggers" and "single-payer" protesters.
It's always who collects the premiums. The MIC will avoid market share loss like plague; the business is already lucrative excluding uninsureds and stands to capture guaranteed revenue in fed payments for 40M+ uninsured. If Congress cuts eligibility to say 200% poverty level, "public option" will pass with the rest of the package --which is distinguished for defining health care "reform" entirely in terms of finacial coercion. Diversity is the key to economic and political evolution.
