Debating the details…

All supporters of quality, affordable, health care for all have a tough balancing act: being a clear, strong voice for the urgency and necessity of health reform, while at the same time insisting on the provisions and policies to make it workable and meaningful.

Luckily, we have an example of a very good reform proposal to support with H.R.3200, and to a lesser extent, the version of the Senate bill passes by the Kennedy HELP Committee. These are proposals to rally around.

But the proposal coming out of the Senator Baucus’ Senate Finance Committee does raise serious concerns. The framework is similar to the other proposals that we support. But the details matter on key issues on affordability, securing employer-based coverage, and the public health insurance option. And some of those details are very concerning.

Senator John Rockefeller, who is one of the most knowledgeable elected leaders on health policy issues, said today he couldn’t support the current Baucus proposal (as reported by Jon Cohn at The New Republic).

Here are some issues of importance, some major, some specific. There’s a lot of links below, but they are worth your time–it’s my best compilation of the current flashpoints regarding the details in the debate:

* The ThinkProgress WonkRoom goes into the crucial specifics of Medicaid and SCHIP, as well as the state’s share of financing. These are key issues, ones that impact the health coverage of millions of Americans, that Senator Rockefeller is raising as well.

* Jon Cohn also had a scoop on the affordability subsidies in the Baucus bill, and what they provide–and what they don’t. Elsewhere, he correctly wonders why it makes sense politically to take out the assistance to middle-class families in order to make minor reductions to the overall cost of the bill.

* Ezra Klein of the Washington Post challenges Senator Snowe to find any economist who agrees with the employer responsibility section of the Baucus framework. This “free-rider” concept has gotten other negative comments and an entire Center for Budget and Policy Priorities paper on why it’s unworkable and unwise, especially in comparison to the more sensible proposals to secure employer-based coverage in the House and Senate HELP bills.

* Michael Hiltzik of the Los Angeles Times takes on the complicated issue of the structure of the new exchange to get coverage, and draws exactly the right conclusion from California’s experience. Some have used the failure of PACAdvantage to argue that pools don’t work. The real lesson is the rules they live under, and whether we allow insurer to “cherry-pick” the customers they want.

* Michael Scherer of’s Swampland reports about a troubling push to include undue exclusions for undocumented immigrants from the exchange to buy coverage. It’s one thing to bar federal funds from subsidizing coverage for undocumented immigrants–which is in all the bill being considered (without comment on whether that’s a good or bad policy–that’s in the bills now.) It makes no sense to exclude them from buying private coverage with their own money and wages–it leaves them uninsured, health providers often unpaid, and simply places more paperwork burdens on the rest of us.

* Other issues, like the public health insurance option, are brought up in the last issue of Health Wonk Review, was posted at the Lucidicus Project over a week ago, but has a very good run down on these topics and many more.

We have our work cut out for us not just to pass health reform, but to make it a good health reform. The Senate Finance Committee isn’t the end of the process, but a step along the way. If this was easy, it would have been done before.

Finally, to make it clear what we are fighting for, and if you want to see how a good health reform would help so many consumers, check out this interactive graphic from the House Education and Labor Committee, which tells you how H.R.3200 would directly help you after knowing your specific situation.

Health Access California promotes quality, affordable health care for all Californians.
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