More problems with the Senate health care bill

Nate Silver thinks any Democrat who opposes the Senate's health care bill is "batflippin' crazy." He posts a chart showing how a family of four earning $54,000 a year would get much more in subsidies if the bill goes through.

Silver tacitly admits that this bill won't do anything to contain costs. The overall cost of health insurance will increase just as fast with the bill as without it. The only difference is, taxpayers will be covering a greater portion of the cost.

I think most families earning $54,000 per year won't find it particularly affordable to spend more than $8,500 out of pocket for premiums either.

Silver ignores other problems with the bill too. Remember President Obama's promise that we can all keep the insurance we have? The Senate bill contains an excise tax on employer-provided insurance, which is likely to encourage employers to change the policies they offer. Writing at Firedoglake, Jon Walker summarized conclusions reached by The Centers for Medicare & Medicaid Services:

To translate, your employer will reduce what your current insurance plan and put in place high co-pays and deductibles. The result is that many people with employer-provided health insurance will see their insurance get much worse. For younger, healthier employees, possibly getting less comprehensive insurance but maybe higher wages (I think it is very doubtful that there is a pure dollar for dollar passthrough), this might be a decent deal. For older, less healthy employees this is a very bad deal. They will be forced to pay much more out-of-pocket for their health care.

Republicans won't stop screaming about a "government takeover of health care" just because the Senate dropped the public health insurance option. They will pin all the failures of this bill on the government. Democrats may pass a shoddy bill and declare victory this year, but the results won't be pretty if many people see their employer-provided health insurance getting worse.

Medical bankruptcies won't go away either. Writing for the Consumer Reports health blog, Kevin McCarthy discusses the preservation of annual caps on coverage, which I wrote about here, and brings up an additional problem the current bill won't solve:

Another problem with the Senate bill is that it doesn't plug a loophole that a lot of junk insurance plans use: not counting deductibles or co-payments for doctor's visits or prescription drug payments toward a plan's annual out-of-pocket maximum. That can be a catastrophe for people who are seriously ill. And it's one of the things we recommended legislators fix.

The Senate bill does say that the stingiest plans must cap consumer's out-of-pocket payments at around $6,000 (at least in the first year after reform goes into effect; the cap could go up in succeeding years based on inflation). But it fails to specify that ALL out-of-pocket expenses-- deductibles, coinsurance, co-payments, and similar charges--would count against that out-of-pocket-maximum. The House bill does. It's not too late for the Senate to follow suit.

Those who keep defending compromises made in the Senate need to explain why Democrats won't take a hit for these and other flaws in the bill.

Tags: Barack Obama, Congress, health care reform, health insurance, Senate (all tags)

Comments

117 Comments

Re: More problems with the Senate health care bill

Quoted from your linked article:

We can debate whether $9,000 for a family earning $54,000 is "affordable"; what we know is that it's a hell of a lot more affordable than the status quo, under which the family might have to pay more than twice as much to receive equivalent coverage.

And then there's the people who can't currently purchase insurance at any price. I call them the babies in the bathwater which progressives want to toss out. (and I'm not trying to convince you. I ain't that crazy! )

by QTG 2009-12-15 05:54AM | 0 recs
Re: More problems with the Senate health care bill

Aah Mr. Knowitall! Didn't you once tell me we will get a very good bill with a strong public option? :))

by tarheel74 2009-12-15 06:19AM | 0 recs
Re: Name calling?

 Whether or not I'm a "Mr. Know-it-all", you shouldn't be calling your fellow bloggers names. And we are going to get the best Health Care Reform in a generation, btw. So stick that in your X-mas stocking!

by QTG 2009-12-15 06:29AM | 0 recs
Re: Name calling?

Sure we are, we expecting one seemingly in every generation!! :))

by tarheel74 2009-12-15 06:32AM | 0 recs
Defending and supporting are two different things

You raise all very good points here.

Simply put, I think some people are willing to take half a loaf and fight on.

by NoFortunateSon 2009-12-15 05:55AM | 0 recs
Re: Defending and supporting

I fail to see all the what all the wailing is about. AFAKT the senate bill now looks a lot like the MA health care. It may not be perfect, but it's not too bad either.

We just have to gear up and fight for another PO down the road. Not take our baby and go home.

by vecky 2009-12-15 09:36AM | 0 recs
Re: More problems with the Senate health care bill

For Nate Silver to state that $9k is affordable shows how far his butt is up his rear.

by BuckeyeBlogger 2009-12-15 05:56AM | 0 recs
Reading is Fundamental

From Nate Silver, directly above:

We can debate whether $9,000 for a family earning $54,000 is "affordable"; what we know is that it's a hell of a lot more affordable than the status quo, under which the family might have to pay more than twice as much to receive equivalent coverage.
by NoFortunateSon 2009-12-15 06:01AM | 0 recs
but you guys are crazy

The Nate figures show the price the famiy will pay is $4000K. The $9K figure as "premiums" is purely invented.

by John DE 2009-12-15 06:31AM | 0 recs
Re: $4000K?

 I don't think so.

by QTG 2009-12-15 06:36AM | 0 recs
Re: but you guys are crazy

The premium is 4k and the out-of-pocket costs are 5k, for a total of 9k.  You can see this from Nate's own explanation.

by Steve M 2009-12-15 07:50AM | 0 recs
Re: More problems with the Senate health care bill

 Nate was comparing 9K to the current range of 13K to infinity, and saying 9K is more affordable than 13K to infinity. That's called 'math'.

by QTG 2009-12-15 06:08AM | 0 recs
if $9K is unaffordable

it's little consolation to the family affected that $15K would be more unaffordable. The outcome is the same--no insurance coverage, or junk insurance with sky-high out of pocket costs the family can't pay if someone gets sick.

by desmoinesdem 2009-12-15 06:54AM | 0 recs
Re: if $9K is unaffordable

 Nate said it was more affordable, which is unarguable. You're may be too emotionally invested to discuss this rationally. Not a judgment, just an observation.

by QTG 2009-12-15 07:07AM | 0 recs
why did candidate Obama

promise to provide a public health insurance option, to allow reimportation of drugs from Canada, to allow Medicare to negotiate for lower drug prices, and NOT to allow insurance benefits to be taxed, and NOT to impose an individual mandate to buy health insurance?

Was there any reason behind those campaign promises, or was Obama as hopelessly misguided then as I supposedly am now?

by desmoinesdem 2009-12-15 07:35AM | 0 recs
to get people to vote for him

where have you been? Politicians lay a case for what they want when they run so people will vote for them...doesn't mean they'll deliver on them, because a lot of times that depends on other people...like now.

Obama's promises don't mean much if Congress is willing to thumb their nose at him.

by ND22 2009-12-15 12:38PM | 0 recs
Re: if $9K is unaffordable

is there anything in the (proposed) bill that would keep the insurance companies from raising rates so that the family would be back to paying the $13k or whatever?

by jeopardy 2009-12-15 07:39AM | 0 recs
Re: if $9K is unaffordable

Nice of you to insist that a family that cant even afford $4000 should be forced to pay it....

by BuckeyeBlogger 2009-12-15 11:08AM | 0 recs
Re: if $9K is unaffordable

Wait, a family that earns $54,000 can't even afford $4,000 a year for something as critical as HEALTH CARE?  Come on now.  Are they buying $54,000 worth of food?

by Steve M 2009-12-15 11:38AM | 0 recs
Re: if $9K is unaffordable

But we can't want them to give that money to evil insurance companies, who without these reforms could just drop them when they get sick. No better to leave them as they are now - without any insurance.

by vecky 2009-12-15 12:00PM | 0 recs
Re: if $9K is unaffordable

Are you kidding me....a family of four perhaps earning $54k before taxes and you think that $4k is money they have. A family of four earning that little money would be and is struggling to make it. You havent a clue if you dont understand that.

by BuckeyeBlogger 2009-12-15 12:22PM | 0 recs
Re: if $9K is unaffordable

That family isn't rich - since I was part of a family of 4 that made less than that for most of my childhood, I'm happy to attest to that - but I don't think 4,000 for insurance is completely beyond the pale either.  It's also worth remembering that the example we're talking about is using the anticipated prices for a family of four buying insurance on the exchanges and without any contribution from their employer.  On a macro-level, that's a very very small percentage of the population.  

by HSTruman 2009-12-15 12:41PM | 0 recs
Re: if $9K is unaffordable

Of course they're not rich, but they can certainly afford $4000 for a necessity like health care for four people.  Are you saying we should put that family on welfare?

by Steve M 2009-12-15 12:50PM | 0 recs
Re: if $9K is unaffordable

You think a family of 4 in nyc for example can afford that?

by bruh3 2009-12-15 03:25PM | 0 recs
Re: if $9K is unaffordable

Maybe we should all admit to how much our insurance costs us right now, so we have some context about each others' perspective on what costs are being discussed. I'll go first: 1675 a month for a family of 4. 20,100 a year - 30 dolar co-pay, 500 dollar per event hospitalization deductible. This represents the 2010 subscription year, and is a 10% increase (roughly) year over year. It stings.

by QTG 2009-12-15 05:19PM | 0 recs
Re: if $9K is unaffordable

Obviously you would be better off canceling your coverage and going without than padding the profits of Insurance companies!

by vecky 2009-12-15 06:08PM | 0 recs
Re: if $9K is unaffordable

 Well, call me masochistic! The only thing I get out of HC(insurance)R personally is longer lines. But I hedge my bets with investments in HC and Pharma stocks. Yeah, I know.

by QTG 2009-12-16 12:29AM | 0 recs
Re: if $9K is unaffordable

It's adjusted for geography. 54K is just the nationwide average. For NYC I imagine it would be 70K or so.

by vecky 2009-12-15 05:32PM | 0 recs
Re: if $9K is unaffordable

Yes, absolutely I do.

by Steve M 2009-12-15 07:16PM | 0 recs
Re: if $9K is unaffordable

Guess they'll have to cut down on the Xbox and plasma TV...

Hey my family of 4 made far less than 54$K even adjusted for inflation.

by vecky 2009-12-15 05:27PM | 0 recs
Re: if $9K is unaffordable

It is $45,000 in today's money (meaning that that $54,000 will have the same buying power as $45,000 today).  And after the $4000 premium,  you have to add the deductible if you usae the insurance.  I'm sorry, but $45,000 ($54,000) is not a lot of money.  How is a family expected to send their children to college, or buy a home, or replace a broken appliance, or save money for a rainy day.  This health care bill should help put the American middle class back on firmer ground.  Instead, this has the potential to eviscerate it even further.  

by orestes 2009-12-15 01:35PM | 0 recs
Re: if $9K is unaffordable

Currently a family of 4 can expect to spend $13k on health insurance per year. Or they can go without. How does that work with children.

$4K is a steal, complete steal. It's biggest, hugest tax break anyone has ever given the middle class.

by vecky 2009-12-15 05:28PM | 0 recs
Re: if $9K is unaffordable

This is just a replica of commonwealth care in Massachusetts, it covers everyone but at high cost to both the state and the individual without doing anything to control the rising costs (or bending the curve as people fashionably call it). The argument that Silver is putting forward now was the same argument championed by Mitt Romney, until recently when people started losing jobs, the number of people wanting subsidies increased and then there was an unholy mess.

by tarheel74 2009-12-15 07:35AM | 0 recs
Re: if $9K is unaffordable

Ahhh, but the unholy mess in MA is a lot better than the unholy mess in other states.

And face it, senate is a lot more conservative than the MA state legislature.

Costs will continue to go up, obviously, but that just means we can continue to fight for a PO in the coming election cycles. Trying to kill this bill is crazy.

by vecky 2009-12-15 09:42AM | 0 recs
Re: if $9K is unaffordable

you do realize that 30000 legal immigrants were forced off the commonwealth plan because the state faces a budget crisis. The premiums have increased 12% over the last 2 years and another 10% this year. The subsidies had to be reduced and people who would have normally qualified for subsidies are being forced to buy insurance during this recession because of a budget shortfall. How does extrapolating this disaster to the entire nation help anyone?

If insurance reform is the goal, i.e. covering people with pre-existing or chronic conditions and also stopping rescission, all that can be done without spending a dime of tax-payer money or forcing a mandate. I would even support a mandate if there was cap on premiums and a strong cost control measures. Right now there is none.

by tarheel74 2009-12-15 09:56AM | 0 recs
Re: if $9K is unaffordable

However once this plan goes into effect those 30000 legal immigrants can get back in as this bill provides significant help from the Fed, the costs of which MA is covering on it's own.

Immigrants in MA are still a lot better off that immigrants in other parts of the country. This reform is not the end, it's merely a first step. We shouldn't kill it just because it's a baby step and not a giant leap.

You can't ban rescission or pre-existing conditions discrimination without a mandate.

by vecky 2009-12-15 10:17AM | 0 recs
Re: if $9K is unaffordable

That's a good example of why we need higher subsidies than the Senate Bill provides - an issue that I hope can be addressed in conference.  Personally, I don't think it's a reason to oppose the bill in its entirety, which is stil projected to reduce the number of uninsured by 30 million people while also bending the cost curve over the next 20 years.    

by HSTruman 2009-12-15 11:51AM | 0 recs
Re: if $9K is unaffordable

The bill includes mandates with no real measure to reduce costs....how does anyone who cant afford it, afford it?

by BuckeyeBlogger 2009-12-15 12:23PM | 0 recs
Re: if $9K is unaffordable

You keep arguing that the bill does nothing to address costs, but the CBO scoring suggests otherwise, and that doesn't even take into account all of the pilot programs for delivery reform and preventative care that may very well save a ton of money.  The bill isn't ideal, but it clearly does start to address costs.  

As far as affordability goes, the subsidies in the Senate bill will allow lots of people to buy insurance.  But I wholeheartedly agree that they should be more generous.  Which is why I would love to see progressives focus on that issue moving forward.  If the final bill has subsidy levels that look more like the HOuse bill than the Senate bill, that would make a huge difference.  

by HSTruman 2009-12-15 12:38PM | 0 recs
Re: More problems with the Senate health care bill

Are there any figures for how many employer-provided health care plans will be affected by the excise tax?

by Steve M 2009-12-15 06:02AM | 0 recs
Not clear

I looked through the pdf file Jon Walker links to, and those estimates are still based on analysis of a bill with a weak public option. But here's one relevant passage:

Another provision that would tend to moderate health care cost growth rates is the excise tax on high-cost employer-sponsored health insurance coverage in section 9001 of the bill. In reaction to the tax, many employers would reduce the scope of their health benefits. The resulting reductions in covered services and/or increases in employee cost-sharing requirements would induce workers to use fewer services. Because plan benefit values would generally increase faster than the threshold amounts for defining high-cost plans (which are indexed by the CPI plus 1 percent), over time additional plans would become subject to the excise tax, prompting those employers to scale back coverage. This continuing cycle would have a moderate impact on the overall growth of expenditures for employer-sponsored plans. The expected impact of the excise tax is described in more detail in the section of this memorandum on national health expenditures.

And here's the relevant paragraph from that later portion of the memo:

Section 9001 of the PPACA would place an excise tax on employer-sponsored health insurance coverage with a benefit value above specified levels (generally $8,500 for individuals and $23,000 for families in 2013, adjusted in future years by growth in the CPI plus 1 percentage point).15    The tax would be 40 percent of the excess benefit value above these thresholds. We estimate that, in aggregate, affected employers would reduce their benefit packages in such a way as to eliminate about three-quarters of the current excess benefit value. The resulting higher cost-sharing requirements for employees would have an initial, significant impact on the overall level of health expenditures. Moreover, because health care costs would generally increase faster than the CPI plus 1 percent, we anticipate additional, incremental benefit coverage reductions in future years to prevent an increase in the share of employer coverage subject to the excise tax. These further adjustments would contribute to a small reduction in the growth in health care expenditures for affected employees through at least 2019.16    In 2019, these impacts would reduce total NHE by an estimated 0.3 percent.

In a different place, the analysis estimates that

Employer-sponsored health insurance has traditionally been the largest source of coverage in the U.S., and we anticipate that it would continue to be so under the PPACA. By 2019, an estimated 12 million workers and family members would become newly covered as a result of additional employers offering health coverage and a greater proportion of workers enrolling in employer plans. However, a number of workers who currently have employer coverage would likely become enrolled in the expanded Medicaid program or receive subsidized coverage through the Exchanges. For example, some smaller employers would be inclined to terminate their existing coverage, and companies with low average salaries might find it to their--and their employees'--advantage to end their plans, thereby allowing their workers to qualify for heavily subsidized coverage through the Exchanges. Somewhat similarly, many part-time workers could obtain coverage more inexpensively through the Exchanges or by enrolling in the expanded Medicaid program. Finally, the per-worker penalties assessed on non-participating employers are very low compared to prevailing health insurance costs. As a result, the penalties would not be a significant deterrent to dropping or forgoing coverage. We estimate that such actions would collectively reduce the number of people with employer-sponsored health coverage by about
17 million, or somewhat more than the number newly covered through existing and new employer plans under the PPACA. As indicated in table 2, the total number of persons with employer coverage in 2019 is estimated to be 5 million lower under the reform package than under current law.

Again, that analysis was of the earlier version of the Senate bill, which contained the opt-out public option.

by desmoinesdem 2009-12-15 06:53AM | 0 recs
Re: Not clear

I'm trying to sort out whether the excise tax would impact the top 10% of employer-sponsored plans (the so-called "Cadillac plans") or if we're talking about more like the top 40%.  I don't consider it a big problem unless the percentage is a lot larger than what I'm assuming.

by Steve M 2009-12-15 07:12AM | 0 recs
even if it's just the "Cadillac plans"

you'd be screwing over a lot of union workers who have foregone pay hikes over the years in exchange for better benefits.

I think Obama was correct about this during the campaign. When you start taxing employer benefits, you create incentives for employers to drop coverage.

by desmoinesdem 2009-12-15 07:36AM | 0 recs
Re: even if it's just

Of course you create such an incentive.  But the unions that had the bargaining power to insist on those benefit packages in the first place didn't magically lose it.  They have the bargaining power to insist that the employer can't simply take away the health care plan and offer nothing in return.

I'm concerned about the people who have no bargaining power because of the state of the economy - although I'd note that if it were really so trivial for their employer to unilaterally reduce their compensation, most likely it would have already happened, because employers don't pay wages and benefits out of the goodness of their heart.  But I'm less worried about the unions, who have the bargaining power to take care of themselves.

by Steve M 2009-12-15 07:50AM | 0 recs
This isn't a healthcare bill

This is a bailout for health insurance companies. If insurance reform is the aim, that can be done without spending a dime of the tax-payers' dollars or for that matter mandating people to buy expensive insurance that does not have cost saving measures.

What Nate Silver in his infinite wisdom (and fluffery) conveniently forgets is that there is a model for this reform already, it's called the Commonwealth Plan in Massachusetts and that plan ran into all sorts of trouble in times of economic difficulty.  Hospitals are suing the government and people with reduced income are being forced by law to buy expensive insurance. Even the subsidies are failing, legal immigrants (green card) cannot participate in the exchange or get subsidies as part of the cost-cutting measures. The only people to come out on top there are insurance companies. We are just taking that very shaky and fundamentally flawed model and applying it to all of USA. Or, essentially we are basically passing a Republican bill with a Democratic control of both House, Senate and WH.

by tarheel74 2009-12-15 06:15AM | 0 recs
Re: This isn't a healthcare bill

MA residents are pretty happy with their system from all the polls I have seen.

by Lolis 2009-12-15 07:38AM | 0 recs
Re: This isn't a healthcare bill

MA bill was passed by the MA legislature, which is heavily democratic.

Romney did support it, but he did veto some parts, which were over-ridden.

by vecky 2009-12-15 09:48AM | 0 recs
Question

What in the bill would stop Insurance companies to just raise rates some more?

If there isn't anything, then that $9k figure or whatever is completely bogus and irrelevant

by jeopardy 2009-12-15 07:35AM | 0 recs
Re: Question

There is nothing. It is a desperate attempt of some hard-core supporters, who incidentally have no idea how the real world works, telling everyone from their ivory towers to accept this shit sandwich for the "greater good".

by tarheel74 2009-12-15 07:40AM | 0 recs
Re: Question

There absolutely is a rate review process in the bill.  Why spout off if you have no idea?

by Steve M 2009-12-15 07:49AM | 0 recs
Re: Question

...beacuse it's way more fun.  I'll put this question to you (not because I expect you to have an answer necessarily, but because you're one of the few here who can discuss the issue without wetting your pants (lately, this is high praise):

Why not use reconciliation?

Time, now, for the Senate to act under reconciliation. That is what it is there for. And, it need not act on a bill that contains the myriad of compromises that has diluted its effects. It can act boldly. By doing so, it may even induce the naysayers to come back on board for a good 60-vote comprehensive bill in "normal (non-reconciliation) order" in exchange for some compromises. With Medicare, after opposing it as socialized medicine leading to the loss of liberty, even some Republicans voted for it when it was clear it was going to pass. With HCR about to be passed under reconciliation, some wayward Democrats may see the light.

Every part of the health care bill that involves how the government spends or receives money can be handled by reconciliation. That includes: a public option (might as well make it robust), the provision for individuals to buy into the Federal Employee Health Benefits Plan (FEHBP) enjoyed by Members of Congress; reducing Medicare eligibility to age 55 along with premiums to cover costs; enabling seniors who are on Medicaid and Medicare to purchase drugs at the (lower) Medicaid prices; expanding Medicaid, establishing a minimum medical loss ratio of 90% for insurance companies that take any federally subsidized insured. That's all pretty good stuff and needs 51 votes to pass it.

http://www.huffingtonpost.com/...

As for removing anti-trust exemptions, prohibiting life-time caps and rejections for pre-existing conditions, establishing a commission to recommend best practices, etc., why not just bring them to the floor as a separate bill?  Or attach them to a defense appropriation bill, then we'll see who hates hates America and it's troops?

by fogiv 2009-12-15 07:56AM | 0 recs
Re: Question

Don't you guys have an echo-chamber where you fluff each other endlessly?

by tarheel74 2009-12-15 08:23AM | 0 recs
Re: Question

Your Mom's house. Any other questions, Knucklehead?

by fogiv 2009-12-15 08:33AM | 0 recs
Re: Question

I've never seen an argument as to why it can't be done in a two-step process like you suggest.  I think the reason it's not happening must be strictly political, which is to say, either leadership simply doesn't want to use reconciliation for this purpose or there are more Democrats against reconciliation than we think.

by Steve M 2009-12-15 08:24AM | 0 recs
Thanks.

...there are more Democrats against reconciliation than we think.

I wonder same.  Way back, when reconcilition was trooted out as a potential course, it seemd to me like most folk were quick to dismiss it as a terrible idea, or at best, non-optimal.  I'm certainly no procedure wonk, but everything I've read about reconciliation leads me to believe it was more likely to succeed than trying to drum up the magical 60.

As of yesterday, Podesta sees the possibility:

Podesta said he is confident a health care bill will pass. Reconciliation is difficult and complicated, he said, but "it definitely can be done." Among the complications: it can only include provisions that directly relate to how much money the government spends and takes in. Insurance reforms such as banning exclusions of people who have pre-existing conditions would have to be in a separate bill, which would be subject to a filibuster. Finally, anything passed as part of a budget reconciliation bill would expire in 10 years unless it was renewed or revised.

http://www.politicsdaily.com/2009/12/14/ podesta-democrats-will-pass-health-bill- with-or-without-lieberm/

by fogiv 2009-12-15 08:44AM | 0 recs
Re: Thanks.

Reconciliation has to go back to committee. Particularly it has to go back to Ken Conrads committee. Do you think you'll get a robust PO bill from there? Plus It will be several months (April?) before it emerges.

We should still advocate for that route though. Pass this bill now, pass a PO via reconciliation later.

by vecky 2009-12-15 09:51AM | 0 recs
Re: Thanks.

Do you think you'll get a robust PO bill from there?

No, probably not.  The SFC is what it is, but I'm not seeing any better options given the current state of affairs. IMO, trying to kill the thing at this point would be pretty stupid.

by fogiv 2009-12-15 10:02AM | 0 recs
Re: Thanks.

The SFC is Baucus. Baucus is mushy on the PO but atleast he's somewhat in favour of it.

The Budget Committee has Ken Conrad as Chairman. Reconciliation bills go via the Budget Committee.

by vecky 2009-12-15 10:23AM | 0 recs
Re: Thanks.

The 2010 budget resolution provides:

SEC. 201. RECONCILIATION IN THE SENATE.

     (a) Committee on Finance- The Senate Committee on Finance shall report changes in laws within its jurisdiction to reduce the deficit by $1,000,000,000 for the period of fiscal years 2009 through 2014.

     (b) Committee on Health, Education, Labor, and Pensions- The Senate Committee on Health, Education, Labor, and Pensions shall report changes in laws within its jurisdiction to reduce the deficit by $1,000,000,000 for the period of fiscal years 2009 through 2014.

     (c) Submissions- In the Senate, not later than October 15, 2009, the Senate committees named in subsections (a) and (b) shall submit their recommendations to the Senate Committee on the Budget. Upon receiving all such recommendations, the Senate Committee on the Budget shall report to the Senate a reconciliation bill carrying out all such recommendations without any substantive revision.

So I don't think Conrad has much juice in the reconciliation process.

by Steve M 2009-12-15 10:28AM | 0 recs
Re: Thanks.

Interesting.

by fogiv 2009-12-15 10:30AM | 0 recs
Re: Thanks.

True enough, but one can argue whether a PO tied to medicare vs one that is not is a "substantive revision".

Also the part where it outlines only the time frame of 2009-2014... does that mean the PO would only be valid for those 4 years?

by vecky 2009-12-15 11:09AM | 0 recs
Re: Thanks.

I think that would very clearly be a substantive revision, I don't think it's a close question.

As to the second point, I think that merely represents a minimum that the bill needs to accomplish.  From everything I've read, the reconciliation language was drafted to create the maximum amount of flexibility regarding health care (not that they're taking advantage of it now).  

Of course, anything passed through reconciliation would have to be budget germane and would need a 10-year sunset in order to satisfy the Byrd Rule.

by Steve M 2009-12-15 11:41AM | 0 recs
Re: Thanks.

thanks.  worse than I thought.

by fogiv 2009-12-15 10:28AM | 0 recs
Re: Question

Steve, could you please elaborate about the rate review process in the bill?

Thanks.

by jeopardy 2009-12-15 08:02AM | 0 recs
Re: Question

Really? Have you read the bill? Show me the line and paragraph that says that the premiums will be capped at this percent per year unless authorized by the Secretary. There is nothing like that. It just says premiums will be reviewed by the secretary. There are no caps on premiums. There are rate review processes in place now, but that does not stop the rates from rising. So before insulting someone please read the goddamn bill.

Also this is from the old iteration of HR 3590. We had an opt-out public option in that one. Since then, the public option has been stripped. Then we had a medicare buy-in, that too has been stripped. So we really don't know what the final bill will be, but it sure as hell won't have much teeth to it.

by tarheel74 2009-12-15 08:22AM | 0 recs
Re: Question

You didn't say there was a provision that in your opinion isn't tough enough, you said there was nothing at all.  That's misinformation.

by Steve M 2009-12-15 08:23AM | 0 recs
Re: Question

Now you are using semantics. The entire reason people are up in arms against this bill is because there is no provision that can keep costs down. The bill is riddled with loopholes through which an insurance company can drive an army of trucks through.

Set aside that for once. We are talking of a $9000/year cap. That was when there was an opt-out public plan in the bill. In other words, if you happen to live in state that has a public plan and you don't want to spend $9000 you have the choice of moving to a public plan. Conversely, the presence of a public plan will provide the incentive for cost control. There are NONE now.

In MA, in spite of having all of the above, except public plan (i.e. mandated coverage, universal coverage, a review process and an exchange) premiums increased by 12% between 2006-2008 for a family, and another 10% this fall. There is already a model for the kind of reform the senate is proposing and it is doing nothing to control costs.

by tarheel74 2009-12-15 08:31AM | 0 recs
Re: Question

All your points are valid, however neither PO in the bill or the medicare buy-in controlled costs either. They achieved some saving for the fed, but they didn't effect the cost of insurance for workers. The PO was expected to have cost more than many private plans. The Medicare buy-in was only open to a tiny sliver of the population who the insurance industry was not interested in anyway.

by vecky 2009-12-15 09:54AM | 0 recs
Re: Question

I thought the medicare buy-in was a terrible idea, because that shifts the burden of older and less healthy population on to the state. However as far as incremental reform goes it was a step in the right direction. The PO too was more in the similar vein, incremental reform, even though it was so watered down that it would be inconsequential to most. However the presence of a functioning public plan with its expansion in case the private insurance premiums were not being controlled satisfactorily provided a great incentive to the insurance companies to offer competitive prices. Right now there are none. So this is not incremental reform, or cost control reform, this is just shoveling new customers to private insurers under the threat of legal persecution. If I were an insurance company exec I would be having orgasms of pure delight. It's like their wildest dream come true.

by tarheel74 2009-12-15 10:03AM | 0 recs
Re: Question

I agree with the PO as an incremental idea, and the medicare buy-in. I don't think however it's worth killing the whole bill just because those too elements aren't there.

We can always continue to fight for the PO with this bill in place. If the bill goes nowhere and dies we won't have a chance for anything.

by vecky 2009-12-15 12:03PM | 0 recs
Re: Question

well, i'll try to let one of them answer it, because it is possible that there IS something in it that keeps this from happening.

however, in the absence of some sort of premium-reducing or freezing measure, any potential savings for people due to subsidies will be quickly wiped out by increases in premiums, ESPECIALLY if people are forced by law to buy insurance.

by jeopardy 2009-12-15 07:51AM | 0 recs
Re: More problems with the Senate health care bill

The only difference is, taxpayers will be covering a greater portion of the cost.

I think Nate would argue that if the burden will in this case involve more redistribution of wealth (i.e. more taxes), that should not in itself constitute a good "progressive" reason to knock the bill.  In other words, even though we ALL agree insurance industry costs are an unnecessary evil that could be done away with if we had a single-payer public system, given that we don't have a single-payer public system, increasing taxes to spread the burden of paying for this evil is better than not doing so.    

by Rob in Vermont 2009-12-15 08:21AM | 0 recs
Re: More problems with the Senate health care bill

that's assuming that insurance companies (who are protecting by an antitrust exemption, remember) won't just go ahead and raise the rates to offset the savings people would get form subsidies.

do you have ANY reason at all to think that the insurance companies won't do that?

by jeopardy 2009-12-15 08:28AM | 0 recs
Re: More problems with the Senate health care bill

I said they were evil, so I have no good expectations about them.  I wish we'd just kill the evil, but if that's not going to happen, it's better to increasingly share the burden of that evil (assuming the tax hikes are progressive), than to not do so. All other things being equal.  Right?

by Rob in Vermont 2009-12-15 08:41AM | 0 recs
Re: More problems with the Senate health care bill

The problem is that the evil will lead to as many deaths but through a different way. We are covering up how the deaths occur by giving people junk insurance. Whether people are unable to pay because of no insurance or under insurance- the effect is the same except now you are mandating that they have the junk insurance. In that way, you have now made the evil worse.  THis is the sham of Nate's post. He pretends we are saving lives when we are not. It is based on the faulty assumption that people will not realize that their policy are shit. However, people do realize their policies are shit, then what? By the way, this problem already exists , but will not be magnified to nth degree.

Here's an example of this already works:

"Cost of health care can prevent some from seeking cancer treatment    "

"I've been doing this for 37 years," he said. "Deductibles used to be $250 to $500. Now deductibles for many people are $2,000, $2,500 or $3,000. That's a lot of money to pay out of pocket. When it was $250, it was easy to make five payments of $50 each. Now it's five payments of $500 each."

http://www.thecompassnews.org/index.php? option=com_content&view=article& id=220:cost-of-health-care-can-prevent-s ome-from-seeking-cancer-treatment&ca tid=37:Local&Itemid=67

The senate bill allows for this to continue AND it will only cover 60 percent of cost.

The issue is not the same- but the underlying concept of what the Democrats are creating is there. Essentially, insurance that will not cover costs so people still not go to the doctor. Thus, people are still dead. The assumptions that Nate makes is  just that- wild assumptions not based on patient behavior.

As mentioned above, there are no provisions to adequately address this issue, and I would add to Tarheel's statement that those provisions are going to be watered down further.

This is important because the cost of the policies are going to increase at 4.4 times to increase of wages and the premium subsidies are not determined by COLA. Thus, why this is now a ticking time bomb that is just being punted.

by bruh3 2009-12-15 09:00AM | 0 recs
Re: More problems with the Senate health care bill

by the way- the cost are not exactly the  same- the point that I am making is that you are not saving lives because the cost of health care remains prohibitive for most people, and that over the next decade that will  not get worse and worse. Thus any theory of saving  lives is gone because of the cost increase. Nate misses how cost kills as much as anything else. One would not need insurance if they could address the cost of health care without it.

by bruh3 2009-12-15 09:03AM | 0 recs
Re: More problems with the Senate health care bill

I have the same fear.  I remember that after my first year of law school the caps on certain of the student loan programs (can't remember the details) were raised.  I thought, great, I won't have to scrape up $2500 next year.  Well, surprise, my tuition increased significantly to cover the added funds and a personal outlay of $2800.  This is a common problem.  The provider assesses what is an acceptable outlay for the customer and sets rates accordingly.  Since the government funds are free money, they frequently treat it as a windfall.  

by orestes 2009-12-15 08:52AM | 0 recs
Re: More problems with the Senate health care bill

That's an excellent analogy. The subsidies are likely to make the rise in premiums even worse just as education costs rise became worse due to the easy access to low interest loans produced a rise in the cost of education that outstripped inflation. My numbers showed an increase from 12k for health premiums to 24 k, but I wonder what they would look like now that there is the incentive to milk the government? As I wrote above- there is the COLA issue, and what that will then mean for the number of people going untreated.

by bruh3 2009-12-15 09:05AM | 0 recs
Re: More problems with the Senate health care bill

by definition, corporations HAVE to do that. They would be subject to shareholder derivative lawsuits if they don't try to maximize profit.

In order to maximize profit, companies will have prices that are the highest they can, up to the point where revenue would start to fall from the loss of customers more than the increased revenue from higher prices.

the problems with mandates with subsidies and without price controls, especially for an industry with an antitrust exemption are that:

1) the mandate means that there is lesser risk of losing customers from raising prices,thus prices will go up MORE.  

2) the subsidies just increase the prices that the companies can charge since the "ability to pay" of people goes up by the amounts of the subsidies. thus, prices will go up MORE.

3) they can still price out people with preexisting conditions and wither keep them from getting the insurance, or still make an incredible amount off of very large premiums.
___

So this sort of bill will probably increase the costs of premiums MORE than it would otherwise be, while at the same time shoveling huge amounts of taxpayer money to the already filthy-rich insurance industry.

by jeopardy 2009-12-15 09:23AM | 0 recs
Re: More problems with the Senate health care bill

Although I agree with your points, I believe you overstate the fiduciary duty directors/officers have to shareholders with regard to pricing.  I don't think that not maximizing the price of goods or services constitutes a breach of that duty.  I doubt any court would accept that argument.  I certainly am not aware of any derivative suits based on this issue.  

by orestes 2009-12-15 09:30AM | 0 recs
Re: More problems with the Senate health care bill

yes and no.

the business judgement rule will protect them in most cases.

but when it's a particularly egregious lack of competence in terms of maximizing value, then yes, derivative suits are appropriate.

some interesting reading on it:

on discussing Posner's "maximizing value" post:

http://crookedtimber.org/2008/07/25/what -obligation-maximise-what/

"I have a real bee in my bonnet about the claim made by Richard Posner that " The managers of corporations have a fiduciary duty to maximize corporate profits".

It raises a whole load of topics relevant to plenty of my favourite economic hobby-horses as soon as you start to look remotely critically at what the seemingly simple phrase "maximise corporate profits" actually means anyway."
__

some more, this time on a particular state's (Maine) corporations code:

http://www.nancho.net/bigdna/ccbizeth.ht ml

It dawned on me that the law, in its current form, actually inhibits executives and corporations from being socially responsible. So in June 2000 I quit my job and decided to devote the next phase of my life to making people aware of this problem. My goal is to build consensus to change the law so it encourages good corporate citizenship, rather than inhibiting it.

The provision in the law I am talking about is the one that says the purpose of the corporation is simply to make money for shareholders. Every jurisdiction where corporations operate has its own law of corporate governance. But remarkably, the corporate design contained in hundreds of corporate laws throughout the world is nearly identical. That design creates a governing body to manage the corporation-usually a board of directors-and dictates the duties of those directors. In short, the law creates corporate purpose. That purpose is to operate in the interests of shareholders. In Maine, where I live, this duty of directors is in Section 716 of the business corporation act, which reads: ...the directors and officers of a corporation shall exercise their powers and discharge their duties with a view to the interests of the corporation and of the shareholders....

Although the wording of this provision differs from jurisdiction to jurisdiction, its legal effect does not. This provision is the motive behind all corporate actions everywhere in the world. Distilled to its essence, it says that the people who run corporations have a legal duty to shareholders, and that duty is to make money. Failing this duty can leave directors and officers open to being sued by shareholders.

Section 716 dedicates the corporation to the pursuit of its own self- interest (and equates corporate self-interest with shareholder self- interest). No mention is made of responsibility to the public interest. Section 716 and its counterparts explain two things. First, they explain why corporations find social issues like human rights irrelevant--because they fall outside the corporation's legal mandate. Second, these provisions explain why executives behave differently than they might as individual citizens, because the law says their only obligation in business is to make money.
__

by jeopardy 2009-12-15 09:56AM | 0 recs
Re: More problems with the Senate health care bill

Like orestes, I have never seen a successful derivative case where the claim is simply "you should have charged more for your product," and I used to do this stuff for a living.

by Steve M 2009-12-15 10:20AM | 0 recs
Re: More problems with the Senate health care bill

there's a duty under the code.

it will be obvious they are violating that duty if they don't raise rates with these changes put into place.

I agree that they probably won't be successful. They sure will be brought though. ANd CEO's can get removed for these sorts of things.

And that's just one more incentive to maximize profits. There's plenty others. and that's the point - they will seek to maximize profits, which will lead to increased premiums for the reasons I outlined.

by jeopardy 2009-12-15 10:34AM | 0 recs
Re: More problems with the Senate health care bill

I just don't see it.  In fact, the link you provide sets forth exactly what I was going to say in response.  The BJR would insulate officers in this case.  And there's the question, what does "maximize profits" mean?  Goodwill is certainly a corporate asset.  And keeping rates reasonable would increase goodwill- and could lead to increasing market share, which would increase profits.

by orestes 2009-12-15 11:30AM | 0 recs
Re: More problems with the Senate health care bill

i said that myself, if you look a few posts above. I said that except for really egregious situations, the BJR protects them.  

Still, if you don't think that executives take the duty to maximize profits seriously, then i just don't know what to say.

by jeopardy 2009-12-15 11:35AM | 0 recs
Re: More problems with the Senate health care bill

I have never even seen an unsuccessful lawsuit under this theory.  Of course companies charge what the market will bear, but you went way off the rails when you brought derivative lawsuits into the equation.  

by Steve M 2009-12-15 11:43AM | 0 recs
Re: More problems with the Senate health care bill

fine, although I said it is possible, I agree that it won't happen.

Still,t here is a legal duty under the code for them to try to maximize profits or (value) whatever that nebulous term may mean, and I think that executives take profit maximization seriously (even if mostly just because they will likely get fired if they didn't.

Either way, the rest of the post - which is the IMPORTANT PART of the post remains accurate, does it not?

by jeopardy 2009-12-15 12:07PM | 0 recs
Re: More problems with the Senate health care bill

I don't know if it's accurate.  I think the analogy to tuition costs and financial aid is pretty appropriate, though.

by Steve M 2009-12-15 12:53PM | 0 recs
What I don't understand is this

wouldn't this then make it easier to elect pro-single payer and pro-public option Senators and Congressman to office in primary and general elections in the future?

I mean if the private system fails, what are Republicans going to say is causing it?

I remember learning that racism imbedded in the New Deal helped light fires the civil rights movement, maybe this is what we need..."a more perfect union.""A more perfect healthcare system"

If people are really expecting all their ills to be solved by this Congress and this President right now, then we're hopeless as a country.

by ND22 2009-12-15 12:44PM | 0 recs
Re: What I don't understand is this

The problem is that by that logic, there should already be a consensus that the private system has failed.

by Steve M 2009-12-15 12:52PM | 0 recs
Re: More problems with the Senate health care bill

WATERLOO

When Barack Obama came into office we were told a crisis is a terrible thing to waste. Faced with the worst economic catastrophe since the Great Depression the voters had elected a charismatic young President promising change and overwhelming Democratic majorities in both the Senate and the House.

What have the Democrats done with this opportunity?

1. Made a farce of healthcare reform.

  1. Made a farce of financial reform.
  2. Ensured that bankers stayed fat and healthy while offering chump change to struggling homeowners and businesses.
  3. Created an infrastructure program that's virtually invisible, while unemployment soars.

Next up, making a farce of any meaningful action on climate change and offering only empty platitudes on gay civil rights.

We had a Golden Oppurtnity, such as has not been presented to progressive forces since 1932 and the Democrats blew it. BIG TIME!!!! The moment has passed and we will pay for this squandered opportunity for decades.

I can not shrug this off. I am a lifelong gungho Democrat. I have always rooted for the Democrats the way most people root for their football teams.

NO MORE!!!! This deal with Lieberman is my liberal Waterloo. I will no longer look to my once beloved Democratic Party for leadership. I will no longer look to them to give me hope. This failure was too profound. It is time to leave the party.

by liberalart76 2009-12-15 09:12AM | 0 recs
Re: More problems with the Senate health care bill

I share those sentiments.  I felt the same way (on a differnt level) when Bush ruined the opportunity that 9/11 provided.  The world was united for good.  And then he squandered it.  Obama has done the same thing.  If a health insurance lobby bill passes, I am out of the Democratic party and will try to take as many people as possible with me.  This is the final betrayal of everything the party stands for.  For forty years, national health care has been in the party platform.  We truly need a  third party if this goes through.

by orestes 2009-12-15 09:21AM | 0 recs
Re: More problems with the Senate health care bill

Feel free to join the Tea-Party.

by vecky 2009-12-15 10:26AM | 0 recs
Re: More problems with the Senate health care bill

Stop being an asshole.  It may make you less attractive.

by orestes 2009-12-15 10:31AM | 0 recs
Good luck with your third party

maybe you'll win in an electoral vote in Maine or something.

by ND22 2009-12-15 12:48PM | 0 recs
Re: Good luck with your third party

Yes and maybe someday the Democratic party will produce healthcare reform that isn't a massive transfer of wealth from working people to the for-profit insurance companies. However, neither of these things appears likely to happen anytime soon.

by liberalart76 2009-12-15 01:54PM | 0 recs
Re: More problems with the Senate health care bill

I'm thinking more along the lines of "Green" Tea.

by liberalart76 2009-12-15 10:49AM | 0 recs
For most of those forty years

when the Democrats talked national health care, this bill IS what they talked about.

by ND22 2009-12-15 12:47PM | 0 recs
Waterloo

Those who want to leave the Democratic Party because of Republican successes in obstructing health care reform are giving the Republicans just what they wanted and threatened: Obama's Waterloo.  How foolish!

I'm not happy with Obama's failure to lead on this issue.  He should have made it his plan and gone to the people to educate and advocate.  Instead of leading, he got out of the way.  His desire for bipartisanship was/is remarkably naive.  But I'm not surprised by this.  His call for bipartisanship in the face of a rancid Republican caucus was the reason I didn't vote for him in the primary.  He was not experienced enough to recognize an unpalatable reality.

But the real problem is the Republican caucus and the lobbyists, the political vulnerabilities of swing state Democrats, and Joe Lieberman's narcissism.  Obama and the Dems aren't responsible for that.  Even stripping Lieberman of his committee chair (which, of course, should have happened and the failure to do so showed terrible weakness) wouldn't have helped with HCR.  We need to keep the blame where it belongs and educate people about the corrupt obstructionism of the Republicans.

Hostility towards those closer to us is a great temptation, but disappointment and petulance should not take the place of political analysis and commitment.

by Thaddeus 2009-12-15 09:32AM | 0 recs
Re: Waterloo

"Those who want to leave the Democratic Party because of Republican successes in obstructing health care reform are giving the Republicans just what they wanted and threatened: Obama's Waterloo.  How foolish!"
____

you are misstating the problem.

This bill is worse than nothing. if there are no consequences, yet again, for Dems not representing progressives, then there is no future incentive for them to represent progressives.

by jeopardy 2009-12-15 09:36AM | 0 recs
Re: Waterloo

How is it worse than nothing? Is the MA health care worse than nothing? No.

by vecky 2009-12-15 09:55AM | 0 recs
Re: Waterloo

i addressed this in a post above, but I will repost it here for you:

by definition, corporations HAVE to do that. They would be subject to shareholder derivative lawsuits if they don't try to maximize profit.

In order to maximize profit, companies will have prices that are the highest they can, up to the point where revenue would start to fall from the loss of customers more than the increased revenue from higher prices.

the problems with mandates with subsidies and without price controls, especially for an industry with an antitrust exemption are that:

1) the mandate means that there is lesser risk of losing customers from raising prices,thus prices will go up MORE.  

2) the subsidies just increase the prices that the companies can charge since the "ability to pay" of people goes up by the amounts of the subsidies. thus, prices will go up MORE.

3) they can still price out people with preexisting conditions and wither keep them from getting the insurance, or still make an incredible amount off of very large premiums.
_

So this sort of bill will probably increase the costs of premiums MORE than it would otherwise be, while at the same time shoveling huge amounts of taxpayer money to the already filthy-rich insurance industry.

by jeopardy 2009-12-15 10:12AM | 0 recs
Re: Waterloo

The mandate exists in MA as well. AFAICT it's not a big issue there. As costs go up more and more folk have been exempted from the mandate - I believe the threshold now for the mandate is over 100K earning a year.

However many lower income workers have taken advantage of the subsidies and signed up for insurance. MA insurance rates are 10% higher than the rest of the country. Hell, some states have non-insurance rates of 30% or more.

Yes costs are going up in MA just as quickly as they are everywhere else. That's why this HCR is a first step. Just because 2-3 senators made a fuss we shouldn't end it and go home with nothing. Take what we can now and come back in a year or too, when the economy is growing again, the tea-partiers are spent, and health care moves it's way back to the top of folks political priorities.

by vecky 2009-12-15 10:31AM | 0 recs
Re: Waterloo

so what you are saying is...that this won't reign in premium increases, but it will shovel tons more money to the insurance companies.

thanks for agreeing.

by jeopardy 2009-12-15 10:36AM | 0 recs
Re: Waterloo

In exchange for insuring greater percentage of people.

You can't have one without the other.

by vecky 2009-12-15 11:10AM | 0 recs
Re: Waterloo

100k??? are you serious? or are you making stuff up? The only way you do not buy insurance and not pay a fine in MA is if your yearly income is less than $16,248.

by tarheel74 2009-12-15 10:49AM | 0 recs
Re: Waterloo

Why don't you go to MA and look it up. For a family of 4 if your income is lower than 100K you don't pay the fine if you don't have health insurance.

by vecky 2009-12-15 11:11AM | 0 recs
Re: Waterloo

From the MA Connector website:

    *  $54,600 if you are an individual
     *  $85,800 if you are a married couple without children or
     *  $114,400 if you are a family (at least one parent, one child/dependent)?

Those are the exemptions.

For folk with lower incomes the exemptions are based on average premium amounts. For example if your an individual and you make $25K a year and you can't find an insurance policy (via their exchnage) for $924 a year ($ 77 a month), your exempt from the mandate too.

It's fairly generous and strikes a good balance between an incentive to get insurance and being fleeced by the private companies in MA.

by vecky 2009-12-15 11:23AM | 0 recs
Re: Waterloo

You obviously have not gone through the affordability tables in detail. The only way you are exempt is if your family income is less than $27,469 (one adult and one dependent).

by tarheel74 2009-12-15 12:25PM | 0 recs
um no

that's the threshold to receive government subsides.

by ND22 2009-12-15 12:46PM | 0 recs
Re: Waterloo

Why would you assume that people who are fed up are acting out of petulance and disappointment without regard to political analysis and commitment?  That's a pretty unfair accusation to make against people who you do not know, especially when the only argument you have is that the republicans are worse.  (Actually, it mirrors the position being pushed by the apologists with regard to this health care bill.)  I don't know how old you are (I suspect, by your comment, that you are in your 20's), but I have been a staunch Democrat all my 46 years (grew up in a traditional, working class, union, Dem family (heck, my grandmother ran the polling place on election days).  I have heard and accepted every delaying excuse you could ever come up with for waiting for the Democrats to return to their core principles.  This point in time was as good as it was ever going to get.  

by orestes 2009-12-15 10:29AM | 0 recs
Re: Waterloo

Let's be honest here. The Democrats not sticking for "core Dem principles" are Lieberman, Lincoln and Nelson (NE). It's not a party wide phenomenon.

by vecky 2009-12-15 10:32AM | 0 recs
Re: Waterloo

the party is kowtowing to them. that's the problem.

either way, by rewarding these people for screwing progressives and the country, there is no incentive for them to do the right thing next time.

by jeopardy 2009-12-15 10:37AM | 0 recs
Re: Waterloo

Before the debate started, the party gave up national healthcare altogether, then a robust public option, and now the Medicare buy-in, and who knows what next.  There has been no strong advocacy from the party leadership (save perhaps Pelosi) for a good, pro-public health care alternative.  

Ultimately, though, we'll see.  If the House progressive caucus caves, as the white house and senate leadership have, and it all gets spinned as a rounding success, then we'll know it's over.  We'll just have to wait and see.  You may think that I am stomping my feet and holding my breath, but I guarantee you my decision will be reasoned.

by orestes 2009-12-15 11:40AM | 0 recs
Re: More problems with the Senate health care bill

Can someone explain to me what happens after the bill passes the Senate?  It goes to conference committee, and then the emerging bill can be voted up or down?  Can a bill be filibustered in the Senate at that point?  Is it possible that the buy-in or the PO could be added back in conference committee?

by the mollusk 2009-12-15 10:45AM | 0 recs
Re: More problems with the Senate health care bill

You can filibuster a conference report, but it has to be a "real" filibuster as far as I know.

At least in theory, everything in the House bill is fair game to get back into the bill during the conference process, assuming there is one.  That doesn't mean it will happen of course.

Alternatively, the House could simply vote on the Senate bill, in which case there would be no conference.  I believe that's what the WH has been pushing for.

by Steve M 2009-12-15 11:45AM | 0 recs
Re: More problems with the Senate health care bill

thanks, you always seem to have information in addition to opinion.  a rarity it seems.

by the mollusk 2009-12-15 11:48AM | 0 recs

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