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Senate Finance

What, You Have a Better Idea for Cost Control?

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Obama to GOP: Fine, Let's Talk (Updated)

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President Obama is making good on his pledge, first put forth in the State of the Union, to reach out to Republicans on health care reform.

In a CBS News interview with Katie Couric that just aired, Obama announced that he's inviting Republican leaders to the White House this week to put their ideas on the table--and then holding a public forum to discuss them.

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Transparency and Sausage Making

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When the Democrats announced that they would be forgoing conference committee proceedings and negotiating a final health care reform bill informally, critics pounced on President Barack Obama for violating his promise of greater transparency in government. And I, for one, had no great urge to defend him.

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Peter = Robbed, Paul = Paid

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A few weeks ago, Capitol Hill sources began warning that the Senate leadership might decide to offer extra assistance to the middle class by taking money away from the poor. Now it looks like they've done it, albeit in a convoluted way that helps some people even as it hurts others.

It's not easy to see and, predictably, it's not easy to explain. But here's my best shot, based on conversations with analysts and experts who have studied the bill's language.

A key feature of health reform are the subsidies that the government would make available through the new insurance exchanges. Basically, the government would establish what's known as a "premium cap": If you were buying a standard policy through an exchange, the government would give you enough financial assistance to make sure the premiums didn't exceed a certain percentage of your income.

That percentage would vary depending on how much you were making. The more money you make, the more the government would let you pay premiums on your own. The less money you make, the more the government would step in to help you with them.

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On the Job

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Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Weblog and is a regular contributor to the Treatment.

When Senate Majority Leader Reid held a press conference announcing the inclusion of a version of a public health insurance option in the merged Senate health reform bill, he didn’t mention the outcome of another major difference between the two Senate committee proposals--what would be responsibility of employers with regard to on-the-job coverage. And not a single reporter asked.

It’s strange that on-the-job coverage gets relatively little attention in the debate, even though more than half of Americans have health coverage through their employers. That's more than the Americans in programs like Medicaid and Medicare (around a third of the population) and much more than the Americans who buy coverage as individuals (less than a tenth of the population).

For all its flaws, employer-based coverage generally provides good benefits to workers and their families. It pools together shared contributions by employer and employees, leveraging group purchasing power for better premiums and/or a better level of benefits. Among other things, employers use their purchasing power to prevent any of their workers from being denied for pre-existing conditions. The workplace provides an easy place to sign up for coverage--and sometimes a useful ombudsman to deal with the insurer. It is also efficient way for insurers to get multiple customers at once, rather than incurring the expense of marketing and selling policies one at a time. That helps keep premiums down.

But despite its dominance, employer-sponsored insurance doesn’t extend to all workers. More than 80 percent of the uninsured are workers, or family members of workers. And without reform, on-the-job benefits are eroding. The percentage of Americans who get coverage through employers shrank by over 5 percent in the past decade. And in some states, like California, it’s about to go under the half-way mark--which is why the state has been exploring setting some minimum standard for health benefits. With the overall cost of health care rising, employers are scaling back coverage or in some cases dropping it altogether.

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BREAKING: Baucus Releases Bill. No, Really!

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It's out! Senate Finance Chairman Max Baucus just released his proposal for health care reform. It's a "chairman's mark," which, again, means it's written in regular English rather than the gobbledygook of legislation. Gobbledygookification will take place later on, when--and if--the full Finance Committee passes it.

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BREAKING: No Snowe, For Now

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Multiple outlets are reporting that when Senate Finance Chairman Max Baucus introduces his health reform bill tomorrow, it will not have any Republican endorsements. (Update: it's out, and here's my initial reaction.) That means no support from Mike Enzi or Charles Grassley, which isn't surprising. It also means no support from Olympia Snowe, which is a little bit surprising. Snowe is the Republican most serious about reform and working with Democrats.

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A Peek at What Max's Bill Really Means

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Senate Finance Chairman Max Baucus says he will release a health care bill* very soon, maybe in the next 24 hours. And we already have a pretty good idea what it will look like, thanks to an outline Baucus has distributed to the Gang of Six--the bipartisan group with which he’s been trying to hammer out a compromise.

Sources inside the Finance Committee say that the formal bill will look a lot like that proposal, with some minor modifications. Of the three Republicans engaged in those discussions, only Maine Senator Olympia Snowe seems likely embrace the proposal, although one can never be entirely sure about what Iowa's Charles Grassley will do--or how he'll decide to tell the world. (I'm hoping for a tweet: "Sorry MAx. NoDEATH panel 4 me.")

Regardless of which Republicans sign on, affordability is going to be a major source of controversy, both within the Finance Committee and outside of it. Relative to both the bills that three House committees approved and the one that the Senate Health, Education, Labor, and Pensions (HELP) Committee passed, Baucus’s proposal is less generous. It offers less financial assistance--and would not guarantee that plans offer as much protection from medical expenses.

But does that mean it's actually inadequate?

To address this very question, Finance Committee staff last week distributed a memo outlining the proposal’s effects. The key table, which appears on the last page and is reproduced below,

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It's All About Affordability

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The plan Senate Finance Chairman Max Baucus distributed to the Gang of Six is now available via various sources, including TNR.COM. And, generally speaking, it looks like the summaries that were circulating over the weekend. It's not as good as it could be, but better than it might have been, given earlier drafts.

Off the bat, though, one section caught my attention--and not in a good way. It's this one, in which Baucus describes the assistance for people at various income levels:

Individuals between 300-400% of poverty would be eligible for a premium credit at a flat percent of income.  Liability for premiums would be capped at 13% of income for the purchase of a Silver plan.  Cost-sharing assistance would not be provided. (Emphasis mine.)

What does that all mean?

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More on the Administration's Drug Deal

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What kind of deal did the administration and Senate Finance Chairman Max Baucus make with the drug industry? And was it a good deal? I (try to) answer those questions in an article that appears in TNR's latest print edition--and is running on our (new!) home page today.

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