This is a copy of the long reply that Maggie Mahar made to my post "Why Is Maggie Mahar Lying About Health Reform?" at TPMCafe. I’ve now gone through in turn and posted responses to her statements. I will not have time to do another round of replies, but hopefully this will be enough. I suggest that people show up to the Firedoglake book salon on November 9 and ask her to stop saying that the public "option" is anything at all like "Medicare E (for everyone)."
I am, of course, not lying about Health Care reform.
If you read CBO director Elmendorf’s letter to Charles Rangel where he suggests that only 30 million Americans will be in the h Exchange in 2019 (six years after reform begis) and that just 20% of the people eligible for the Insurance Exchange will choose the public plan, you would find that he has No basis for saying this. No numbers. No real analysis.
When Elmendorf explains why, in his opinion only 1/5 of the folks in the Exchange will choose the government plan, the paragraph is filled with "probably’s." (I will be publishing a post quoting that pargraph very soon.)
CMS estimated 40% compared to CBO’s 1/3 when the public option paid at Medicare rates. That leads me to conclude that while the CBO estimate may not be perfect, it’s probably not crazy either.
The truth is that No One can guess what percentage of millions of Americans will choose a public plan three years from now. We don’t know anything about the details of the public plan. Or the price. We know little about the private plans that will be competing.
Elmendorf is indulging in an exercise in mind-reading-guessing what millions of Americans will decide three years from now.
And when I heard that Elmendorf said only 30 million would be in the Exchange in 2019, and that the public plan would be tiny and more expensive than private plans, I wondered: how did he come up with those numbers?
So I went to the source where he laid out these figures, a letter he wrote to Rangel in late October. There I found all of the "probably’s"-
and no facts to justify his conclusion.He just assumes that because the public plan is a governement plan, it "probably" will make no real effort to control costs or utilization-which makes no sense whatsoever. Medicare makes a real effort to control costs (see below) and going forward, Medicare plans to slash some fees beginning next year (see blow). The public plan will too.
CMS reached a very similar conclusion to CBO about utilization. It’s not just Elmendorf here.
Moreover, what we know with certainty is that a public family plan will be at least $2000 less expensive because it won’t have the private sector’s administratie costs. (This number is from Commonwealth.) The public plan will not have to lobby. It will not spend much (if anything) on marketing and advertising. EVeryone will know that it exists, and it will get much free advertising in the many,many stories that will be written about it in the press, on blogs, plus stories on television.
Commonwealth Fund talks about a completely different situation with an enormous public plan that takes up around half of the nation’s health insurance market. In my original post I pointed out Karen Davis’s statement on how different their study’s assumptions are from the bills now in Congress. You ignored it.
(Mahar did an article on the Commonwealth Fund report here. Somewhat shockingly because it directly contradicts her arguments below, at one point she says: "…in many cases, the doctors who treat them would be paid less. As a result, patients who choose the public sector plan might well have a hard time finding physicians willing to take their insurance…The private plans would have the funds needed to pay providers more and create "integrated networks," overcoming some of the fragmentation that leads to errors in our health care system.Quite simply, they would be able to offer better care." The emphasis is mine.)
The public plan will not need to pay executives mutli-million-dollar salaries.
And the public plan will not have to provide profits for investors. So its administrative costs will be much, much lower.
CMS estimates only 10 percent lower administrative costs. This is nowhere near as low as Medicare.
Commonwealth Fund offers good analysis on this point.
Finally, the public plan will not be cherry-picking. By contrast, private insurers will continue to spend vaast sums trying to figure out how to avoid the sick. One of the things we need to figure out over the next 3 years is how to regulate them so that it is very, very difficult for them to do that.
It can be done. And we have a brain trust in the White House (White House budget director Peter Orszag and his healthcare adviser, Zeke Emanuel, who) no doubt, will put their minds to this problem.
Because it’s so unusual to have a brain trust in the White House,, most pundits forget that we actually have people in the administration who know an enormous amount about healthcare, and, to be perfectly candid, are much smarter than all but the most brilliant reporters and pundits.
Adequate risk adjustment would be a fundamental change to the system and people like Orszag don’t have the authority to do that. The Netherlands for example puts literally half the system’s money into risk adjustment funded through taxes.
We also know that the public plan will be modeled on Medicare, and that it will incorporate the Medicare reforms that have already begun and will continue for the next three years-lowering costs while lifting quality, Again go to the primary source. Read the legislation. Don’t read what people say about the legislation (most haven’t read it and are repeating others who haven’t read it) .
Read the legislation for yourself. See sections on Medicare reform and sections on the public option.
Let’s get out the legislation. Here’s the table of contents of the relevant sections. The rest can be viewed here.
The public plan is not modeled after Medicare. You’re just lying. There are certain small intersections between the two, like in the fraud and abuse provisions, but the basic structures are totally different.
Subtitle B—Public Health Insurance Option
Sec. 321. Establishment and administration of a public health insurance option
as an Exchange-qualified health benefits plan.
Sec. 322. Premiums and financing.
Sec. 323. Payment rates for items and services.
Sec. 324. Modernized payment initiatives and delivery system reform.
Sec. 325. Provider participation.
Sec. 326. Application of fraud and abuse provisions.
Sec. 327. Application of HIPAA insurance requirements.
Sec. 328. Application of health information privacy, security, and electronic
transaction requirements.
Sec. 329. Enrollment in public health insurance option is voluntary.
Sec. 330. Enrollment in public health insurance option by Members of Congress.
Sec. 331. Reimbursement of Secretary of Veterans Affairs.
DIVISION B—MEDICARE AND MEDICAID IMPROVEMENTS
TITLE I—IMPROVING HEALTH CARE VALUE
Subtitle A—Provisions Related to Medicare Part A
PART 1—MARKET BASKET UPDATES
Sec. 1101. Skilled nursing facility payment update.
Sec. 1102. Inpatient rehabilitation facility payment update.
Sec. 1103. Incorporating productivity improvements into market basket updates
that do not already incorporate such improvements.
PART 2—OTHER MEDICARE PART A PROVISIONS
Sec. 1111. Payments to skilled nursing facilities.
Sec. 1112. Medicare DSH report and payment adjustments in response to coverage
expansion.
Sec. 1113. Extension of hospice regulation moratorium.
Sec. 1114. Permitting physician assistants to order post-hospital extended care
services and to provide for recognition of attending physician
assistants as attending physicians to serve hospice patients.
Subtitle B—Provisions Related to Part B
PART 1—PHYSICIANS’ SERVICES
Sec. 1121. Resource-based feedback program for physicians in Medicare.
Sec. 1122. Misvalued codes under the physician fee schedule.
Sec. 1123. Payments for efficient areas.
Sec. 1124. Modifications to the Physician Quality Reporting Initiative (PQRI).
Sec. 1125. Adjustment to Medicare payment localities.
PART 2—MARKET BASKET UPDATES
Sec. 1131. Incorporating productivity improvements into market basket updates
that do not already incorporate such improvements.
PART 3—OTHER PROVISIONS
Sec. 1141. Rental and purchase of power-driven wheelchairs.
Sec. 1141A. Election to take ownership, or to decline ownership, of a certain
item of complex durable medical equipment after the 13-month
capped rental period ends.
Sec. 1142. Extension of payment rule for brachytherapy.
Sec. 1143. Home infusion therapy report to Congress.
Sec. 1144. Require ambulatory surgical centers (ASCs) to submit cost data and
other data.
Sec. 1145. Treatment of certain cancer hospitals.
Sec. 1146. Payment for imaging services.
Sec. 1147. Durable medical equipment program improvements.
Sec. 1148. MedPAC study and report on bone mass measurement.
Sec. 1149. Timely access to post-mastectomy items.
Sec. 1149A. Payment for biosimilar biological products.
Sec. 1149B. Study and report on DME competitive bidding process.
Subtitle C—Provisions Related to Medicare Parts A and B
Sec. 1151. Reducing potentially preventable hospital readmissions.
Sec. 1152. Post acute care services payment reform plan and bundling pilot
program.
Sec. 1153. Home health payment update for 2010.
Sec. 1154. Payment adjustments for home health care.
Sec. 1155. Incorporating productivity improvements into market basket update
for home health services.
Sec. 1155A. MedPAC study on variation in home health margins.
Sec. 1155B. Permitting home health agencies to assign the most appropriate
skilled service to make the initial assessment visit under a
Medicare home health plan of care for rehabilitation cases.
Sec. 1156. Limitation on Medicare exceptions to the prohibition on certain physician
referrals made to hospitals.
Sec. 1157. Institute of Medicine study of geographic adjustment factors under
Medicare.
Sec. 1158. Revision of medicare payment systems to address geographic inequities.
Sec. 1159. Institute of Medicine study of geographic variation in health care
spending and promoting high-value health care.
Sec. 1160. Implementation, and Congressional review, of proposal to revise
Medicare payments to promote high value health care.
Subtitle D—Medicare Advantage Reforms
PART 1—PAYMENT AND ADMINISTRATION
Sec. 1161. Phase-in of payment based on fee-for-service costs; quality bonus
payments.
Sec. 1162. Authority for Secretarial coding intensity adjustment authority.
Sec. 1163. Simplification of annual beneficiary election periods.
Sec. 1164. Extension of reasonable cost contracts.
Sec. 1165. Limitation of waiver authority for employer group plans.
Sec. 1166. Improving risk adjustment for payments.
Sec. 1167. Elimination of MA Regional Plan Stabilization Fund.
Sec. 1168. Study regarding the effects of calculating Medicare Advantage payment
rates on a regional average of Medicare fee for service rates.
PART 2—BENEFICIARY PROTECTIONS AND ANTI-FRAUD
Sec. 1171. Limitation on cost-sharing for individual health services.
Sec. 1172. Continuous open enrollment for enrollees in plans with enrollment
suspension.
Sec. 1173. Information for beneficiaries on MA plan administrative costs.
Sec. 1174. Strengthening audit authority.
Sec. 1175. Authority to deny plan bids.
Sec. 1175A. State authority to enforce standardized marketing requirements.
PART 3—TREATMENT OF SPECIAL NEEDS PLANS
Sec. 1176. Limitation on enrollment outside open enrollment period of individuals
into chronic care specialized MA plans for special needs
individuals.
Sec. 1177. Extension of authority of special needs plans to restrict enrollment;
service area moratorium for certain SNPs.
Sec. 1178. Extension of Medicare senior housing plans.
Subtitle E—Improvements to Medicare Part D
Sec. 1181. Elimination of coverage gap.
Sec. 1182. Discounts for certain part D drugs in original coverage gap.
Sec. 1183. Repeal of provision relating to submission of claims by pharmacies
located in or contracting with long-term care facilities.
Sec. 1184. Including costs incurred by AIDS drug assistance programs and Indian
Health Service in providing prescription drugs toward the
annual out-of-pocket threshold under part D.
Sec. 1185. No mid-year formulary changes permitted.
Sec. 1186. Negotiation of lower covered part D drug prices on behalf of Medicare
beneficiaries.
Sec. 1187. Accurate dispensing in long-term care facilities.
Sec. 1188. Free generic fill.
Sec. 1189. State certification prior to waiver of licensure requirements under
Medicare prescription drug program.
Subtitle F—Medicare Rural Access Protections
Sec. 1191. Telehealth expansion and enhancements.
Sec. 1192. Extension of outpatient hold harmless provision.
Sec. 1193. Extension of section 508 hospital reclassifications.
Sec. 1194. Extension of geographic floor for work.
Sec. 1195. Extension of payment for technical component of certain physician
pathology services.
Sec. 1196. Extension of ambulance add-ons.
TITLE II—MEDICARE BENEFICIARY IMPROVEMENTS
Subtitle A—Improving and Simplifying Financial Assistance for Low Income
Medicare Beneficiaries
Sec. 1201. Improving assets tests for Medicare Savings Program and low-income
subsidy program.
Sec. 1202. Elimination of part D cost-sharing for certain non-institutionalized
full-benefit dual eligible individuals.
Sec. 1203. Eliminating barriers to enrollment.
Sec. 1204. Enhanced oversight relating to reimbursements for retroactive low
income subsidy enrollment.
Sec. 1205. Intelligent assignment in enrollment.
Sec. 1206. Special enrollment period and automatic enrollment process for certain
subsidy eligible individuals.
Sec. 1207. Application of MA premiums prior to rebate and quality bonus payments
in calculation of low income subsidy benchmark.
Subtitle B—Reducing Health Disparities
Sec. 1221. Ensuring effective communication in Medicare.
Sec. 1222. Demonstration to promote access for Medicare beneficiaries with
limited English proficiency by providing reimbursement for culturally
and linguistically appropriate services.
Sec. 1223. IOM report on impact of language access services.
Sec. 1224. Definitions.
Subtitle C—Miscellaneous Improvements
Sec. 1231. Extension of therapy caps exceptions process.
Sec. 1232. Extended months of coverage of immunosuppressive drugs for kidney
transplant patients and other renal dialysis provisions.
Sec. 1233. Voluntary advance care planning consultation.
Sec. 1234. Part B special enrollment period and waiver of limited enrollment
penalty for TRICARE beneficiaries.
Sec. 1235. Exception for use of more recent tax year in case of gains from sale
of primary residence in computing part B income-related premium.
Sec. 1236. Demonstration program on use of patient decisions aids.
TITLE III—PROMOTING PRIMARY CARE, MENTAL HEALTH
SERVICES, AND COORDINATED CARE
Sec. 1301. Accountable Care Organization pilot program.
Sec. 1302. Medical home pilot program.
Sec. 1303. Payment incentive for selected primary care services.
Sec. 1304. Increased reimbursement rate for certified nurse-midwives.
Sec. 1305. Coverage and waiver of cost-sharing for preventive services.
Sec. 1306. Waiver of deductible for colorectal cancer screening tests regardless
of coding, subsequent diagnosis, or ancillary tissue removal.
Sec. 1307. Excluding clinical social worker services from coverage under the
medicare skilled nursing facility prospective payment system
and consolidated payment.
Sec. 1308. Coverage of marriage and family therapist services and mental
health counselor services.
Sec. 1309. Extension of physician fee schedule mental health add-on.
Sec. 1310. Expanding access to vaccines.
Sec. 1311. Expansion of Medicare-Covered Preventive Services at Federally
Qualified Health Centers.
Sec. 1312. Independence at home demonstration program.
Sec. 1313. Recognition of certified diabetes educators as certified providers for
purposes of Medicare diabetes outpatient self-management
training services.
TITLE IV—QUALITY
Subtitle A—Comparative Effectiveness Research
Sec. 1401. Comparative effectiveness research.
Subtitle B—Nursing Home Transparency
PART 1—IMPROVING TRANSPARENCY OF INFORMATION ON SKILLED NURSING
FACILITIES, NURSING FACILITIES, AND OTHER LONG-TERM CARE FACILITIES
Sec. 1411. Required disclosure of ownership and additional disclosable parties
information.
Sec. 1412. Accountability requirements.
Sec. 1413. Nursing home compare Medicare website.
Sec. 1414. Reporting of expenditures.
Sec. 1415. Standardized complaint form.
Sec. 1416. Ensuring staffing accountability.
Sec. 1417. Nationwide program for national and State background checks on
direct patient access employees of long-term care facilities and
providers.
PART 2—TARGETING ENFORCEMENT
Sec. 1421. Civil money penalties.
Sec. 1422. National independent monitor pilot program.
Sec. 1423. Notification of facility closure.
PART 3—IMPROVING STAFF TRAINING
Sec. 1431. Dementia and abuse prevention training.
Sec. 1432. Study and report on training required for certified nurse aides and
supervisory staff.
Sec. 1433. Qualification of director of food services of a skilled nursing facility
or nursing facility.
Subtitle C—Quality Measurements
Sec. 1441. Establishment of national priorities for quality improvement.
Sec. 1442. Development of new quality measures; GAO evaluation of data collection
process for quality measurement.
Sec. 1443. Multi-stakeholder pre-rulemaking input into selection of quality
measures.
Sec. 1444. Application of quality measures.
Sec. 1445. Consensus-based entity funding.
Subtitle D—Physician Payments Sunshine Provision
Sec. 1451. Reports on financial relationships between manufacturers and distributors
of covered drugs, devices, biologicals, or medical supplies
under Medicare, Medicaid, or CHIP and physicians and
other health care entities and between physicians and other
health care entities.
Subtitle E—Public Reporting on Health Care-Associated Infections
Sec. 1461. Requirement for public reporting by hospitals and ambulatory surgical
centers on health care-associated infections.
TITLE V—MEDICARE GRADUATE MEDICAL EDUCATION
Sec. 1501. Distribution of unused residency positions.
Sec. 1502. Increasing training in nonprovider settings.
Sec. 1503. Rules for counting resident time for didactic and scholarly activities
and other activities.
Sec. 1504. Preservation of resident cap positions from closed hospitals.
Sec. 1505. Improving accountability for approved medical residency training.
TITLE VI—PROGRAM INTEGRITY
Subtitle A—Increased Funding to Fight Waste, Fraud, and Abuse
Sec. 1601. Increased funding and flexibility to fight fraud and abuse.
Subtitle B—Enhanced Penalties for Fraud and Abuse
Sec. 1611. Enhanced penalties for false statements on provider or supplier enrollment
applications.
Sec. 1612. Enhanced penalties for submission of false statements material to
a false claim.
Sec. 1613. Enhanced penalties for delaying inspections.
Sec. 1614. Enhanced hospice program safeguards.
Sec. 1615. Enhanced penalties for individuals excluded from program participation.
Sec. 1616. Enhanced penalties for provision of false information by Medicare
Advantage and part D plans.
Sec. 1617. Enhanced penalties for Medicare Advantage and part D marketing
violations.
Sec. 1618. Enhanced penalties for obstruction of program audits.
Sec. 1619. Exclusion of certain individuals and entities from participation in
Medicare and State health care programs.
Sec. 1620. OIG authority to exclude from Federal health care programs officers
and owners of entities convicted of fraud.
Sec. 1621. Self-referral disclosure protocol.
Subtitle C—Enhanced Program and Provider Protections
Sec. 1631. Enhanced CMS program protection authority.
Sec. 1632. Enhanced Medicare, Medicaid, and CHIP program disclosure requirements
relating to previous affiliations.
Sec. 1633. Required inclusion of payment modifier for certain evaluation and
management services.
Sec. 1634. Evaluations and reports required under Medicare Integrity Program.
Sec. 1635. Require providers and suppliers to adopt programs to reduce waste,
fraud, and abuse.
Sec. 1636. Maximum period for submission of Medicare claims reduced to not
more than 12 months.
Sec. 1637. Physicians who order durable medical equipment or home health
services required to be Medicare enrolled physicians or eligible
professionals.
Sec. 1638. Requirement for physicians to provide documentation on referrals to
programs at high risk of waste and abuse.
Sec. 1639. Face-to-face encounter with patient required before eligibility certifications
for home health services or durable medical equipment.
Sec. 1640. Extension of testimonial subpoena authority to program exclusion
investigations.
Sec. 1641. Required repayments of Medicare and Medicaid overpayments.
Sec. 1642. Expanded application of hardship waivers for OIG exclusions to
beneficiaries of any Federal health care program.
Sec. 1643. Access to certain information on renal dialysis facilities.
Sec. 1644. Billing agents, clearinghouses, or other alternate payees required to
register under Medicare.
Sec. 1645. Conforming civil monetary penalties to False Claims Act amendments.
Sec. 1646. Requiring provider and supplier payments under Medicare to be
made through direct deposit or electronic funds transfer (EFT)
at insured depository institutions.
Sec. 1647. Inspector General for the Health Choices Administration.
Subtitle D—Access to Information Needed to Prevent Fraud, Waste, and
Abuse
Sec. 1651. Access to Information Necessary to Identify Fraud, Waste, and
Abuse.
Sec. 1652. Elimination of duplication between the Healthcare Integrity and
Protection Data Bank and the National Practitioner Data
Bank.
Sec. 1653. Compliance with HIPAA privacy and security standards.
See what Obama has said about the public option.
He’s said that "…based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up."
See what White House Budget Direct Peter Orszag has written about Medicare reform and health care reform. (He will be pivotal in how reform and the public plan are implemented.)
Orszag has much to say on Medicare reform, since as a former CBO director in 2007 he studied its cost growth in detail. But Medicare reform has little or nothing to do with the public option, so this doesn’t tell us much about it.
As for who will be in the public plan: 7% of Americans now buy individual coverage in the private market. They are relatively affluent and healthy (otherwise they wouldn’t be able to get individual insurance in the private market. Half make over $56,000 (See EBRI on this).
Exactly.
Meanwhile, the poorest of the uninsured will go into Medicaid when it expands in 2013. (Elmendorf acknowledges this in his letter to Rangel) This means that the formerly uninsured in the Exchange (and in the public plan) will not be the poorest-and by and large not the sickest (Very poor Americans are generally sicker than the rest of us.)
True, but they don’t have to be because those buying individual insurance are, as you say, unusually well off and so may be healthier still.
A large percentage of 25-34-year olds are currently uninsured. They will be able to go into the Exchange. Some 20-somethings will choose a private plan for "young invincibles"
but as they get into their late 20 and 30s, most young adults are sensible enough to realize that
they are not immortal. Many want to start families. They realize they need real insurance.
The uninsured are considerably less healthy overall than the insured.
A fair number will pick the public plan. No one can estimate how many. But, however many, this will be a relatively healthy group joining the pool.
Those offered subsidies in the exchanges must satisfy three criteria: they must not have access to employer sponsored insurance, they must be below 400% of poverty level (63% of the combined insured and uninsured population is), and they must not be below 150% of poverty level (22%). Given the above facts it’s hard to doubt that on balance they’ll be less healthy than those ineligible for subsidies. And if so, then those ineligible would seemingly be better off purchasing insurance elsewhere. I’m sure there are many complicating factors, but this seems like a problem.
In addition, the employees and owners of small business will be eligible for the public plan.
Some will be affluent, some will be low-income.
Some will be older, some younger. By the second year of reform (2014) people working for businesses with up to 30 employees will be eligible. That’s a lot of people.Much has been made of the fact the HHS will have to negotiate rates with providers.
There is no reason to suspect that the public plan won’t insist on reasonable rates. It’s likely to pay far less than private insurers-even if, in some cases, it pays slightly more than Medicare.
That depends on the size of the public plan.
First of all, Medicare is already beginning to cut fees. Next year, it plans to cut fees for CT scans and MRIs by as much as 38%-as well as fee for docs who buy the equipment and do the tests in their offices. (These docs recommend twice as many tests.)
And Medicare has proposed cutting fees to cardioloigsts by 6% next year-while raising fees to primary care docs by 4% as of January.
Congress will have a chance to weigh in on this-but only 60 days -betwteen now and Jan. 1
Expect more changes in teh fee scedule over the next 3 years.
PRivate insurers have said they will follow Medicare’s lead. They just want Medicare to provide political cover.
Even if true, why would any of this impact a public plan’s ability to compete against private insurers?
So in 2013, when the public plan is negotiating fees, it will be negotiating in an environment where many fees will be lower, while payement for the prevent services and chronic disease management will be higher. Net, net, Medicare will be saving money.
And, in 2013, the public plan will be negotiating in an enviroment where costs are lower and reimbursements are more rational.
So what?
Today, private insurers pay some brand-name hospitals 15% to 25% more than it costs them (or should cost them) to care for patients. On average, Medicare pays 98% of hospital costs. A
great many hospitals (over 40% if memory serves) make a profit on Medicare payments. See an excelletn post on my blog by Pat S. laying outthe numbers.So if the public plan pays some hospital 7% more than Medicare, it still will be paying far less than private insurers -which means its premiums will be higher.
Why will hospitals accept the public plans lower rates? Because the public plan will not be tiny and the people in the plan will not be extremely poor patients (who are more costly to care for.(Those patients will be in the expanded Medicaid)
You assume it will not be tiny. But there’s absolutely nothing underlying your assumption. When the plan first begins, no one will even know exactly how many people will be in it. Will providers accept that?
The public plan will be large enough that very few-if any- hospitals will be able to see "we don’t need to be in the public plan’s network."
Some doctors will reject the public plan-but fewer than you think. In Manhattan, I find that Park Avenue specialists are in my insurers’ network and take the insurers’ payments-which are good, but not nearly as much as NY specialists who don’t take insurance charge.
Moreover, I can get an appointment with a specialist even if I have never seen him/her-usually in 2-5 days.This suggests that NY specialists need patients. The vast majority take Medicare-even though it pays significanlty less than prviate insurers.
Medicare is huge.
My research suggests, that conservaitvely, 17-18% of the population will be in the Exchange during the first two years of reform. A less conservative estimate would say up to 25%. I really don’t know. But I do know that the Exchange plans to open to more Americans each year,
Who will be in te Exchange? The relatively affluent self-employed who now buy their own insurance, and many of the employees and owners of small business will make the pool in the Exchange a cross-section of low-income middle-class and upper-middle class Americans -many relatively young and healthy.
Elmendorf’s own numbers (from the letter to Rangel) suggest that in 2013-2014 some 49 million Americans will be not just eligible for the Exchange but in the Exchange. (He acknowledges that those who now buy their own insurance (21 million Americans) will be in the Exchange and suggests that 7 million employees and oweners from small businesses will be in there. It’s hard to estimate how many of the uninsured will choose the Exchange- some will be in Medicaid and some of the uninsured will choose to pay the penalty and not buy insurance. But, based on what Elmendorf himself says, 21 million is a conservative estimate.
This is wrong. Elmendorf does not say that those who buy their own insurance will be in the exchanges. In the letter dated October 29, the final projection is 21 million getting individual insurance through the exchanges and 9 million others, bringing the total to 30 million.
That takes us to 49 million Americans- roughly 17% to 18% of the population, and all of the hard numbers that I can find suggests they’ll be in the Exchange at the beginning 2013-2014.
Not correct.
Meanwhile, Elmendorf is talking about 30 million in the Exchange 5 to 6 years later-in 2019. That makes no sense.
The legislation makes it clear that "in subsequent years" the Exchange will be open to more Americans until it is open to all Americans. Staff of one House committee told me that kt’s likely that employees of large corporations who now have employer-based insurance will be able to join the exchange "in 4 or 5 years."
There is absolutely nothing in the legislation prescribing that large employers ever be added. I don’t care what some staffer told you. Maybe you should follow your own lead and actually look at the bill.
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