I have been following the health-care debate for much longer than I thought it would be possible, watching more C-Span than I had ever desired or thought possible. And, sometimes, I cannot help but wonder (cue Carrie Bradshaw voice-over here): What exactly are the House and the Senate fighting over? Why won't the House just pass the Senate bill and get this health-care reform effort done this week? Even after issuing a strong directive earlier today, Obama does not expect action until the end of the month. But the two bills have a broadly similar structure and the same goal: extend health insurance to more Americans. What is the holdup?Two words: actuarial value.
I have been following the health-care debate for much longer than I thought it would be possible, watching more C-Span than I had ever desired or thought possible. And, sometimes, I cannot help but wonder (cue Carrie Bradshaw voice-over here): What exactly are the House and the Senate fighting over? Why won't the House just pass the Senate bill and get this health-care reform effort done this week? Even after issuing a strong directive earlier today, Obama does not expect action until the end of the month. But the two bills have a broadly similar structure and the same goal: extend health insurance to more Americans. What is the holdup?
Two words: actuarial value.
In nonwonk terms, actuarial value is what percent of health-care costs an average subscriber can expect to be on the hook for. An insurance plan with a 70 percent actuarial value, for example, can expect their insurance to pick up 70 percent of the tab and cover 30 percent themselves. Short story: lower actuarial value, higher cost for the policyholder. And over on the Senate bill, the actuarial values of plans that low-income Americans would likely enroll in are consistently lower than those of the House. The midlevel health insurance in the Senate bill, the silver plan, has an actuarial value of 70 percent. The comparable House-side plan--the enhanced plan--has an actuarial value of 85 percent. And for all other tiers of plans--bronze through platinum on the Senate side; basic through premium plus in House language--the Senate bill would require consistently lower actuarial values. (If you want to get into the weeds how actuarial values effect different levels of low-income families, the Center on Budget and Policy Priorities has done an excellent job with two helpful reports here and here).
To show how ridiculous this can be, using the same benefit guide (link above) for a family with a $10,000 deductible plan, the out-of-pocket maximum looks like it is $7,000, but it is actually $17,000 for In-Network services ($7,000 plus $10,000 deductible), plus $25,000 for Out-of-Network ($15,000 plus $10,000 deductible). In addition to this $42,000, the family must pay monthly premiums, all Out-of-Network costs in excess of the allowable charges, and any services that are not a benefit of the plan (no maternity benefits for a young family!). Read more...
Read more...
It's a pretty funny scenario, if you are a literate pirate. Diversity is the key to economic and political evolution.
The Post described Gruber in 2007 as "possibly the party's most influential health-care expert and a voice of realism in its internal debates." How can a "voice of realism" claim that this is "a tax that's not a tax," one that affects "generous" plans? That statement was published only nineteen days after a paper in the influential journal Health Affairs (summarized here) disproved it. Using actual benefits data, the authors showed the tax would not target "generous" plans. Instead it would unfairly affect plans whose enrollees were older, worked in the wrong industry, or lived in an area where treatment costs are high. A leading actuary came to a similar conclusion.
...and Hacker.
Hacker's article for Slate bore the condescending title, "Better medicine: Fixing the left's health care prescription." The problem in need of "fixing," according to Hacker, was "the left's" support for single-payer. Hacker urged "the left" to support instead his proposal to "give employers the option of providing ... coverage to their workers through a new public program modeled after Medicare" or through the insurance industry, a proposal that would, by 2009, be called "the public option" for short.
I think a 6-part series qualifies for stalking, do you? Diversity is the key to economic and political evolution.
