Time to make noise! They allowed a cap to go through to get a lower CBO score, but how do we know what we'll get instead? Let your congress critter know they don't have their priorities straight. If you get cancer, you shouldn't have to lose your house to pay for it.

WASHINGTON — A loophole in the Senate health care bill would let insurers place annual dollar limits on medical care for people struggling with costly illnesses such as cancer, prompting a rebuke from patient advocates.

The legislation that originally passed the Senate health committee last summer would have banned such limits, but a tweak to that provision weakened it in the bill now moving toward a Senate vote.

As currently written, the Senate Democratic health care bill would permit insurance companies to place annual limits on the dollar value of medical care, as long as those limits are not "unreasonable." The bill does not define what level of limits would be allowable, delegating that task to administration officials.

Adding to the puzzle, the new language was quietly tucked away in a clause in the bill still captioned "No lifetime or annual limits."

As Marcy points out, this is another cute deal:

So what Ezra’s sources really mean is that the Senate bill–partly because it has traded off other means to keep premiums down–has had to eliminate a key promise of health care reform: that families experiencing a catastrophic health care event wouldn’t lose coverage at the time they needed it the most. What Ezra’s sources really mean is that, because they chose not to pursue other strategies which would have made it unecessary to eliminate the cap, they have instead been forced to eliminate the caps to keep the bill competitive with the House bill.

Don’t let Harry Reid fool you. The problem is not that health care “premiums would go through the roof” without caps. The problem is that Harry Reid has deliberately chosen not to use other means to prevent health care premiums from going through the roof, means that wouldn’t mean families bear the brunt of the problem.

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(h/t Heather.)

First of all, I'd like to reiterate that yes, a bill without a public option can serve the same purpose as the public option: namely, to force efficiency and competition. So yeah, I do see this as a win - and so does Nate Silver. And I don't buy the insurance company "we won" mantra just yet, because the Medicare buy-in proposal is a real threat to them. After all, the 55+ group is very profitable for them.

It seems clear the most important component of a plan lacking a public option is a mandated medical-loss ratio. But here's the most important detail of a requirement that companies spend 90 percent of each premium dollar on care: Who will be responsible for enforcement? In order to work, it's got to be the feds.

This is the most important part of the argument, because insurance companies (and their PACs) have enormous influence in state markets - and in state legislatures. State insurance commissioners are usually (not always) hired from the ranks of the industry, and are famous not only for rubber-stamping rate increases, but for far too often turning a blind eye to insurance company abuses.

What we want to watch in the Medicare buy-in is, are they going to take premiums (subsidies, whatever form it finally takes) into the Medicare trust fund? Believe it or not, it would be a very good thing if they did. A younger, healthier population would actually lessen the strain on the Medicare system. But I'm betting Republicans will shamelessly present it as "an assault on Medicare."

We also have to look at who gets to buy in - and why. Under the current proposal, people 55+ get to pick Medicare through the new exchanges in 2014. But what do we do until then? Well, they plan to allow them in starting in 2011.

Is this only for high-risk patients? Because it would really be a drain on the Medicare system (if the premiums went into the same system) if it was. It would be a bad idea anyway, because it would be too difficult to sustain if it was all people with pre-existing conditions.

Will the new Medicare members be charged the full cost? At 65, you're heavily subsidized for most of the cost, paying about $100 a month. The real cost is closer to $500. So will there be subsidies to purchase Medicare? Definitely, in 2014.

In the meantime? Not clear. This is one of the areas on which you want to lobby Congress.

You probably already know the problems with triggers - namely, that they're usually written in such a way as to make it highly unlikely they ever kick in. (That's why Queen Olympia loves them.)

As you might expect, we'll be watching closely.

You know, it really is depressing - and infuriating - to see how little will actually be accomplished with this so-called health care "reform."

And unless the House leadership waves a magic wand in the conference committee hearings, I doubt much will change:

Measured against the promises President Obama and congressional Democrats have made about health-care reform, the bill the Senate begins debating this week could be setting Americans up for disappointment: Some of the main reforms would not take place for several years, and even when they do, some observers say, the bill does too little to make sure they would be enforced.

Until 2014, insurance companies could continue to deny coverage or charge higher premiums based on people's medical history. Another highly touted reform -- banning annual and lifetime limits on coverage -- would take effect in 2010, but it would permit significant exceptions.

Even with those rules in place, "there's no power to really hold the insurance companies accountable," said consumer advocate Betty Ahrens, executive director of the Iowa Citizen Action Network. "It's toothless."

Jim Manley, a spokesman for Senate Majority Leader Harry M. Reid (D-Nev.), said the bill was a compromise. "This is not the legislation we would have written in a perfect world, but Senator Reid believes that this bill has the best chance possible to get the 60 votes necessary to overcome a Republican filibuster," Manley said.

The delay in implementing some key reforms contrasts with the urgency of Obama's call for action.

Although some changes might take years to implement, Obama said in July, "We shouldn't have to wait a long time to make sure that people don't lose their insurance because of a preexisting condition."

Delaying relief until 2014 means that Obama could face reelection -- and Congress be transformed by two elections -- before voters begin feeling the legislation's full effect.

Here's the real kicker: The feds won't even enforce their own laws. That's right, kids, it'll be left to the notoriously industry-friendly state regulators. The feds will only get involved under rare conditions.

Which means never. This is exactly what happened with HIPAA (Health Insurance Portability and Accountability Act). Insurers weren't allowed to make rescissions unless consumers defrauded the insurer or deliberately misrepresented their medical condition.

SS,DD.

Nate Silver on why we shouldn't celebrate just yet:

Needless to say, it would have been very, very bad news for the Democrats if the motion to proceed to debate on their health care plan had failed tonight. But I'm not sure how newsworthy this really is. The potential hold-outs, like Lincoln and Ben Nelson, are going to have much greater leverage later on, when the bill nears its second major procedural hurdle: the cloture motion to proceed to the final vote.

And there's some bad news for Democrats too: Lincoln has joined Senators Ben Nelson and Joe Lieberman in making a fairly explicit threat to filibuster a bill that contains a public option. Mary Landrieu, on the other hand, sounds a little bit more open to compromise. But this impromptu Gang of 3 -- Lincoln, Nelson, Lieberman -- could be a tough one for progressives to penetrate.

Yeah, it's going to be ugly by the time they get done dealing away any real hope of competition for the insurance companies. I'm not optimistic about the short-term results here and I have to keep muttering to myself that this will be good for our children and grandchildren - probably.

If they're already admitting to causing deaths, why should they care about a little girl's hearing?

What more do we have to do to fight back against these horror stories? What will it take to get these insurance companies to see the inherent immorality of focusing on the bottom line to the exclusion of all else? Think Progress:

One of the worst abuses of the private health insurance industry is its practice of denying claims to pay for necessary care for patients. This practice has become so rampant in the industry that a recent study by the California Nurses Association found that a whopping 21 percent of all insurance claims filed in the first half of 2009 in the state of California were denied by insurers.

As the story of six-year-old Madison Leuchtmann of Franklin County, MO, demonstrates, even children are victims of this insurance company abuse. Madison was born with bilateral atresia, which means she lacks ear canals in both ears. In order to hear, she wears a special device on a headband that allows her to make out sounds. Despite her disability, Madison is at the top of her kindergarten class and is slowly learning to read.

Yet Madison, due to her growth, will soon require a new hearing implant to be able to recognize sounds. Her hearing and speech therapist warns that “if she doesn’t get her implants by age seven, she’s not going to be able to blend her words. … She won’t be able to hear herself [talk].” Madison’s pediatrician, Dr. Randall Clary, also insists that without the implant, the girl may never be able to hear again. Unfortunately, the Leuchtmann’s family insurer, Cigna, has issued "one denial after another,” flatly refusing to cover the $20,000 bill for the implant. In a written statement to the local news station Fox 2, Cigna explained, “It is not unusual for commercial benefit plans to exclude hearing assisted devices,” prompting Dr. Clary to angrily respond, “This is obviously medically necessary. You have a child that has no ear canals!” Dr. Clary also told Fox 2 that he sees these sort of denials “on a weekly basis.”

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Washington Journal host Peter Slen asks Marsha Blackburn about an editorial in The New York Times The Republican Health Plan and reads this passage:

It has some good provisions, such as prohibiting insurers from imposing annual or lifetime caps on what they will pay and automatic enrollment of workers in employer-sponsored group coverage. But it would not prevent insurers from denying coverage or charging higher premiums based on pre-existing conditions.

Blackburn's response:

Blackburn: Well, one of the ways to address that is going another route and getting to that universal access component that so many people want to see but doing it through high risk pools and through re-insurance and this is a model that many of our businesses are accustomed to dealing with. You know, they have different high risk for things—worker’s comp and other issues—and there is a way to do that and to address that and bring people into that, into those high risk pools. Addressing pre-existing and chronic conditions absolutely and being certain that there is a pool for that, that is set up, and there again, people can go to gop.gov and look at that, look at the bill and see how that is specifically addressed.

So the GOP's plan according to Rep. Blackburn is if you have a pre-existing condition, you're going to be put into a high risk pool. I don't believe she explained how that would prevent people from paying higher premiums for pre-existing conditions or from being denied care—quite the opposite.

Under conservative plans for health care reform, many more Americans with pre-existing conditions would find it even more difficult to obtain reasonably priced care. This is because conservative plans often seek to substitute insurance coverage purchased in the individual market for group coverage, such as the insurance that many Americans have through their employers. These proposals also call for expanding existing high-risk pools, such as the Maryland program, to provide coverage for people with chronic illnesses and costly health histories. Today’s state-based high-risk pools provide an important coverage option for some individuals, but the coverage is expensive, and it’s only available to a small portion of those eligible.

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While I definitely do not agree with Dylan Ratigan on a host of issues, the one thing I've found refreshing about his show is that the guests had better not come on there and start spouting mindless talking points without expecting to be challenged on them--because they will be if they do, and forcefully as Betsy McCaughey found out the hard way about a month ago. Rep. Pete King was no exception today. With some help from Chrystia Freeland, Ratigan calls out Rep. Pete King for distorting what's in the House health care bill.

King asked for everyone to come join the Tea Baggers "press conference" on Capitol hill today and trotted out the tired old line about being able to buy insurance across state lines as a cost saving measure and allowing people "the freedom to choose" their health insurance provider. He also said that 85% of people are happy with their insurance companies and that Pelosi's plan would "cancel every policy".

Ratigan pointed out that it is not true that people are happy with their insurance companies and that the GOP bill would not assure more choices. Freeland noted that allowing people to cross state lines to buy insurance would just mean a race to the bottom and companies going to the states with the least regulations and make it even harder with people with pre-existing conditions to get coverage.

King and the rest of the GOP have nothing but the same tired rhetoric to offer on what their idea of “reform” is. They’re more worried about getting the Tea Baggers whipped into a frenzy than anything that resembles legislating.

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Keith talks to Rep. Alan Grayson about whether he thinks the Democrats will get a bill through the House this week and whether we'll be able to call what's passed reform. He also asked him what he thought would be in John Boehner and the Republicans' yet to be written health care plan they're supposed to be releasing this week.

Olbermann: You have already outlined on the floor of the House one of or the basic Republican tenets of a health insurance plan. When Mr. Boehner says he's going to have an alternative bill ready, first off they've been saying that all year and there's been nothing yet, so far. But is there actually one in the works and have your heard anything of what's been in it?

Grayson: I think what's in it is more of the same. They're going to try to do whatever they can to placate the insurance companies. The Republican national party is now a wholly owned subsidiary of corporate America and that's especially true of the insurance companies. They'll do whatever the insurance companies want.

Sadly the same thing can be said about a few too many of the Democrats with positions on the Senate Finance Committee. If you want to help out one of the good guys out there and donate to Rep. Grayson't Act Blue money bomb, here's the link.

Linda R. Monk, J.D.: Let Us Now Praise Uppity Women (h/t Where’s the Outrage?)

The Plum Line: Harry Reid calls GOP's transparency bluff: Is your health care bill a secret, or merely non-existent?

AMERICAblog News: Top McCain campaign advisor running out of insurance. He has a "pre-existing condition."

Apoliticus: Top 5 annoying talents of President Obama

Bill in Exile (not work safe) : New York Twenty Three

Family and Friends blog: Our Achilles Heel

Just like we here outside the Beltway Bubble, sometimes you've just had enough and there's no more need for diplomacy:

President Barack Obama is “getting bad advice from… clowns” on Afghanistan and “sucking up to the wrong people” on health care, U.S. Rep. John Conyers told a Detroit radio audience this morning, according to show host Rev. Horace Sheffield.

Conyers, a Detroit Democrat, made the comments during a discussion about the effects of the economic recession on the urban poor, Sheffield said. The liberal congressman expressed frustration that health care legislation pending in Washington, D.C., was too solicitous of insurance companies and special interests, Sheffield said.

“He wasn’t angry. He was just deeply concerned that some of the issues being focused on don’t address the human reality,” said Sheffield, who hosts the program “On The Line” on WGPR-FM radio.

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Rachel Maddow talks to Glenn Greenwald about Joe Lieberman's threat to filibuster the health care bill if it contains a public option, Evan Bayh quickly following suit and the financial gain being made by both men and their spouses for doing so.

Maddow: Sen. Lieberman has made it very clear that he plans to oppose health reform that includes a public option. He’ll filibuster it in fact which would be historic. What do you think is motivating him?

Greenwald: Well I think you have to look first of all at a Research 2000 Daily KOS poll that was taken last month that shows that a margin of 68 to 21% of Connecticut voters, the people who he’s essentially representing, favor a public option. That’s a 47 point margin which is almost impossible to find on almost any other issue. So when you ask why he’s doing this, it’s clearly not because the people he’s supposed to be representing favor it.

I think clearly what it’s about is primarily that fact that the industry that he’s serving by doing this—by preventing competition with the public option—is an industry from which he receives very substantial benefits. He’s drowning in campaign contributions from the insurance industry, the health care industry, the pharmaceutical industry—more than $2.5 million.

In early 2005 his wife was hired by a large P.R. firm, Hill & Knowlton, in the pharmaceutical division, which at the time was representing the health care giant Glaxo in major legislation before the Senate. And several months later Joe Lieberman was on the floor of the Senate offering legislation that would directly steer huge amounts of incentives to that company in order to develop vaccines.

So I think what you’re seeing here is the kind of legalized corruption, legalized bribery that runs the United States Senate; only in this case it’s particularly sleazy and transparent because Lieberman is ready to gut the major initiative of the Democratic Party.

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Speaker of the House Nancy Pelosi was heckled by someone with a loudspeaker while announcing details of the House health care reform bill. It was not immediately clear what the hecklers were saying or who they represented but Pelosi seemed to have an idea. She turned to the protesters and replied, "Thank you insurance companies of America."

Talking Points Memo talked to some of the demonstrators outside the capital. All of them denied the protest was organized:

Joann Abbott, a grandmother from Northern Virginia, made the drive to the protest this morning after seeing the email sent by Tea Party leaders last night. When asked if she was part of the "flash mob," she laughed. "I'm here on my own," she said, looking around at the scattered protesters around her. "If this is organized, we suck."

Lisa Miller, another protestor, said she was an organizer with a D.C. tea party group. She insisted that the event wasn't organized by a national organization, despite yesterday's email which was signed by a group calling itself "Your Tea Party Patriots National Coordinator Team."

"People keep reporting we're a single group," she said. "But we're not -- we're all separate."

"It's like we're in different cars but we're all going in the same direction," Abbott explained.

The health care reform debate has been brutal. The insurance companies, right wing media and the Republican Party have spreading myriad lies and distortions about the public option and

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I really don’t know how Joe Conason can manage to sit through these panel segments on Lou Dobbs’ show, but it’s nice to see him on there to dispel some of the right-wing talking points being thrown around by Dobbs and the other guests. He does a good job countering KellyAnne Conway on the Republicans' newfound love of Medicare, and Dobbs for downplaying some of the profits of the larger insurance companies.

He may not have known that Dobbs was parroting Glenn Beck at the end of the segment. Dobbs needs to just move on over to ClusterFox and get it over with.

CONWAY: The opt out is a canard because if you really want people—if you really want to provide an opt out, allow small business owners to opt out. This administration's policies have been an assault on small business owners, believe me, and or allow seniors to opt out of the cuts in Medicare which are currently on the table.

CONASON: Cuts in the private Medicare.

CONWAY: But Joe it's huge. When people hear it, they think it’s mostly a bad idea.

CONASON: We should discuss what that really is.

CONWAY: Go ahead because, again—explain the differences.

CONASON: It's the $500 billion in cuts. It’s to cut something called Medicare Advantage…

CONWAY: Right, which a lot of seniors rely on.

CONASON: No, it’s a subsidy to private insurance companies to try to compete with Medicare because they can't compete with Medicare. When people complain about a government-run health care program Lou, they're complaining about a program that is very like Medicare which the Republicans now claim to be defending. So it's a very interesting contradiction in their positions. On the one hand, they're trying to save Medicare, that government run program. On the other hand, they don't want anyone else to have it…

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Harry Reid held a press conference earlier today and said he's including a "public option" in the Senate bill that will have a states "opt out" provision, which means that all the states will have to stay in the bill until 2014 and then have the opportunity to opt out of it.

Frankly I'm shocked that he stood up to the White House on the public option and said no to President Olympia Snowe. Remember when all the Chuck Todds of the pundit class said that the public option was dead and liberals supported it because conservatives didn't? Wrong again.

Obviously, Reid talked to the Democratic senators and feels like he has the votes, or I didn't think he would have said what he did.

Senate Majority Leader Reid confirmed this afternoon he would include a public option in the overhaul bill that allows states to opt out if they choose. Reid said he plans to send an overhaul proposal to CBO today.

He said he is not asking CBO to score a trigger alternative, one supported by Sen. Olympia Snowe, R-Maine, but added that the bill will include a version of a co-op.

Robert Gibbs from the White House applauds Reid via email:

"The President congratulates Senator Reid and Chairmen Baucus and Dodd for their hard work on health insurance reform. Thanks to their efforts, we’re closer than we’ve ever been to solving this decades-old problem. And while much work remains, the President is pleased that at the progress that Congress has made. He’s also pleased that the Senate has decided to include a public option for health coverage, in this case with an allowance for states to opt out. As he said to Congress and the nation in September, he supports the public option because it has the potential to play an essential role in holding insurance companies accountable through choice and competition."

I agree with mcjoan at Daily Kos when she says:

Everyone is on the same page moving forward, meaning that we're that much closer to having meaningful, comprehensive healthcare reform pass this year.

There is much to still discuss and learn about the merging bills, but I think it's a positive step.

Steve Benen has a nice roundup, and found a statement from Max Baucus:

Perhaps more interesting was the reaction from Senate Finance Committee Chairman Max Baucus (D-Mont.), who has been a public option detractor.

"It is time to make our system work better for patients and providers, for small business owners and for our economy. It is time for health care reform. For more than a year, we've been working to meet the goals of reducing the growth of health care costs, improving quality and efficiency and expanding coverage. There are a tremendous number of complicated issues that go into reform and the public option is certainly one of them. I included a public option in the health reform blueprint I released nearly one year ago, and continue to support any provision, including a public option, that will ensure choice and competition and get the 60 votes needed to pass the Senate. Success should be our threshold and I am going to fight hard for the 60 votes we need to meet that goal this year."

What's fascinating about this is that Baucus was reportedly fighting tooth and nail to keep the public option out of the merged bill. This statement suggests he's on board with Reid's bill, and almost seems to be trying to take some credit for it.

I know there are a lot of questions about the bill and we haven't seen it yet, but the fact the Reid put some form of the public option without a trigger is huge and I didn't expect it from him.

Americans United wrote this about Harry Reid:

Senator Reid's announcement that the Senate health care bill will include a public health insurance option, shows that he has refused to buckle in the face of withering pressure from the big insurance companies and sided instead with everyday health care consumers.

HCAN released their statement.

Today, you stood up and delivered the kind of leadership America needs in the health care fight. You put a public health insurance option in the Senate bill, something the vast majority of Americans support.1

For your leadership, you deserve our thanks.

The Republicans' response is pure comedy gold. They called Harry a "partisan bully." '

A primary reason Harry Reid is one of the most endangered incumbents facing re-election in either party next year is due to the fact that he is viewed by many of his constituents as a partisan bully," said Brian Walsh, NRSC Communications Director.

The idiot known as Michael Steele says he's "the cow on the tracks."

Josh Marshall has a good take on the news. So What Is the 'Opt-Out' Compromise?

Howard Fineman sounded like a blogger when he wrote this about President Obama's obsession with Mount Snowe:

But the pursuit of Snowe is pretty close to obsessive, which is not a good thing either for Democrats or for the prospects of health-care reform worthy of the name. First, Snowe's exaggerated prominence is both the result and symbol of Obama's quixotic and ultimately time-wasting pursuit of "bipartisanship." In case the White House hasn't noticed, Republicans in Congress are engaged in what amounts to a sitdown strike. They don't like anything about Obama or his policies; they have no interest in seeing him succeed. Despite the occasional protestation to the contrary, the GOP has no intention of helping him pass any legislation. Snowe may very well end up voting for whatever she and Democrats craft, but that won't make the outcome bipartisan any more than dancing shoes made Tom DeLay Fred Astaire.
--
Worse, the pursuit of Snowe isn't uniting Democrats; it is dividing them. Democrats who haven't been in the room with her as she bargains with the leadership bristle at her role, even as they personally like and admire her. She remains deeply skeptical of a publicly financed alternative to private insurance, in good part because of what she sees as the failure of Maine's version of the idea—and yet some form of a public option is favored not only by most Democrats in Congress but by most of the American people. If Obama and the Democrats really want such a plan, they may as well try to get tough. For inspiration, the president might consider a Longfellow aphorism. "In this world," the poet wrote, "a man must either be an anvil or a hammer."

More coming....