Friday, December 11, 2009

Voters Are Right: They'll Pay a Lot for Health Care Reform

By Mort Kondracke

The White House and liberal think tanks insist that health care reform will lower costs, but the public isn't buying it - and for good reasons.
Practically every aspect of the bills Democrats are considering - from covering the uninsured to taxes on providers, insurance reforms and Medicare cuts - will result in higher premiums for those with insurance.


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And unless Congress is willing to impose stricter cost controls than presently contemplated, many experts think there's little chance of "bending the curve" of national health outlays or premiums.
Moreover, while the Senate's new privately run alternative to a government-run public insurance plan is a welcome step away from Canadian-style single-payer health care, the idea of allowing people ages 55 to 64 to buy into Medicare could be an even bigger step toward it.
And, even if President Barack Obama triumphantly signs a health care bill, there's a political menace in it - taxes and premiums will rise immediately, but most benefits won't be seen until 2014.
Americans generally aren't aware of that, and yet a new Quinnipiac University poll shows that by 52 percent to 38 percent, the public opposes Congress's health care plans and, by 56 percent to 38 percent, disapproves of Obama's handling of the issue.
Deservedly, though, Republicans aren't beneficiaries of public displeasure. Voters still trust Obama more than the GOP on health care, 44 percent to 37 percent.
That's probably because Republicans have harped - often hyped - the negatives about Obamacare while barely mentioning positive alternatives, to the extent that they have them.
On the Senate floor, for instance, Republicans suddenly have become great defenders of Medicare - opposing "cuts" for "grandma" - but as Senate Finance Chairman Max Baucus (D-Mont.) pointed out, the GOP for years has advocated "slowing the growth" of the program, just what Democrats are now proposing.
(Of course, when Republicans proposed it in the past, Democrats howled that they were cruelly "cutting Medicare.")
The Quinnipiac poll, like most others, shows that the public favors - 56 percent to 38 percent - "giving people the option of being covered by a government health insurance plan that would compete with private plans."
My guess is that the words "option" and "compete" elevate support for government-run health insurance, but in any event, it's dead in the Senate. Negotiators have substituted a system like the Federal Employees Health Benefit Program that relies on negotiation with and competition between private companies.
That should be the design for the whole of U.S. health care reform, modeled on successful programs in Switzerland and Holland, and Republicans would be smart to propose it.
But the Democrats' new companion idea - allowing people ages 55 to 64 to buy into Medicare - would expand a government-run program that is already going broke.
Moreover, because Medicare pays hospitals and doctors only 80 percent of what private plans do, the plan would lead to yet more shifting of costs to private payers, raising premiums.
According to Quinnipiac, by 63 percent to 30 percent, voters think that covering the uninsured will raise their health care costs and only 19 percent believe that Obama can keep his promise that health care reform won't raise the federal deficit.
On health care costs, the Congressional Budget Office projects that the Senate bill will raise premiums in the individual market by 10 percent to 13 percent but have a limited effect on workers in small or large firms.
The White House and other boosters of health care reform, such as the Commonwealth Fund and the liberal Center for American Progress, project premium savings of $2,000 per family and reduced national health spending of $683 billion over 10 years.
But a study released by the Blue Cross Blue Shield system - and savaged by the White House - made a compelling case that premiums will surge by 54 percent for individual buyers and 20 percent for small firms.
That's because taxes on providers and Medicare payment cuts imposed on them will be passed on to private payers.
And insurance reforms - such as limits on age-based premium differentials - plus weak penalties for not being insured will give incentives for young people to go without insurance until they get sick or injured.
Democratic freshmen led by Mark Warner (Va.) are pushing to toughen cost-containment measures in the Senate bill - now, mainly pilot programs - but even these reforms apply only to Medicare and Medicaid.
U.S. health spending will explode, from 18 percent of gross domestic product now to possibly 30 percent by 2030, unless costs are controlled for public and private care.
The broad-based National Coalition on Health Care is calling for a "fail-safe" mechanism to reduce total spending by 1.5 percent per year - the figure pledged by providers at the White House earlier this year.
Such a plan - yet to be fully spelled out, let alone introduced as legislation - might control costs. In the meantime, voters have it right: Health care reform is going to cost and they are going to pay.

Mort Kondracke is the Executive Editor of Roll Call, the newspaper of Capitol Hill since 1955. © 2007 Roll Call, Inc.

Obama and Democrats' Health Care Plan


Polling Data

PollDateSampleFor/Favor Against/Oppose Spread
RCP Average11/13 - 12/6--38.350.7Against/Oppose +12.4
CNN/Opinion Research12/2 - 12/31041 A3661Against/Oppose +25
Quinnipiac12/1 - 12/62313 RV3852Against/Oppose +14
Rasmussen Reports12/4 - 12/51000 LV4151Against/Oppose +10
Gallup11/20 - 11/221017 A4449Against/Oppose +5
Ipsos/McClatchy11/19 - 11/221176 A3446Against/Oppose +12
FOX News11/17 - 11/18900 RV3551Against/Oppose +16
CBS News11/13 - 11/15873 A4045Against/Oppose +5

Thursday, December 10, 2009

NEW HEALTH CARE DEAL: THEY'RE ON THE RUN!

By DICK MORRIS & EILEEN MCGANN

Faced with a massive center-right uprising, the Obama liberals have been forced to abandon a public option.  But in doing so, they are throwing the Medicare program under the bus.

Already, we have been asking how you can treat a growing number of elderly with a Medicare program that this bill cuts by $500 billion dollars. Now, by adding tens of millions of people 55-64 to the program, it makes it even more financially untenable.

Nonetheless, a brief congratulations to all on having seemingly killed the public option.  Without our efforts, it would be en route to becoming law.  Now there will not be a government owned, government run and government subsidized insurance company that will put all others out of business.
   
But the current proposal Reid is loudly trumpeting is horribly flawed as well.
   
It has all of the old flaws (minus the public option) in that the government, through the Secretary of Health, will decide who gets what treatment at what cost and will force rationing through an artificial scarcity on all people, particularly the elderly.  And it still has such high premiums for young uninsured people that it will compete with student loans for the honor of being their number one headache.
   
But the compromise itself is flawed.  Here's why:

1.  By breeching the historic dividing line between private and public plans now at 65, it opens the door for an expansion of Medicare to become just the single payer we are trying to stop.

2.  How can you expand Medicare, potentially to tens of millions more people while cutting it by $500 billion? 

3.  The cuts in doctor and hospital reimbursement rates written into this bill will force hundreds of thousands of medical providers to refuse to treat Medicare patients.  By applying these low reimbursements to patients 55-64, now, you are driving doctors out of the profession and discouraging others from entering it.  A permanent scarcity of doctors will be the inevitable result.

4.  The expansion of Medicaid to 150% of the poverty level imposes huge new financial burdens on states.  It will cost Texas $3 billion, Pennsylvania $2 billion, California $2 billion, and Florida $1.3 billion.  It will cost Arkansas and Louisiana $500 million each.  This is net of federal aid and only counts the 10% share of expanded Medicaid costs the states must pay.

The federal purchasing program that solicits bids from insurance companies and offers the policies to members of Congress actually functions quite well.  It does tend to widen coverage and hold down costs and, at least in its current form, does not pretend to be an insurance company, just a kind of broker. 

If the program is unchanged in the new law, its work could be valuable in helping consumers choose adequate and affordable insurance.  But who knows whether Reid will try to ramp it up to be a government run and owned insurer?
   
The strategic message from all of this is that we have them on the run!  We have forced Obama to retreat from a very dangerous excursion into socialism.  Our pressure is working and we must keep it up.

Will Senate Democrats’ healthcare reform tradeoffs seal the deal?

The healthcare reform tradeoffs reached Tuesday - no public option but expanded Medicare access - may help Senate Democrats win more moderates' votes. But it's still not clear they've got to 60.




Washington
With a breakthrough in negotiations announced Tuesday night, Senate Democrats are closing in on a historic overhaul of US healthcare – even if no Republicans join them.
The agreement dropped plans for a big government role in the health insurance market (aka, the public option), which had been a deal-breaker for a handful of centrist Democrats, but in exchange for that compromise it expands access to healthcare through Medicare to workers as young as 55.
Other issues remain to be resolved, notably on cost-cutting and public funding of abortion services, but the public option had been a show-stopper in the Senate.
“This has been a long journey. We have confronted many hurdles, and tonight I believe we have overcome yet another one,” said Senate majority leader Harry Reid in a statement Tuesday night. “I know not all 10 senators in the room agree on every single detail of this, nor will all 60 members of my caucus … [but] tonight we are confident.”
A public-option task force
In a bid to resolve this issue, Senator Reid tasked 10 Democrats – five moderates and five progressives – to come up with a compromise that would keep all 60 members of the Democratic caucus on the bill. Lawmakers in both Democratic camps were threatening to vote down the bill over the public-option issue.
Sen. Joseph Lieberman of Connecticut, an Independent centrist who caucuses with Democrats, had said he would filibuster the bill if it included a strong public option. Progressive Sen. Bernard Sanders had said he would filibuster if it did not. With no support from Republican senators, Democrats need them both to push through health reform.
The deal proposes, in place of a government-run insurance program, mandating private, nonprofit companies to administer low-cost national insurance policies, along the lines of the health plans offered to members of Congress and federal workers. The federal Office of Personnel Management would set up the new national plan but nonprofit private companies would run it.
Details of the agreement won’t be set until the nonpartisan Congressional Budget Office (CBO) gives its report on the cost of the bill with the public-option compromise, expected this week. President Obama and congressional Democrats say they are committed to designing a plan that adds not a dime to the federal deficit.
After a bill goes to the CBO, there will be considerable back-and-forth – both sides insist this is not bargaining – to ensure that the legislation is budget-neutral. If the bill clears the Senate, Democrats still expect hard bargaining with the House, whose version of the bill includes a strong public option.
Why moderate Democrats won this fight
But in any standoff between the centrist and progressive wings of the Democratic Party, at least for now, the centrists have an edge: Red-state moderates could lose reelection if they vote a position too far from that their constituents on healthcare reform, posing a threat to the Democratic majority in both the House and Senate.
Moreover, a review of senators’ voting record on healthcare amendments over the past two weeks shows that moderates are much more willing to break with their caucus than are progressives.
In his bid for compromise on the public option, majority leader Reid asked 10 Democrats to negotiate differences over the public option. These included moderate Sens. Mark Pryor of Arkansas, who led the centrists; Thomas Carper of Delaware; Mary Landrieu of Louisiana; Blanche Lincoln of Arkansas, and Ben Nelson of Nebraska. Progressives were Sens. Charles Schumer of New York, who also chairs the campaign arm of the Senate Democratic caucus; Sherrod Brown of Ohio; Russ Feingold of Wisconsin; Tom Harkin of Iowa, and John Rockefeller of West Virginia.
Since the first votes on amendments on Dec. 3, moderates on the negotiating team crossed party lines to vote with Republicans 17 times, on issues ranging from cuts to Medicare and home health services to tort reform. Senator Nelson of Nebraska voted with Republicans on all but 2 of 16 votes. Progressives split with the party only once.
But progressives say their votes can’t be taken for granted.
“While I appreciate the willingness of all parties to engage in good-faith discussions, I do not support proposals that would replace the public option in the bill with a purely private approach,” said Senator Feingold, a negotiator, in a statement Tuesday night. “We need to have some competition for the insurance industry to keep rates down and save taxpayer dollars. I will base my vote on the bill
on the entirety of what is in the bill, and whether I think the bill is good for Wisconsin.”

Wednesday, December 9, 2009

Quinnipiac Poll: Americans Oppose Democrats Health Plan By Wide Margin

December 9, 2009 - Obama Approval Falls To New Low, Quinnipiac University National Poll Finds; U.S. Voters Oppose Health Care Plan By Wide Margin


Word format

American voters give President Barack Obama a split 46 - 44 percent job approval, his lowest ever, and both the health care reform package that he wants Congress to pass and his personal rating on handling health care now win support from less than four in 10 Americans, according to a Quinnipiac University poll released today.

Voters disapprove 52 - 38 percent of the health care reform proposal under consideration in Congress, and they disapprove 56 - 38 percent of President Obama's handling of health care, down from 53 - 41 percent in a November 19 survey by the independent Quinnipiac (KWIN-uh- pe-ack) University.

But voters support 56 - 38 percent giving people the option of being covered by a government health insurance plan, compared to 57 - 35 percent November 19.

American voters trust Obama more than Republicans in Congress to handle health care 44 - 37 percent, down from 45 - 36 percent three weeks ago. Voters disapprove 58 - 30 percent of the way Republicans in Congress are doing their job, and disapprove 56 - 33 percent of Democrats in Congress.

American voters say 63 - 30 percent that extending health insurance to all will raise their cost of health care, although they are split 47 - 46 percent on whether they are willing to pay more to make sure everyone is covered. Voters split 48 - 46 percent on whether they think covering everyone will decrease the quality of their own care, but by 71 - 21 percent they do not think universal coverage is worth lower quality of care.

"It's a good thing for those pushing the health care overhaul in Congress that the American people don't get a vote. At this time, supporters are down 14 percentage points," said Peter Brown, assistant director of the Quinnipiac University Polling Institute.

"President Barack Obama's job approval rating continues to slide and it's evident the deterioration stems from voter unhappiness over domestic policy matters," Brown added.

American voters disapprove 54 - 41 percent of Obama's handling of the economy, down from a 52 - 43 percent disapproval November 18 and his worst score ever on this issue. The biggest shift is among Democrats who approve 71 - 24 percent, down from 77 - 18 percent three weeks ago.

The biggest drop in Obama's overall approval is among independent voters, who disapprove 51 - 37 percent, down from 46 - 43 percent disapproval.

The President's support declines as one goes up the age and income scale. Analyzed by religion, Obama gets a thumbs up from 32 percent of white Protestants, 42 percent of white Roman Catholics and 52 percent of Jews.

"The decline in Obama's overall approval in the last month has been small, with the exception of independent voters who went from three points negative to 14 points," Brown said. "If the trend continues, it won't be long before he could be in the unenviable position of having more Americans disapprove than approve of his job performance.

"The White House certainly is concerned about Obama's approval rating, but the President has three years before facing the voters again. With just 11 months until congressional elections, the White House and all Democrats must worry about the steady deterioration in their lead over the GOP in congressional job performance. Now, only 33 percent give the Democrats in Congress a positive rating, compared to 30 percent for Republicans. Last July Democrats had a nine point edge.

"Also, the 20-point lead in July and nine point lead in November that Obama enjoyed when voters were asked who they trusted more to handle health care - he or congressional Republicans - has shrunk to just seven points, 44 - 37 percent."

From December 1 - 6, Quinnipiac University surveyed 2,313 registered voters nationwide with a margin of error of +/- 2 percentage points.

The Quinnipiac University Poll, directed by Douglas Schwartz, Ph.D., conducts public opinion surveys in Pennsylvania, New York, New Jersey, Connecticut, Florida, Ohio and the nation as a public service and for research. For more data or RSS feed- http://www.quinnipiac.edu/polling.xml, call (203) 582-5201, or follow us on Twitter.

1. Do you approve or disapprove of the way Barack Obama is handling his job as President?

Tot    Rep    Dem    Ind    Men    Wom    Wht    Blk    His



Approve              46%    17%    80%    37%    42%    51%    38%    89%    65%
Disapprove           44     75     11     51     50     38     51      6     28
DK/NA                10      8      9     11      8     11     11      6      6



                     AGE IN YRS.......    INCOME.............  POL PHIL.........
                     18-34  35-54  55+    <50    50-100 >100K  Lib    Mod    Con



Approve              56%    44%    42%    49%    45%    44%    74%    56%    21%
Disapprove           32     49     47     40     47     49     16     33     72
DK/NA                12      7     11     11      8      8     10     10      7



                                   WHITE.............
                     NoColl Coll   BrnAgn                      Military
                     Degree Degree Evngl  Prot   Cath   Jew    Households



Approve              44%    51%    23%    32%    42%    52%    41%
Disapprove           45     41     68     57     50     35     49
DK/NA                11      8      9     10      9     13     10



Nelson Goes Down

By Daniel Foster


Update: 8:57 P.M.: Breaking: The AP and the New York Times are reporting that Senate Democrats have come to a tentative deal to drop the public option. The Times had this update at 8:48 P.M.:
The Senate majority leader, Senator Harry Reid of Nevada, said Senate leaders “have a broad agreement” on dropping a government-run plan from the health care bill, and that the Congressional Budget Office would review the implications of such a move on the budget.
“I told head of C.B.O. we would send him something he would have to score,” Mr. Reid said. He added that he had asked Senators Charles E. Schumer and Mark Pryor to work together with a group of liberals and moderates on making sure the health care bill has a vehicle to expand coverage to achieve the aims of the so-called public option.
Update: 8:49 P.M.: The National Right to Life Commitee (NRLC) has come out against the Reid bill as it now stands, and warns that "a number of pro-life Democrats in the House, who supported passage of health care legislation on November 7, will not vote for the Senate bill in its current form.  So, this is a long way from over."
Update: 8:38 P.M.: Evan Bayh, Bob Casey, Kent Conrad, Byron Dorgan, Ted Kaufman, and Mark Pryor were the Democrats who joined Nelson and voted to preserve the amendment. Republicans Susan Collins and Olympia Snowe joined the majority. The roll call is here.
Senator Ben Nelson’s battle to prevent federal funding for abortions is fought and lost. The Senate voted 54-45 to table the pro-life Democrat’s amendment, which would have prevented health care plans purchased with government subsidies from covering abortions.

By all accounts, Democratic Leader Harry Reid’s strategy was to let the amendment, co-sponsored by Orrin Hatch (R-Utah) and Bob Casey (D-Penn), come to the floor—as the successful Stupak Amendment did in the House—and die there, hoping that the gesture would allow the pro-lifers in his caucus to satisfy their consciences and ultimately vote for the Democrat bill.

But during debate Nelson and other pro-life Democrats threatened that, should the amendment fail, they would join with Republicans in opposing cloture. It remains to be seen whether they will follow through on that threat.

Opponents of the Nelson amendment argued that existing language in Reid’s bill maintained the status quo banning federal funding for abortions. In fact, the Reid language would bar only the direct funding of abortions through federal tax credits, but would still allow women who receive health care subsidies to use them to purchase abortion coverage from private insurers.

During his remarks on the floor, Nelson said the claim that federal funds would be segregated from abortion funding under the Reid language was “an accounting trick”

Sen. Sam Brownback (R-Kan.) agreed, and pointed to President Obama’s claim, during a September 9 address to a joint session of Congress, that “under [the Democrats’] plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place. Said Senator Brownback, “under the Reid bill, this is not true.”

For his part, Stupak has said he will continue to fight for the inclusion of his amendment’s language should health care reform pass the Senate and reach a conference committee. This is not an inevitably, as there are reports that both chambers are discussing bypassing the conference process and “ping-ponging” the Senate bill directly to the House before sending it to the president’s desk. This would leave Reid’s catch-all “manager’s amendment” as the only place to resolve outstanding objections to the bill.

AP sources: Dems reach deal to drop gov't-run plan

AP sources: Democrats reach tentative deal to drop government-run plan from health bill

WASHINGTON (AP) -- After days of secret talks, Senate Democrats tentatively agreed Tuesday night to drop a full-blown government-run insurance option from sweeping health care legislation, several officials said, a concession to party moderates whose votes are critical to passage of President Barack Obama's top domestic priority.
In its place, officials said Democrats had tentatively settled on a private insurance arrangement to be supervised by the federal agency that oversees the system through which lawmakers purchase coverage, with the possibility of greater government involvement if needed to ensure consumers of sufficient choices in coverage.
Additionally, the emerging agreement calls for Medicare to be opened to uninsured Americans beginning at age 55, a significant expansion of the large government health care program that currently serves the 65-and-over population.
At a hastily called evening news conference in the Capitol, Majority Leader Harry Reid, D-Nev., declined to provide details of what he described as a "broad agreement" between liberals and moderates on an issue that has plagued Democrats' efforts to pass health care legislation from the outset.
With it, he added with a smile, the end is in sight for passage of the legislation that Congress has labored over for months.
The officials who described the details of the closed-door negotiations did so on condition of anonymity, saying they were not authorized to discuss them publicly. Several officials stressed that so far, Democrats had technically agreed only on submitting proposals to the Congressional Budget Office for their impact on the bill's cost and other analysis.
At its core, the legislation would expand health care to millions who lack it, ban insurance companies from denying coverage on the basis of pre-existing medical conditions and rein in the rise of health care spending nationally.
The developments followed a vote on the Senate floor earlier in the day in which abortion opponents failed to inject tougher restrictions into sweeping health care bill, and Democratic leaders labored to make sure fallout from the issue didn't hamper the drive to enact legislation. The vote was 54-45.
Taken together, the day's developments underscored the complexity that confronts the administration and Reid as they seek the 60 votes needed to overcome Republican opposition and pass a bill by Christmas. Despite their reluctance, some senators had talked openly and in detail earlier in the day about the progress of the negotiations.
The provision in the legislation to be dropped under the emerging agreement provides for a government-run insurance option to be available to consumers, with individual states permitted to drop out. Liberals have long sought such as arrangement, as a means of forcing competition on insurance companies.
One participant in the talks, Sen. Tom Harkin, D-Iowa, referring to a deal among the negotiators, told reporters he didn't like it, but added, "I'm going to support it to the hilt" in hopes of securing passage of the health care bill.
Another senator involved, Sen. Russ Feingold, D-Wis., issued a statement saying, "I do not support proposals that would replace the public option in the bill with a purely private approach. We need to have some competition for the insurance industry to keep rates down and save taxpayer dollars." But he did not rule out voting for the measure.
The White House quickly applauded the developments. "Senators are making great progress and we're pleased that they're working together to find common ground toward options that increase choice and competition," said a spokesman, Reid Cherlin.
In his comments to reporters, Reid said the emerging compromise "includes a public option and will help ensure the American people win in two ways: one, insurance companies will face more competition, and two, the American people will have more choices."
It wasn't clear what he meant by a "public option," the Medicare expansion or a fallback in case private insurance companies declined to participate in the nationwide plan envisioned to be overseen by the Office of Personnel Management. One possibility was for the agency to set up a government-run plan, either national in scope or on a state-by-state basis.
Under the tentative agreement, liberals lost their bid to expand Medicaid, the federal-state program that provides health care for the poor, elderly and disabled. But they prevailed on the Medicare expansion, and the negotiators appeared ready to maintain a separate health care program for children until 2013, two years longer than the bill currently calls for, according to officials familiar with the details.
Additionally, there was consensus support for a requirement long backed by Sen. Jay Rockefeller, D-W.Va., and other liberals for insurance companies to spend at least 90 percent of their premium income providing benefits, a step that supporters argue effectively limits their spending on advertising, salaries, promotional efforts and profits.
Reid -- the chief architect of the health care bill as well as an abortion opponent -- played a prominent role in the debate over attempts by conservatives to toughen restrictions in the Senate measure. "No one should use the health care bill to expand or restrict abortion," he said, arguing that abortion foes were attempting to do just that. "And no one should use the issue of abortion to rob millions of the opportunity to get good health care."
The current legislation would ban the use of federal funds to pay for abortion services under insurance plans expected to be offered in a new health care system, except in cases of rape, incest or when the life of the mother is in jeopardy.
Individuals who receive federal subsidies to purchase insurance under the plans would be permitted to use personal funds to pay for abortion services -- the point on which the two sides in the dispute part company.
"Segregation of funds is an accounting gimmick," said Sen. Ben Nelson, D-Neb., the chief Democratic supporter of tightened restrictions. "The reality is federal funds would help buy coverage that includes abortion."
Abortion rights supporters, Senate Democratic women most prominently, countered heatedly.
Sen. Dianne Feinstein, D-Calif., said abortion opponents were driven by ideology, and Sen. Jeanne Shaheen, D-N.H., called the proposed changes "a very far-reaching intrusion into the lives of women."
The amendment that Nelson, Sen. Robert Casey, D-Pa, Sen. Orrin Hatch, R-Utah, and numerous Republicans proposed would also have barred insurance plans from covering abortions except in the three categories if any of their policyholders received federal subsidies. It also would have required insurance companies that offer no-abortion plans to make available a policy that offers such services.
In all, 50 Democrats, two Republicans and two independents voted to kill the abortion proposal. Thirty-eight Republicans and seven Democrats favored it.