After the CBO projected major deficits, the plan was revised and recirculated. And this comes just in the nick of time, as Daschle & Dole’s “state run healthcare” plan has made a major splash today.
Ezra Klein got his hands on the latest and describes it as such…
Sources say that it’s a major scale-back of the outline they had before. Specifically, subsidies have dropped from 400 percent of the poverty line to 300 percent. Medicaid eligibility has been tightened to 133 percent of poverty for children and pregnant women and 100 percent of poverty for parents and childless adults. The plans being offered in the exchange have seen their actuarial values sharply lowered.
Beyond the changes, this is also the clearest look we’ve had at the specific policies being considered. There’s a fairly strong individual mandate, albeit with exemptions for those beneath the poverty line, those who would have to spend more than 15 percent of income for a plan, and undocumented workers. There are a variety of options for an employer mandate, or the absence of one. Sen. Kent Conrad’s co-op idea is up for discussion. There’s no public plan mentioned anywhere in the document.
Find the file here.
And while no public plan is mentioned anywhere in the doc per se, trust me, they’ll still be pushing for one. But maybe Conrad’s co-op idea, which is still technically a public plan, could take the place of a massive federal entity? Personally, I think both have pluses and minuses.
However, we may also want to look at another plans that aren’t under serious consideration right now.
Again, Klein highlights…
Rather than capping the employer tax exclusion, the Finance Committee could end it entirely and convert it, as Ron Wyden does, to a progressive standard deduction. Wyden’s plan, incidentally, was scored by CBO as being revenue neutral in two years and revenue positive in four. Rather than protecting the private insurance system, the Finance Committee could include a public plan with the ability to bargain to Medicare rates, thus saving, according to the Commonwealth Fund, 20 percent to 30 percent against traditional private insurance. Ezekiel Emmanuel, brother to Rahm and health-care adviser to Peter Orszag, has a proposal for a universal voucher system funded by a value-added tax. All these ideas would make health reform better, cheaper, and more sustainable. None of them, so far as I know, are under serious consideration.
But I do think the reality is that the current system is unsustainable. Will it take a genuine seismic policy shift in order to change it?
More as it develops…