WASHINGTON BUREAU — Senate Democrats appear to be developing a “public option plan” compromise that could attract support from at least one insurance producer group.
The compromise health plan, negotiated by 10 moderate and liberal Democrats, would create a national health plan administered by private organizations in lieu of a public option.
The plan also would include a Medicare “buy-in”; an extension of the State Children’s Health Insurance Plan; and no Medicaid expansion beyond the 133%.
The compromise also would keep the state-based health insurance exchange distribution system and insurance market reforms already included in H.R. 3590, the Senate health bill developed by Senate Majority Leader Harry Reid, D-Nev.
“Of course, we need to see the details of how this national plan would be administered through state exchanges, but, on the surface, we think that this may be something that competes fairly,” says Joel Kopperud, a director of government relations at the Council of Insurance Agents and Brokers.
In terms of creating a new competitor that would compete fairly, the compromise plan “sounds like it threads the needle,” Kopperud says.
But agents’ “anxiety level right now is through the roof through language in the bill that authorizes the Department of Health and Human Services to define broker compensation rates at state exchanges,” Kopperud says.
Reid has declined to give details pending a cost analysis of the Medicare “buy-in” provision.
According to lobbying groups and congressional staffers, the Medicare buy-in option initially would be made available to some uninsured people ages 55 to 64 in 2011, 3 years before the exchanges would open.
During the period between 2011 and 2014, the Medicare option would not be subsidized.
In 2014, after the exchanges launched, the Medicare option would be offered through the exchanges, and consumers could use health insurance subsidies to buy into Medicare.
The proposal would give insurance companies the option of creating nationally based non-profit insurance plans that would be offered on the exchanges in every state.
But, officials say, if insurance companies did not step up to the plate to offer such plans, that would trigger the creation of a national public option.
America’s Health Insurance Plans, Washington, has been expressing concern about a component of the plan that apparently would set a high minimum ratio of medical claims losses to premium revenue.
The medical loss ratio floor “is essentially a price control,” one analyst says.
Some accounts have suggested that the MLR in the new compromise plan could be as high as 90%.
The bill now on the Senate floor would set the MLR at 80% for group policies and 75% for individual policies.
The House bill would set the MLR at 85% for both the group and individual markets, with a rebate requirement as well. The House bill provision would let the HHS secretary to waive 85% MLR for the individual market if it were felt that the minimum would destabilize that market.
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