Congressional Progressive Caucus Principles for the Health Care Reform Bill Conference Report

General comment—I’m noticing that there is not a single word in here about what you intend to do if these principles are not enacted in the final bill.

Congressional Progressive Caucus Principles for the Health Care Reform Bill Conference Report

Members of the Congressional Progressive Caucus applaud Speaker Pelosi and members of leadership for passing a health care reform bill in the House that protects vulnerable Americans and improves the quality and efficiency of our health care delivery system. The House bill includes many positive elements: closing the Medicare Part D doughnut hole; addressing racial and ethnic minority health disparities; allowing immigrants to purchase health insurance; language to ensure fairer treatment of the U.S. Territories by bolstering Medicaid parity and expanding access to the Health Exchange; and adequately funding community health centers and DSH hospitals. Just as importantly, the House funding mechanism follows President Obama's commitment not to raise taxes on those families making under $250,000 or to penalize workers by taxing health plans. These provisions must be preserved in a final bill. .

The House bill can be improved in several ways. We continue to support the inclusion of a provision that will allow each state to offer its own single-payer plan; such a measure was not included in the House bill. On the other hand, the Stupak-Pitts amendment unfairly restricting reproductive coverage must be excluded from any final bill.

Good. And do you intend to vote against it if the final bill does not comply with either of these?

We are also very concerned that the overall strength of the House bill will be damaged by proposed changes in the Senate. Any final bill must assure the following:

The creation of a nation-wide public option, such as the one in the House bill that increases competition, affordability and access for all Americans.

The House public option is neither public nor an option. If any member of the public is restricted from applying for any reason, it just isn’t a public option, period.

“Competition”? Could you please just stop spouting this utter bullshit? As you well know, competition in the area of what should be public goods does nothing but drive costs skyrocketing upwards. If you aren’t familiar with the studies demonstrating that communities of similar size with more than one hospital have health care costs that are much higher than those communities with only one hospital, you could at least apply basic common sense.

If Seattle had three competing for-profit fire departments, fire protection costs would rise dramatically, as the public would have to pay capital and operating costs for duplicate sets of equipment. If a new hospital opens in town, the public is NOT going to obligingly start to have more heart attacks. Both hospitals will have fewer patients per item of capital equipment, and will dramatically raise prices to compensate.

My employer used to offer three health care plan options—Cigna, Premera and Group Health. They just cancelled all but Premera. So much for “choice.” The reason why they eliminated choice ought to be obvious—by giving Premera a much larger captive risk pool, they likely got a much lower per capita price for the insurance. Eliminating choice and competition is saving them a lot of money. And now Vanna, tell our contestants what they will win if they answer the grand prize question “What is the biggest and cheapest possible risk pool of all?”

Given that most of you cosponsor HR 676 and HR 1200, you jolly well know what the answer is. If we can’t get single payer, why are you not holding out for the largest public option risk pool that you can get? That would be Jacob Hacker’s original public option proposal with about 100 million enrollees. That would do to go on with.

Health insurance that is affordable for everyone. The Senate should not decrease the cost of the bill at the expense of affordability for the consumer. Any changes the Senate makes to decrease the costs of the bill should not be at the expense of affordability credits or subsidies. We should not be held to an arbitrary cap of $900 billion. We must protect lower and middle income Americans by:

I want to vomit every time I hear anyone refer to health care as “affordable.” Private insurers are now killing and bankrupting us for profit, and supposed progressives can’t think of any other option than to adopt their terminology and framing unchallenged. A heart attack is NOT like an iPod, dammit! When, oh when, will any Democrat, or any progressive Democrat, start publicly talking about and DEFENDING the basic notion of public goods? Or do you just plan to keep on letting 40 years of Republican attacks on “government” go unanswered?

Is Congress “affordable”? The Washington State Legislature? The Seattle Fire Department? The library system? Public schools? The word is stupid by its very nature when applied to these public services. What we ask of them is that their budgets be SUSTAINABLE.

And patients are not effing “consumers” either, any more than we are “consumers” of the services of the fire department.

• Ensuring that necessary subsidies are provided to everyone who needs them. The House subsidies for those under 250% of the Federal Poverty Line and Senate subsidies for those above 250% of the Federal Poverty Line are the best approach to achieving this goal.
• Expanding Medicaid to 150% of federal poverty level
• Increasing payments to primary care providers under Medicaid.

How nice that the poverty level is being lowered just in time. With age rating, subsidies make no difference whatsoever in “affordability.” Even with subsidies, the costs imposed on individuals of modest means are totally unacceptable.

Insurance market regulations to keep premiums reasonable and end abusive practices.

These are totally inadequate, with not a single mention of any enforcement mechanism whatsoever. There is only one way to regulate costs if you intend to provide universal care through private insurance, and that is to regulate it the way you would any private utility—directly dictate what benefits must be offered and what they must cost. That’s how it’s done in France, Japan and the Netherlands. I define a “reasonable” premium as what the Dutch pay under their mandatory private insurance system—100 euros/month/adult, with NO co-pays, NO deductibles and NO age rating.

Those provisions include:

• Prior justification, disclosure and review of premium increases, as in the House bill.
• Repeal of the health insurance industry exemption from antitrust laws.
• FTC review.
• Minimum percentage of premium dollars that must be spent on medical care should be at least as high as the House bill.
• Prohibitions on Exchange participation by insurers that act irresponsibility.
• The employer insurance provision mandate in the House reform bill.
• Comprehensive services for children, including preventive services, EPSDT, mental health and substance abuse provisions, and administrative simplification of the enrollment process.


I would appreciate it if you would acknowledge that the core of this bill is not any of the add-on benefits, some of which are quite helpful. This bill is about forcing everyone to be slaves to private insurance companies, and penalizing people for not buying mandatory underinsurance.