Some folks may have not yet noticed the “Steps to Win” section at the top of the Health Care for America Now site. It’s a section of the site managed by our legislative team, and has the best information on the process by which we’ll pass health care reform this year, broken down into six easy-to-understand steps.

For the last few months, we’ve been in step two, where committees in Congress that have control over health care have been holding hearings and drafting legislation. Now, with legislation set to be introduced in the Finance Committee in the Senate and the tri-committees in the House, and with HELP already marking up a bill, we’re firmly in the third step towards passing health reform: Committees passing bills.

Here’s what’s going to happen:

Because health reform legislation is so complicated, five different committees – three in the House and two in the Senate – are entitled to have some say in the legislation. Each House and Senate committee in charge of different parts of health care reform has been holding hearings and drafting legislation. Committees consider their first draft, usually called the Chairman’s mark, in a process called “mark-up.” During these committee meetings, members propose changes to the Chairman’s mark (amendments) and then vote on final approval in their committee. The committees may consider hundreds on amendments in the process.

Once each committee completes its process, the two Senate committees will combine their bills and work out any differences to bring one bill to the Senate floor. The same process will be happening among the committees working in the House. The committees involved in health care reform have pledged to work together to minimize differences and make this process easier.

And, because we’re a campaign after all, here’s what you can do to help this process:

• Call your Senators in support of a public option - Call your Senators in support of a strong public health insurance option, not “co-ops” or other proposals that won’t do all the things a strong public option can.
• Ask your Senators about the public option - Ask your Senators where they stand on the public health insurance option and what kind of public option they stand for.
• Sign the petition for a public option - Senators Leahy, Durbin, and Schumer have created a petition you can sign in support of a public health insurance option.
• Call your Members of Congress - This is by far the most important thing you can do. Members take calls from constituents very seriously, much more seriously than faxes or emails. Please take a moment and call, even if your Members of Congress are already supporting our efforts.
• Spread the word about our campaign - When President Bill Clinton tried to pass health care reform back in 1993, he didn’t have a grassroots army behind him to hold Congress’ feet to the fire and fend off opponents. That critical mistake eventually doomed his efforts. This time will be different, but we need your help to recruit your friends and family. Please send a message to anyone you know who supports President Obama and his promises of health care reform and ask them to join our campaign.
• Volunteer in your state - Health Care for America Now has grassroots offices in 42 states and grassroots supporters in all 50. Get involved in the effort in your state and in your community to help us pressure Congress and win quality, affordable health care for all in 2009.

So, hooray for progress! Things are indeed moving. A little historical note: If we make it pass step three onto the full House and Senate considering a bill for a vote, we’ll have officially made it farther in the process than President Clinton did in the ’90s. That’ll be a real milestone.

Now, all we have to do is pass a bill out of committee, pass a bill out of both Houses of Congress, get them to agree on a bill, and have the President sign it - all while preserving our principles for health reform. Not easy, but we’ll get there.

(also posted at the NOW! blog)

The HELP Committee has released their final version of a health care bill, including a public health insurance option and a provision for shared responsibility:

Democrats on a key Senate Committee outlined a revised and far less costly health care plan Wednesday night that includes a government-run insurance option and an annual fee on employers who do not offer coverage to their workers.The plan carries a 10-year price tag of slightly over $600 billion, and would lead toward an estimated 97 percent of all Americans having coverage, according to the Congressional Budget Office, Sens. Edward M. Kennedy and Chris Dodd said in a letter to other members of the Senate Health, Education, Labor and Pensions Committee. The AP obtained a copy.

By contrast, an earlier, incomplete proposal carried a price tag of roughly $1 trillion and would have left millions uninsured, CBO analysts said in mid-June.

You got that cost number right - $611 billion. If you’ll remember, the last version of the HELP bill - without a public option or shared responsibility - came in at $1 trillion. Clearly, these changes saved money. (And remember when John Boehner, Republican leader in the House, said the public option would cost over $1 trillion? He’s dead wrong.)

On the conference call announcing the measure, Senators Dodd, Brown, and Whitehouse said that all 13 HELP Democrats would be voting for this bill. That’s right, every single one.

Richard Kirsch, our national campaign director, had this to say:

The HELP Committee’s bill will give Americans all across this country what they want - a choice of a strong public health insurance option that will provide lower costs and keep the insurance companies honest. The public health insurance option included in the HELP bill will be available on day one, giving Americans a new alternative to the private insurance industry. It will also encourage the delivery of better health care at a lower cost. The public health insurance option, combined with other key sections of the HELP Committee legislation, makes this bill a good prescription for health care reform. More specifically, the bill invests enough resources to make good, affordable health care available to middle-class families and includes strict rules to stop insurance company abuses.

We urge the Senate Finance Committee and the full Senate to follow Senator Kennedy and his fellow Democrats’ lead in giving everyone a choice of keeping their current health insurance coverage or selecting a new public health insurance option. That public health insurance option would be a real alternative to the private insurance companies that have failed to make health care affordable while regularly delaying and denying needed care.

I concur. The HELP Committee is standing up today and doing the right thing for the American people, and indeed, doing something they deeply support. Finance should follow suit.

(also posted at the NOW! blog)

Everybody, but mostly members of Congress, should read this article by Jacob Hacker and Rahul Rajkumar about what life would be like if we passed health reform - an individual mandate, an insurance exchange, and all that other great stuff - and not a public health insurance option.

That future is bleak. Insurers still control the markets, as they do now, and in fact, the giant insurance companies have grown. Hacker and Rajkumar predict we’ll have a choice “basically between WellPoint and UnitedHealth–gargantuan for-profit insurers each about the size of Medicare.” Sounds great, right?

Hacker and Rajkumar also pointed out a peculiar fact our geography and politics:

Ironically, the problem is worst in the rural areas of the country whose Democratic Senators–such as Kent Conrad of North Dakota and Finance Committee Chair Max Baucus of Montana–have been among the Democrats most willing to forsake the public health insurance plan. In these rural areas, one or two dominant insurers hold over 90 percent of the market. (In all of Montana, for example, one insurer has 75 percent of private enrollees.) For people in these parts of the nation, a real choice of health plans is as mythical as unicorns.

I would add that the overwhelming majority of rural voters support the choice of a public health insurance option [pdf]. They know what’s best for them.

What if we passed a co-op plan? Not much:

Equally mythical, it soon becomes clear, are the consumer cooperatives that Conrad and Baucus had backed to attract Republican support. The reform legislation envisioned that these cooperatives would be chartered by the government and owned by consumers–the idea being that a democratically-controlled enterprise would be driven not by profit, but by serving the interests of its citizen-owners. But the cooperatives are almost impossible to get off the ground, just as similar consumer-oriented ventures have been in the past. Doctors largely boycott them, insurers undercut them, state politicians argue over them, and federal dollars are woefully insufficient to nurture them. It soon becomes clear that they represent little more than a fig leaf covering a lack of commitment to the basic aim of a public plan: having a tough competitor that forces large insurance companies to bring up their standards and bring down their prices.

All this means premiums remain high, as do provider rates and drug prices. Medical inflation keeps increasing. And guess who pays for that? Taxpayers, seeing as how people who can’t afford the skyrocketing premiums get government subsidies to help them pay for their private health care. Needless to say, the plan isn’t terribly popular.

Rationing of care by private insurers continues. This hits people’s individual lives:

Those with chronic conditions or nearing retirement age who are self-employed or work for small businesses are hit hardest. A 59-year-old self-employed man with diabetes, or a 48-year-old single mother with breast cancer who works at a small retailer–these are the sort of people who will fall through the cracks without a public plan available in all parts of the nation. They may qualify for a “hardship exemption” so that they are not compelled to buy insurance under the reform legislation’s “individual mandate.” But not being forced to buy insurance they can’t afford is a poor substitute for having access to a public plan they can afford.

These are the stakes before us. If we do reform right, with a public health insurance option, costs can come down, people will be covered, and none of this will come to pass. But if we remove just one element in the reform package, this idea of choice and competition, we’ll end up with an unpopular and ineffective plan that does nothing to control costs and keeps us crushed within the status quo.

This is what makes health reform so hard - change just one piece of the whole plan and suddenly it doesn’t work anymore.

Hacker and Rajkumar have another point to make on this idea of public/private competition:

This is a not a radical idea. In many areas of American commerce, private and government programs comfortably co-exist. FHA insured loans and non-FHA loans, Social Security and private pensions, public and private universities–all have long thrived side by side. Each side of the divide has strengths and weaknesses, but in every case the public sector is providing something the private sector cannot: A backup that’s there if and when you need it; a benchmark for private providers; and a backstop to make sure costs don’t spin out of control. Just as it is comforting to have Social Security in case your 401(k) evaporates or an FHA loan in case your credit score tanks, a new public plan provides an added level of protection against the vicissitudes of an unaccountable insurance market. A public plan is about competition as well as choice.

This is exactly right. The idea that private industry can’t ever compete with government is, as President Obama says, illogical, especially because the same people who say this say at the same time that government is too inefficient to run anything correctly.

As Hacker and Rajkumar make desperately clear, we need the public health insurance option. It’s not negotiable. We need one available nationally on day one, accountable to voters and Congress, and able to set rates with providers. If we get something less, we don’t get health reform.

(also posted at the NOW! blog)

This is pretty much what I imagine goes on in the meetings of Conservatives for Patients Rights, or Patients United Now, or AHIP’s Campaign for an American Solution, or Blue Cross Blue Shield’s Get Health Reform Right. They’re clueless.

Meet HAARM - Healthy Americans Against Reforming Medicine:

The front group “Get Health Reform Right,” funded by the insurance industry, sent out their first “grassroots” email today. Here’s what it says:

The healthcare reform debate is heating up in Washington and we all have a stake in the outcome. Draft health reform legislation in the House of Representatives is now under consideration. While this draft legislation takes some of the critical steps needed to transform our healthcare system and expand coverage, it also takes a huge leap in the wrong direction by creating a new government-run health plan.

We all agree that it is critically important to enact comprehensive healthcare reform this year, but legislation that includes a government-run health plan will actually undermine the goals of reform and have devastating consequences on our healthcare system. Take action now and tell Congress to get health reform right.

More government bureaucracy will only create more problems, not solve the ones we have. A new government health plan would use its built-in advantages to eventually take over the entire health insurance market, forcing out private plans and limiting consumers’ choices. Many Americans would lose their current employer-sponsored coverage as millions of people are shifted into a government plan. This is not the answer for improving our healthcare system. Instead, Congress should build on the current employer-sponsored healthcare system that is already working for more than 160 million Americans. Tell Congress to build on healthcare that’s working for most until it works for all.

Thank you for making your voice heard on this important issue. With so much riding on healthcare reform, Congress needs to get health reform right for America.

Now, given that it’s the insurance industry sending this message, I’m going to rewrite it so you can see what they really mean:

The healthcare reform debate is heating up in Washington and our profits have a stake in the outcome. Draft health reform legislation in the House of Representatives is now under consideration. While this draft legislation takes some of the critical steps needed to transform our healthcare system and expand coverage, it also forces us to compete and actually provide health insurance, or lose money. We don’t like that.

We keep saying that it is critically important to enact comprehensive healthcare reform this year, but we’re really worried that our CEOs won’t be able to take that 2nd vacation this year if our profits get cut a couple percentage points. So we’re going to tell people that offering them a choice of a public health insurance option somehow will cause them to lose health care. It’s not true, but it sure is scary! And if we scare them enough, maybe they’ll complain to their Members of Congress!

If we actually had to compete, we couldn’t pay our CEOs billions, and we would have to stop denying care for prexisting conditions. That would be a big problem - for us. And of course, though we’ve argued for years that government is so incompetent that it can’t do anything, we’re going to pretend that we’re so vulnerable that we can’t compete with government. Yes, we know this doesn’t make sense, but we’re going to say it anyway. If we make it sound scary enough, people might not realize they would love to choose to dump us if they could, and that most of them (76%) support giving us a bit of competition.

We hate competition, and so we’re against health reform. And we’re trying to scare you so you are, too.

Boo!

I don’t expect anything better from the industry - they lie about everything else, why not lie about being grassroots.

Update: The Education and Labor Committee sends along this fact-check of the insurance industry’s lies:

1. Government plan would use its built-in advantages to eventually take over the entire health insurance market, forcing out private plans and limiting consumers’ choices.

The public health insurance option would be just one choice for consumers and families in a menu of private health insurance options called the national health insurance exchange. The public health insurance option would be required to follow the same rules as private insurers (level playing field). And, the public health insurance option would self-sustaining through premiums, not government subsidies.

If we are serious about real competition to help control costs, and most Americans agree, a public health insurance option must be one of many choices consumers will have. As studies have shown, many Americans have little or no choices in health plans in their region.

2. Many Americans would lose their current employer-sponsored coverage as millions of people are shifted into a government plan.

No one will be forced into the public health option. If an employer drops their insurance coverage for their employees, those workers would have a choice of any plan in the health insurance exchange, including a public insurance option. In addition, the employer would then have to pay an 8 percent penalty, based on their payroll, for not covering its employees in order to assist low and moderate income employees to obtain insurance coverage that is right for them.

(also posted at the NOW! blog)

Some text for the HELP Committee’s public health insurance option leaked last night. The language includes:

–HHS-based plan: The community health insurance option would be run by HHS. The government would pay for the first three months of claims as a way to capitalize it; this would be a loan to be repaid over time. For the first two years and longer if necessary, the option would also qualify for “risk corridor protections” which offset or reclaim excessive losses and gains which could result during the start-up period (identical to those in Medicare Part D). Subsequently, its premiums would be set to make it self sufficient. This would make the health insurance option quickly available in all areas of the country.

–Plays by the same rules: The option would be one of the Gateway choices. It would follow the same rules as private plans for defining benefits, protecting consumers, and setting premiums that are fair and based on local costs. The only difference between this option and others is that the Secretary would set the reserve requirements for this plan rather than states.

–Provider payments and participation:

• Negotiated rates within limits: The payment rates paid by the option would be no more than the local average private rates – but could be less. The Secretary would negotiate these rates.

• Input from Advisory Councils: Each State would create a Council of provider and consumers to recommend strategies for quality improvement and affordability. States would share in the savings that result.

• Purely voluntary: Health care providers would have the choice of participating in this plan; there would be no obligation to do so.

Why It Will Make Health Care Affordable:

–Pooled purchasing power: This health insurance option can pool the purchasing power of its enrollees nationwide to leverage lower prices to compete with private plans. Similar negotiation power has been used by states to get drug rebates in Medicaid beyond the statutory minimum. It has been used by large businesses to drive delivery system change. This negotiation would be backed by a ceiling of paying no more than average local rates.

–Flexibility and incentives to innovate: Unlike administered pricing, the negotiation for payment rates gives the Secretary the ability to quickly and aggressively promote payment policies that promote quality and best practices. In addition, the State Advisory Councils would tailor delivery system reform for the plan, with a financial bonus for success.

–Lower administrative overhead: The community health insurance option would not need to raise premiums to support shareholder profits, extensive marketing, and extra risk reserves required by require to protect enrollees from plan insolvency or mismanagement of funds.

This fulfills the broad requirements for a public option: Available everywhere and on day one, and accountable to Congress and the voters, as well as rate flexibility. Of course, things are still very much in flux and these details could all change, for better or for worse. But so far, so good.

(also posted at the NOW! blog)

Via Talking Points Memo:

For all of the foregoing reasons, we affirm the decision of the trial court that Al Franken received the highest number of votes legally cast and is entitled under Minn. 32 Stat. § 204C.40 (2008) to receive the certificate of election as United States Senator from the State of Minnesota.

Now, will Pawlenty sign the certificate, or make an ass out of himself in front of the country for his Presidential ambitions (because apparently, you’re a better shot for President if you defy Supreme Courts…).

Chris Bowers has been keeping track of the answers you all have gotten from the Senate over the last few weeks. For those just joining the campaign, we, along with Chris at OpenLeft and Democracy for America, are asking Senators to answer for questions on the public health insurance option:

• Do you support a public healthcare option as part of reform?
• Do you support a public healthcare option that is ready on day one?
• Do you support a public healthcare option that is national, available everywhere, and accountable to our government?
• Do you support a public healthcare option that has the clout to establish rates with providers and big drug companies?

The answers are starting to trickle in, and we’re going to publish them all this week. But we want to make sure we’ve gotten all the responses so our count is accurate. So, if you’ve gotten a response from your Senator, click here to report it.

Of course, if you haven’t gotten an answer yet, keep asking. As Chris says (and I concur), if there’s one thing he’s learned from blogging, it’s that you have to keep asking Senators over and over until you get the answer you want. So, click here to email you Senator.

And of course, tell your friends about this campaign, so we can turn up the pressure.

Stay tuned for the answers!

(also posted at the NOW! blog)

As usual:

This won’t come as the slightest surprise to those versed in health care policy issues. But I fear it’s only barely permeated the health care reform debate in the country, certainly in Washington. And that’s this: the opposition to a so-called ‘public option’ comes almost entirely from insurance companies who have developed monopolies or near monopolies in particular geographic areas. And they don’t want competition.

Note, I’m not saying more competition. I’m saying any competition at all. As Zack Roth explains in this new piece 94% of the health care insurance market is now under monopoly or near-monopoly conditions — the official term of art is ‘highly concentrated’. In other words, there’s no mystery why insurance costs keep going up even as the suck quotient rises precipitously. Because in most areas there’s little or no actual competition.

That’s exactly right. As President Obama pointed out last week, the arguments used by the industry and by conservatives are illogical at best and dishonest at worst:

If private insurers say that the marketplace provides the best quality health care; if they tell us that they’re offering a good deal, then why is it that the government, which they say can’t run anything, suddenly is going to drive them out of business? That’s not logical.

They’re not against the public plan because it would be bad for you and me, they just don’t want the competition. Pretty self-serving, no?

(also posted at the NOW! blog)

Just so we’re clear, we know Republicans aren’t going to vote for health reform that actually does anything right?

Via the New York Times:

Representative John A. Boehner of Ohio, the House Republican leader, said he was unaware of any House Republican inclined to support the Democrats’ proposed legislation.

Asked how many Senate Republicans could sign on to developing Democratic plans, Senator Richard M. Burr of North Carolina, author of a Republican alternative, said: “I think right now, none. Zero.”

So, the question becomes, how far are you willing to push this “bipartisanship” thing? Will you go for bipartisanship at the expense of getting a bill that does what President Obama and the American people want it to do - lower costs, make health care affordable, and increase coverage?

Because it’s possible to get, say, one or two Republican votes in the Senate, but that might not even be enough to satisfy Republicans:

Hoping to lessen the divide, a handful of senators from the two parties who sit on the Finance Committee have been meeting privately, trying to find some consensus. But they left for the weeklong Fourth of July recess without any firm agreement, though they pledged to keep trying. Even a senator at the center of those talks among four Republicans and three Democrats, Charles E. Grassley of Iowa, the senior Republican on the committee, indicated a reluctance to back any legislation unless it was constructed to attract more than a handful of Republicans.

“This is not going to be a bipartisan bill with just three or four Republicans,” Mr. Grassley said. “This is a bill that gets broad bipartisan support or it is not going to be a bipartisan bill.”

Now you tell me: What kind of bill do you think more than a few Republican Senators would vote for? Do you think it would do any good? Do you think it would be anything but the status quo? Do you think it would lower your costs instead of bailing out the insurance industry with taxpayer dollars?

If I had to guess, any bill Senate Republicans support would do nothing for the American people. The health care crisis is too great - bipartisanship isn’t worth the price we’d pay.

(also posted at the NOW! blog)