I will be on Live from the Left Coast at 9:45 eastern / 6:45 pacific to discuss the Medicare buy-in compromise--Chris
To no one's surprise, the Senators who have worked to weaken the bill all along are now also working to weaken this compromise. Rather than Medicare simply being available to all Americans aged 55-64, starting on the day the bill is passed, several attempts are being made to weaken even that bargain. They current debates include:
- Start date. The opt-out public option would not have started until 2014. The start date of the Medicare buy-in has not been determined, but an immediate, 2010 start-date appears to be winning the day:
According to the well-placed source, Democrats are rallying behind a proposal that would allow a portion of the 55-64 year old age group to buy in to the Medicare system as early as 2010. By contrast, a public plan for insurance coverage would not come into being until 2014.
This would be a dramatic improvement for the bill as a whole. It is would also have real political benefits for the 2010 elections.
- Will it have an end date? Another argument is whether or not the Medicare buy-in option will end in 2014, when the subsidies to purchase health insurance begin. An end date to the buy-in would simply not be acceptable, but it is on the table:
Under discussion is a Medicare "buy-in" for people 55 to 64 that would be available until government subsidies start flowing in 2014 to new health insurance markets for people who have trouble getting and keeping affordable coverage. Liberals also want a Medicare option permanently available after that date.
To take a step forward, only to give that step away in four years, is not a compromise at all.
- Will it include all 55 to 64 year olds, or not? Yet another important issue is whether the Medicare buy-in would be open to everyone who is 55 or older. Unsurprisingly, many want to further protect private insurance companies by only allowing the sickest people to buy-in:
In addition to debating a potential start date for a Medicare buy-in proposal, Senate Democrats are also in negotiations over who, exactly, should be allowed to qualify for the expanded Medicare program. At this juncture, it doesn't appear that everyone in the 55-64-age bracket would be granted access. Negotiators are considering limiting consumers to those who would qualify for high-risk insurance pools already set up under the Senate's health care legislation. This would mean primarily those who have been uninsured for a certain amount of time, have a history of poor health or are unable to get insurance because of a preexisting condition.
This would improve the risk pool for private insurance companies, and weaken the risk pool for Medicare. Protecting the private companies like this, while hurting Medicare, is pure bullshit. It needs to be open to everyone in the 55-64 age range.
- Medicaid expansion. A different public option expansion, Medicaid, was defeated today. The goal was to allow families at 150% of the poverty level to purchase Medicaid, instead of the current 133%. The House bill mandates 150% though, so this isn't over. If there is a conference committee, and the Progressive Caucus is demanding one, expanding the Medicaid public option will be one of the main fights.
Overall, Jay Rockefeller says a deal is close, but they are waiting for CBO scores:
Added Rockefeller: "All in all, I have to say we are in a pretty good place right now. You can see a kind of overarching sense of 'Well, yes, let's do this,' but we have to see what the (Congressional Budget Office cost estimate) is."
While leaks will continue to come out, don't expect any of the decision on details 1, 2 and 3 to be confirmed until the new version if bill is reviewed by the CBO. When it comes to our chances of winning those fights, Sherrod Brown is drafting the proposal, which is a positive development.
Update--Senate defeats Stupak amendment: By a vote of 54-45, the Senate comfortably defeated a Senate version of the Stupak amendment, 54-45.
Given that 45% of Senators voted for this restriction, compared to 55% of all Representatives, the Senate appears to be far more pro-choice than the House.
Update 2--Nelson not threatening to filibuster anymore: Even though his amendment went down, Ben Nelson is no longer threatening to filibuster the health care bill:
After his abortion amendment did not win the day on the Senate floor, Sen. Ben Nelson (D-NE) did not come out swinging. Though he insisted that the failure of his abortion amendment "makes it harder to be supportive" of Senate health care bill, he did not reiterate his pledge to filibuster the bill.
"We'll just have to see what develops," Nelson told reporters. "I have no plan B."
This gives real hope both to get a public option through expanded Medicare (and possibly Medicaid, and also to defeat the Stupak amendment. Pulling off either seemed virtually impossible as of yesterday.
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