SB 2016-047 - Universal Healthcare and Affordability Act (Debating)

[The world will shine with light in our nightmare]

Can my motion get a second, please?

[Associate Justice PiT]

     I will second the motion.

[The world will shine with light in our nightmare]

I'm going to lift the motion to suspend debate.  (Technically such a motion is not provided for in the Senate rules anyway, but alas.)

More to come.

[The world will shine with light in our nightmare]

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[The world will shine with light in our nightmare]

Senators have 24 hours to object to the amendment.

Yes, folks, after months of bipartisan deliberations, I'm proud to finally unveil the Scott-Yankee-PiT-dfwlibertylover healthcare plan.  This plan establishes a national health care system similar to the one Germany uses, which spends considerably less on healthcare and reports positive outcomes.  This multi-payer system will make healthcare universal as well as affordable and consumer-oriented.  Patients will be allowed to seek almost any type of care they wish whenever they want it, regardless of income or zip code, and the regions will retain regulatory autonomy over their health care systems as well.

I urge our members to read the amendment thoroughly and to provide input.  Because this is a BFD.

[Unconditional Surrender Truman]

Well, Huzzah! Y'all are making me wish I was still a Senator.

At first glance (and having had an opportunity to read a previous draft of the amendment), the proposal appears both reasonable and comprehensive, and I'm looking forward to working on this at the regional level should it become law.

To clarify, per Section 2(1d), there would be no federal individual mandate (though presumably a region could chose to establish one), correct?

[The world will shine with light in our nightmare]

Well, Huzzah! Y'all are making me wish I was still a Senator.

At first glance (and having had an opportunity to read a previous draft of the amendment), the proposal appears both reasonable and comprehensive, and I'm looking forward to working on this at the regional level should it become law.

To clarify, per Section 2(1d), there would be no federal individual mandate (though presumably a region could chose to establish one), correct?

That's correct.

[Grumpier Than Thou]

I like the look of this plan a lot. I am in favor of an individual mandate, and will encourage the Governor of Lincoln to institute one if this passes.

[Southern Senator North Carolina Yankee]

Reposting this here.

So before people go crazy let me state clearly what does this.

1. Expands Regional Involvement in Healthcare.

- It is easy to write up and bill and have Nyman make all decisions and both Conservatives and Liberals have presented plans that do just that. Aside from the subsidy, a few minimal regulations and public option (which I will explain later, so please hold off the guillotine), most every major decision regarding the nature of the healthcare system will and can be determined by the Regional Governments. This will therefore stimulate discussion and activity and regional elections by having elections of real consequence at that level. This will include but is not limited to the decision of whether or not to have single payer/individual mandate. With the passage of this bill, that will become a regional decision.

It is important to consider healthcare as an issue, but it is also important to remember that this is a game and the things we do policy wise should stimulate the game and the regions, not shut them down.

2. Yes there is a public option in this bill. But guess what, we already have public Option(s) and the "s" is important. Depending on which special group you are, you have your own little siloed public option. This bill takes all those public options and consolidates them into one federal public option, and paves the way (if a regional opts for such) for everyone to have alternatives. This means that seniors, vets, the poor, will now have greater access to choice and quality healthcare, will preserving the important promises we have made to our seniors etc.

3. Replacing the multitude of public options with one public options enables us to eliminate a metric f@$kton of government programs and offices that will now longer be necessary, or to trim down others that will remain with a smaller objective.

4. This is the Middle Ground on healthcare between a one sized fits all, top down program, and the real life healthcare situation which I think everyone agrees is a mess. It borrows from non-single payer systems that still ensure universal access like Germany, expands the degree of local control and expands the competition and choice to greatest number of healthcare consumers. In the process of doing so, it consolidates the roll that Nyman plays in healthcare, bringing simplicity, lower cost and higher quality to those who currently depend on Medicare, Medicaid, the VA, etc.

5. This was a massive bipartisan effort and there are elements that all sides can get behind. I am especially grateful for the hard work and patience (especially patience) of Senator Scott, as well as the contributions of Senator PiT (whose math skills were invaluable), President Dfw, Vice President Goldwater and numerous, numerous others. I also want to do like wise for former and hopefully soon to be Representative Potus, who while probably not thrilled with the overall proposal, some of his recommendations from his proposal this spring are present or shaped similarly to those he proposed, including untaxed HSA's and the incorporation of age into the formula was inspired by his use of age along with income in his tax credit proposal.

[Southern Senator North Carolina Yankee]

I will also note once again that once we reform the public health care, it will be necessary to then pursue with reforms to other aspects of health care including but not limited to:

1. Delivery
2. Medical Records
3. Technology
4. Tuition Inflation
5. Malpractice Liability
6. Drugs
7. Mental Health

These will best be handled in subsequent bills and if attempted here would make this bill too large and complex.

[Donerail]

Who is in charge of determining admission to the CIEP? Is there any cap on CIEP funding? I ask because most examples of these kinds of pools eventually failed due to lack of funding, and because I'm concerned about the moral hazard involved with insurers having free license to effectively kick anyone over into the pool.

[The world will shine with light in our nightmare]

Who is in charge of determining admission to the CIEP? Is there any cap on CIEP funding? I ask because most examples of these kinds of pools eventually failed due to lack of funding, and because I'm concerned about the moral hazard involved with insurers having free license to effectively kick anyone over into the pool.

The CIEP is administered within AtlasCare and this bill does not set any cap.

[Associate Justice PiT]

     We forgot to specify f(t) for the subsidy function. As is, it's referring to some unspecified function (to note, f(t) = 0.0022*(t-20)^2 - 0.0291*(t-20) +1.66)).

[The world will shine with light in our nightmare]

I'm not the math guy here.

I'll submit another amendment.  Senators have 24 hours to object.

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[Potus]

The AtlasCare portion of this legislation is insufficiently detailed to actually model its impact on coverage, the budget, and the economy. Particularly, the premium structure of the program must be established. If passed as written, there will be no premiums which means there will be no more private insurance. Also, no mechanisms for cost control or consumer discipline.

Beyond that, previous public option proposals scored by the CBO have assumed the public option was designed to financially support itself. If we are financing this with a large new payroll tax increase, then that's different and will need a full and thorough evaluation of its budgetary, health, and economic impact. The question also needs to be asked if our program will more closely resemble FEHB or Medicare.

[Southern Senator North Carolina Yankee]

Who is in charge of determining admission to the CIEP? Is there any cap on CIEP funding? I ask because most examples of these kinds of pools eventually failed due to lack of funding, and because I'm concerned about the moral hazard involved with insurers having free license to effectively kick anyone over into the pool.

The CIEP is a program within Atlascare itself. So the Atlascare office would be in charge of it.

[Southern Senator North Carolina Yankee]

The AtlasCare portion of this legislation is insufficiently detailed to actually model its impact on coverage, the budget, and the economy. Particularly, the premium structure of the program must be established. If passed as written, there will be no premiums which means there will be no more private insurance. Also, no mechanisms for cost control or consumer discipline.

Beyond that, previous public option proposals scored by the CBO have assumed the public option was designed to financially support itself. If we are financing this with a large new payroll tax increase, then that's different and will need a full and thorough evaluation of its budgetary, health, and economic impact. The question also needs to be asked if our program will more closely resemble FEHB or Medicare.

Atlascare will be charging premiums. It has to compete on the exchanges and there is no other way it could. I am fine with modifying Part 2, Section 1, to make that more clear.

The subsidy and revenues are in Part I and the public option is in Part II for a reason. That is because we are separating the program from money. The AtlasCare program will have to pay for providers at competitive rates and have to compete for customers on the exchanges ( unless a region gives them a monopoly). Eitherway, Atlascare is not getting a dime of this subsidy money directly, the money follows the consumer. Like with Food Stamps. Even when it comes to Seniors, they are not getting the money directly. So the fear that because of this bill, "private insurance" will die if Atlascare doesn't charge premiums, is unfounded. Atlascare will. I am crazy, but I am not stupid. I don't want any complacency in the healthcare system, I want everyone striving for quality and lower costs. That goes for government just as much as it does for the private sector.

That is because most of the crap score by CBO is made by, for and of centralist loving fixers. Our program is trying to get a good portion of healthcare back to the regions, and encourage regions to come up with diverse alternative insurance arrangements to compete with Atlascare, which in turn acts as a fallback (especially for seniors, vets etc), in case a regions smokes some weed and just chills for the next six months and doesn't do anything.

A lot of funding is being transferred over from existing funding mechanism that is the case for all of the seniors, vets, etc, and the portion of the poor covered by Medicaid/CHIP/etc. Beyond that it inherits prexisting funding streams. I didn't consider 2.5% to be a "substantial" increase from 1.75%, but that being said, I am not thrilled with the payroll tax option, just like I wasn't thrilled with it when we had to fund Fritzcare after the fact, back in 2011, but it was the only option available. We have more flexibility this time, because taxes are not as high and our initial program and implementation creates a program that is less expensive and reduces costs for the regions as well. So I am open to alternative funding options if someone can come up with a plausible that people will support in both chambers.

As for what this "resembles" I don't know what the FEHB is and this is not like Medicare. Once again, the money follows the patients to either Atlascare or another option. With Medicare it goes directly to the program and the program provides the coverage assuming you can find a doctor taking new Medicare patients.

It is also not like Medicaid either, since Medicaid doesn't charge premiums (though it can take your estate if you are on it long enough). And Medicaid has even worse problems with finding a doctor.

[Southern Senator North Carolina Yankee]

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Frankly I am of a mind to keep the text as simple as possible for the sake of the game and for the program's efficacy.

But I will be offering an amendment to clause one of this particular section in the House and I will repost it here for Scott or someone to offer.

[The world will shine with light in our nightmare]

New amendment:

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Senators have 24 hours to object.

Also, the first amendment offered on this page is adopted without objection.

[Donerail]

Who is in charge of determining admission to the CIEP? Is there any cap on CIEP funding? I ask because most examples of these kinds of pools eventually failed due to lack of funding, and because I'm concerned about the moral hazard involved with insurers having free license to effectively kick anyone over into the pool.

The CIEP is administered within AtlasCare and this bill does not set any cap.

So effectively any person with a pre-existing condition (since this bill does not contain a community rating provision) will be pushed onto AtlasCare?

[Southern Senator North Carolina Yankee]

Who is in charge of determining admission to the CIEP? Is there any cap on CIEP funding? I ask because most examples of these kinds of pools eventually failed due to lack of funding, and because I'm concerned about the moral hazard involved with insurers having free license to effectively kick anyone over into the pool.

The CIEP is administered within AtlasCare and this bill does not set any cap.

So effectively any person with a pre-existing condition (since this bill does not contain a community rating provision) will be pushed onto AtlasCare?

Assuming the regions do nothing, yes. But the same goes for every other special group as well, not just those with preexisting conditions. I think it would be hard to do a community rating provision federally, especially since a particular region may just opt for having Atlascare as a single payer provider. Considering also that a particular region has to make the determination regarding the presence of an individual mandate, that pretty much means that future legislating on the manner of those with pre-existing conditions will be dealt with at the regional level.

[The world will shine with light in our nightmare]

Hearing no objection, the amendment is adopted.

One thing I'll add, for those who favor a single-payer program, is that this bill does create an easier path to a single-payer system for regions that wish to adopt one.  I personally could support such a system for Lincoln as an experiment for other regions to look to.

[The world will shine with light in our nightmare]

Does anyone have any other concerns?  If not, I would like to put this to a final vote this weekend unless somebody objects.  The House seems about ready, as well.