Let me simply restate ( esp. for others on this email who may not have had the time to study this) my serious concerns about INITIALLY enrolling the 35 million or so Medicaid/SCHIP recipients into an experimental public option (the idea for this coming from the Jacob Hacker report). It's a nice idea that we all would love to see happen eventually (no restricted networks, free choice of practitioner etc), but the problems stem from what's potentially not so nice about it, to put it mildly.
Firstly, initially enrolling Medicaid/S-CHIP is not even necessary to make the public option viable. Initially enrolling uninsured individuals, self-employed, small and large employers (the latter of which are now included in our criteria) into the public Medicare option, will, according to the Lewin estimates, reach sufficient scale of up to 139 million enrollees, at Medicare payment rates, to make the program viable because the premiums would be $200 less per month so people will opt for it, and so will practitioners. It makes sense to include these groups initially because they either have no insurance or it is being scaled back rapidly.
Secondly,the public option, although administered by Medicare, would start out as a separate pool that competes with private insurers and charges premiums (again $200 less/month). If the program is viable, up and running, there is the prospect of merging the 139 million (or even 100 million) with the existing Medicare entitlement program. This is essentially the position of the Rekindling Reform Working Group, many of whom are experts in health care policy and economics research. I happen to agree with this approach, and dont feel tied to Jacob Hacker's idea of including Medicaid and S-CHIP.
Thirdly, because starting the public option is an experiment in the hands of congress,which unfortunately isnt the safest place to be, if the 30 million Medicaid/S-CHIP recipients are rolled into the public Medicare option, suddenly these recipients are subject to federally- subsidized premiums (rather than the current entitlement with no premiums), and will go from the most comprehensive benefits in the U.S. (yes Medicaid is most comprehensive) to a benefit set that remains as yet undefined. In the current economic crisis how sure can we be sure that the subsidy wont be cut back or even eliminated ? In the worst case, this could be a ploy or become an opportunity, to dismantle Medicaid, as many in congress would love to do.
Of course when the public option is viable, i would like to see Medicaid and S-CHIP rolled in as we get closer to the goal of everybody in, nobody out. Yet right now, it seems very risky, and seems prudent to do no potential harm to these programs. So the order by the public option is implemented is an important issue.
So for purposes of reaching some consensus for the Letter on the minimum criteria we'd like MN members of congress to support re: who would be in the Medicare public option pool initially:
1. the uninsured, self-employed, small and large employers or
2. the uninsured, self-employed, small and large employers AND Medicaid/S-CHIP recipients
Having problems with message search?
Offline 
Send Email