Fwd: Senate Bill Update

[Melodi Masaniai]

Dear friends,

 

This is a message from the Organizing for America staff. Some of you know Peggy Moore from the campaign, when she was the Northern California Field Director (Giselle's boss) or from her presentation to us at the Democratic 21st Century Club a few months ago. Her message brings a little clarification.

 

This is in line with what Gov. Dean said last night (MSNBC) and I'll forward his message when I get it.

 

A great man once said, "It ain't over until it's over." Keep up the pressure and the good work. I'll send an update when I get it. Sincerely,

 

Melodi Masaniai

---------- Forwarded message ----------
From: Jeff Harry, OFA Northern California Regional Field Director

Date: Wed, Dec 9, 2009 at 16:51
Subject: Senate Bill Update
To: ofa-norcalco

Northern California Community Organizers,

Thanks for your patience today as we tried to get the best information about the Senate Bill to share with you. 

We were able to get on a call with the OFA National and Senior Staff on the hill earlier today and they provided us some information about what is going on with the Senate Bill.  Attached below is an email from our Political Director, Peggy Moore, summarizing it. 

We are getting close to the finish line so the challenges are going to get that much harder.

Thanks for all of your hard work amidst the challenges, 

Ruby Reid & Jeff Harry
Organizing For America (OFA)
Northern California Regional Directors

---------- Forwarded message ----------
From: "Margaret Moore"

To: OFA CA

Date: Wed, 09 Dec 2009 19:21:22 -0500
Subject: Senate Bill Update

I know there has been lot of noise about the recent Senate agreement on the public option. Here is what we know right now – and the good news is that we are closer than ever before to achieving comprehensive Health Insurance Reform.

Ten Democratic Senators – five progressives, five moderates – reached a tentative compromise that represents another important step on the road to passing health insurance reform in the Senate. The final details of the agreement are still coming to light, but it’s clear that the Senate is making progress. 

 

President Obama and his team are pleased that the Senate is working together to find common ground. The President said this tentative compromise could represent a “creative framework” to increase choice and competition and lower costs.

 

Though the details have yet to be released and it is still being scored by the CBO, as we understand it the agreement would:

 

·         Allow older Americans – aged 55 to 64 - to buy into Medicare, a significant step that would give millions of Americans, who are among the most vulnerable population with regard to cost and coverage, access to quality, affordable care.

·         Require insurance companies to comply with new and strengthened insurance regulations, including a requirement that they spend at least 90 cents of every dollar they collect in premiums on medical services for their customers.

·         Create several new non-profit national insurance plans – similar to those offered to federal employees (including members of Congress). These non-profit plans would be negotiated by the Office of Personnel Management (OPM) but managed by private insurers.

·         If insurance companies fail to achieve the agreed upon goals through these non-profit plans (making affordable coverage available to all Americans), the government would step in with its own plan

 

This tentative agreement is another step on the road to reform that will make quality, affordable insurance available to every American, provide unprecedented stability and security for consumers, and lower costs for American families, businesses and our entire country.

 

Many people have been asking if the Senate deal means the public option is “dead.”

The Answer is no.  President Obama has said all along that he supports a public insurance option because he thinks it’s one of the best ways to increase choice and competition and lower costs. However, he’s always been open to other creative ideas that achieve those goals. What’s most important is passing reform that makes coverage more stable and secure for the insured, providing more quality affordable options to those who don’t have insurance, and lowering costs for families, businesses and our government.

 

Providing Americans age 55 and older the option to buy into Medicare will make quality health care more affordable for millions of older Americans. The new national health plans (which would be negotiated by OPM but managed by private insurance companies) are essentially how federal employees and members of Congress get their health care coverage now. And if the private companies don’t achieve the agreed upon goals, the government will step in with its own plan. New regulations will make sure our health care system works for families and workers, not just the insurance companies.

 

The legislation passed by the House and under consideration in the Senate will finally put an end to unfair industry practices, like denying coverage based on a pre-existing condition and dropping or watering down coverage when someone gets sick and needs it most.

Don’t hesitate to shoot us any other questions you may have. And in the meantime, let’s continue our hard work. The finish line is in sight.

 

Peggy

Peggy Moore
California Political Director,
Organizing for America

[Elaine Coombs]

Melodi,

Thanks very much for this update.  I have been wondering about opening up Medicare to 55 and above.  Will enough doctors accept the number of new Medicare patients?  And will there be enough hospitals to serve these new Medicare patients?  Also, will HMOs such as Kaiser still receive Medicare subsidies for Senior Advantage patients? 

Folks 55 to 65 will be paying the same premiums that soc sec recipients pay toward their Medicare coverage out of pocket I am assuming.   Propping up the Kaisers of the of current system with Medicare dollars does not make sense to me.  And when will this take effect.

My Senior Advantage contract is already in place for 2010 with a modest $74 a month premium and much less in the Central Valley.  If the subsidy is taken away to offer this price is taken away, I presume the Senior Advantage program would either disappear or go way up in price in monthly premiums and presumably less coverage.  Meanwhile, Medicare payments from my soc security will continue whatever.

The devil is always in the details and I guess we've arrived  at the point where these devilish details will have to come out in the open----- and also the timing.

I hope OFA is or will be in a position to answer these questions.

Elaine

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[Elaine Coombs]

Many thanks for this review of Medicare.  Zoe Lofgren told me Medicare subsidization would go away so I am going to be very interested if it is indeed in the Senate legislation (or in the House for that matter that should be available if one wants to take the time to read the bill) and when. 

I've heard commentary early on by healthcare experts in Contra Costa County that right now there are not enough doctors in that area to serve everyone.  There is a doctor shortage in this country, maybe not in Santa Clara County, but perhaps Mike Honda would have some information about that.  Apparently some doctors in Alaska are not accepting Medicare patients now. I am very uncomfortable about the issue of accessibility to doctors and hospitals.

I'm interested to hear that the premiums for new Medicare patients in the 55-65 age bracket will be as much as $600 a month, I presume per person?

Best regards,   Elaine Coombs 

On Wed, Dec 9, 2009 at 9:02 PM, <Jsin...@aol.com> wrote:

 

Hi Elaine,

 

I think I can address some of your questions.  To do this, it might be good to first review some basics about Medicare:

 

There are several Parts to Medicare:

 

Part A

- covers mainly inpatient services

- almost 100% of funding comes from the familiar payroll Medicare taxes (1.45% of salary paid by employer and the same by employee)

- automatic coverage for all those age 65 and over

- benefits are paid to service-providers on a fee-for-service basis

 

Part B

- covers mainly outpatient and preventive services

- about 25% of funding comes from participant premiums (generally paid by automatic deductions from social security distributions), and most of the remaining 75% comes from general federal funds (e.g. income taxes, borrowed funds, etc.)

- coverage is voluntary; most people over age 65 do participate

- benefits are paid to service-providers on a fee-for-service basis

 

Part C (Medicare Advantage)

- voluntarily selectab;e substitute for Parts A and B, in which services are offered through a managed-care plan instead of being reimbursed on a fee-for-service basis

- required to offer at least those services covered by Parts A and B

- funded by participant premiums and federal funds that otherwise would go to provide Parts A and B coverage for participant

- presently subsidized such that it costs 14% more per participant to offer services through Medicare Advantage than it does to cover the same services through regular Parts A and B.

 

Part D

- covers prescription drugs

- offered only through private plans, including many Medicare Advantage plans (for additional premiums)

- about 10% of funding comes from participant premiums, about 15% comes from state funding, and about 75% comes from general federal funds

- participation is voluntary

 

 

The proposed new plan for people age 55 to 65 is that they would be able to "buy in" to Medicare coverage.  As such, they would not receive the coverage subsidization that older Medicare participants receive.  Consequently, for this new group, premiums for participation in Medicare would be quite high; I have seen one estimate as being more than $600 per month. 

 

The present 14% subsidization of the Medicare Advantage program is a very costly extra burden on Medicare that benefits only a small minority of participants.  The elimination of the subsidization would be a very good thing, enhancing the financial viability of the Medicare program while providing the same levels of coverage to all participants, whether through Parts A & B or through Part C. 

 

Many managed care programs (like Kaiser's) would continue to offer Medicare Advantage plans, but they probably would limit their basic offering to what services are covered by Parts A and B.  The premiums for such basic plans probably would be very similar to those paid by participants in regular Part B.  Additional services probably would be available for additional premiums, just as participants in Parts A & B can supplement their coverage through private "Medigap" policies.

 

-- Jonathan Starr

 

 

 

 

 

 

 

 

 

 

 

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[mariasa...@comcast.net]

According to the interview with Dr. Dean yesterday on MSNBC, those 55 to 65 will have to pay the full premium for medicare coverage, not just the out of pocket that seniors over 65 pay. As with younger people enrolled in other plans, the government may subsidize those which income is below a certain level, but the idea is that the individual will be responsible for their own coverage. In other words, medicare enrollment offers an alternative to those over 55. It is not as I understand it an entitlement program.

 

As for when the program will be available, it could be as soon as next June. The reasoning here is that it will be administered by the same group as medicare and it does not require development of new administrative procedures.

 

Maria

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[Elaine Coombs]

Thanks Maria.  I'm feeling more comfortable about that.  Now, the availability of Medicare accepting physicians and hospitals is another key question.

And are Medicare payments to HMOs like Kaiser going to continue? 

I am going to contact Honda's office about these questions.

Elaine