Now we know what was going on behind closed doors. A “gang of ten” senators (5 liberals, 5 conservatives) were taking the public option out of the Senate’s health care reform bill, in an effort to gain enough support to overcome a Republican-led filibuster.
The news is not as bad as it might seem, though, because the compromise alternative appears to include lowering the age of eligibility for Medicare to 55, and expanding the eligibility for Medicaid (though preliminary news accounts differ on whether the latter survived the conference). For the two affected groups – seniors between 55 and 65, and everyone under 150% of the poverty level – this would bring a single-payer, government-funded program into the mix.
Those of us who have preferred a single-payer system all along have reason to be heartened. This is actually much better -- again, for the affected groups -- than the anemic public option plans in either the Senate or House version of the health care reform bill. And it has the further advantage of building on an existing, successful government program rather than putting a new one in place.
Other good news coming from the compromise deliberations includes the following potential provisions: (1) allowing health insurers to sell policies nationally, thereby challenging monopolies in local markets; (2) providing access to a health insurance exchange through the Office of Personnel Management which provides lawmakers with their menu of health insurance choices; and (3) requiring insurance companies to spend 90% of their income on health benefits, bringing their administrative costs almost in line with Medicare.
Preliminary news accounts are also saying that the Medicare expansion provision will kick in as early as next year, rather than four years down the road under the current version of the public option.
The bad news – and it is far from insignificant – lies in the fact that everyone younger than 55 who is not eligible for Medicaid has been left out. With no public option available to them, and the mandate that they must purchase insurance, they are poised to be prime victims of the predatory private health insurance companies.
Hope for the younger middle class lies in two directions. First, if insurers really do come up with nationwide, non-profit policies for those otherwise unable to obtain insurance through their employers, affordable insurance in the private market place may be available to them. Secondly, if downward expansion of Medicare eligibility to age 55 works well (and it should, because these younger seniors should pay in more and take out less), the political momentum for extending Medicare for all should be increased.
All of this information is very tentative. Senate Majority Leader Harry Reid (D-NV) is appropriately withholding details until the Congressional Budget Office (CBO) has had time to assess the cost. Thus, we aren’t sure of what the provisions actually are, when they would take effect, or what, if anything, would trigger them. So stay tuned to the RioGrandeRift – your best source for informed news and commentary on the progress toward health care reform.