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one person's assessment of Max Baucus' health reform plan can be found at:

http://www.healthbeatblog.com/2009/0...r-reform-.html

Health Beat by Maggie Mahar
Max Baucus's proposed health care reform plan:

Health Insurance premiums could vary based upon smoking status, age, and family composition--smokers could be charged up to 50% more; parents with children 50% more; single mothers 80% more than single adult. Insurers cannot charge more if you are sick--though able to charge up to 5X's more if you are elderly.
Article notes that charging those who smoke more will ultimately mean the taxpayer will pay for those premiums since a large % of smokers are without financial means and thus receive full subsidies. Same with many single mothers--many live on the poverty level and thus qualify for subsidies.
The author notes:

"This is simply another way to funnel more taxpayer money to private sector insurers."

the elderly can be charged up to 5X's as much as the young--except when there is an exemption:

authors' words: “An exemption [from mandate that everyone buy insurance] is permitted if coverage is deemed unaffordable – defined based on a circumstance where the lowest cost premium available exceeds 10% of a person’s income.” Okay, here’s the answer for 50-somethings that just can’t afford paying five times as much as younger customers: we excuse them from the program. No penalty, no mandate. In other words, we don’t cover them at all—at the point in their life when they are most likely to need heath care.

Somehow, this isn’t what I thought they meant by “universal coverage.”

Oh, and in case you wondered. . . No, there is no public sector insurance option in the Baucus plan. The private sector insurance industry will have a monopoly on the millions of new customers who will be coming their way, tax subsidies in hand."


(I read the 18 pages of this plan with eyes glazed. The language is so dense-I became lost in attempting to understand the "rebates", how to determine who is covered, etc. -or I am too dense to decipher much of it. As an example:

http://msnbcmedia.msn.com/i/MSNBC/Se...0Framework.pdf

"Part D Drug Discount Program. Beginning in 2010, in order to have their drugs covered under Medicare, manufacturers must provide a 50% discount off the negotiated price for brand-name drugs covered on plan formularies when beneficiaries enter the coverage gap. Beneficiaries are eligible provided they do not qualify for low-income subsidies, do not have employer sponsored coverage, or do not pay higher Medicare premiums under Part B or Part D."

What is the "negotiated price--how is it determined? Who determines which drugs are included in the 'plan formulary'? what is the period "when beneficiaries enter the 'coverage gap'--what is the 'coverage gap? and once one is thru this "coverage gap" do the discounts still apply?and what about generic drugs? So who exactly are the "beneficiaries" and what happens to those who qualify for subsidies--are they not allowed the 50% discount for name brand drugs? thus the taxpayers pay full price for those with subsidies? those who do not have employer sponsored coverage or who do not pay higher medicare premiums under Part B and D are also denied the discount? why? one is penallized for working for a small company? and since one does not pay higher premiums under part B and D, one has to forgo the drug discount? what is the reasoning behind this? you must pay one way or the other?
Other than the above questions, I understand that this Part D drug discount program begins in jan 2010..... I feel one could drive a truck thru the loopholes-Perhaps I expect too much

madelyn)

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http://msnbcmedia.msn.com/i/MSNBC/Se...0Framework.pdf

"...Prescription Drug Coverage. Prescription drugs would become a mandatory Medicaid benefit. The status of drugs used to promote smoking cessation, barbiturates, and benzodiazepines would be changed from “excludable” to “non-excludable.” Medicaid prescription drug rebates would be applied to Medicaid managed care organizations. Similarly, the rebates would be applied to new formulations of existing drugs, with an exception for orphan drugs. The rebate amounts would be increased, with the minimum rebate percentage for single-source and innovator multiple source drugs going from 15.1% to 23.1% and from 11% to 13% for generic drugs. For clotting factors and drugs approved by the FDA for pediatric use only, the rebate would be increased from 15.1% to 17.1%.

The federal upper limit (FUL) would be changed to no less than 175% of the weighted average (determined on the basis of utilization) of the most recently reported monthly average manufacturer price (AMP)..."

a couple of answers to my questions.. I think, though am more than puzzled over the "FUL" change to "no less than 175% of the 'weighted average' "--what was the prior "FUL"? and this weighted average is based upon the "most recently reported monthly average manufacturer price" (and what determines the cap for these drug prices--the "market forces"? ) the "FUL" changes-- I get that the drug cos may only charge up to 175% of the FUL