Baucus Watch, Part XI

The first glimpse of what he has brought forth

As chairman of the Senate Finance Committee, Senator Max Baucus holds the keys to health care reform; any health care legislation must pass through his committee. So what he says or doesn’t say is important to those following the twists and turns of the congressional effort to fix our health care system. This is the eleventh of an occasional series of posts on the senator’s pronouncements and how the media has covered them. The entire series is archived here.

The Washington Post’s Ezra Klein got a big scoop today—the first hint of what the Senate Finance Committee is likely to put in its bill mark-up in the next week or so. Sen. Max Baucus has postponed his mark-up until after the Fourth of July recess, but the committee apparently is sending up trial balloons to see what might fly after all these many months of deliberations and pleas from stakeholders. Says Klein: “Sources say that it’s a major scale-back of the outline they had before. This is the clearest look we’ve had at the specific policies being considered.”

Klein is spot on. The draft (PDF) leaked to Klein begins to answer a lot of the questions Campaign Desk’s Baucus Watch series has asked and explored all year. Two are particularly important:

• How much have Baucus et al have been listening to special interest lobbyists?

• Will there or won’t there be a public plan, especially one that looks like Medicare and offers Americans the choice between government-provided coverage and coverage from Blue Cross and its brethren?

In January, we praised ABC Nightly News for its story about Washington lobbyists and their cozy relationships with legislators. Brian Ross reported Baucus’s claim that lobbyists just want the best for America, and captured him on camera saying: “They really care about our country.” The first peek at what the Finance Committee has in mind certainly looks like they’ve listened to the lobbyists. The insurance industry’s fingerprints are all over the document.

The draft envisions a tough individual mandate. That means that most people will be required to carry insurance from their employers, or venture into the individual insurance market to buy coverage from the very insurance companies that polls show consumers dislike. If they don’t buy, they face fines based on the cost of insurance where they live. People would be exempt from penalization only if the government decrees that insurance would be unaffordable, buying coverage is a hardship, or if their incomes are below the poverty level. Native Americans also wouldn’t be fined if they didn’t buy. Given the serious health problems plaguing that community, insurance companies are probably pleased they won’t have to cover them. It cuts down on their risk exposure.

Insurers would collect premiums from a large portion of the 50 or so million people now without coverage. In return for this business, insurers would have to agree to cover people who are already sick. They could, however, still require higher premiums for older people, which would compensate for the health risks that seniors present. The Finance Committee proposes tax credits for individuals with incomes less than $32,490; a family of four would be eligible if it had an income below $66,150. If people are just over the line, they’ll have to cough up the money themselves, as they now do in Massachusetts.

Small businesses would get a temporary tax credit to help cover their workers, and the big business insurance apparatus is virtually untouched—they would not be required to provide coverage. The document leaves open a “place holder” for employer responsibility and suggests different ways they can fulfill that obligation. Interpretation: the business community doesn’t yet know what sort of health reform it wants. Oh yes, businesses with fewer than 200 workers do get tax incentives for wellness programs—something many in the business community have been urging, despite mixed evidence on whether such programs actually reduce health care costs.

It should come as no surprise to Baucus Watch readers that the draft omits mention of a public plan a la Medicare. Baucus has been lukewarm to the concept for months. In March, he said he considered a public option a bargaining chip to force insurers into accepting other so-called market reforms. It looks like Baucus has struck his bargain. The draft document doesn’t even call for a public plan lite. Instead it proposes non-profit co-op health plans—a lackluster option which sounds like what moderate Dems and some Republicans have been talking about as an alternative to a real public plan. Insurers, doctors, hospitals, and other foes of a public plan may be winning on this one.

The Baucus draft shows that, while the special interests will be taken care of, the public is another matter. How do millions of people feel about buying insurance they may not want or can’t realistically afford? How, for example, can a family with an income of $70,000 afford a premium of $12,000 or $13,000? If they choose the penalty because it’s cheaper than buying a policy, they will still be uninsured—so much for universality. And if they buy a cheapie limited policy, which companies will be selling by the boatloads, how will that help them when serious illness strikes? Won’t they still be underinsured and at risk for medical bankruptcy?

For starters, the media might press the White House on just where the president stands on the Baucus draft. This week, his Secretary of Health and Human Services, Kathleen Sebelius, told the AP that the shape of a new public plan (which Obama has been pushing) isn’t a make or break issue for the president: “It’s way too early to say ‘This is absolutely in, this is absolutely out. I mean what he’s trying to do is get a bill passed.”

The president apparently wants something that he can sell to the public. That something is fertile ground for digging real deep.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.