Courtesy of our very own sharpchick, we have access to a copy of a “confidential” health care compromise that was proposed by the Senate, but rejected by the House. State House News posted a copy of the whole thing at their site.
It’s a very, very interesting document, and it seems to me to tell us a lot more than we knew before about where the parties really are.
One of the biggest questions has been whether the Senate is willing to force employers who don’t offer health insurance to somehow participate in the system. Here is what the Senate proposed on that topic:
As you can see, the Senate would charge a “non-offering employer” with more than 10 employees an annual $62 per-employee surcharge (called a “fair share assessment”) – which, according to the Senate document, matches the uncompensated care pool assessment that employers who do offer coverage must pay. In addition, the Senate plan would assess a capped “free rider surcharge” on an employer who does not offer coverage whenever an uninsured employee uses the uncompensated care pool. The document does not explain the precise calculation of the surcharge, nor how it would be capped. The free rider surcharge is expected to bring in $80 million per year, and the fair share assessment should bring in $7 million, according to the Senate document.
The Senate plan also addresses “individual responsibility.” It does not include an individual mandate, but it does include an “individual free rider surcharge” for individuals who have, but decline, the option of purchasing health insurance through their employer and then use the free care pool. This surcharge would be on a sliding scale of 30% to 100% of the cost of care, capped at $5,000. The plan also includes a variety of mechanisms designed to make it easier for individuals who want to purchase health insurance to do so.
As for Medicaid, here’s what the Senate proposes:
I’m not enough of a health policy wonk to really know what that means, so I’ll leave it to others to explain it.
The overall goals of the plan are as follows:
My initial reaction: this isn’t bad. Has it got problems? Sure – as others have noted, there is a risk of creating an incentive for employers who don’t offer coverage to dump employees who seem likely to get sick and who don’t have other insurance, since otherwise they risk getting hit with the free care surcharge. But it at least takes some steps toward reducing the unfairness that exists in the current system. Maybe it doesn’t go “far enough.” But it strikes me as having come a significant distance from where the Senate started out.
So, Mr. Speaker: don’t just reject this plan out of hand. This is politics – sometimes you have to compromise. If you don’t like it, you should explain exactly why, and come back with a reasonable counterproposal that tries to bridge the gap between this and your original plan.
I’ve been critical of Trav in the past for his stance on health care. But I give him credit for what’s in this proposal. Seems to me there now ought to be pressure on DiMasi from the left as well as the center-right to work with the Senate to come up with something so that we don’t penalize the entire state by losing federal money that we can’t afford to lose.
I thought the whole hangup was that the House wanted an assesment on employers and the Senate didn’t. Or am I getting that confused with the Romney plan?
The House proposal is an assessment in the form of a set percentage (around 5% – it varies by year and I think by size of employer) of the company’s payroll, for companies that don’t provide coverage. The assessment proposed in this Senate plan is smaller – $62 per employee, plus an additional charge every time someone uses the free care pool. Still, both sides now appear to agree that some sort of assessment on non-offering employers is appropriate, and that’s progress.
I think DiMasi is thinking of a much larger assessment on employers — the $ raised @ $62 a head isn’t enough to cover much of the cost of care for those folks. I believe that ‘BUR said he was talking about $600-800 a year — still cheap, compared to the cost of actually insuring someone. Hey, what’s a power of 10 between friends?
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Also, the charge for use of the free care pool leaves in place the severe disincentive to keep someone on your payroll who actually has medical costs. Not very humane – and not an efficient, productive way to use health $.
I agree, this seems like a very reasonable compromise. I’m surprised that DiMasi dismissed it so quickly last week and is publically critizing the Senate for not offering any serious counter-proposals. I wonder how this leak will affect the negotiations?
The Speaker complained that the Senate wasn’t offering any compromise earlier in the week.
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So what happens today?
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Oh a confidential Senate compromise proposal suddenly appears in the State House news.
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Come on. This is a PR skit by the Senate.
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Negiotiations don’t happen through the press. Clearly the Senate is more concerned with the public perception than actual policy.
They set out “goals”. Well, that’s nice. I have the “goal” of pitching a perfect game in the World Series for the Sox. We all got goals.
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What’s the mechanism for getting 195,000 people “insured” in the private market — and then what does that “insurance” consist of?
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And as I’ve said, $62/year is cheap cheap cheap. Expect more and more employers to start paying that fee, since we’ve now quantified how cheap it is to get off the hook. (See Freakonomics re: day care and late pickup fees.)
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(And yes, as usual, I’m shamelessly cribbing my talking points from Health Care for All — read John’s post.)
This Senate “compromise” plan really isn’t all that different from the Senate’s original plan. Which, by the way, included an employer assesment in the form of the free rider charge for uninsured employees who use the free care pool (http://www.mass.gov/legis/bills/senate/st02/st02282.htm – see Sec. 18 esp.).
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I agree that the timing of this leaked compromise is suspicious. But I want to back up a minute… Everyone jumped on the House plan because it had an employer assesment. But the Senate plan had an employer assesment as well AND it covered fewer uninsured people. The only reason everyone in the business communities preferred the Senate plan is because the Senate didn’t talk about their employer assesment.
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We need to recharacterize this debate. If you are opposed to the House plan, then you SUPPORT requiring businesses to subsidize the healthcare costs of the uninsured (because right now, those businesses that provide insurance are paying twice – for their own employees and for the employees of irresponsible businesses that refuse to provide insurance). Businesses ought to be embracing the House plan: it’s going to level the playing field. Businesses just don’t get that the assesment in the House plan only impacts businesses that don’t already provide insurance; everyone bought Mitt Traviglini garbage about a “payroll tax” and panicked.
Watch. DiMasi has history of being luke warm to slot machines. The expected revenue from slots is $350 million to $500 million.
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The Health Care Bill will be negotiated with the slots, which Trav really wants. BadaBing and you have a good chunk of the slot revenue funding DiMasi’s version.
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Capiche
I think I could support this.