The House of Representatives will soon bring a health care reform bill up for a floor vote. All three relevant committees have approved bills containing a public health insurance option. In August, Jacob Hacker explained one of the key differences between those bills (pdf file):
The versions of the House bill approved by the House Ways and Means Committee and House Education and Labor Committee contain a Medicare tie-in that has two crucial characteristics:
1. Providers participating in Medicare would automatically be considered participating providers in the new public plan, although they would have the right to opt out.
2. Initial payments to providers would be set at Medicare rates plus 5 percent. After three years, the Secretary of Health and Human Services could adjust rates. But during the crucial start-up period, the public plan would be able to piggyback on Medicare’s payment methodology. 17
These are good provisions. They would be even better if they included an explicit protection of providers’ rights to join the public plan. Private plans (at least those that participate in the exchange) should be prohibited from setting as a condition of participation in their networks that providers not join the public plan.
By contrast, the House Energy and Commerce Committee approved the House bill with amendments that preserve only the first of these two elements. 18 Providers participating in Medicare would be presumed to participate in the new public plan (but, again, allowed to opt out). 19 However, rather than setting the rates the public plan would pay providers on the basis of Medicare rates, the Secretary of Health and Human Services would have to “negotiate” rates directly with providers. 20 These rates in the aggregate would have to be between Medicare rates and private rates, but no other details are given. 21 This is a not-so-good provision that could drive up individual premiums and federal costs, burdening Americans as health care consumers and taxpayers alike. It threatens the viability of the public plan because it may require the government to pay providers higher rates than they would otherwise accept if the rates were set.
Click here to download Hacker’s full report, which includes analysis of the Senate HELP Committee’s bill.
When the House Energy and Commerce Committee passed a watered-down bill to placate Blue Dog Democrats, most people assumed that this compromise would be the health care reform bill sent to the House floor. However, House Progressives have been rounding up votes for the stronger public option provisions, and yesterday Progressive Caucus co-chair Raul Grijalva claimed to have 210 votes supporting or leaning toward supporting the stronger bill. Speaker Nancy Pelosi won’t bring that bill to the floor unless she is sure she has the 218 votes needed to pass, however. As many as 19 House Democrats have not decided whether they would support the “Medicare plus 5 percent” public option.
Chris Bowers published a pdf file listing 36 House Democrats who are either undecided, “lean yes” or “lean no” on the stronger public option. Representative Leonard Boswell (IA-03) is on that list. It’s not clear whether he is undecided or leaning one way or the other. I have sought clarification from his office and will update this post when I hear back.
You know the drill. Boswell needs to hear from as many constituents as possible. The “Medicare plus 5 percent” version of the public option is better policy, and if the House approves it, our negotiating position in the Senate will be stronger. I would call Boswell’s office rather than e-mail, because phone calls are harder for staffers to ignore. Office contact information:
Washington DC Office
Phone: (202) 225-3806
Fax: (202) 225-5608
Iowa District Office
Phone: (515) 282-1909
Fax: (515) 282-1785
Toll Free Phone: (888) 432-1984
In related news, Boswell joined Representatives Bruce Braley (IA-01) and Dave Loebsack (IA-02) today in announcing final legislative language to change “the way Medicare pays healthcare providers for services, from its current fee-for-service system into a quality and value-based system.” After the jump I’ve posted a joint press release explaining how this deal will affect Medicare reimbursement rates.
UPDATE: Supposedly there are at least 218 votes in the House for the “robust” public option. The deal on Medicare reimbursement rates helped secure some extra votes for the public option. Also, the House bill will strip the insurance industry of its anti-trust exemption.
CORRECTION: Apparently we don’t have 218 votes for the stronger public option after all.