Baucus's Exchanges are . . . Good!

by publius

Ezra Klein notes a very, very promising aspect of Baucus's bill:

The House bill, for instance, specifically allows businesses with only 20 or fewer people to join. Baucus goes quite a bit further. He begins by mandating that businesses with up to 50 employees be allowed to buy into the exchanges. If states want, they can expand that to businesses with 100 employees. . . . 

This, however, is where the Baucus plan takes that crucial next step: "In 2017, states must develop and submit to the Secretary a phase-in schedule (not to exceed five years), including applicable rating rules, for incorporating firms with 50 or more (or 100 or more for those states that already included firms with 51-100 employees) into the state exchanges." In other words, by 2022, the Health Insurance Exchanges will be open to all businesses of all sizes. That's a huge deal.

Comments

[TJ]

In other words, by 2022, the Health Insurance Exchanges will be open to all businesses of all sizes. That's a huge deal.

By 2022? That's a definition of "huge deal" I'm unfamiliar with.

[hairshirthedonist]

By 2022? That's a definition of "huge deal" I'm unfamiliar with.

By 2022 is a lot short than never, which seems to be the most likely alternative.

[TJ]

Practically, 2022 = never.

[Free Lunch]

Do the exchanges actually do anything for anyone?

We could get the same thing by mandating community rating for all insurance companies.

[woody]

Great! 2022! Wow. I'll be dead, but hey, who needs health insurance when they're dead...

[Nate]

What's to stop any Congress between now and 2017/2022 from changing the date, or undoing the law? Especially given the weakness of the rest of Baucus's bill.

[hairshirthedonist]

Health-care reform has been an issue since Teddy Roosevelt, and now 13 years equals never. Well...okay.

[Nate]

Well, 13 years isn't a bad estimate for how long until we'd have another chance at doing something to fix things, either.

[cleek]

2022 = plenty of time for the insurance companies to kill it

[Eric Martin]

Health-care reform has been an issue since Teddy Roosevelt, and now 13 years equals never.

It just means a 13 year hibernation for the Harry, Louise, Death Panel, rationing, insurance industry dollars, etc. that will kill it the next time around.

[TJ]

Health-care reform has been an issue since Teddy Roosevelt, and now 13 years equals never.

What every one else said. Plus, IMO, this country doesn't have 13 years left to fool around with health care. Implosion will come long before that.

[John Thullen]

I'm going to see how many pre-existing conditions I can come up with before 2022.

[John Thullen]

I'm going to see how many pre-exisitng conditions I can come up with before 2022.

[John Thullen]

I'm already going downhill in the space of 8 minutes --- I must have had a stroke because my spelling went kaputnik.

[Anthony Damiani]

Man, such a shame.
Blade Runner's Roy Batty could have purchased health care on the exchange, if only he'd lived two or three years longer.

Is being a replicant a pre-existing condition?

[hairshirthedonist]

Plus, IMO, this country doesn't have 13 years left to fool around with health care. Implosion will come long before that.

I agree, but what's under discussion is the full implementation of one aspect of health-care reform. And don't get me wrong - the bar's been lowered such that small victories loom large, but that's where we are.

[Jay Jerome]

Yo, Mr. Thullen...

The Baucus bill contains a planned half-a-trillion dollars in Medicare cuts...

The only pre-conditions you will be able to apply for regularly is shortage-of-doctor-visits--

[Woody]

The Baucus Plan cuts Half-A-TRILLION from Medicare?

May I please have a citation/link,

and, if true, loaded weapon?

Or maybe i'll just walk in front of a truck...

[kyllaros]

@Woody:

The half trillion figure is the same one that Obama has been using. The idea was to wring efficiencies from Medicare by stopping overpayments to hospitals and payments to insurance companies through Medicare Advantage. The idea is that no money that is actually used for care would be cut - just stuff that's being wasted now.

[kyllaros]

Incidentally, that means that Jay's assertion is a misleading scare tactic, but what would this debate be without demagoguery?

[Nate]

Wasn't Medicare supposed to cut payments to doctors and hospitals every year when health care costs grew faster than inflation? And money to the Medicare Advantage corporations, too. These cuts were prevented bipartisanly, (I don't think that's a word) but it seems to me like it would have been better for something like that to happen earlier, with smaller cuts, rather than keep kicking the can down the road. Heck, if it had happened at 1%, could the fact that might be enforced actually have helped prevent the costs from going up as much? I dunno.

[Jay Jerome]

Kyllaros says: Incidentally, that means that Jay's assertion is a misleading scare tactic, but what would this debate be without demagoguery?

I got the 1/2 trillion from this news article on Huffington Post. If those are scare tactics, tell it to them.

And if those overpayment savings and efficiencies exists, why don't they write the bill with a trigger: put the savings in a fund, and when they reach the promised amounts, then the bill becomes law, but not until then. Like the old conventional wisdom saying: money talks and bullshit walks.

[Bruce Webb]

In other words, by 2022, the Health Insurance Exchanges will be open to all businesses of all sizes. That's a huge deal.

It is? Why? Because if I look at the House Bill I find this:
SEC. 202. EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS
(skip)
(c) TRANSITION.—Individuals and employers shall only be eligible to enroll or participate in the Health Insurance Exchange in accordance with the following transition schedule:
(1) FIRST YEAR.—In Y1 (as defined in section 100(c))—
(A) individuals described in subsection (d)(1), including individuals described in paragraphs (3) and (4) of subsection (d); and
(B) smallest employers described in subsection (e)(1).
(2) SECOND YEAR.—In Y2—
(A) individuals and employers described in paragraph (1); and
(B) smaller employers described in subsection (e)(2).
(3) THIRD AND SUBSEQUENT YEARS.—In Y3 and subsequent years—
(A) individuals and employers described in paragraph (2); and
(B) larger employers as permitted by the Commissioner under subsection (e)(3).

Okay. Y1=2013 Individuals and 'smallest employers' (10 or fewer employees) can enroll in plans through the Exchange.
Y2-2014. 'smaller employers' (20 or fewer employees) become eligible.
Y3-2015 'larger employers' become eligible. Subject to (e)(3) where limits are set out in (e)(3)(B)

(B) PHASE-IN.—In applying subparagraph (A), the Commissioner may phase-in the application of such subparagraph based on the number of full-time employees of an employer and such other considerations as the Commissioner deems appropriate.
__________________________

I must be awfully dim, because on my reading by Jan 1, 2015 employers of all sizes will be eligible to enroll in a QHBP through the Exchange. Now at the discretion of the Commissioner giant employers might not be able to drop every unit into the exchange all at the same time, but there is no reason a priori to believe that any that want to could already do so well before the 2022 date Ezra is touting here.

I know there is an idea floating around that there are huge barriers to the Exchange and so to the Public Option but I just don't see them, not in the House Bill. What am I missing here? More Ezra:

The House bill, for instance, specifically allows businesses with only 20 or fewer people to join.

Hmm yeah. IN YEAR TWO. Which is actually 366 days after the establishment of the exchange. Add another 365 days to that and larger employers become eligible. That is two years and one day after establishment of the Exchange it should be open to all but the very largest of employers, and those allowed to phase in.

Frankly Ezra seems to be the victim of a serious mis-reading of the bill language. I suppose it is possible that all of this got dumped in the markup in all three committees and won't get added back. But the idea that the Baucus Markup is some huge advance on this front is horribly misplaced.

[Bruce Webb]

CBO scoring of the Baucus Plan extracted and put in JPEGhttp://1.bp.blogspot.com/_fjW71B3WLTQ/SrFE3SmIX9I/AAAAAAAAATQ/jxR-9Jgt-yE/s1600-h/CBO-Baucus-Deficit.jpg

$500 billion to extend coverage offset by
$409 billion in savings, i.e. Medicare Cuts
$139 billion in revenues, i.e. taxing higher level plans plus fining shlubs who can't afford even subsidized coverage

Breakdown that produces that net $500 billion cost figure
http://3.bp.blogspot.com/_fjW71B3WLTQ/SrFE4L77QjI/AAAAAAAAATY/EDhb61SQclI/s1600-h/CBO-Baucus-Coverage2.jpg