Feeling ill

From Kieth Hennessey: (emphasis added)

  1. The Kennedy-Dodd bill would create an individual mandate requiring you to buy a “qualified” health insurance plan, as defined by the government.  If you don’t have “qualified” health insurance for a given month, you will pay a new Federal tax.  Incredibly, the amount and structure of this new tax is left to the discretion of the Secretaries of Treasury and Health and Human Services (HHS), whose only guidance is “to establish the minimum practicable amount that can accomplish the goal of enhancing participation in qualifying coverage (as so defined).”  The new Medical Advisory Council (see #3D) could exempt classes of people from this new tax.  To avoid this tax, you would have to report your health insurance information for each month of the prior year to the Secretary of HHS, along with “any such other information as the Secretary may prescribe.”
  2. The bill would also create an employer mandate.  Employers would have to offer insurance to their employees.  Employers would have to pay at least a certain percentage (TBD) of the premium, and at least a certain dollar amount (TBD).  Any employer that did not would pay a new tax.  Again, the amount and structure of the tax is left to the discretion of the Secretaries of Treasury and HHS. Small employers (TBD) would be exempt.
  3. In the Kennedy-Dodd bill, the government would define a qualified plan:
    1. All health insurance would be required to have guaranteed issue and renewal, modified community rating, no exclusions for pre-existing conditions, no lifetime or annual limits on benefits, and family policies would have to cover “children” up to age 26.
    2. A qualified plan would have to meet one of three levels of standardized cost-sharing defined by the government, “gold, silver, and bronze.”  Details TBD.
    3. Plans would be required to cover a list of preventive services approved by the Federal government.
    4. A qualified plan would have to cover “essential health benefits,” as defined by a new Medical Advisory Council (MAC), appointed by the Secretary of Health and Human Services. The MAC would determine what items and services are “essential benefits.”  The MAC would have to include items and services in at least the following categories:  ambulatory patient services, emergency services, hospitalization, maternity and new born care, medical and surgical, mental health, prescription drugs, rehab and lab services, preventive/wellness services, pediatric services, and anything else the MAC thought appropriate.
    5. The MAC would also define what “affordable and available coverage” is for different income levels, affecting who has to pay the tax if they don’t buy health insurance.  The MAC’s rules would go into effect unless Congress passed a joint resolution (under a fast-track process) to turn them off.
  4. Health insurance plans could not charge higher premiums for risky behaviors:  “Such rate shall not vary by health status-related factors, … or any other factor not described in paragraph (1).” Smokers, drinkers, drug users, and those in terrible physical shape would all have their premiums subsidized by the healthy.
  5. Guaranteed issue and renewal combined with modified community rating would dramatically increase premiums for the overwhelming majority of those Americans who now have private health insurance.  New Jersey is the best example of health insurance mandates gone wild.  In the name of protecting their citizens, premiums are extremely high to cover the cross-subsidization of those who are uninsurable.
  6. The bill would expand Medicaid to cover everyone up to 150% of poverty, with the Federal government paying all incremental costs (no State share).  This means adding childless adults with income below 150% of the poverty line.
  7. People from 150% of poverty up to 500% (!!) would get their health insurance subsidized (on a sliding scale).  If this were in effect in 2009, a family of four with income of $110,000 would get a small subsidy.  The bill does not indicate the source of funds to finance these subsidies.
  8. People in high cost areas (e.g., New York City, Boston, South Florida, Chicago, Los Angeles) would get much bigger subsidies than those in low cost areas (e.g., much of the rest of the country, especially in rural areas). The subsidies are calculated as a percentage of the “reference premium,” which is determined based on the cost of plans sold in that particular geographic area
  9. There would be a “public plan option” of health insurance offered by the federal government.  In this new government health plan, the federal government would pay health care providers Medicare rates + 10%.  The +10% is clearly intended to attract short-term legislative support from medical providers.  I hope they are not so naive that they think that differential would last.
  10. Group health plans with 250 or fewer members would be prohibited from self-insuring. ERISA would only be for big businesses.
  11. States would have to set up “gateways” (health insurance exchanges) to market only qualified health insurance plans.  If they don’t, the Feds will set up a gateway for them.
  12. Health insurance plans in existence before the law would not have to meet the new insurance standards.  This creates a weird bifurcated system and means you would (probably) be subject to a different set of rules when you change jobs.
  13. The bill does not specify what spending will be cut or what taxes will be raised to pay for the increased spending.  That is presumably for the Finance Committee to determine, since it’s their jurisdiction.
  14. The bill defines an “eligible individual” as “a citizen or national of the United States or an alien lawfully admitted to the United States for permanent residence or an alien lawfully present in the United States.”
  15. The bill would create a new pot of money for state gateways to pay “navigators” to educate people about the new bill, distribute information about health plans, and help people enroll.  Navigators receiving federal funds “may include … unions, …


There’s some really nasty stuff in there. It’s crucially important to remember that the economics of public chopice dictate that these kinds of programs are subject to quick capture by parties with long-term vested interest (health insurers). The mandatory minimum coverage terms that come associated with this plan will quickly become exhaustive lists of coverage. The number of “essential health benefits” will erode as quickly as “inessential health benefits” will fade from private coverage.

The net effect of these lists and requirements will be shortages and queues. This bears repeating because supporters will insist, despite all evidence to contrary, that some how, some way, by some miracle of hope, the laws of economics won’t apply to subsidized health care. But they will. And when you reduce the cost of a scarce good to zero (through subsidy) and constrain supply of that same good (through price controls and increased regulation) the result is a shortage of that good.

The most appalling on the list (it’s hard to pick) may be that plans will not be allowed to adjust rates for risky behavior.

Part of the reasoning behind that little bit of genius (just wait until the queue for liver transplants gets jumped by some congressman’s drug-addled, meth-freak of a nephew), is that I imagine the plan will rely on increased sin-taxes for financial support.

I eagerly await the chorus of denunciation from the Democrats in Congress who will surely decry the delegation of such enormous power to the Executive branch. Right? They were exorcised about the over-reaching Bush White House and will surely stand up to what amounts to granting the White House total control over a significant portion of the federal tax-rate, right?


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