Posted by rogerhollander in Canada, Health.
Tags: aca, bernie sanders, Canada, health costs, health insurance, healthcare, obamacare, private insurance, Ralph Nader, roger hollander, single payer, universal healthcare, vermont, vermont health
Roger’s note: this posting gives you two articles on health care, including Ralph Nader’s on the Canadian system. Having lived most of my life in Canada, and with the early detection of my daughter’s meningitis that saved her life at age two, I know first hand the benefits of no one excluded single payer. Like the system in Great Britain (which is more like socialized medicine than Canada’s universal insurance), Canada’s health care is deteriorating, not because of flaws in the system, but rather neoliberal under funding. It is not quite the Utopia that Nader pictures, but it is a thousand percent better than what Americans have.
Costly complexity is baked into Obamacare. No health insurance system is without problems but Canadian style single-payer full Medicare for all is simple, affordable, comprehensive and universal.
In the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months. There were no websites. They did it with index cards!
Below please find 21 Ways the Canadian Health Care System is Better than Obamacare.
Repeal Obamacare and replace it with the much more efficient single-payer, everybody in, nobody out, free choice of doctor and hospital.
In Canada, everyone is covered automatically at birth – everybody in, nobody out.
In the United States, under Obamacare, 31 million Americans will still be uninsured by 2023 and millions more will remain underinsured.
In Canada, the health system is designed to put people, not profits, first.
In the United States, Obamacare will do little to curb insurance industry profits and will actually enhance insurance industry profits.
In Canada, coverage is not tied to a job or dependent on your income – rich and poor are in the same system, the best guaranty of quality.
In the United States, under Obamacare, much still depends on your job or income. Lose your job or lose your income, and you might lose your existing health insurance or have to settle for lesser coverage.
In Canada, health care coverage stays with you for your entire life.
In the United States, under Obamacare, for tens of millions of Americans, health care coverage stays with you for as long as you can afford your share.
In Canada, you can freely choose your doctors and hospitals and keep them. There are no lists of “in-network” vendors and no extra hidden charges for going “out of network.”
In the United States, under Obamacare, the in-network list of places where you can get treated is shrinking – thus restricting freedom of choice – and if you want to go out of network, you pay for it.
In Canada, the health care system is funded by income, sales and corporate taxes that, combined, are much lower than what Americans pay in premiums.
In the United States, under Obamacare, for thousands of Americans, it’s pay or die – if you can’t pay, you die. That’s why many thousands will still die every year under Obamacare from lack of health insurance to get diagnosed and treated in time.
In Canada, there are no complex hospital or doctor bills. In fact, usually you don’t even see a bill.
In the United States, under Obamacare, hospital and doctor bills will still be terribly complex, making it impossible to discover the many costly overcharges.
In Canada, costs are controlled. Canada pays 10 percent of its GDP for its health care system, covering everyone.
In the United States, under Obamacare, costs continue to skyrocket. The U.S. currently pays 18 percent of its GDP and still doesn’t cover tens of millions of people.
In Canada, it is unheard of for anyone to go bankrupt due to health care costs.
In the United States, under Obamacare, health care driven bankruptcy will continue to plague Americans.
In Canada, simplicity leads to major savings in administrative costs and overhead.
In the United States, under Obamacare, complexity will lead to ratcheting up administrative costs and overhead.
In Canada, when you go to a doctor or hospital the first thing they ask you is: “What’s wrong?”
In the United States, the first thing they ask you is: “What kind of insurance do you have?”
In Canada, the government negotiates drug prices so they are more affordable.
In the United States, under Obamacare, Congress made it specifically illegal for the government to negotiate drug prices for volume purchases, so they remain unaffordable.
In Canada, the government health care funds are not profitably diverted to the top one percent.
In the United States, under Obamacare, health care funds will continue to flow to the top. In 2012, CEOs at six of the largest insurance companies in the U.S. received a total of $83.3 million in pay, plus benefits.
In Canada, there are no necessary co-pays or deductibles.
In the United States, under Obamacare, the deductibles and co-pays will continue to be unaffordable for many millions of Americans.
In Canada, the health care system contributes to social solidarity and national pride.
In the United States, Obamacare is divisive, with rich and poor in different systems and tens of millions left out or with sorely limited benefits.
In Canada, delays in health care are not due to the cost of insurance.
In the United States, under Obamacare, patients without health insurance or who are underinsured will continue to delay or forgo care and put their lives at risk.
In Canada, nobody dies due to lack of health insurance.
In the United States, under Obamacare, many thousands will continue to die every year due to lack of health insurance.
In Canada, an increasing majority supports their health care system, which costs half as much, per person, as in the United States. And in Canada, everyone is covered.
In the United States, a majority – many for different reasons – oppose Obamacare.
In Canada, the tax payments to fund the health care system are progressive – the lowest 20 percent pays 6 percent of income into the system while the highest 20 percent pays 8 percent.
In the United States, under Obamacare, the poor pay a larger share of their income for health care than the affluent.
In Canada, the administration of the system is simple. You get a health care card when you are born. And you swipe it when you go to a doctor or hospital. End of story.
In the United States, Obamacare’s 2,500 pages plus regulations (the Canadian Medicare Bill was 13 pages) is so complex that then Speaker of the House Nancy Pelosi said before passage “we have to pass the bill so that you can find out what is in it.”
In Canada, the majority of citizens love their health care system.
In the United States, the majority of citizens, physicians, and nurses prefer the Canadian type system – single-payer, free choice of doctor and hospital , everybody in, nobody out.
For more information see Single Payer Action.
This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License.
Vermont Approves Single-Payer Health Care: ‘Everybody in, nobody out’
November 20, 2013,
The Affordable Care Act continues to plow ahead, despite Republican attempts to fight it at every turn. What is unfolding in front of us is nothing short of spectacular. The problems with healthcare.gov are slowly being resolved which is helping more and more people sign up for affordable healthcare, many for the first time in their life. The law provides so much more than that, including standards for even the lowest level plans, protections for young adults 26 and younger, and the elimination of pre-existing plans. Of course, you will not hear the success stories on the news, because those stories are not nearly as sexy as the “Obama Lied” slogan they are so fond of.
The biggest downside of the ACA is the reliance on the private insurance industry. It does not have to be this way, however. There is yet another provision in the Affordable Care Act that can open the door for states to institute their own single-payer healthcare system. Other states have a public option, especially for those below a certain income level, but no state had instituted a true single-payer system. All of this has changed thanks to President Obama and the Affordable Care Act.
Vermont—Home of Ben and Jerry’s, Maple Syrup, Bernie Sanders and the first state to pass marriage equality. Now, Vermont will be known for something that will impact every resident in the state.
The ACA provided states with federal funds to institute a Medicaid expansion. The states chose to expand the program also were able to set up their own state exchanges, which were relatively free from the problems the federal site had. Vermont decided to take it a step further by setting up their very own single payer system.
The slogan of the program: Everybody in, nobody out.
The program will be fully operational by 2017, and will be funded through Medicare, Medicaid, federal money for the ACA given to Vermont, and a slight increase in taxes. In exchange, there will be no more premiums, deductibles, copay’s, hospital bills or anything else aimed at making insurance companies a profit. Further, all hospitals and healthcare providers will now be nonprofit.
This system will provide an instant boost the state economy. On the one side, you have workers that no longer have to worry about paying medical costs or a monthly premium and are able to use that money for other things. On the other side, you have the burden of paying insurance taken off of the employers side, who will be able to use the saved money to provide a better wage and/or reinvest in their company through updated infrastructure and added jobs. It is a win-win solution.
To make sure that it is done right the first time, Vermont brought in a specialist who knows a thing or two about setting up a single-payer system.
Dr. William Hsaio, the Harvard health care economist who helped craft health systems in seven countries, was Vermont’s adviser. He estimates that Vermont will save 25 percent per capita over the current system in administrative costs and other savings.
Many like to say that the United States has the best healthcare system in the world. The problem is we don’t. Not even close. In fact, the only way you can get the best healthcare in the world, is if you are willing and able to pay for it. The United States can and must do better for its people.
Costs have to be held down — there is no reason why the U.S. has to pay twice the amount per capita as the next most costly system in the world (Norway’s), and still not cover millions of its citizens. A Harvard Medical School study states that 45,000 Americans die each year from treatable diseases because they cannot afford to get treatment.
45,000 Americans die every single year because they cannot afford treatment, are you ready for that? That is 15 times the amount of people that died during the September 11, 2001, attacks, or perhaps for you Righty’s out there you would rather see it put this way, 11,250 times the amount of people that died in the Benghazi attack. That equals 5 Americans that die every hour, of every day, of every year because of a preventable illness that was not taken care of due to lack of access and means.
Even once the Affordable Care Act wrinkles are ironed out, which they will be, and every America is covered, which will happen, that will not change the fact that all of this is being driven by a for-profit system by companies that only care about their bottom line. Despite rules in the ACA which prevent insurance companies from absolutely gouging their customers, insurance companies are not exactly know for their ethical behavior.
A single-payer system would all but eliminate anybody dying unnecessarily due to lack of access to healthcare. Our Declaration of Independence states, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” How can somebody have life and happiness, without their health? Despite the glaring hypocrisy of rich, white males who owned slaves stating all men are created equal, we have come a long way from 1776. Yet when it comes to the very basic need, we are left to the whim of a business. Single-payer is inevitable, and the ACA is a giant step in that direction. We need must hold our officials to a higher standard which will get us there faster. 40,000 people a year is absolutely unacceptable. Vermont saw the writings on the wall. Will the rest of us?
Bernie Sanders on MSNBC discussing his state’s new single-payer system.
Posted by rogerhollander in Barack Obama, Health, Race.
Tags: glen ford, health, health care, health reform, healthcare, heritage foundation, individual mandate, insurance industry, medicare, obamacare, princeton research, private insurance, roger hollander, single payer
Black Agenda Radio commentary by Glen Ford
President Obama’s mandate to buy private insurance was born in the rightwing Heritage Foundation, and has not found a home among any actual constituency of the public – white, non-white, Republican, Democrat, college-educated or not. A new poll confirms that “Obama has based his plan on a scheme that nobody likes – even his most loyal supporters.”
All U.S. Groups Oppose Obama’s “Individual Mandate” for Health Care
A Black Agenda Radio commentary by Glen Ford
“The new poll shows that no significant constituency supports Obama’s individual mandate.”
When one takes a cursory look at where various groups in the nation stand on President Obama’s health care legislation – now under review by the U.S. Supreme Court – it appears the country is split along party and race lines. A new poll conducted by Princeton Research Associates shows 75 percent of Democrats support the Obama position, and 86 percent of Republicans oppose it, with so-called independents evenly split. The racial divide is similar. Sixty-eight percent of non-whites “strongly favor” or “somewhat favor” the overall health care law, with only 18 percent opposed. Whites are far more divided, with 33 percent favoring Obama’s law, and 47 percent opposed.
These numbers are, however, heavily influenced by what people think is in the law, and what side they think they should be on, based on their larger loyalties. It is doubtful that majorities on either side of the issue actually understand most of the law’s many provisions, some of which do not go into effect for several years. Therefore, many of the respondents are using the poll to register their broader preference for or against the incumbent president and his party. It is no surprise that majorities of whites and super-majorities of Republicans oppose ObamaCare, as Republicans call it, and more than two thirds of non-whites and three-quarters of Democrats support Health Care Reform, as Obama calls it.
However, most people do understand the central element of the law, the “individual mandate” that forces nearly everyone to buy health insurance from private companies, or face a fine. The new poll shows that no significant constituency supports Obama’s individual mandate, with only 28 percent of the overall public favorable to the scheme. Even non-whites, two-thirds of whom claim to support Obama on health care in general, balk at mandatory purchase of insurance from private companies. Fifty-three percent of non-whites give thumbs down to the individual health insurance mandate, as do 71 percent of whites. More Democrats are opposed to Obama’s individual mandate than favor it: 48 to 44 percent. And Republicans are off the scale in opposition, at 15 to 1.
“Fifty-three percent of non-whites give thumbs down to the individual health insurance mandate.”
So, if the core of the Obama health care plan is the individual mandate, as both the administration and the Republicans contend in their arguments before the Supreme Court, then Obama has based his plan on a scheme that nobody likes – even his most loyal supporters.
There’s another interesting aspect to the new poll. It shows that only a hard core of one in four people want to tamper with Medicare as the Republicans do, with around two-thirds of all racial groups opting to keep the program the way it is, with the government paying doctors and hospitals directly for the service they provide to seniors.” Taken together, the poll indicates strong support for the core elements of the U.S. healthcare safety net, and rejection of private schemes, including Obama’s mandatory purchase of insurance from private companies. It appears that most Americans would rather have the option of dependable, direct health care paid for by the government – which was the case at the beginning of 2009, before Obama unveiled his health care scheme, when 60 percent and more of the American people favored single-payer health care. But Obama maneuvered them into a something they hadn’t asked for, and which, three years later, nobody wants. For Black Agenda Radio, I’m Glen Ford. On the web, go to BlackAgendaReport.com.
Posted by rogerhollander in Health, Women.
Tags: abortion, choice, health, health care, healthcare, margaretandhelen, republicans, rick perry, roger hollander, therepeutic abortion, Unwanted Pregnancy, women, women's choice, women's health, women's rights
Roger’s note: from time to time when I feel the need for a boost to my spirits, I go to www.margaretandhelen.wordpress.com. The cover photo itself is worth the price of admission. I usually, not always, agree with Helen. For one thing I cannot understand her ongoing love affair with Obama, who has long shown his true colors. Nevertheless, Helen writes with a flolksy charm and wit, and, above all, pulls no punches. She is a tough old gal, and Sarah Palin is not one of her favorite people. She’s not that crazy about Fox News either. Check her out. Read on …
Margaret, I read the comment you sent me and felt compelled to respond. I know you don’t like it when I do, but honey you know how I feel about this particular subject.
In case you are new to my web page blog, I’ll give you a little background. I told my friend Margaret that I thought Sarah Palin was a bitch… is a bitch. Anyway, my grandson really hadn’t fully explained to me that other people could see this page besides Margaret. Which is kind of funny because Margaret actually has to have her husband, Howard, print the pages out for her to read because she doesn’t like computers very much….
But I digress.
So I kept writing about things and more people kept stopping by. Just yesterday I was telling Margaret that I find it very odd that Republicans think government is too big and healthcare for all Americans is just insane. It doesn’t seem to matter that it would cost less than Bush’s wars… but that would just be unAmerican of me to suggest…afterall Sarah Palin’s son is in that war…
Again, I digress.
I find it odd because I know that Rick Perry, the Governor of my state, is really upset about how big government has gotten. Evidently it’s not big enough, however, because ‘ole Ricky seems to think its small enough to crawl up my vagina with a sonogram machine and a recorder so that Ricky can tell me how to think based on what God whispers in his ear when no one else is around. To be truthful, it could just be something he picked up in church. I’m not sure. It might have happened at his office. It’s really hard to tell the difference between his office and his church these days.
I just can’t seem to stay on subject today…
So that is what I was writing about to my friend Margaret. And then she had Howard print out my letter and some of your comments. Sometimes – like last night – she calls me because she gets so worried when one of you gets a little upset. But I tell her, “Margaret, dear. It’s just the internet. It’s not like anyone forces them to read it.” But Margaret worries. She just wants everyone to get along. You know. Agree to disagree and things like that. Which would be nice except that Governor Ricky wants to pass some new laws. And once that happens you can’t just agree to disagree. Once it becomes law if you disagree you have to spend a lot of money with lawyers or go to jail.
But I digress.
So last night some fool (sorry Margaret) named Noah decided to call you all sheep because you seemed to like what I had written about Ricky. I wasn’t aware sheep could read, and I have always thought that too often used insult about following like sheep is a bit far-reaching. Yes. Survival instincts in sheep tend to mean that one sheep will more than likely follow the sheep in front. Did you know, however, there is a certain strain of sheep in Iceland known as leadersheep? Leadersheep are highly intelligent animals that have the instinct to lead a flock home during dangerous and difficult conditions. They have an exceptional ability to sense danger. There are many stories in Iceland of leadersheep saving lives during the fall roundups when blizzards threatened shepherds and flocks alike…
But I digress.
Among other things, Noah decided to leave a little pearl of personal wisdom in his not so well thought out diatribe:
With my wife being almost 7 months pregnant this subject really touches home for me so I can understand the passionate feelings from both sides of the issue. Having gone to the first ultrasound I could never have made a choice to abort the child for any reason. I can understand why the governor wants to have women have that firsthand experience of hearing that heartbeat, it is very powerful. I guess I don’t see a problem if what he is suggesting isn’t stopping all abortions, which he is not and I would be opposed to if he was.
Well isn’t that just precious? Noah is particularly knowledgeable about this subject because his wife is 7 months pregnant. Congratulations Noah. I know my readers will join me in wishing you and your family all the best. You’re almost there: two more months to go.
I assume your wife had her amniotic fluid test and that everything turned out fine? It’s a scary time those first few months. Did you know that if you and your wife learned through the amniocentesis that something had gone terribly wrong with the developing fetus that one of your options might be to terminate the pregnancy? Sometimes the abnormality of the fetus is significant. Survival of both the fetus and the mother can be called into question. [By the way. I am using the word fetus not to dehumanize but rather because that is what it is called - a fetus] Often women facing this type of heartbreak consult with their doctors, their family members and even their pastor. I am sure more than a few say a prayer and ask for wisdom. Did you know, Noah, that if your wife was in that situation and she decided to terminate her pregnancy good ‘ole Rick Perry would still force her to look at a sonogram and listen to a heartbeat so that she can agonize further that the child she wanted so desperately isn’t to be. I wonder how comforting you would be to her at that moment. “Look, honey. I can understand why the governor wants to have women have that firsthand experience of hearing that heartbeat, it is very powerful.” Thank goodness that you and your wife are not dealing with that.
And I assume, of course, that the child due to arrive in two months is your child? How blessed for you and your family. Did you know that if your wife had been raped and subsequently discovered that she was pregnant, she may not even want to consult with her family, her priest or even her God. She may want nothing more than to simply ask her doctor to end the unwanted pregnancy so that maybe she can begin to heal from this traumatic experience. Thank goodness that isn’t your situation Noah. Can you imagine how horrible it would for a women like your wife in this moment of sadness, anger, disbelief, denial to have Rick Perry then force her to reconsider by showing her a sonogram and letting her listen to a heartbeat. She’ll have to sign a paper declaring that she watched and listened and still decided to terminate the pregnancy.
Even worse, Noah. Imagine if that woman was your daughter. Do you know the sex of your child yet? What a world she will get to grow up in. So very different from your childhood or even mine. You were there at the invention of the internet. I was there at the invention of the television. I also grew up in a world where abortions were illegal Noah. I watched women die because they had no choices. You realize that Rick Perry wants that world back, right? This nonsense about abortions should only be legal in the case of rape or the life of the mother… what a crock. The world is never so black and white.
But that is not for you Noah. No. This is a time of great joy and celebration for you and your wife. Thank goodness. Some women struggle with the idea of motherhood. They know deep down inside that bringing a life into this world is a blessing yes – but also an enormous responsibility and for some the ultimate sacrifice. To know that another life will depend entirely on your ability to find it within yourself to love so selflessly and care so deeply. To give birth is not to be taken lightly, Noah. Some women, after very serious consideration about where they are in life and what they can and can’t offer to a child, decide that they are just not prepared to bring another life into the world. And after much thought and prayer and probably tears, they still have Rick Perry there to given them even more to consider. Thank goodness for thoughtful ‘ole Ricky.
But not you Noah. Thank goodness you and your wife have made the decision that this is a wanted child… that this will be a loved child… that you have the means to feed and care for this child. I am sure Rick Perry will be sending you a bouquet of flowers after the delivery to show you how much he cares about the very personal decision you have made. I hear that just the other day, Rick sent a letter of congratulations to the woman who just delivered her 5th child because her husband feels that using condoms are a sin. Good ‘ole Rick. I think his letter said something along the lines of don’t worry about where you will get the money to feed the child because you chose life and that is all that matters. Good ‘ole Ricky even sent her one of those lovely Choose Life license plates. She doesn’t own a car, but it’s the thought that counts.
Noah dear. Stick to football. And Mrs. Noah? Slap him for me. He really should spend more time tending to you rather than writing to me. But I digress. I mean it. Really.
Posted by rogerhollander in Health.
Tags: affordable care, anne galloway, health, health care, health care reform, health reform, healthcare, healthcare reform, obamacare, peter shumlin, roger hollander, single payer, universal health care, universal healthcare, vermont, vermont health, vermont senate
Roger’s note: I confess that I don’t understand the ins and outs of Obama’s Byzantine insurance industry dominated health care legislation, or how a Vermont single payer universal coverage plan can occur in that context. As a Canadian, however, I cannot but think of Tommy Douglas. Tommy Douglas was a clergyman and an unrepentant socialist who happened to be the Premier of the Canadian Province of Saskatchewan in the 1950s. Against massive resistance and fears of economic collapse, he introduced universal health care into the province, which became the catalyst for its adoption by the entire country. The domino theory at work. Do Canadians value their system of single payer universal health insurance? Would they support going back to private health care? In 2004 the CBC polled Canadians on who what the greatest Canadian of all time. Tommy Douglas won hands down. We can only hope that what the governor and senate have now accomplished in Vermont will be more than symbolic, that it will introduce genuine universal coverage where no one is left unprotected and health care costs come under control through the limitation of windfall profits by private insurers. Americans will then see what they are missing and demand single payer universal health care on a national basis. I love what Dr. Richter said: You go for what you want, not for what you think you might get – that’s what the bill does. Would that that great advocate of change you can believe in, Barack Obama, had had the courage to do just that instead of compromising the principled position of universal care from the very beginning of the congressional process.
by Anne Galloway | April 27, 2011
In a historic vote on Tuesday, the Vermont Legislature created the enabling legislation for a first-in-the-nation universal health care system. The state Senate approved the visionary plan for a single-payer system in a 21-9 vote after four hours of debate. The split was largely along party lines.
Gov. Peter Shumlin, a Democrat, campaigned on a promise to create a single-payer system in Vermont that would contain health care costs and give all of the state’s residents universal access to medical care. On Tuesday, Shumlin made good on the first step toward fulfilling that promise, and just five hours after the Senate vote, he marked the legislative victory in an appearance on MSNBC’s “The Rachel Maddow Show.”
Shumlin said in a statement to the Vermont press: “Today the Legislature took a huge step toward making Vermont the first state in the first in the nation to control skyrocketing health care costs and remove the burden of providing health care coverage from small business owners. This bill is good for Vermonters and Vermont businesses.
Many Vermont businesses, however, believe otherwise. Though small employers have said they will benefit, some larger employers actively lobbied against the bill. Opponents of H.202 argued that the legislation would leave businesses in the lurch during the transition period between 2013 and 2014 when the state is required under federal law to participate in insurance exchanges. The opposition was led by insurance brokers (the Fleischer Jacobs Group, Business Resource Specialists), business associations (Vermont Chamber of Commerce, Vermont Grocers’ Association and Vermont Retailers Association), large employers (Dealer.com, Biotek, Rhino Foods and IBM). The Senate debate on Monday and Tuesday centered on changes to the legislation that would have made it more palatable to these groups.
Sen. Vince Illuzzi, R/D-Essex Orleans, who proposed two amendments that would have made the bill more business friendly, said companies are afraid “we will end up with a plan most won’t be able to afford.”
The legislation sets the state’s health care system on a new trajectory. Instead of continuing to use an insurance model for covering the cost of care, the bill moves the state toward an integrated payment system that would be controlled by a quasi judicial board and administered by a third party entity. The system would be funded through a broad-based tax.
The universal health care system would be implemented in 2014, if it clears 10 very high hurdles, including the receipt of a federal waiver. Otherwise it wouldn’t kick in until 2017.
Longtime single-payer advocate Dr. Deb Richter was ecstatic about the Senate passage of the bill.
“I’m absolutely thrilled,” Richter said. “It’s one of the best days of my life. I’ve given 400 speeches over the last 10 years and it feels like the work was worth it. We have a ways to go, but this is a step in the right direction.”
A universal health care system is the only way to cover everyone and contain costs, Richter said.
The passage of H.202 marks the first time any state in the country has attempted to provide universal care and a cost containment system that addresses administrative costs, hospital budgeting and uniform payments to doctors, Richter said.
Whether the federal government will give Vermont a waiver to adopt a universal health care system in 2014 is an open question. Richter said the state has a 50-50 chance of getting the exemption from the Affordable Care Act. Even so, she believes Vermont’s attempt to create a single-payer system is worthwhile.
“You go for what you want, not for what you think you might get – that’s what the bill does,” Richter said.
The Senate debate focused on the state’s implementation of the insurance exchanges that are required under federal law. The Affordable Care Act has mandated that states provide an actuarial value for insurance products (the insurance equivalent of a per unit price mechanism that allows consumers to compare the cost of on the shelf grocery items). The federal government has set up very general guidelines for the actuarial levels for insurance products insurers must provide under the exchange. The idea is to create an easy system for comparison between health insurance benefit plans that offer a dizzying array of deductibles, co-insurance, co-pays and premiums. The products, under the federal requirements, range from bronze (60 percent actuarial value) to silver (70 percent), gold (80 percent) and platinum (90 percent). It also puts minimum requirements on the “qualifying plans.” Many of these mandates are already in Vermont law. Insurers, for example, are not allowed to “cherry pick” consumers who are healthy and create pools without a cross-section of the sick and healthy populations.
Read this summary of the ACA requirements from Kaiser Foundation.
The Affordable Care Act requires individuals without insurance to buy into the exchange or face a $695 fine. Families of four with incomes of less than $88,700 qualify for tax credits. Businesses with more than 50 employees that do not buy insurance face a penalty of $2,000 per worker.
The fight between employers and proponents of H.202 was about the potential for mandatory inclusion of businesses that have between 50 and 100 workers in the exchange. Sens. Hinda Miller, D-Chittenden, and Illuzzi argued that requiring companies of that size to participate in the exchange could jeopardize their economic viability. Employers in that range tend not to self-insure and so are not protected under the Employee Retirement Income Security Act.
The federal law allows states some flexibility. States can decide what benefit plan levels can be offered, for example. They can also determine the size of the businesses that must be included in the exchange. The Shumlin administration pushed for intent language in the bill that could have led to the inclusion of businesses with 50 to 100 employees into the exchange. Proponents of H.202 have said it’s important to include these 28,000 workers in the state’s insurance exchange in order to build toward a single-payer system.
An amendment proposed by Sen. Diane Snelling, R-Chittenden, and approved by the Senate struck the intent language. The Green Mountain Care board, which will oversee the health care reform effort including the exchanges, is charged with producing a report that would outline the impact of excluding the 50-100 employee group on the exchange, which the Shumlin administration wants to use as a stepping stone toward the single-payer system.
Illuzzi proposed two amendments that would have forced the state to include a broader array of insurance carriers in the exchange, would have specifically allowed health savings accounts and high deductible plans under the exchange and would have allowed “nonqualified” plans outside the exchange. H.202 allows for two carriers.
“Let’s not kid ourselves it will be more than one carrier,” Illuzzi said on the Senate floor. “It will likely be Blue Cross Blue Shield. It will be two carriers in name only. Both will be required to offer same (plans). It will be a change without a difference.”
Anya Rader Wallack, Shumlin’s special assistant on health care, said she was impressed by the Legislature.
“A lot of people worked very hard educating themselves in a short period of time,” Wallack said. “This isn’t simple stuff. I was impressed with the amount of effort both bodies have put into this.”
The Shumlin administration was heavily involved in drafting the bill, H.202. By the time the legislation reached final passage it had changed somewhat from its original incarnation, which was based in part on recommendations from Professor William Hsiao, the renowned Harvard economist who created a single payer system for Taiwan.
Sen. Claire Ayer talks with Anya Rader Wallack and Robin Lunge before Monday’s session. VTD/Josh Larkin
Over the next year, the Shumlin administration will hire a director of health care reform and the chair of a quasi-judicial board. The board would be in place by January 2012 and would begin the arduous task of sorting through the maze of federal laws, waivers, benefits, provider reimbursements, system financing and cost containment options.
H.202 will be read in the House Health Care Committee on Wednesday morning. Rep. Mark Larson, D-Burlington, said he expects the bill will go to conference committee in several days. He expects to have no major beefs with the Senate version.
“The core composition of the bill remains identical to what passed in the House,” Larson said. “There are differences between the two bills but they are things we can work out.”
Larson said those details include a change in the dynamic of the board. “We want to make sure it’s an independent board.”
He also referred to the so-called “Mullin” amendment, which set conditions for implementation of Green Mountain Care, the single-payer style system that would be created under H.202. Larson said he thinks the new criteria for the implementation standards need to be more clearly defined.
“It has to be clear what hurdle has to be overcome,” Larson said.