Apparently, the president's last-minute embrace of certain additional Republican ideas is a problem with the Congressman. Particularly, Grijalva is peeved that the President is agreeing to ensure the existence of Health Savings Account plans (HSA's) in the exchanges.
That provision "was, when we were in the minority, something that we fought tooth and nail to keep out [of legislation]," Grijalva said. "I find that ironic -- something that we had fought to keep out, and indeed were successful, gets back in as part of reconciliation.Liberals are rightly concerned about HSA's, which are nothing more than a way to sell catastrophic coverage with really high deductibles that most people cannot afford. It is, as the President himself once called it, house insurance, not health insurance. Nonetheless, I'm not entirely sure what the Congressman is talking about; the fact of the matter is that while the President is proposing that there be HSA's in the exchanges, no one is forced to buy an HSA plan. The good essential benefits requirements are still there, and only plans with those requirements met are counted when the individual mandate is in play (which one is exempt from if premiums cost more than 8% of one's income). In other words, if one is able to afford an HSA insurance plan that is under 8% of one's income in premiums but don't meet the essential benefits requirements, one is not subject to the mandate if one chooses not to buy it. What's more, I am not aware of a provision in the House bill that bans HSA's from being sold on the exchanges. The Senate bill allows those under 30 who are already exempt from the mandate to buy HSA catastrophic plans.
Three other items in the President's last-minute adoptions were relatively non-controversial:
- Reducing waste, fraud and abuse by having undercover health professionals randomly investigate providers who receive federal health care money.
- Demonstration/pilot projects on malpractice lawsuit reforms. It doesn't cap damages, but just sets up pilot projects to test the best ideas.
- Improving the Medicaid reimbursement rates and regional disparities therein.
But I believe the real gripe of Rep. Grijalva is the exclusion of the public option.
And a public option that enjoys great support in the House and up to 30 senators gets left out. That's something I just don't understand.Twenty-nine Senators have signed a letter asking for Sen. Reid to include the public option through reconciliation, and six others have made statements that they will vote for it if Reid did happen to include it (the difference, I believe, is substantial in the sense that the last six aren't asking for it to be included, but merely saying that it has their votes should it be up for a vote - they are not demanding a vote on it).
While no one on the liberal side celebrates the demise of the public option, 35 Senators are not 51 Senators. And as Ezra Klein has repeatedly pointed out, even Senators who support the public option privately do not believe its resurgence is good news for health reform getting passed. We just simply cannot wait around to get the votes together for the public option under reconciliation - votes that in every likelihood will never materialize - while health reform dithers.
At the end of the day, when all is said and done, the health reform package will:
- Give 31 million additional Americans health insurance.
- Massively expand community health centers with an additional $11 billion in funding.
- Expand Medicaid and have the federal government pick up the vast majority of the tab.
- Create exchanges with both state and federal oversights in which Americans can shop for the best deals.
- Provide Americans who need it with federal financial assistance to purchase health insurance.
- Provide a basic benefits package based on the one members of Congress get.
- Strengthen Medicare and stop over-subsidizing private insurance to provide the same services as Medicare.
- Outlaw the worst insurance company practices like denying insurance based on pre-existing conditions.
- Outlaw annual and lifetime limits on health insurance plans.
- Institute other strong insurance regulations.
- Require that insurance companies spend 85% of premium dollars providing care.
Update: Returning from a meeting at the White House, Grijalva indicated that House progressives will vote for the proposal, although he didn't say anything specific about himself. He did mention that the President has committed to fighting for a public option once this group of legislation becomes law.