Congress

Can health reform heal our federal budget? Yes, but whatever passes now is just the beginning, and there will always be room for improvement.

That's our takeaway from an excellent event we tweeted this morning hosted by the US Budget Watch, a joint project between the Committee for a Responsible Federal Budget and The Pew Charitable Trusts.

There was a lot of ground covered by a panel of experts moderated by the Washington Post's Ceci Connolly and featuring New America's director of health policy Len Nichols. They tackled everything from raising Medicaid eligibility rates to fixing the Sustainable Growth Rate formula in a fiscally responsible way. But for now, we'll just give you the highlights of the discussion.

The AP reports that the AARP is ready to announce it's support for the Democratic health reform legislation in the House. The endorsment from the influential retiree's lobby should provide a big boost as House Democrats are expected to vote on H.R. 3962 Saturday evening. Streaming video of the AARP announcement, set to begin at 11:30 a.m., is available below.

Meanwhile, the American Medical Association will announce it's position on the House bill's at 12 p.m. More on that after we get off the call.

In a floor speech Monday, Rep. Virginia Foxx (R-NC) argued the prospect of passing health reform gave us more to fear than "any terrorist right now in any country."

Foxx has previously suggested that there "are no Americans who don't have health care," and that health reform would cause seniors to be "put to death by their government."  

We guess there's not much else to say about Foxx and health care, except, well, bless her heart.

This post appears on the National Journal's Health Care Experts Blog where you can also see what other health policy analysts have to say about allowing states to opt out of a public health insurance option.

The public plan debate marches on this week as we discuss whether or not states should be allowed to “opt-out” of the public health insurance plan. Allowing states to choose not to provide the public health insurance plan as an option in their markets has its virtues. It establishes the infrastructure necessary to create a public health insurance plan nationwide, but it also makes the decision ultimately a state judgment. This may be a safer way to go for those who worry about government expansion.

While we do not know the details of what kind of public plan states would be able to “opt-out” of, we suspect the center of gravity is closer to a level playing field approach, such as that proposed by Senator Schumer (where the plan would have to negotiate payment rates with providers) as opposed to the version supported by progressive Democrats in the House (where the plan would administer prices based at least in part on Medicare rates). If the level-playing field approach is in fact adopted, assertions that the plan would simply “underpay providers” rather than “driving real reforms that bring down costs and improve quality” are unfounded.

H.R. 3962, the Affordable Health Care for America Act, is available online. All 1990 pages of it.

UPDATE: Politico's Live Pulse has the supporting documents:

• 11-page detailed summary.
• Topline changes
• Implementation timeline
• Immediate investments
• Section by section summary

House Leadership will unveil its merged health reform bill at 10:30 a.m. today at the West Front of the U.S. Capitol Building. The Affordable Health Care for America Act should be posted on the House Rules Committee website at 10:00 a.m. We'll have more thoughts later, but early details on the legislation formed from the Tri-Committee bills are as follows:

• Coverage: The bill is expected to lower the ranks of the uninsured by 35 to 36 million. As expected, the bill contains sweeping changes to the health insurance market, such as guaranteed issue, community rating, and an end to the practice of exclusions based on pre-existing conditions. It requires all Americans to purchase insurance, provides subsidies to make insurance affordable and establishes insurance exchanges to create a new marketplace for consumers.
• Cost: The bill will come in under President Obama's target of $900 billion over ten years. The bill is deficit neutral running surpluses in the first half of the 10-year  budget window, but deficits in the second. Democrats in the House say they expect the bill to be budget neutral in the second 10 years as well.
• Public Plan: The bill will contain a public plan with negotiated rates. The move is seen as compromise to help appease concerns of some of the moderate and conservative Democrats in the House.
• Medicaid: The bill expands Medicaid eligibility to 150 percent of the federal poverty level for all adults -- an increase from previous drafts which had set eligibility at 133 percent of FPL.
• Financing: The bill is funded largely savings from changes in Medicaid and Medicare and a a 5.4 percent surtax on individual making more than $500,000 and couples making more than $1 million -- an increase from the original thresholds. The fix to the sustainable growth rate formula has been carved out and will be introduced separately. There is also an 2.5 percent tax on medical device makers and an increase in the cuts faced by drugmakers.

In the odyssey of health reform, the public plan is the Proteus of our wonkish mythology -- constantly shifting, capable of divining the future, but never willing to give you a straight answer. Sorry, Politico's Pulse already took the soap opera metaphor, "As the Public Option Turns" so we had to get Homeric.

Still, trying to get a handle on where the public plan stands is like wrestling a wet seal.

Earlier in the week, Democratic House leadership felt confident they had the votes to pass a "robust public option" tied to Medicare payment rates, but the latest whip counts suggest the leadership still has some work to get 218 votes in the House.

Meanwhile, in the Senate, Majority Leader Harry Reid (D-NV) is leaning toward including a public insurance option that would allow the states to opt out. The White House is said to favor a trigger option, hoping to keep the Republican Penelope from Maine weaving at her loom.

All this is subject to change, and next week, it will no doubt change again. And the week after that, too.  However, lawmakers should not let the protean politics of the public plan obscure other key aspects of reform. Insurance market reforms like guaranteed issue and community rating, may not have the same siren call of public plan debate, but they are critical in making health reform work.

A new issue brief from the Robert Wood Johnson Foundation and Health Affairs provides a thorough overview of the issue, looking at why insurance market regulation is needed, what's proposed in the various bills, and the possible objections and barriers to proposed solutions.

The Nationals may have never had a shot at the playoffs, but Washington's senators are still playing hardball in October.

Much of the action centers on the public plan, which has reemerged as one of the central issues in merging the Senate's HELP and Finance bills.

Senate Finance Chairman Max Baucus told reporters on Monday that he believed a "pure public option" did not have the votes to pass the Senate, but that there were many options on the table that could form the basis of a compromise.

Remember duck, duck, goose? The Senate health reform version might be Snowe, Snowe, Snowe, Collins.

Maine's Republican moderate Sen. Olympia Snowe is currently the only Republican supporting a Democratic-led health care bill. But if the Democrats get down to business, they might be able to lure Sen. Snowe's fellow Maine senator -- Susan Collins (R-ME) -- across the aisle as well.

At Higher Ed Watch, we have made clear our opposition to a provision in the pending student loan reform legislation that would provide a set aside for all existing non-profit student loan agencies to service up to 100,000 borrowers in their home states. But we have also said that if Democratic Congressional leaders insist on keeping the provision in the bill -- because they believe that they can't pass a bill without it -- they should at least bar from participation non-profit lenders that have broken the law or acted in ways that are harmful to students.

Case in point: the Iowa Student Loan Liquidity Corporation (ISL), the state-affiliated non-profit student loan provider. As both federal and state investigations have shown, ISL's aggressive pursuit of market share and financial rewards over the last decade has been damaging to students and taxpayers alike. According to these investigations, the loan agency has done the following: